Page 77 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

INTRODUCTION
To support adolescents to make healthier food choices, many national governments have formulated food policies to encourage a healthy offering of foods and drinks in schools and their canteens [34]. To create healthier canteens, nudging strategies are used, by which the healthier option is made easier without restricting the freedom of choice [24]. Such strategies focus on availability and accessibility by offering mainly healthier products, discouraging the consumption of unhealthy foods by making them less readily available, making the healthier option the default, and promoting healthier products [38, 42, 46, 168]. Evaluations of such strategies show improvements in food and drinks offered in schools, which is likely to influence students’ consumption of healthier foods and drinks [37, 38, 42, 46]. However, these results are only seen when the policy is implemented adequately [39, 117], which can be increased with supportive implementation tools [50, 51, 182]. The provision and type of such tools differ within and across countries, though training, modelling, continuous support such as helpdesks and incentives are commonly provided [50].
In the Netherlands, most schools have no tradition of offering school meals, but do
offer complementary foods and drinks in a cafeteria and/or vending machines. Most 5 students bring their lunch from home, and buy additional food and drinks at school, or
at shops around the school [19]. The national Healthy School Canteen Programme of
the Netherlands Nutrition Centre, financed by the Dutch Ministry of Health, Welfare and
Sports, provides schools with free support to create healthier canteens (cafeteria and/or
vending machine) [73, 74, 76]. This includes, for example, a visit and advice from school
canteen advisors (i.e., nutritionists), regular newsletters, and a website with information
about and examples of healthier school canteens. The programme has been shown to lead
to greater attention to nutrition in schools and a small increase in the offering of healthier
food and drinks in the cafeterias, but not in vending machines [33, 74, 127]. However, until
then, the programme only included availability criteria.
Based on literature and in collaboration with future users and experts in the field of nutrition, the Netherlands Nutrition Centre developed the “Guidelines for Healthier Canteens” in 2014, and updated them in 2017 [78]. These guidelines include criteria on both the availability and accessibility of healthier foods and drinks (including tap water) and an anchoring policy. The guidelines distinguish three incremental health levels: bronze, silver and gold [78]. Only silver (≥60%) and gold (≥80%) are qualified for the label “healthier school canteen”. These guidelines define healthier products as food and drinks recommended in the Dutch Wheel of Five Guidelines, and products that are not included but contain a limited amount of calories, saturated fat and sodium [79]. To increase dissemination of the guidelines, an implementation plan was developed, based on experience within the Healthy School Canteen Programme and in collaboration with involved stakeholders from policy, practice and science [183]. This study investigated the effect of this implementation plan to support implementation of the Guidelines for Healthier Canteens in schools on both changes in the health level of the canteen and in purchase behaviour of students. Moreover, the relation between the health level of the canteen and purchase behaviour is determined.
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