Page 23 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

INTRODUCTION
Prevention of overweight and obesity during childhood is important because of the high prevalence worldwide and associated short and long-term physical, social and mental
health problems [7, 12, 83, 84]. Although prevention should start in early life, adolescence
is also a critical period for prevention, because adolescents start to deal with more 2 responsibilities, and develop their own identity and habits in eating behaviour, which may
persist in later life [10, 14]. To promote healthy dietary behaviour, it is important to change the food environment to stimulate individuals towards healthier food choices [15, 74, 85, 86]. For adolescents, schools are a key setting to encourage healthy eating as schools have a pedagogical task and a large reach, and adolescents spend a lot of time there [15, 87]. Although schools are increasingly aware of their role in obesity prevention and the need for a healthier school canteen, there is room for improvement [32, 33, 36]. Schools often experience barriers to implement a healthier school canteen and need support to implement and continue actions regarding a healthier school canteen [36, 39]. Hence, improvements in the canteen like removing the marketing of less healthy products and increasing the offer of healthier food and drinks in vending machines remain difficult [32, 33].
Decreasing the availability of low-nutrient, energy-dense foods/beverages in comparison to high-nutrient, low energy foods/beverages in the school canteen and vending machines, and formulating relevant school food policy, are examples of promising strategies to change the food environment and reduce consumption of low nutritious foods, and increase purchases of favourable foods/beverages [27, 38, 42, 88]. The Dutch Ministry of Health, Welfare and Sport has set a policy target to increase the number of schools with a healthier canteen [75]. The Netherlands, has around 1500 secondary schools, which offer different educational levels for youth between the ages of 11 to approximately 18 years. Most schools offer food or drinks for sale as substitute to the food/drink’s students bring from home. In 2014, the Netherlands Nutrition Centre developed the “Guidelines for Healthier Canteens” in consultation with future users and experts in the field of food and behaviour change [78]. These guidelines are based on studies which investigated influences on making choices, the Dutch Nutritional guidelines “The Wheel of Five”, and experiences with the “Healthy School Canteen” programme [73, 79]. According to the “Guidelines for Healthier Canteens” school canteens should offer a majority of healthier products. Healthier products are defined as foods and drinks that are included in the Dutch “Wheel of Five”, such as whole wheat bread, fruit and vegetables, and products that are not included, but contain a limited amount of calories, saturated fat and sodium [79]. In addition, the canteen should promote healthier products by applying “accessibility criteria”, such as placing the healthier products at the most eye-catching spots and attractive presentation of fruit and vegetables. Further, drinking water should be encouraged and in its written policy, the school should state that their canteen meets the guidelines [78].
Stakeholders need support to implement the guidelines in their school [39, 52, 89]. Such an implementation support plan will be better aligned to the needs of practice, and thereby more feasible, if the needs and wishes of stakeholders are taken into account [86, 90, 91]. Therefore, during the development and evaluation stage, collaboration with these stakeholders is recommended [90, 91]. It is also recommended to apply theory, such as the use of a structural framework for the development and evaluation of the
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