Secondary school food survey School lunch: provision, selection and consumption

Transcription

1 Research Report Secondary school food survey School lunch: provision, selection and consumption Overview By September 2009, all secondary schools in England were required by law to meet new food-based and nutrient-based standards for school food provision. The School Food Trust has carried out a survey to assess the impact of the standards on catering provision and pupil food selection and consumption in a nationally representative sample of 80 secondary schools in England. The survey replicates a similar survey carried out in 79 secondary schools in Compared with 2004, catering provision at lunchtime is now healthier. Foods promoted by the new standards such as compliant drinks, fruit juice, vegetables and salad, water and starchy food not cooked in oil were offered more regularly in 2011 than in Foods with less healthy nutrient profiles, such as condiments, starchy food cooked in oil, non-permitted drinks, confectionery and non-permitted snacks were offered far less regularly in 2011 compared with The impact of these changes is reflected in pupils food and drink choices at lunchtime. For example, 12% more pupils took starchy food not cooked in oil in 2011 compared with 2004, and 6% more took vegetables. The number of pupils taking starchy food cooked in oil fell by two-thirds, and almost 50% fewer pupils took nonpermitted items at lunchtime. Meals eaten in 2011 had nearly 50% more vitamin A compared with 2004, and at least 30% less fat, saturated fat, sodium and sugars. Meals eaten by pupils were well-balanced in relation to macronutrients, with the percentage energy from fat down by a quarter compared with Percentage energy from carbohydrate, fat and saturated fat all met healthy eating recommendations. Food provision and consumption at mid-morning break is also reported. This Research Report is published alongside a report on packed lunches and other food brought into school, and the third report published will include further information on data collection tools and methods, catering service and eating environment.

2 Secondary school food survey 2011: school lunch provision, selection and consumption Page 2 Contents OVERVIEW... 1 BACKGROUND... 4 AIMS OF THE SURVEY... 4 HOW THE DATA WERE COLLECTED... 4 FOOD AND DRINK PROVIDED BY CATERERS AT LUNCHTIME... 5 FOOD AND DRINK SELECTED BY PUPILS AT LUNCHTIME... 7 FOOD AND DRINK CONSUMED BY PUPILS AT LUNCHTIME... 9 CONSUMPTION BY FOOD GROUP... 9 NUTRIENT INTAKE COMPLIANCE WITH NUTRITIONAL STANDARDS FOR SCHOOL FOOD DETERMINING COMPLIANCE FOOD-BASED STANDARDS NUTRIENT-BASED STANDARDS FOOD PROVISION AND CONSUMPTION AT MID-MORNING BREAK FOOD AND DRINK PROVIDED BY CATERERS AT MID-MORNING BREAK FOOD AND DRINK SELECTED BY PUPILS AT MID-MORNING BREAK COMPLIANCE WITH NUTRITIONAL STANDARDS AT MID-MORNING BREAK CHALLENGES CONCLUSIONS RESEARCH AND REPORTING REFERENCES APPENDIX ISSUES RELATING TO THE DETERMINATION OF COMPLIANCE WITH THE FOOD-BASED AND NUTRIENT-BASED STANDARDS... 26

3 Secondary school food survey 2011: school lunch provision, selection and consumption Page 3 List of tables Table 1. Frequency of lunchtime provision of foods from different food groups, according to number of days provided per week, secondary schools, England, 2004 and $ *... 6 Table 2. Percentage of pupils taking specific food and drink items, weight as taken, weight as eaten, and wastage, by food group, secondary schools, England, Table 3. Number of portions of vegetables and fruit taken and eaten, by food group, secondary schools, England, Table 4. Mean energy and nutrient intake from school lunch, taken and eaten, secondary schools, England, Table 5. Mean nutrient intake from school lunch according to spend, secondary schools, England, Table 6. Mean energy and nutrient intake from school lunch according to whether pupil had meal deal items, secondary schools, England, Table 7. Energy and nutrient content of an average school lunch compared with nutrient-based standards, modelled to meet the nutrient-based standard for energy, based on actual provision of food and drink at lunchtime, secondary schools, England, Table 8. Frequency of mid-morning break provision of foods from different food groups, according to number of days provided per week, secondary schools, England, Table 9. Mean energy and nutrient content of foods taken at morning break, secondary schools, England, List of figures Figure 1. Change in the percentage of schools providing types of foods and drinks at lunchtime on 4-5 days per week, by food group, secondary schools, England, 2004 and 2011.*... 7 Figure 2. Percentage of pupils taking specific items of food and drink at lunchtime, by food group, secondary schools, England, 2004 and 2011.*... 8 Figure 3. Change in percentage of pupils taking specific items of food and drink at lunchtime, by food group, secondary schools, England, 2004 and 2011.*... 9 Figure 4. Percentage mean difference in the nutrient content of an average meal as eaten, 2011 compared with 2004, energy and nutrients, secondary schools, England.* Figure 5. Percentage of schools meeting food-based standards at lunchtime based on actual provision, secondary schools, England, Figure 6. Percentage of pupils taking specific items of food and drink at mid-morning break, by food group, secondary schools, England, Figure 7. Percentage of schools meeting food-based standards at mid-morning break based on actual provision, secondary schools, England,

4 Secondary school food survey 2011: school lunch provision, selection and consumption Page 4 Background Since September 2009, all secondary schools in England have been required by law to comply with new standards for school lunch. 1 The purpose of this legislation is to enable pupils to eat more healthily at lunchtime and throughout the school day. These standards replaced the food-based standards introduced in The 2001 standards helped to ensure that healthy food and drink options were available throughout the lunch service, but did nothing to limit the range of less healthy options available. Nor did they address the provision of food across the school day. The new standards balance the range of choice toward healthier options, and include non-lunch provision. For example, a portion of fruit and vegetable must be provided at lunchtime for every pupil having a school lunch. Chips can be served occasionally, but not every day, as before. Aims of the survey Observe and record the provision of all food and drink in the dining room at midmorning break and at lunchtime Observe and record the food and drink choices of random samples of pupils having school food and drink at mid-morning break and at lunchtime Determine the consumption and wastage a of all food and drink served Measure the consumption of food and drink from packed lunches and other food brought into school b Assess the nutrient content of school lunches and packed lunches b Assess compliance of provision with the food-based and nutrient-based standards for school food Gather information from catering providers and headteachers about the arrangements for provision and school policies relating to healthy eating b How the data were collected The study was carried out by the School Food Trust, with TNS-BMRB providing support for sampling and fieldwork. A nationally representative sample of 11,697 pupils in 80 secondary schools in England was recruited between October 2010 and April 2011 to assess the eating habits of secondary school pupils at mid-morning break (5,728 pupils) and at lunchtime (5,969 pupils). A further 1,823 pupils who brought packed lunches or other food from outside school were also recruited. Caterers provided information relating to catering policies and practices. Headteachers were interviewed about school food policies and finances. Between October 2010 and April 2011, trained field workers collected observations at lunchtime on five consecutive days at each school. On each day in each school, fieldworkers made a list of all food and drink served at mid-morning break and lunch time and recorded the number of portions of each item provided at the beginning of each service. They weighed and recorded typical portion weights for all foods (where possible), c and recorded the number of pupils catered for. They then observed and recorded the food and drink items taken and eaten by 15 randomly selected pupils at mid-morning break and 15 randomly selected pupils having a school lunch on each day of the week. When pupils had finished their lunch, they returned their trays to the field a Wastage was not assessed at mid-morning break b Findings on packed lunches and the impact of catering practices and school policies on lunchtime catering provision and consumption will be presented in subsequent Research Reports. c There were some occasions where it was not possible to record portion weights for items, for example where there were no spare portions available for weighing. This applied to 4.1% of food and drink items overall.

5 Secondary school food survey 2011: school lunch provision, selection and consumption Page 5 workers who then recorded and weighed leftovers. d For a further five randomly selected pupils who brought a packed lunch or other food to school, field workers recorded the weights of each item of food and drink eaten (allowing for food left over). A nutritionist visited each school to confirm details of provision and to interview caterers. Caterers were asked to provide copies of their school lunch menus and recipes (with details of ingredients, cooking methods, and number of portions). Nutritionists reviewed all records and contacted headteachers and caterers for clarification where necessary. The Food Standards Agency Nutrient Databank 3 was used to provide food composition data. All food and drink items were allocated a unique code by choosing the most similar item on the databank, or assigning a new code using data taken from manufacturers product specifications or other food composition data, or a new recipe created. Food and drink items were categorised into one of 41 different food groups. e The present results are compared with those from a similar study carried out in 2004 in a nationally representative sample of 5695 pupils attending 79 secondary schools in England. 4 To allow comparisons with data collected in 2004, the 2004 data were recoded to match the new food group classification. Food and drink provided by caterers at lunchtime Table 1 shows the foods and drinks offered at lunchtime, based on direct observation by fieldworkers in the dining room and compares provision in 2011 with that in f In 2011, all schools offered main dishes and sandwiches 4-5 days per week. Dairy food, starchy food not cooked in oil, and other desserts were also commonly offered. 98% of schools offered vegetables and salad 4-5 days per week, and 96% offered fruit. Comparison of provision in 2011 and 2004 suggests that provision has moved toward a more healthy balance. Fewer schools regularly offered pizza (50% vs. 66%), starchy food cooked in fat or oil (53% vs. 77%) and condiments (84% vs. 95%) in 2011 compared with In addition, in 2011, a higher percentage of schools offered starchy food not cooked in fat or oil (99% vs. 82%), vegetables and salad (98% vs. 60%), water g (98% vs. 68%) and fruit (96% vs. 91%) on 4-5 days per week compared with The biggest changes were seen in relation to confectionery and snacks. Confectionery was not provided at all in 74 out of 80 schools (93%) of schools in This compares with the three-quarters of schools who did offer confectionery in Similarly, the provision of snacks such as crisps on 4-5 days per week fell from 75% of schools in 2004 to only 5% of schools in The number of schools offering non-permitted drinks on 4-5 days per week more than halved. h Thus, while it is clear that foods and drinks not permitted by the new standards have not disappeared completely from schools, their availability has been dramatically reduced as part of the transition towards healthier provision. d Leftovers were not recorded at mid-morning break. For purposes of calculation, it was assumed that pupils consumed all food purchased. This may result in a small overestimation of pupil nutrient intakes at mid-morning break. e Further details of data preparation and analysis will be available in the full Technical Report. f It was not possible to compare the overall balance of provision in 2011 and 2004 as information on the number of portions provided of each food and drink item was not collected in Table 1 therefore shows data in a comparable format from both surveys. g Includes bottled water h Where confectionery was provided in 2011, it was generally cereal bars; one school provided chocolate confectionery on two out of five days. Non-permitted drinks provided in 2011 included flavoured water, non-permitted milkshakes and non-permitted hot chocolate. Further information about the types of non-permitted items provided can be found in the section on Food-based standards

6 Secondary school food survey 2011: school lunch provision, selection and consumption Page 6 Table 1. Frequency of lunchtime provision of foods from different food groups, according to number of days provided per week, secondary schools, England, 2004 and $ * Schools 2011 Schools 2004 Food Group Food not offered Offered 4-5 days per week Food not offered Offered 4-5 days per week n % n % n % n % Main dishes * Pizza Starchy food not cooked in oil * Starchy food cooked in oil * Vegetables and salad * Baked beans Sandwiches * Fruit $ Dairy Bread and bread-based items $ Fruit-based desserts Other desserts * Non-permitted food and drink: Confectionery $ * Desserts, cakes and biscuits $ * including confectionery Non-permitted snacks $ * Non-permitted drinks $ * Permitted snacks and cereals Condiments * Water $ * Fruit juice $ * Other drinks incl. soup $ * Base (schools): 2011: 80; 2004: 79 $ The proportion of schools not offering particular food items differs between the two studies (statistically significant, p<0.005) *The proportion of schools offering particular food items on 4 or 5 days per week differs between the two studies (statistically significant, p<0.005) This identified schools providing items every day or almost every day. Schools not shown in Table 1 are those providing items between 1 and 3 days per week, so the row totals for 2011 do not add up to 80, and for 2004 do not add up to 79. Healthier foods promoted by the new standards such as compliant drinks, fruit juice, vegetables and salad, water and starchy food not cooked in oil were offered more regularly in 2011 compared with 2004 (Figure 1). Foods with less healthy nutrient profiles, i such as condiments, starchy food cooked in oil, non-permitted drinks, confectionery, desserts including confectionery, and non-permitted snacks were offered far less regularly in 2011 compared with i In particular, those foods that tend to be higher in fat, sugar or salt.

7 Secondary school food survey 2011: school lunch provision, selection and consumption Page 7 Figure 1. Change in the percentage of schools providing types of foods and drinks at lunchtime on 4-5 days per week, by food group, secondary schools, England, 2004 and 2011.* The bars to the left of the y axis indicate a lower proportion of schools offering the item in 2011 compared with * All differences were statistically significant (p<0.001) except for: dairy; baked beans; fruit; fruit based desserts; bread and bread-based items; permitted snacks and cereals; and pizza, for which p values ranged from to Base (schools): 2011:80; 2004:79 Food and drink selected by pupils at lunchtime The main purpose of introducing stricter standards relating to school food was to change the balance of food and drink available throughout the school day toward healthier options. A combination of food and nutrient-based standards for lunch and food-based standards for food other than lunch was intended to encourage healthier choices and consumption, whilst controlling levels of fat, salt and sugar. Figure 2 shows the percentage of pupils making specific food selections in 2004 and The changes are likely to be due primarily to the impact of the standards on food provision. Results in both years are based on direct observations of what was on pupils trays, not what they said they ate. In 2011 pupils took more sandwiches (29% vs. 13%) and fewer main dishes (38% vs. 47%) than in In total, more pupils took a balanced meal (sandwich j or main dish) in 2011 (67%) than in 2004 (60%). The number of pupils taking starchy food cooked in oil or fat decreased from 50% in 2004 to 17% in 2011, with those taking starchy food not cooked in oil or fat increasing from 15% in 2004 to 27% in There was a substantial decrease in the percentage of pupils taking non-permitted j A fuller analysis of the combinations of foods taken with sandwiches (drink, dessert, fruit, other foods) is presented in the technical report. The net impact on changes in energy and nutrients eaten at lunchtime is shown in Figure 4.

8 Secondary school food survey 2011: school lunch provision, selection and consumption Page 8 food and drink, from 56% in 2004 to 9% in The percentage of pupils taking nonpermitted items fell for drinks from 45% in 2004 to 5% in 2011, for confectionery from 5% to less than 1%, and for non-permitted snacks (e.g. crisps) from 11% to less than 1%. The number of pupils having confectionery in cakes, biscuits or desserts in 2011 was only one-third of that in The proportion of pupils taking discrete portions of vegetables and salad and fruit in 2011 was twice that in Although the percentages of pupils taking these items appears low, k in reality almost three-quarters of pupils had some vegetables, pulses, fruit or fruit juice as part of their lunch, when composite dishes were taken into account (see Table 3). Figure 2. Percentage of pupils taking specific items of food and drink at lunchtime, by food group, secondary schools, England, 2004 and 2011.* *All differences were statistically significant at p except baked beans (p=0.056) and permitted snacks and cereals (p=0.474). Base (pupils): 2011: 5,969; 2004: 5,695 Figure 3 summarises the change in the percentage of pupils taking items in a specific food group between 2004 and 2011 (equal to the differences in the percentages shown in Figure 2). For example, in 2004, 13% of pupils took a sandwich at lunchtime; in 2011 this had increased to 29%, and so the graph shows that 16% more pupils took sandwiches in 2011 compared with Similarly, 12% more pupils took starchy food not cooked in fat or oil in 2011 compared with 2004, and 6% more took vegetables. In contrast, the number of pupils taking starchy food cooked in oil fell by two-thirds. This is particularly striking in relation to chips. In 2011, only 7% of pupils chose chips, compared with 43% of pupils in This reflects a reduction of about 80%, which is of the same magnitude as the reduction in the number of days chips were available in schools (80% of days in 2004 compared with 17% of days in 2011). Almost 50% fewer pupils took items from the non-permitted group at lunchtime. Overall, the balance of food taken by pupils at lunchtime reflects the more healthy choices available. k These low values arise because the contribution of fruit and vegetables from composite dishes cannot be represented in this format, so only discrete portions are represented.

9 Secondary school food survey 2011: school lunch provision, selection and consumption Page 9 Figure 3. Change in percentage of pupils taking specific items of food and drink at lunchtime, by food group, secondary schools, England, 2004 and 2011.* The bars to the left of the y axis indicate a lower proportion of pupils taking the item in 2011 compared with *All differences were statistically significant at p except baked beans (p=0.056) and permitted snacks and cereals (p=0.474). Base (pupils): 2011: 5,969; 2004: 5,695 Food and drink consumed by pupils at lunchtime Consumption by food group The food and drink that pupils ate at lunchtime was measured by direct observation. Field workers noted the food and drink taken by each pupil in the sample; the weight of a standard portion was based on direct measurements made in each school; and the amount of food left over by each pupil was weighed. Table 2 shows the percentages of pupils who took food and drink from specific food groups, and the average amounts of food and drink taken and eaten by those who took the items. The percentages in the table reflect those shown in Figure 2 for In addition to the choices described in Figure 2, the table shows that only 10% of pupils took meat products (sausages, burgers, sausage rolls, etc.), and only 9% of pupils took non-permitted items This is far fewer than in 2004, and reflects their reduced availability at lunchtime. Of the food and drink taken, pupils left about 7% as plate waste. l Wastage varied by type of item, and was greatest for fruit (21.0%, including skin and core), followed by soup (18.4%), fruit-based desserts (16.0%) and vegetables and vegetable side dishes (13.5%). Portion sizes for fruit and vegetables were generally sufficient for those eating l Overall percentage plate waste was calculated as the mean of the plate waste of every item (weight of food or drink not eaten by a pupil divided by the weight of the food or drink served). This is likely to be a slight overestimate, as some measurements included containers (e.g. yogurt pots) which could not readily be weighed separately from the wasted food itself during the weighing process in the dining room.

10 Secondary school food survey 2011: school lunch provision, selection and consumption Page 10 them to consume at least one portion, even when wastage is taken into account. m These levels of wastage are substantially lower than in the primary sector, 5 and presumably reflect the fact that in the secondary sector the choice to take these items is more directly under pupils control. Table 2. Percentage of pupils taking specific food and drink items, weight as taken, weight as eaten, and wastage, by food group, secondary schools, England, Pupils taking Weight as taken Weight as eaten Plate wastage * g g g g % Food Group mean sd ** mean sd g % Meat and meat main dishes Vegetable products and main dishes Meat alternatives and main dishes Fish and fish main dishes Eggs and egg dishes Pizza Protein other Meat products Starchy foods not cooked in oil Starchy foods cooked in oil Vegetables and side dishes Baked beans Salad and raw vegetables Soup Hot sandwiches and wraps Cold sandwiches and wraps with salad Cold sandwiches and wraps no salad Other cold sandwiches/ wraps no salad Condiments Fruit Yoghurt Fruit-based desserts Other desserts and puddings Desserts/puddings with confectionery Dessert/pudding accompaniment Cakes Cakes containing confectionery Sweet and savoury biscuits Biscuits containing confectionery Confectionery Permitted snacks Non-permitted snacks Bread-based items Water Fruit juice Plain milk and milk alternatives Milky and milky alternative drinks Other drinks Non-permitted drinks Permitted breakfast cereals Base (pupils): 5,969 * The differences between the weight as taken and the weight as eaten were computed item by item within each food group, so the values are not equal to the differences between the averages as given in the table. ** sd: standard deviation One of the key objectives of the food-based standards was to ensure that every pupil had access to one portion of fruit and one portion of vegetables at lunchtime. Table 3 shows the average number of portions n of vegetables and fruit taken and consumed. On average, pupils were taking 0.8 portions of fruit and vegetables at lunchtime. A key aspect of this analysis is that it takes into account the fruit and vegetable intake from composite dishes. One in ten pupils overall took fruit or a fruit-based dessert, a quarter m See also Table 3 n One portion of vegetable=80g; one portion of fresh/tinned fruit =80g; one portion of dried fruit=30g. One portion of fruit juice=150ml; one portion of beans and pulses=80g. Fruit juice and baked beans and pulses count as a maximum of one portion per day regardless of the amount over 150 ml or 80 g, respectively. The fruit and vegetable content was calculated for each composite dish.

11 Secondary school food survey 2011: school lunch provision, selection and consumption Page 11 took fruit juice, o and more than half took some vegetables (including pulses). Overall, nearly three-quarters of pupils (72%) took some fruit or vegetables as part of their meal at lunchtime. Amongst consumers (those pupils who took an item), an average of 1.2 portions were taken and 1.1 portions eaten. About one in ten pupils (11%) consumed at least two portions of fruit and vegetables on a given day, and two in ten (22%) consumed at least one and a half portions. Analysis suggests that pupils were consuming more portions of fruit and vegetables in 2011 compared with 2004, p although the majority of pupils were not meeting the goal of the legislation which was to eat two portions of their five a day from a school lunch. The standards have helped to ensure that fruit and vegetables are more readily available at lunchtime, but better strategies are needed to encourage secondary school pupils to take and eat more fruit and vegetables. Table 3. Number of portions of vegetables and fruit taken and eaten, by food group, secondary schools, England, As taken As eaten Food or drink % Consumers All pupils * % Consumers taking only eating only All pupils * Vegetables, salad or dishes with vegetables Baked beans and pulses Fruit or fruit-based desserts All foods containing vegetables, salad, baked beans, pulses or fruit (excluding fruit juice) Fruit juice All food and drink containing vegetables, baked beans, pulses or fruit (including fruit juice) Base (pupils): 5,969 All pupils taking a school lunch Nutrient intake There were only minor differences in mean nutrient intakes between meals taken and meals eaten, reflecting the low levels of waste at lunchtime in secondary schools, and no differences in relation to meeting the nutrient-based standards (Table 4). q The energy content of meals taken and eaten by secondary school pupils at lunchtime was below the nutrient-based standard. The standard, which is based on the average requirements of pupils with physical activity at recommended levels states that 30% of daily energy intake should be obtained at lunchtime. On average, pupils were not taking or eating 30% of their daily energy requirement at lunchtime. Given the levels of overweight and obesity amongst 11 to 18 year-olds, and typical levels of physical activity, it could be argued that consumption below the 30% level is not inappropriate. Alternatively, it could be argued that there is a need for greater levels of physical activity. Thus, the finding reflects teenage eating patterns, rather than that the standard for energy is itself too high. Nutrient-based standards for nutrients where a maximum level is specified (NMES, fat, saturated fat and sodium) were met or very nearly met. This is due in part to the low overall energy content of food taken and eaten. Of greater importance, however, is that the balance of the contribution of total carbohydrate, sugars, fat and saturated fatty acids o This figure is different to that in Figure 2 because it includes fruit juice in other drinks (permitted drinks must contain at least 50% fruit juice; proportion in non-permitted drinks will vary). p It was not possible to make a direct comparison because the fruit and vegetable content of composite dishes was not available from the 2004 data. Analysis showed that in 2011, mean fruit and vegetable intake (not including the contribution from composite dishes) was 0.4 portions for all pupils taking a school lunch, compared with 0.2 portions in q The nutrient-based standards relate to provision, not consumption. Intakes are compared with the standards to benchmark the extent to which pupils choices and consumption reflect healthy eating patterns.

12 Secondary school food survey 2011: school lunch provision, selection and consumption Page 12 (SFA), expressed as the percentage contribution of these nutrients to energy intake, also met (carbohydrate, fat, SFA) or nearly met (sugars) the standards. r This indicates that food taken and eaten was appropriately balanced in relation to macronutrient content. Meals taken and eaten, on average, also met standards for protein and vitamin C. A key finding, as in the primary school food survey, 5 was that as a result of restrictions of access to savoury snacks and condiments, sodium intakes were over one-third lower in 2011 than in There were some differences between sub-groups (boys and girls; 11 to 14 years versus 15 to 18 years) in relation to meeting nutrient-based standards. Older (but not younger) boys and girls met the standard for percent energy from NMES (not more than 11% of energy); boys were marginally above the standard for percent energy from SFA (11.1%, compared with the standard of not more than 11%); only older boys did not meet the standard for sodium (mean intakes as taken of 779mg compared with the standard of 714mg). Table 4. Mean energy and nutrient intake from school lunch, taken and eaten, secondary schools, England, Nutrient-based As taken As eaten Nutrient standard mean sd ** mean sd Energy (kcal) Protein (g) Carbohydrate (g) NMES (g) * Fat (g) * SFA (g) * Fibre (g) Sodium (mg) * Vitamin A (µg) Vitamin C (mg) Folate (µg) Calcium (mg) Iron (mg) Zinc (mg) Percent energy from: Protein Carbohydrate % NMES * % Fat * % SFA * % Base (pupils): 5,969 * To meet the standard, mean nutrient content should be below the value shown ** sd: standard deviation - No standard for percent energy to be met from protein Values shown in bold minimum standard met Values shown in bold italic maximum standard met Mean nutrient intakes from lunch (as eaten) in 2011 were, on balance, healthier than in 2004 (Figure 4). For example, meals eaten in 2011 had nearly 50% more vitamin A compared with 2004 (due largely to increases in fruit and vegetable consumption), and at least 30% less saturated fat, sodium, non-milk extrinsic sugars and fat. Considering that mean energy intake was about 20% lower in 2011 than in 2004, increases in the vitamin A, calcium, fibre and protein content of meals demonstrate that meals in 2011 were more nutrient dense than in In addition, the decreases in fat, sodium, NMES and saturated fat are greater than could be attributed to the decrease in energy alone. Of particular significance in relation to healthy eating is the change in percentage energy from macronutrients since the introduction of the school food standards. Percentage energy from fat decreased by a quarter (41.1% to 30.7%), saturated fat by one-fifth r Nearly 50% of all NMES came from other desserts, about 23% came from juice, and 11% from other drinks.

13 Secondary school food survey 2011: school lunch provision, selection and consumption Page 13 (13.6% to 11.0%), and NMES by one-sixth (13.5% to 11.6%). Percentage energy from carbohydrate increased from 46.9% to 53.0%. These changes represent significant progress towards healthier eating at lunchtime in secondary schools. Low intakes of zinc, iron and folate (seen also in 2004) remain of concern. The decreases in zinc, iron and folate intakes since 2004 can be partly attributed to fewer main dishes being chosen in 2011 compared with 2004, as well as to energy intakes having decreased. Figure 4. Percentage mean difference in the nutrient content of an average meal as eaten, 2011 compared with 2004, energy and nutrients, secondary schools, England.* *All differences were statistically significant (p<0.001) except for iron (p=0.062) and zinc (p=0.625). Base (pupils): 2011: 5,969; 2004:5,695 Unlike the primary sector, where expenditure is typically for a set meal, pupils in the secondary sector can spend as much or as little as they like at lunchtime. It is helpful, therefore, to analyse the consumption data in relation to the amount spent in the dining room. It could be argued that pupils who spent at least the equivalent of the free school meal (FSM) value s on their school meal, and indeed those actually having a free school meal, are having a proper meal, in contrast to those spending less than the FSM value. The intake of pupils spending at least the equivalent of the FSM value met the standards for energy and for carbohydrate and vitamin A (Table 5). Their intakes of folate, fibre, calcium, iron and zinc were also closer to the standards than pupils spending less than the FSM value, or those in receipt of a FSM. However, their average NMES, saturated fat and sodium intakes did not meet (were above) the standards whereas the other groups did. In relation to percentage energy from macronutrients, their profile was similar to the other two groups, except for percentage energy from saturated fat which was just above the standard. Although pupils in some schools can spend their FSM allowance on food and drink of their choice (not necessarily a main meal or a sandwich with fruit and s The amount allocated to pupils in the dining room. The average FSM value across all schools was 2.03.

14 Secondary school food survey 2011: school lunch provision, selection and consumption Page 14 drink), their average intake (and ability to meet the standards) was not very different from those spending over the FSM value. Table 5. Mean nutrient intake from school lunch according to spend, secondary schools, England, Pupil spend is Pupil spend is at Free school meal Nutrientbased Nutrient less than FSM least FSM value value standard mean sd ** mean sd mean sd Average spend ( ) Energy (kcal) $ Protein (g) $ Carbohydrate (g) $ NMES (g) * $ Fat (g) * $ SFA (g) * $ Fibre (g) $ Sodium (mg) * $ Vitamin A (µg) $ Vitamin C (mg) $ Folate (µg) $ Calcium (mg) $ Iron (mg) $ Zinc (mg) $ Percent energy from: Protein Carbohydrate % NMES * % Fat * % SFA * % Base (pupils): Spend less than FSM: 2,553; spend at least FSM value: 1,390; Free School Meal: 1,492 * To meet the standard, mean nutrient content should be below the value shown ** sd: standard deviation $ Means across the three groups were different from each other (p<0.001) - No standard for percent energy to be met from protein Values shown in bold minimum standard met Values shown in bold italic maximum standard met The data were also analysed in relation to whether pupils had items that were part of a meal deal. t Table 6 shows the energy and nutrient intakes of pupils whose meals contained meal deal items compared with pupils whose meals did not. Pupils having meal deal items had higher energy intakes compared with other pupils, and had a more favourable micronutrient profile (vitamin A, vitamin C and folate intakes met the nutrientbased standard, and iron and zinc intakes were higher even though they did not meet the standard). The macronutrient profile in relation to energy was similar for both groups, but pupils having meal deal items met the standard for percentage energy from NMES, whereas pupils having other types of meals did not. Meal deals appear to encourage consumption of meals with higher energy and nutrient content. t This includes pupils whose selections included some meal deal items, not necessarily only meal deal items.

15 Secondary school food survey 2011: school lunch provision, selection and consumption Page 15 Table 6. Mean energy and nutrient intake from school lunch according to whether pupil had meal deal items, secondary schools, England, Nutrient-based Meal deal items No meal deal items Nutrient standard mean sd ** mean sd Energy (kcal) Protein (g) Carbohydrate (g) NMES (g) * Fat (g) * SFA (g) * Fibre (g) Sodium (mg) * Vitamin A (µg) Vitamin C (mg) Folate (µg) Calcium (mg) Iron (mg) Zinc (mg) Percent energy from: Protein Carbohydrate % NMES * % Fat * % SFA * % Base (pupils): 5,969 * To meet the standard, mean nutrient content should be below the value shown ** sd: standard deviation - No standard for percent energy to be met from protein Values shown in bold minimum standard met Values shown in bold italic maximum standard met Compliance with nutritional standards for school food Determining compliance The final food-based and nutrient-based standards introduced in secondary schools in England in 2009 provided benchmarks for caterers to provide food and drink that enable pupils to have balanced, healthy meals at lunchtime. Compliance with the standards in law relates to planned provision. Due to the cash cafeteria nature of food provision in secondary schools, however, menus often do not include all items available on a given day, or information on the numbers of portions of each item provided. It has not therefore been possible to assess planned provision against the food-based or nutrient-based standards in the same way as in the primary sector, where statements of planned provision provided a good marker for actual provision, and could readily be adjusted when plans were modified at short notice. In this report, compliance has been assessed against actual provision, using information collected by direct observation in the dining room. This raises issues which are outlined in the Appendix, and discussed in detail in the technical report. Food-based standards Compliance with the food-based standards (based on actual provision) varied widely depending on the standard (Figure 5). The food-based standards met most consistently were for salt and condiments (met by 91% of schools), confectionery (90%) and snacks (89%). Salt was available in only three schools (4%). Where confectionery was available in schools, it was mainly in the form of cereal bars; u only one school served a chocolate confectionery item. Although most u Cereal bars are often as high in sugar as other confectionery, in spite of being advertised as healthy.

16 Secondary school food survey 2011: school lunch provision, selection and consumption Page 16 schools did not offer confectionery, cakes and biscuits containing confectionery v were available in more than half of schools. Where non-permitted snacks were provided, they included crackers or breadsticks (only permitted at lunchtime if served with dairy food, fruit or vegetables/salad), flavoured rice cakes (plain rice cakes are permitted), salted nuts, and crisps (available in only two schools). More than half of schools met the healthier drinks standard. Non-permitted drinks available in the remaining schools included squash, flavoured water, and non-compliant flavoured milk, juice drinks (less than 50% fruit juice), and hot chocolate. Nearly half of schools (46%) met the standard for starchy food cooked in oil not served on more than three days per week. However, the frequency of serving has decreased from an average of 4.2 days per week in 2004 to 3.5 days per week in 2011, demonstrating good engagement by caterers with the standards. w This reduction in frequency of serving also had an impact on pupils choices, with the percentage of pupils choosing starchy food cooked in oil falling from 50% in 2004 to 17% in Fewer schools (35%) met the standard for deep-fried food, which limits schools to providing no more than two deep-fried items per week, although a further 11% of schools were close to compliance, providing only three deep-fried items at lunchtime. Forty per cent of schools provided extra bread every day and met the standard, with a further 10% providing extra bread on four days per week. Just over a third of schools (37.5%) did not provide extra bread at all. Compared with the other standards, those for fruit and vegetables were met least often. Although 98% of schools provided vegetables and salad on 4-5 days per week, only 22.5% provided at least one portion per pupil every day. x A further 20% of schools provided at least three-quarters of a portion of vegetables per pupil, with a further 25% providing at least half a portion. Only two schools (3%) provided at least one portion of fruit per pupil each day. This is likely to reflect caterers trying to avoid wastage less than 5% of pupils took fruit, so providing a portion per pupil had the potential to incur high levels of wastage from the caterer s perspective. A further 30% of schools provided at least half a portion of fruit per pupil. y Standards which required assessment over two or three weeks (meat products, oily fish) could not be assessed as data were collected over one week only. v Mainly chocolate chips, hundreds and thousands. w Because of differences in the way in which foods are classified when reporting provision and assessing compliance, figures here differ from those in Table 1. x Vegetables and salad were counted as one portion per serving. Composite dishes were assessed individually (e.g. a dish containing 40% vegetables was counted as 0.4 portions pre serving). Compliance for fruit and vegetables was assessed for 77 schools; the number of pupils having meals was not available for the remaining 3 schools. Percentages quoted in the text relate to 80 schools. y Because the standard for fruit includes fruit juice, it should be noted that had the number of portions of drinks not been capped (see Appendix), 53% of schools would have been compliant with the standard for fruit. However, this level of compliance would not actually relate to provision in relation to the likely take up of fruit/fruit juice as a choice at lunchtime.

17 Secondary school food survey 2011: school lunch provision, selection and consumption Page 17 Figure 5. Percentage of schools meeting food-based standards at lunchtime based on actual provision, secondary schools, England, Base (schools): 77 (fruit and vegetables); 80 (all other standards). Nutrient-based standards The mean energy and nutrient content of an average school lunch was compared with the nutrient-based standards for secondary schools. The calculation of an average school lunch was based on actual provision observed in the dining room at lunchtime over one week. Schools with more than 5% missing portion numbers were excluded from the analysis. Drinks provision was capped to account for over-provision. Take up was estimated from the number of pupils catered for each day, adjusted using average spend relative to FSM value to reflect the number of meal equivalents provided. z On initial calculation, the energy content of the average school lunch provided appeared to be about 20% higher than the standard. This is likely to reflect biases in the calculation attributable to a number of factors which are outlined in the Appendix. It is likely that these biases in calculation would also apply to other nutrients. To understand better whether pupils are being provided with the right balance of nutrients at lunchtime, therefore, the estimated energy content of the average school lunch provided was equated with the standard, aa and the same adjustment was applied proportionally to the other nutrients. Table 7 shows the results of this modelling on the energy and nutrient content of the average school lunch, and the corresponding levels of compliance based on this model. When the energy content of the average school lunch provided by caterers was equated with the standard for energy, all school catering provision appeared to meet the standard for protein, and nearly all for vitamin C. About two-thirds met the standards for carbohydrate, fat and vitamin A and more than 60% of schools met, or were within ±10% of the standard for NMES, SFA, fibre and folate. Although only 18% of schools met the standard for sodium, a further 27% were within ±10%. z Details on methods of analysis relating to determination of compliance with nutrient-based standards are outlined in the Appendix and further elaborated in the technical report. aa This value, 646 kcal per meal, is roughly 18% higher than the observed average energy content of meals taken (530 kcal, shown in Table 4), and 23% higher than average energy consumption. This would allow for some catering losses and (5%) plate waste, which in turn accords with the reported 7% plate waste (based on food weight).

18 Secondary school food survey 2011: school lunch provision, selection and consumption Page 18 Table 7. Energy and nutrient content of an average school lunch compared with nutrient-based standards, modelled to meet the nutrient-based standard for energy, based on actual provision of food and drink at lunchtime, secondary schools, England, Schools meeting the nutrient-based standard Nutrient Standard Nutrient content of average meal Met Within ±10% of standard Not within ±10% of standard mean se * n % n % n % Energy (kcal) See text Protein (g) Carbohydrate (g) NMES (g) Fat (g) SFA (g) Fibre (g) Sodium (mg) Vitamin A (µg) Vitamin C (mg) Folate (µg) Calcium (mg) Iron (mg) Zinc (mg) Percent energy from: Protein Carbohydrate 50% NMES 11% Fat 35% SFA 11% Base (schools): 55 (24 schools excluded due to more than 5% missing portion numbers; 1 school excluded due to no estimated value for take up) * se: standard error No school catering provision met the standard for iron, two schools met the standard for zinc, and six schools for calcium. The average lunch, as modelled, met about seven of the 14 standards, with 36% of schools providing an average lunch that met eight standards. In 2004, set meals (rather than total provision) were compared with nutrient-based standards. It might be expected that set meals would have been prepared with balanced healthy eating in mind; however, it is clear that total provision in 2011 accords better with nutrient-based standards than set meals in For example, in 2004, only 7% of schools met the standard for fat compared with 69% of schools meeting the standard in 2011; and for vitamin C, one in five schools failed to meet the standard in 2004, compared with only two schools (3%) in This suggests that there has been a substantial improvement in terms of balance of energy and micronutrient density. Secondary schools do not appear to have been as successful as primary schools in meeting school food standards. The two main challenges are the style of service and the starting point prior to the introduction of the standards. In secondary schools, a greater number and variety of items are available at lunchtime, leading to more opportunity for misunderstandings or lack of clarity on the part of the caterer about the types of items that can be provided, how often, and what should be included in the analysis of an average school lunch. In addition, pupils often do not take complete meals, and there is an interaction with morning break provision which is not yet fully understood. Prior to the introduction of the standards, secondary schools were likely to have been further from compliance than primary schools. More time may be required to change provision in secondary schools, and this in turn may depend on changes in catering practice (e.g. less choice, higher quality) and changes in attitude on the part of school senior leadership teams and the pupils themselves. Despite these factors, earlier sections of this report make clear that there have been substantial changes since 2004 in the types

19 Secondary school food survey 2011: school lunch provision, selection and consumption Page 19 of food provided by caterers and the choices made by pupils. These both demonstrate strong evidence of a shift in both provision and food choices towards a healthier balance. This study, carried out only 12 to 18 months after the introduction of nutrient-based standards in secondary schools, demonstrates good progress toward healthier eating in secondary schools. Continued engagement by schools and caterers is needed, however, to ensure that the current shortfalls in compliance are rectified in order to benefit the diets of secondary school pupils further. Food provision and consumption at mid-morning break Food and drink provided by caterers at mid-morning break Table 8 shows the types of food and drink offered in school food outlets at mid-morning break in 77 schools, bb based on direct observation of what was available. The foods most commonly offered were drinks, with water and fruit juice offered on 4-5 days per week in 99% of schools, and other drinks in 92% of schools. Dairy foods and sandwiches were offered on 4-5 days per week in 97% and 96% of schools respectively, and pizza in 78% of schools. Fruit was offered regularly in 91% of schools, but not at all in 5 schools (6%). Nearly two-thirds of schools (63%) did not offer vegetables or salad as discrete items at mid-morning break. Provision at mid-morning break generally offered a reduced variety of foods compared with lunchtime provision. Pizza was available more often, with most other types of foods available less often. More schools provided non-permitted snacks than at lunchtime; this is mostly due to the provision of crackers or breadsticks with cheese (permitted in the standards only at lunchtime). Table 8. Frequency of mid-morning break provision of foods from different food groups, according to number of days provided per week, secondary schools, England, Food Group Schools 2011 Food not offered Offered 4-5 days per week n % n % Main dishes Pizza Starchy food not cooked in oil Starchy food cooked in oil Vegetables and salad Baked beans Sandwiches Fruit Dairy Bread and bread-based items Fruit-based desserts Other desserts cc Non-permitted food and drink: Confectionery Desserts, cakes and biscuits including confectionery Non-permitted snacks Non-permitted drinks Permitted snacks and cereals Condiments Water Fruit juice Other drinks (including soup) Base (schools): 77 This identified schools providing items every day or almost every day. Schools not shown in Table 8 are those providing items between 1 and 3 days per week, so the row totals do not add up to 77 bb 3 schools did not offer a mid-morning break service cc Includes cakes and biscuits. The school food standards state that these items are only permitted at mid-morning break if provided as part of lunch provision.

20 Secondary school food survey 2011: school lunch provision, selection and consumption Page 20 Food and drink selected by pupils at mid-morning break Figure 6 shows the choices made by pupils at mid-morning break. dd The most common choice was sandwiches, followed by pizza and bread-based items (typically toast). The majority of items bought by pupils were as a snack (96%), rather than lunch. Nearly all pupils purchasing items at mid-morning break said they were going to eat them at break (96%). Figure 6. Percentage of pupils taking specific items of food and drink at mid-morning break, by food group, secondary schools, England, Base (pupils): 5,571 Table 9 shows the mean energy and nutrient content of pupils morning break food and drink choices as taken. ee In relation to macronutrients, percentage energy from carbohydrate (48%) very nearly met the level recommended for healthy eating (50%), and percentage energy from NMES (8.4%) easily met the recommendation (11%). Pupils choices were too high in saturated fat (13.6% vs. 11%), whereas total fat just met the recommended level (35%). Mean energy taken at mid-morning break was lower than at lunchtime (327 kcal compared with 530 kcal), and was equivalent to 15% of a secondary school pupil s daily energy requirement. In relation to macronutrient content, pupils obtained less energy from carbohydrate and sugars, and more energy from fat and SFA from food chosen at morning break than they did from food chosen at lunchtime. The NMES, fibre, vitamin A, and vitamin C content of food taken at morning break were all lower in relation to energy than foods taken at lunchtime (i.e. the foods were less nutrient dense), whereas calcium was higher. Despite the difference in energy, sodium intake at morning break was nearly dd Analysis does not include items brought into school from home, from outside, or acquired from a friend. 398 pupils (7%) had one or more items from these sources to eat or drink at break (6% of all items), with just over half of these items (52%) being non-permitted food or drink. ee Leftover weights were not measured at morning break, therefore nutrient intakes may be overestimated. Wastage is likely to be no higher than at lunchtime (7%).

21 Secondary school food survey 2011: school lunch provision, selection and consumption Page 21 the same as at lunchtime. These differences in intakes reflect the differences in pupil choices; more pizza and sandwiches and less fruit, fruit juice, vegetables and desserts were chosen at morning break compared with lunchtime. Average spend at morning break was Table 9. Mean energy and nutrient content of foods taken at morning break, secondary schools, England, Nutrient content of items taken mean se * Energy (kcal) Protein (g) Carbohydrate (g) NMES (g) Fat (g) SFA (g) Fibre (g) Sodium (mg) Vitamin A (µg) Vitamin C (mg) Folate (µg) Calcium (mg) Iron (mg) Zinc (mg) Percent energy from: Protein Carbohydrate NMES Fat SFA Base (pupils): 5,571 se: standard error Compliance with nutritional standards at mid-morning break Compliance with the food-based standards for food other than lunch (based on actual provision) varied depending on the standard (Figure 7). All schools provided fruit and/or vegetables and therefore met the standard. Most schools met the standards for salt and condiments (93.5%) and confectionery (87%); where confectionery was provided it was mainly as cereal bars, and some schools (6) served chocolate-type cereal. The non-permitted snacks provided were mainly crackers and breadsticks. More than half of schools met the healthier drinks standard, with slightly more meeting the drinking water standard. Two-thirds of schools provided cakes and biscuits at mid-morning break. Cakes and biscuits are permitted at break as part of lunch provision (for example schools may provide lunch at mid-morning break to reduce queues or to benefit pupils taking part in lunchtime activities). Where cakes and biscuits are part of lunchtime provision, they would be included in the nutrient analysis when assessing compliance with the nutrientbased standards. Information provided by caterers suggested that more than half of schools providing cakes and biscuits at break included at least some mid-morning break provision in their nutrient analysis when assessing compliance with the nutrient-based standards, but the information provided was not always sufficient to determine whether cakes and biscuits specifically were part of lunchtime provision. Only 7% of pupils chose these items at morning break, compared with 30% at lunchtime. In most cases, compliance with food-based standards at mid-morning break was generally consistent with compliance at lunchtime. Where it was less consistent (fruit and vegetables, snacks), it is likely to be because the standards are different at the two

22 Secondary school food survey 2011: school lunch provision, selection and consumption Page 22 occasions: fruit and/or vegetables have to be available at break whereas at lunch they have to be provided in sufficient quantities to allow all pupils a portion of each; and crackers and breadsticks are permitted at lunch when they are served with a fruit, vegetable or dairy accompaniment, but are not permitted at break. Fewer schools met the standard for drinking water at break than at lunchtime, maybe because jugs of water are more commonly provided on tables at lunchtime to cater for pupils sitting down and eating compared with the more grab and go type service at mid-morning break in many schools. Figure 7. Percentage of schools meeting food-based standards at mid-morning break based on actual provision, secondary schools, England, Base (schools): 77 Three of the food-based standards apply across the whole day: starchy food cooked in oil, deep-fried food, and meat products. At lunchtime, 46% of schools were compliant with the standard for starchy food cooked in oil (restricted to no more than three days per week). When mid-morning break provision was included, compliance fell to 35%. The number of schools meeting the deep-fried food standard when mid-morning break provision was included fell from 35% to 26%. Items provided at break in these categories were mainly potato wedges, hash browns and garlic bread. It was not possible to assess compliance with the standard for meat products as this standard applies over two weeks and data were collected over one week only. Challenges The findings reported here demonstrate considerable progress on the part of secondary schools and caterers in making food provision at lunchtime healthier, and there is equally encouraging evidence of an impact on pupils food choices and nutrient intakes. Clearly there are further changes to be made to provide food and drink that is fully compliant with the standards and to encourage secondary school pupils to make healthier choices at lunchtime. Caterers need to: continue to reduce the number of times that starchy foods cooked in oil are provided implement strategies to encourage pupils to take more fruit and vegetables as part of their lunch increase the iron and zinc content of recipes, food items and meals encourage pupils to take a balanced meal