Page 12 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 1. General Introduction
often guided by peers and parents [18-20]. It is therefore even more difficult to influence adolescents’ food choices and dietary behaviour at the individual level. To help them make healthier choices, they need to be supported to resist temptations of unhealthy food that are offered widely in their environment. Consequently, changing the food environment to a healthier environment can facilitate healthier choices.
In a healthy food environment, people are stimulated to make healthier food choices as the default while choosing less healthy options is constrained. In particular, increasing the availability and accessibility of healthier food making use of marketing techniques, may encourage people to choose healthier options [21-23]. Examples of such strategies are placing the healthier products more to the front, presenting them attractively, or in an eye-catching position compared to less healthy products. If these adaptations maintain consumers’ freedom of choice, they are also known as nudges [24]. These nudging techniques, which are cheap to perform and require minimal effort, have proven to be effective in stimulating healthier food choices [25, 26]. Consequently, in recent years, increasing attention has been paid to interventions using such strategies to create healthier food environments [15, 27, 28]. This attention focuses mainly on food environments in settings such as governmental buildings, public transport stations, and places typically visited by children. Interventions aimed at changing the food environment have also received consumers’ approval, especially in settings such as hospitals and schools and when the nudge comes from trusted sources [29-31]. Creating a healthier food environment in schools is therefore an excellent opportunity to influence eating habits of adolescents.
Healthy school canteens
Because of their reach and pedagogical tasks, schools are an appropriate setting to stimulate healthy dietary behaviour among adolescents. Schools are already increasingly aware of their role in stimulating healthier dietary behaviour among their students [32, 33], and many countries have formulated compulsory or voluntary school food policies or guidelines [34]. These consist of nutritional criteria for school meals, and regulations for the availability and promotion of products in the schools’ cafeteria and vending machines [27, 34-37]. Examples of such regulations are: promoting fruit and vegetables and access to (free) drinking water; promoting healthier options through lower prices or more access points; offering age appropriate portions for lunches, with restrictions for salt; and restricting the availability of sweet treats and processed food and drinks. These policies/ guidelines have shown promising results in influencing youth to eat more healthily, although the effect on adiposity needs further investigations and implementation challenges limit their positive effects [27, 37-40].
Healthier food choices can be facilitated particularly in a healthier school canteen, including vending machines, where students can autonomously choose what they buy. In addition, by implementing a healthy school canteen, the school can create a norm about healthy food and drinks. Thereby, they are fulfilling their task of contributing to the personal development of students, which includes learning to make responsible lifestyle choices. It is also of additional value when the school environment is consistent with the lessons about a healthy lifestyle. All these reasons make the school canteen an appropriate location for influencing students’ behaviour through nudging and marketing techniques [36, 41]. Previous research has shown that an increase in the availability of
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