Page 59 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

INTRODUCTION
Although average life expectancy has increased, in general people have more unhealthy life- years, particularly due to an increase in premature non-communicable diseases including cardiovascular diseases, diabetes and cancer [11, 135, 136]. An unhealthy diet is one of the drivers of this trend [6]. Dietary behaviour has shown an unfavourable change, influenced by factors on the individual level like behavioural determinants and demographic factors as well as factors within the food environment [137, 138]. Public food settings have tended to increase the offer (availability), placement and promotion (accessibility) of unhealthy calorie-dense food and beverages [16]. These changes encourage people to consume these foods and drinks more frequently [139-142]. It is important to change the unhealthy food environment into one that helps individuals to make healthier food choices [25].
In recent years, efforts have been made to create healthier food environments. Attention
increased towards school food policy formulation, research on food environment 4 measurements, and environmental interventions in settings as home, school and worksite
[15, 27, 28]. Increasing the availability and/or accessibility of healthier products has proven
to be effective in stimulating healthier food choices (e.g. by placing more fruit/vegetables
on display, advertisement for vegetables, or reducing the number of less healthy products
at the point of purchases) [25, 42, 47, 48, 143, 144]. Altering the environment to make the
healthier option the easier, default option, without restricting the consumer’s freedom
of choice, is also known as “nudging” [24]. Nudges are cheap to perform and require
minimal effort. Examples of effective nudging strategies are: to offer a variety of healthier
products instead of just one (e.g. different types of fruits), to position healthier products
more attractively along the shopping route, and to increase the convenience of healthier
products (e.g. sliced fruit instead of a single piece) [44, 46]. Especially in public settings, like school/sports canteens and worksite cafeterias, where people spend much time and may
consume a significant amount of their daily caloric intake, nudging has received consumers’
approval and has the potential to positively affect customers’ dietary behaviour [29, 31,
142]. Moreover, visitors address the need for a larger range of healthy products [145]
and schools, sports associations and companies have become increasingly interested in
offering a healthier canteen by making use of nudges [146, 147].
The Dutch Ministry of Health, Welfare and Sport has set a policy target to increase the number of schools with a healthier canteen [75, 76]. Due to the absence of international consensus on how to define a “healthy canteen” [148], the “Guidelines for Healthier Canteens” were developed by the Netherlands Nutrition Centre in collaboration with experts in the field of nutrition and health behaviour [78]. These guidelines are based on Dutch nutritional guidelines, experiences with the Dutch school canteen programme, and general research on influencing food choices [73, 79]. The Guidelines for Healthier Canteens aim to change the food environment in school/sports canteens and worksite cafeterias by improving the availability and accessibility of healthier foods. Availability is defined as the presence of products that can be bought. Accessibility is defined as product promotion and placement [78]. The next step is to implement these guidelines throughout the Netherlands. This requires effective infrastructure and support [39, 149, 150]. Therefore, we aimed to develop a user-friendly online tool that i) helps stakeholders to understand and implement the guidelines, ii) facilitates monitoring of the canteen’s status
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