Food choice and school meals: primary schoolchildren's perceptions of the healthiness of foods and the nutritional implications of food choices

Abstract Since the 1980 Education Act, school caterers have been operating within a commercial context and therefore can only provide the foods that they know that children will eat. At the same time, nutritionists have been concerned that the greater degree of choice that children now have at lunchtime is resulting in the more frequent consumption of meals of poor nutritional quality. A knowledge of children's food preferences, the factors influencing them, and their perceptions of the healthiness of foods is needed if school caterers and those involved in nutrition education are to work together to help children choose a nutritionally balanced meal. This paper reports on children's perceptions of the healthiness or otherwise of foods commonly served at school lunches and the reasons for these perceptions. Children's knowledge of the sources of nutrients, their understanding of the relationship between food and health, and how their perceptions of healthiness relate to their preferences for the foods are also explored. The nutritional implications of food choices made by primary school children on the basis of preference rather than healthiness are examined. One hundred and twenty three children aged between nine and eleven from 14 different primary schools in SouthEast England took part. Using photographs of foods commonly served at school lunches, the children were asked to rank the foods in order of preference and then according to their perceptions of the healthiness of the foods and give their reasons in each case. The rankings were analysed numerically and the Wilcoxon's pairs signed rank test was used to determine the significance of the difference. The qualitative data on the reasons given for the rankings were analysed by assigning them to categories. The children were also asked which foods they would choose for the meal that they would be most likely to eat, and which ones for the meal that they thought would be the most healthy. The nutritional value of the two sets of meals were determined and compared. A student T- test was used to determine the significance of any difference between the two sets of meals. It was found that the children had a clear perception of the healthiness or otherwise of the foods. However, understanding of the relationship between foods or nutrients and health was only occasionally evident, as was the idea of moderation or balance. Some children perceived healthiness as the absence of fat while others saw it in terms of the presence of vitamins. It was also found that there was a strongly inverse relationship between children's perceptions of the healthiness of foods and their preferences for them. It was found that while the foods chosen for the ‘healthy’ meal were chosen least frequently for the ‘preferred’ meal, there was no significant difference between the percentage of energy provided by fat in the two sets of meals. However the ‘preferred’ meals did in fact provide a significantly higher percentage of the energy as starch, as well as containing greater amounts of some micronutrients. In other respects the ‘healthy’ meals were indeed ‘healthier’, in that they provided greater amounts per megajoule of some important nutrients. It was concluded that teaching about food in primary schools needs to focus on helping children of this age make balanced food choices. It was suggested that the ‘tilted plate’ model, adapted to use foods that children frequently eat and enjoy, could be the basis of such teaching. Such a model could also be used to help caterers plan menus and as the basis of co-operation between nutrition educators and caterers.