Describing Food Availability in Schools Using Different Healthy Eating Guidelines: Moving Forward with Simpler Nutrition Recommendations

Publication: Canadian Journal of Dietetic Practice and Research
3 October 2018

Abstract

Purpose: Internationally, there is debate on whether a nutrient or a food-based approach to policy is more effective. This study describes the food/beverage availability in schools in Nova Scotia through a comparison of a traditional nutrient classification (“Maximum/Moderate/Minimum”), currently used in the provincial school policy and a simplified food-based system (“Core/Extra”).
Methods: School food environment audits were conducted in schools (n = 25) to record the food and beverages available. Registered dietitians categorized information using both the nutrient-based and simplified food-based classification systems. Number and percent in each category were described for items.
Results: Food and beverage items consisted of breakfast, lunch, snacks, beverages, and vending of which 81% were permissible by the policy, whereas only 54% were categorized as Core. Many snacks and vending items classified as Extra fell within either Moderate (45% and 35%, respectively) or Minimum (29% and 33%, respectively) categories.
Conclusions: Dietitians have a role to support interpretation of classification systems for school nutrition policies. The nutrient-based classification used in the policy permitted some items not essential to a healthy diet as defined by the Extra food-based classification. However, the food-based Core/Extra categorization had less detail to classify nutrients.

Résumé

Objectif. Il y a actuellement un débat à l’échelle mondiale à savoir si une approche fondée sur les nutriments est plus efficace qu’une approche fondée sur les aliments en matière de politique. Cette étude dresse un portrait de la disponibilité des aliments et des boissons dans les écoles de la Nouvelle-Écosse en comparant la classification traditionnelle basée sur les nutriments (maximum/modéré/minimum), laquelle est actuellement utilisée dans la politique scolaire provinciale, à un système simplifié fondé sur les aliments (de base/extra).
Méthodes. Des contrôles de l’environnement alimentaire des écoles (n = 25) ont été menés afin de répertorier les boissons et les aliments qui y sont offerts. Des diététistes ont catégorisé l’information en utilisant à la fois le système de classification fondé sur les nutriments et le système de classification simplifié fondé sur les aliments. Les articles étaient décrits selon leur nombre et le pourcentage qu’ils représentaient dans chaque catégorie.
Résultats. Les boissons et les aliments étaient des articles de déjeuner, de dîner, de collations, de boissons et de machines distributrices dont 81 % étaient autorisés par la politique, alors que seulement 54 % étaient placés dans la catégorie « de base ». Plusieurs collations et articles des machines distributrices classés dans la catégorie « extra » se retrouvaient dans la catégorie « modéré » (45 %, 35 %, respectivement) ou « minimum » (29 %, 33 %, respectivement).
Conclusions. Les diététistes ont un rôle à jouer pour soutenir l’interprétation des systèmes de classification des politiques en matière de nutrition en milieu scolaire. La classification fondée sur les nutriments utilisée dans la politique autorisait certains articles non essentiels à une saine alimentation alors qu’ils étaient définis comme « extra » dans la classification fondée sur les aliments. Cependant, la catégorisation « de base/extra » fondée sur les aliments n’offrait pas une classification des nutriments aussi détaillée.

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Financial support: This research was funded as part of an evaluation for the Nova Scotia Department of Health and Wellness. The authors would also like to acknowledge funding from the Canadian Institutes of Health Research and the Max Bell Foundation relating to a larger research project on the school food environment (FRN: 335426). Jessie-Lee D. McIsaac acknowledges funding from the Canadian Cancer Society (grant #703878). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program.
Conflicts of interest: The authors do not have any conflicts of interest to declare.

References

1
Garriguet D. Diet quality in Canada. Health Rep. 2009 Sep;20(3):41–52.
2
Minaker L and Hammond D. Low frequency of fruit and vegetable consumption among Canadian youth: findings from the 2012/2013 Youth Smoking Survey. J Sch Health. 2016 Feb 1;86(2):135–42.
3
World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva, Switzerland: World Health Organization; 2003 [cited 2017 Sep 8]. Available from: http://www.who.int/dietphysicalactivity/publications/trs916/en/.
4
Holman DM and White MC. Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality. Nutr J. 2011;10:60.
5
Brennan L, Castro S, Brownson RC, Claus J, and Orleans CT. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity. Annu Rev Public Health. 2011;32(1):199–223.
6
Blanck HM and Kim SA. Creating supportive nutrition environments for population health impact and health equity: an overview of the Nutrition and Obesity Policy Research and Evaluation Network’s efforts. Am J Prev Med. 2012 Sep;43(3 Suppl. 2):S85–90.
7
Mozaffarian D and Ludwig DS. Dietary guidelines in the 21st century—a time for food. JAMA. 2010 Aug 11;304(6):681–2.
8
Black JL, Velazquez CE, Ahmadi N, Chapman GE, Carten S, Edward J, et al. Sustainability and public health nutrition at school: assessing the integration of healthy and environmentally sustainable food initiatives in Vancouver schools. Public Health Nutr. 2015 Sep;18(13):2379–91.
9
Mâsse LC, Naiman D, and Naylor P-J. From policy to practice: implementation of physical activity and food policies in schools. Int J Behav Nutr Phys Act. 2013 Jun 3;10(1):71.
10
Metos J and Nanney MS. The strength of school wellness policies: one state’s experience. J Sch Health. 2007 Sep;77(7):367–72.
11
Moore S, Murphy S, Tapper K, and Moore L. From policy to plate: barriers to implementing healthy eating policies in primary schools in Wales. Health Policy. 2010 Mar;94(3):239–45.
12
van Ansem WJ, Schrijvers CT, Rodenburg G, Schuit AJ, and van de Mheen D. School food policy at Dutch primary schools: room for improvement? Cross-sectional findings from the INPACT study. BMC Public Health. 2013 Apr 12;13:339.
13
Downs SM, Farmer A, Quintanilha M, Berry TR, Mager DR, Willows ND, et al. From paper to practice: barriers to adopting nutrition guidelines in schools. J Nutr Educ Behav. 2012 Mar;44(2):114–22.
14
Holthe A, Larsen T, and Samdal O. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools. Matern Child Nutr. 2011 Jul 1;7(3):315–27.
15
McCaughtry N, Martin JJ, Fahlman M, and Shen B. Urban health educators’ perspectives and practices regarding school nutrition education policies. Health Educ Res. 2012 Feb 1;27(1):69–80.
16
Brown KM, Akintobi TH, Pitt S, Berends V, McDermott R, Agron P, et al. California school board members’ perceptions of factors influencing school nutrition policy. J Sch Health. 2004 Feb 1;74(2):52–8.
17
Rangan A, Hector D, Randall D, Gill T, and Webb K. Monitoring consumption of ‘extra’ foods in the Australian diet: comparing two sets of criteria for classifying foods as ‘extras’. Nutr Diet. 2007 Dec;64(4):261–7.
18
World Health Organization, Food and Agriculture Organization of the United Nations. Preparation and use of food-based dietary guidelines. Nicosia, Cyprus: Joint FAO/WHO Consultation; 1998 [cited 2017 Sep 10]. Available from: http://www.who.int/nutrition/publications/nutrientrequirements/WHO_TRS_880/en/.
19
Ministry of Health of Brazil. Dietary guidelines for the Brazilian population. 2nd ed. Brasília, Brazil: Secretariat of Health Care Primary Health Care Department; 2014 [cited 2017 Sep 10]. Available from: http://189.28.128.100/dab/docs/portaldab/publicacoes/guia_alimentar_populacao_ingles.pdf.
20
Ogilvie KK, Eggleton A. Obesity in Canada: a whole-of-society approach for a healthier Canada. Ottawa, ON: Report of the Standing Senate Committee on Social Affairs, Science and Technology; 2016 Mar [cited 2017 Sep 10]. Available from: https://sencanada.ca/content/sen/committee/421/SOCI/Reports/2016-02-25_Revised_report_Obesity_in_Canada_e.pdf.
21
Bell AC, Kremer PJ, Magarey AM, and Swinburn BA. Contribution of ‘noncore’ foods and beverages to the energy intake and weight status of Australian children. Eur J Clin Nutr. 2005 May;59(5):639–45.
22
Webb KL, Lahti-Koski M, Rutishauser I, Hector DJ, Knezevic N, Gill T, et al. Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months from western Sydney, Australia. Public Health Nutr. 2006 Dec;9(8):1035–44.
23
McGowan L, Croker H, Wardle J, and Cooke LJ. Environmental and individual determinants of core and non-core food and drink intake in preschool-aged children in the United Kingdom. Eur J Clin Nutr. 2012 Mar;66(3):322–8.
24
Johnson L, van Jaarsveld CHM, and Wardle J. Individual and family environment correlates differ for consumption of core and non-core foods in children. Br J Nutr. 2011 Mar;105(6):950–9.
25
Taylor JP, McKenna ML, and Butler GP. Monitoring and evaluating school nutrition and physical activity policies. Can J Public Health. 2010 Aug;101(Suppl. 2):S24–7.
26
Health Canada. Eating well with Canada’s food guide; 2008 [cited 2017 Apr 8]. Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php.
27
Province of Nova Scotia. Food and nutrition policy documents. Food and nutrition in Nova Scotia schools; 2008 [cited 2017 Oct 30]. Available from: http://www.ednet.ns.ca/healthy_eating/.
28
Alberta Government. Alberta nutrition guidelines for children and youth: a childcare, school and recreation/community centre resource manual. Edmonton, AB: Government of Alberta; 2012 Sep [cited 2017 Sep 10]. Available from: https://open.alberta.ca/publications/5906406.
29
Olstad DL, Poirier K, Naylor P-J, Shearer C, and Kirk SF. Policy outcomes of applying different nutrient profiling systems in recreational sports settings: the case for national harmonization in Canada. Public Health Nutr. 2015 Aug;18(12):2251–62.
30
World Health Organization. Nutrient profiling: report of a WHO/IASO technical meeting (London, United Kingdom, 4–6 October 2010). Geneva, Switzerland: World Health Organization; 2011 [cited 2017 Sep 10]. Available from: http://www.who.int/nutrition/publications/profiling/WHO_IASO_report2010/en/.
31
Sacks G, Rayner M, Stockley L, Scarborough P, Snowdon W, and Swinburn B. Applications of nutrient profiling: potential role in diet-related chronic disease prevention and the feasibility of a core nutrient-profiling system. Eur J Clin Nutr. 2011 Mar;65(3):298–306.
32
McIsaac J-LD, Shearer CL, Veugelers PJ, and Kirk SFL. Moving forward with school nutrition policies: a case study of policy adherence in Nova Scotia. Can J Diet Pract Res. 2015 Dec;76(4):172–7.
33
Mcisaac J-LD, Read K, Veugelers PJ, and Kirk SFL. Culture matters: a case of school health promotion in Canada. Health Promot Int. 2017 Apr 1;32(2):207–17.
34
Fung C, McIsaac J-LD, Kuhle S, Kirk SFL, and Veugelers PJ. The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children. Prev Med. 2013 Dec;57(6):934–40.
35
Penney TL, McIsaac J-LD, Storey K, Kontak JCH, Ata N, Kuhle S, et al. A translational approach to characterization and measurement of health-promoting school ethos. Health Promot Int. 2017 Aug 9.
36
Gray J. Implementation of school food standards in England—a catering perspective. Nutr Bull. 2008 Sep 1;33(3):240–4.
37
Pettigrew S, Donovan RJ, Jalleh G, and Pescud M. Predictors of positive outcomes of a school food provision policy in Australia. Health Promot Int. 2014 Jun 1;29(2):317–27.
38
Government of Canada, Health Canada. Evidence review for dietary guidance: summary of results and implications for Canada’s food guide; 2016 Jun [cited 2017 Sep 10]. Available from: https://www.canada.ca/en/health-canada/services/publications/food-nutrition/evidence-review-dietary-guidance-summary-results-implications-canada-food-guide.html.
39
Hanks AS, Just DR, and Wansink B. Chocolate milk consequences: a pilot study evaluating the consequences of banning chocolate milk in school cafeterias. PLoS ONE. 2014 Apr 16;9(4):e91022.
40
Goto K, Waite A, Wolff C, Chan K, and Giovanni M. Do environmental interventions impact elementary school students’ lunchtime milk selection? Appl Econ Perspect Policy. 2013 Jun 1;35(2):360–76.

Information & Authors

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Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 80Number 1March 2019
Pages: 22 - 29

History

Version of record online: 3 October 2018

Authors

Affiliations

Jessie-Lee D. McIsaac PhD
Healthy Populations Institute, Dalhousie University, Halifax, NS
Faculty of Education, Mount Saint Vincent University, Halifax, NS
Nicole Ata MSc, MD
Healthy Populations Institute, Dalhousie University, Halifax, NS
Sara F.L. Kirk PhD
Healthy Populations Institute, Dalhousie University, Halifax, NS

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