how to develop healthy eating habits essay

Essay on Importance of Healthy Eating Habits

Students are often asked to write an essay on Importance of Healthy Eating Habits in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Importance of Healthy Eating Habits

The necessity of healthy eating.

Healthy eating is crucial for growing bodies. Consuming a balanced diet gives our bodies the nutrients needed to function correctly.

Benefits of Healthy Eating

Eating healthy foods reduces the risk of chronic diseases. It also helps maintain a healthy weight, boosts energy, and improves brain function.

Healthy Eating Habits

Incorporate fruits, vegetables, whole grains, and lean proteins into your meals. Avoid processed foods and sugary drinks. Remember, moderation is key.

Healthy eating habits are essential for a healthy life. Start today and reap the benefits tomorrow.

250 Words Essay on Importance of Healthy Eating Habits

The vitality of healthy eating habits, nutrition and physical health.

A diet rich in vitamins, minerals, and other essential nutrients fuels our bodies, supporting vital functions. It aids in maintaining a healthy weight, reducing the risk of chronic diseases like heart disease and diabetes. Consuming fruits, vegetables, lean proteins, and whole grains can significantly improve physical health.

Nutrition and Mental Health

Moreover, our diet directly affects our mental health. Foods rich in omega-3 fatty acids, such as fish and nuts, can enhance brain function, improving memory and mood. Simultaneously, a deficiency in certain nutrients can lead to mental health issues like depression and anxiety.

Establishing Healthy Eating Habits

Establishing healthy eating habits involves more than just choosing the right food. It also includes regular meal times, appropriate portion sizes, and mindful eating. It’s about creating a sustainable lifestyle rather than a temporary diet.

In conclusion, healthy eating habits are a cornerstone of overall well-being. They contribute to physical health, mental health, and quality of life. As college students, it is crucial to prioritize these habits to ensure not only academic success but lifelong health. Let’s remember, our food choices today will shape our health tomorrow.

500 Words Essay on Importance of Healthy Eating Habits

Introduction.

The importance of healthy eating habits cannot be overstated, particularly in a world where fast food and processed meals have become the norm. Healthy eating habits are not just about maintaining an ideal weight or avoiding obesity; they are also about ensuring optimal physical and mental health, and enhancing overall quality of life.

The Role of Nutrition in Human Health

The impact of unhealthy eating habits.

On the contrary, unhealthy eating habits such as consuming high amounts of processed foods, sugary snacks, and fatty meals can lead to numerous health issues. These include obesity, heart disease, diabetes, and certain types of cancer. Moreover, poor nutrition can also affect mental health, contributing to conditions like depression and anxiety.

Healthy Eating and Cognitive Function

Healthy eating habits are also crucial for cognitive function. Nutrients like Omega-3 fatty acids, antioxidants, and B vitamins, which are found in foods like fish, nuts, fruits, and vegetables, are essential for brain health. They enhance memory, improve mood, and protect against cognitive decline.

Importance of Healthy Eating Habits in College Students

In conclusion, healthy eating habits are a cornerstone of good health and well-being. They play a critical role in maintaining physical health, supporting mental well-being, and enhancing cognitive function. For college students, they are particularly important for academic success and stress management. Therefore, it is essential to prioritize healthy eating and make it a part of our daily routine. By doing so, we can improve our health, enhance our quality of life, and set ourselves up for long-term success.

That’s it! I hope the essay helped you.

Happy studying!

Healthy Eating Habits

Introduction, nutrition and healthy eating, healthy living strategies, works cited.

Proper nutrition and physical activity are important aspects of healthy livings as their contribution to reducing the rates of chronic diseases is a well-established fact. On the other hand, unhealthy eating habits and lack of physical exercise lead to diseases such as diabetes, obesity, stroke, heart diseases, and osteoporosis, which can sometimes be fatal.

The findings of a study conducted in 1990 established that 14% of all deaths in the U.S. could be attributed to poor eating habits and physical inactivity with sedentary lifestyles, a contributor to 23% of disease-related deaths[1]. Healthy eating habits involve the inclusion of fruits, vegetables, and important minerals in the diet and the reduction of saturated fat intake.

Regular physical activity is essential for healthy living as it reduces the chances of developing coronary heart disease. The reduced physical activity and the changes in eating and dieting habits have long-lasting health consequences on the general health of the public, particularly the children and adolescents.

Developing good eating habits for children and adolescents is important for their long-term nutritional well-being. Proper nutrition, together with regular physical activity, enhances proper physical growth, promotes positive self-esteem, and promotes the children’s capacity to learn. In addition, good nutrition and physical activity also prevent diseases such as obesity.

According to the Center for Disease Control and Prevention, there has been a rapid increase in the rate of children becoming overweight over the past twenty years, attributed to poor nutrition and exercise habits[2]. Proper nutrition and physical exercise habits are important in maintaining a healthy living, and this can be started at an early age.

The parents eating habits influence the children’s feeding practices, and therefore, teaching children healthy eating habits in schools would make them practice healthy behaviors throughout their lives[3]. Increased consumption of vegetables and fruits with a reduction in fat intake coupled with physical activity are among the healthy habits to curb the overweight problems in children.

The consequences of physical inactivity and poor dietary habits in children and adults alike are obesity, which is defined as having a body mass index (BMI) of more than 30k/m2.

The prevalence of obesity increased among the population between 1991 and 2000, affecting all the segments of the population in the U.S[4]. Obesity is the major cause of health complications, including diabetes (type II), hypertension, heart diseases, stroke, osteoarthritis, respiratory complications, and some cancers.

The socio-economic consequences of obesity, now an epidemic, are overwhelming. The intervention strategies usually focus on promoting good eating habits, including a reduction in calorie intake and helping people increase their physical activity. In children, breastfeeding prevents excessive weight gain and obesity in early childhood and adolescence and, thus, a good strategy of reducing childhood obesity[5].

For adults and young people, poor dietary habits and lack of physical activity increase the risk of developing health-related complications. These segments of the population have an increased risk for chronic diseases such as high blood pressure and elevated cholesterol levels.

By establishing healthier eating habits combined with physical activity, the onset of these diseases would be prevented[6]. Additionally, active lifestyles and healthy eating behaviors help people with chronic diseases to cope with or control the effects of the diseases and prevent deterioration of their physical condition.

In order to promote healthy living and prevent complications arising from poor eating habits such as obesity, various healthy living strategies involving behavior change are important[7]. To reduce health-related complications in the elderly, regular physical exercises and sporting, including jogging and regular visits to the gym, can be very helpful.

Given the immense benefits of physical exercises, social support is one way of motivating people to remain physically fit and live healthy lifestyles. This can be achieved by providing programs that help people incorporate exercises into their daily routines.

Furthermore, increasing community-based programs and facilities would encourage people to exercise and in the process, live healthy lifestyles. Increased consumption of vegetables and fruits with lower calorie intake lowers the incidences of diseases, including cardiovascular diseases and some cancers[8].

Excessive intake of saturated fats is the major cause of cardiovascular diseases and cancers[9]. Therefore, to achieve healthy living, the diet should constitute plenty of fruits and vegetables and less saturated fat. Daily consumption of at least two servings of fruit and three servings of vegetables is recommended for healthy living; however, less than 25% of the U.S. population consumes this[10].

For young children and adolescents, school-based physical education (PE) enables students to engage in physical activities to promote their physical well-being and learning. Prolonged television watching among children and adolescents increases overweight incidences among children[11].

This may be because television watching leads to a decline in calorie-burning physical activity and reduces the children’s metabolic rate. Furthermore, television watching may influence the children’s eating habits contributing to an increased risk of obesity.

Physical inactivity and poor eating habits cause health-related complications such as obesity and heart diseases. The intervention methods usually focus on promoting physical exercises and healthier eating habits. Given the current increase in health-related diseases, it is evident that reduced physical activity and unhealthy eating habits have adverse impacts on the general health of the public, more especially the young people.

CDC. Healthy Youth! Childhood Overweight , 2006.

DHHS. Healthy People 2010 . Washington, D.C.: U.S. Government Printing Office. 2000.

McGinnis, John, and Foege, Wrights. “Actual causes of death in the United States.” JAMA 37.2 (1993): 2207-12.

Ness, Amie, and Powles, Jacobs. “Fruit and vegetables and cardiovascular disease: a Review”. Int. J Epidemiol 26.4 (1997): 7-13.

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English that goes straight to the heart

Healthy Eating Habits Essay

The greatest wealth is our own health. People eat junk foods and other unhealthy food items only for taste. They don’t even have time to nourish their bodies with the required diet.

After going through our post “Healthy Eating Habits Essay” you will be able to understand the importance of healthy food.

Healthy Eating Habits Essay (500+ Words)

Introduction:

In our fast-paced world, where the pursuit of material wealth often dominates, it is crucial to recognize the paramount importance of maintaining good health. While wealth can be accumulated through hard work and dedication, it cannot buy genuine well-being. Healthy eating habits play a pivotal role in nurturing our bodies and promoting a balanced, fulfilling life. By prioritizing a nutritious diet and making conscious food choices, we can safeguard our physical, mental, social, intellectual, and financial well-being.

The Importance of a Balanced Diet:

A balanced diet is one that incorporates all the essential nutrients our bodies require in adequate quantities. It is essential to consume a variety of foods that provide essential proteins, vitamins, minerals, healthy fats, and calories. A wholesome diet should include fresh fruits, vegetables, whole grains, lean proteins, dairy products, and healthy fats. These nutrients work synergistically to maintain and improve overall health, boost immunity, reduce stress levels, and prevent chronic diseases.

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Promoting Physical Health:

Nourishing our bodies with a balanced diet is crucial for maintaining optimal physical health. The consumption of fresh, unprocessed foods provides us with essential vitamins and minerals, which are vital for the proper functioning of our organs and bodily systems. Regular intake of fruits, vegetables, and whole grains can reduce the risk of heart disease, diabetes, and obesity. Additionally, a well-balanced diet supports healthy weight management, provides sustained energy levels, and enhances physical performance.

Mental and Emotional Well-being:

Healthy eating habits not only benefit our physical health but also significantly impact our mental and emotional well-being. Research has shown a strong connection between diet and mood. Nutrient-rich foods help regulate brain chemistry, leading to improved concentration, enhanced memory, and reduced risk of mental health disorders such as depression and anxiety. A well-nourished brain is better equipped to handle stress, promoting a positive outlook and emotional resilience.

Social and Intellectual Enhancement:

Adopting healthy eating habits can also foster positive social interactions and intellectual growth. Sharing meals with loved ones creates opportunities for bonding and nurturing relationships. Additionally, proper nutrition supports cognitive function, enabling sharper focus, improved memory retention, and enhanced problem-solving abilities. By fueling our bodies with the right nutrients, we optimize our potential for personal and professional growth.

Financial Implications:

Maintaining good health through healthy eating habits can have significant financial benefits. While the immediate cost of nutritious food may seem higher, it pales in comparison to the long-term expenses associated with medical treatments and managing chronic illnesses. By prioritizing preventive measures, such as a balanced diet, we can minimize healthcare costs and invest in a healthier future. Furthermore, optimal health positively influences productivity, potentially leading to higher career opportunities and financial success.

Conclusion:

In a world where materialistic pursuits often take precedence, it is essential to recognize that the greatest wealth lies within our own health. Healthy eating habits play a fundamental role in nurturing our bodies and fostering overall well-being. By adopting a balanced diet and making conscious food choices, we can enhance physical health, promote mental and emotional well-being, improve social connections, stimulate intellectual growth, and even benefit financially. Let us prioritize our health and embrace the gift of good health as nature’s most valuable treasure.

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Home / Nutrition & Fitness / 11 tips for healthier eating habits

11 tips for healthier eating habits

A healthy diet can help reduce the risk of some health conditions. Picking up some beneficial habits now might help avoid having to make abrupt changes later.

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Eating habits often begin in childhood. Some are healthy, like grabbing your water bottle when you leave the house and layering lettuce and tomato on a sandwich. Some are not so healthy, like drinking soda throughout the day.

You might not think about those established habits — until you have a reason to. Sometimes a test result showing high cholesterol, blood pressure or blood sugar inspires change. Even without a diagnosis, it’s always a good time to adopt healthier eating habits. Making diet changes can help reduce the risk of chronic disease. Diet is linked to heart disease, type 2 diabetes and 13 kinds of cancer.

The majority of Americans don’t eat a healthy diet, according to the American Heart Association. Of course, it’s not all by choice. Systems are in place that make it easier and cheaper to grab a fast-food meal on the way home than it is to buy and prep ingredients for dinner. If you work two jobs, have kids who are picky eaters or don’t live near a grocery store, eating nutrient-rich foods can be even more challenging.

Making changes to diet habits isn’t always as easy as social media influencers might make it sound either. Research shows that the more often a person eats high-sugar or high-fat foods, the more they develop a taste for them. That makes habits even harder to break.

Here are some tips from Mayo Clinic experts for adding some healthy eating habits.

Learn the basics of a healthy diet

The diet you follow should fit your tastes, lifestyle and budget. It shouldn’t be so restrictive that you can’t follow it indefinitely. Here are some basics for a healthy diet:

Eat more vegetables and fruits. Most Americans don’t get the recommended five or more servings per day, so look for opportunities to add more fresh, frozen, or canned fruits and vegetables. When comparing canned options, look for low-sodium vegetables and fruit packed in juice or water rather than syrup.
Pick whole grains. When you look at the ingredients list on foods like bread and cereal, look for the words “whole wheat” or “whole grain.” An easy guideline is to pick the one with the most grams of fiber per serving. You also can include brown rice, quinoa, millet and oats in your diet.
Limit unhealthy fats. Saturated fats are mostly found in animal products like meat, cheese and butter. To help with healthy blood pressure levels , try to keep your intake of saturated fats to 13 grams per day. Avoid trans fats as much as possible.
Choose low-fat protein. Try to use fewer red and processed meats like bacon, sausage, and breaded chicken. Instead, choose eggs, beans, turkey, chicken, fish, lean beef and low-fat dairy.
Reduce salt intake. Healthy adults should try to limit their sodium to 2,300 milligrams of sodium a day, which is about a teaspoon of salt.

Make a plan

It might help to track your food for a few days. Use an app or write down what you ate and when. You could make notes about your mood or your hunger level when you ate. You might notice that you:

Snack while cooking.
Keep eating even if you’re full so you don’t waste food.
Eat while distracted, such as while scrolling social media.
Always crave something sweet after dinner.
Get tempted by the menu of pastry offerings when you stop for coffee.

With this information, you can start looking for patterns you want to break. Some of the following tips might work for you.

Start with an easy one. It’s hard to change everything at once, so start with the healthy habit that would be easiest for you. It might be adding a vegetable to dinner or using brown rice instead of white.

Make an impact. If you’re trying to reduce your sugar intake, for example, start with the biggest sources of sugar, like desserts and sweetened beverages. Don’t worry so much about the sugar in your condiments or salad dressings.

Add instead of subtract. Rather than making cuts, think about what you can add. You might have a serving of fruit with breakfast or enjoy a walk after lunch. Focus on what you can have. That might leave less time in your day or room in your belly for habits you want to break.

Cut your portion sizes. You can enjoy your favorite foods and still cut your sugar or saturated fat intake. Try switching to a small soda, sharing dessert with a friend or using less butter on your toast.

Drink water. Sometimes thirst is mistaken for hunger. Sipping water throughout the day helps keep you full and hydrated.

Sit at the table to eat. Stepping away from your desk or phone will allow you to focus on your food and internal cues for hunger or fullness.

Find a replacement. If you eat out of habit, can you find a different habit? Consider having fruit for dessert. Or go for a walk until the craving subsides. Cravings come like waves. If you ride them out, they will pass.

Relax. People don ‘ t always make the healthiest choices when tired or stressed. Sometimes improving your diet comes from prioritizing sleep or stress management.

Remember why. Think about why forming healthier habits is important to you. Maybe you want more energy to finish projects around the house or to keep up on the company softball team. Consider setting a picture of your healthy-habit motivation as the lock screen of your phone or writing a note to yourself.

Ask for support. Tell your loved ones about your goals and what you’re doing. Ask them to support your efforts. You might even inspire them to make their own healthy changes.

Accept imperfections. Having a doughnut in the breakroom or an extra slice of pizza at dinner doesn’t mean all progress is lost. No side order of guilt needed.

A dietitian can help

You don’t have to make diet changes on your own. Ask your health care team for a referral to a dietitian. The dietitian can help you find solutions that work for your lifestyle and budget. You also can find professional and community support with the Mayo Clinic Diet .

Relevant reading

The Mayo Clinic Diet Book, Third Edition and Journal Bundle

This revised edition of the #1 New York Times bestselling book offers a simple, time-tested, no-nonsense approach to losing weight and keeping it off. The Mayo Clinic Diet isn’t a fad diet – it’s an approach that draws on years of research from thousands of individuals seeking to lose weight. It’s a plan…

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Dietary Consumption: Strategies for Healthy Eating Essay (Speech)

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Introduction

General Goal: To persuade.

Specific Goal: At the end of my speech, the audience will be able to differentiate between healthy and unhealthy eating.

Central Idea: People should incorporate healthy eating in their diets contrary to which it increases the risk of developing various diseases.

A report by the Centers for Disease Control and Prevention (CDC) indicate that, while eating nutritious food is essential for enhancing your health, most people consume an unhealthy diet thus increasing the risk of contracting various diseases such as cancer, reduced brain functioning, type 2 diabetes, stroke, heart disease, or being generally obese or overweight (CDC, 2021a). Most people fall into this category, not because they lack the knowledge about healthy eating, but because they chose to ignore the recommended nutritious consumption.

Reveal Your Topic

Today, I will highlight some strategies of healthy eating against which failure to follow them would be detrimental to your health.

Motivate the Audience to Listen

Probably, you are thinking that you have been eating unhealthy food and nothing has happened to you. Yet, you may not have experienced some of the risks of poor diet, I am here to illustrate to you why you should always have healthy nutrition to boost your health and avoid common diseases that you could develop in the span of your life.

Credibility Statement

While I am not a qualified doctor or nutritionist, I have conducted ample and elaborate research on the strategies for healthy eating.

Today, I will explore three strategies of healthy eating, their benefits, and consequences if not properly followed.

I will first talk about vegetables and fruits
Then, I will talk about proteins and carbohydrates
Finally, I will discuss saturated fats and sugar

Now that I have given you an overview of my topic today, let’s explore my first major point.

It is recommended that we consume vegetables and fruits regularly to stay healthy.

Consumption of vegetables is integral to the health of our bodies:

The Dietary Guidelines for Americans states that people should eat more vegetables to boost their health and prevent themselves from chronic diseases (DietaryGuidelines.gov., 2020).
Surprisingly, only 9% of the people consumed the recommended portions of vegetables in their diet (CDC, 2021b).
In their book, Vegetables: Importance of Quality Vegetables to Human Health , Asaduzzaman and Asao (2018) illustrate that failure to consume the recommended amounts of vegetables in daily meals is associated with increased risk of cancer and stroke.
Moreover, Asaduzzaman and Asao (2018) expound that lack of proper intake of vegetables causes vitamin deficiency diseases such as scurvy (lack of vitamin C) and Sclerosis (lack of vitamin A).

Consumption of fruits is highly encouraged as one of the major eating habits that all people should embrace.

In its 2019 publication, World Health Organization (WHO) explains that fruit intake is associated with disease prevention as it enhances the immunity of our bodies.
Furthermore, WHO (2019) highlights that fruits reduce the risk of adiposity in adolescents and young children.
As its publication shows, failure to take appropriate amounts of fruits leads to increased risk for various diseases such as myocardial infarction.
WHO emphasizes that lack of adequate fruit servings in the meals could cause different types of cancer.
While fruits are crucial in our nutritious feeding, only 12% of Americans eat the recommended amount of fruits (CDC, 2021b).

TRANSITION: Now that we have talked about vegetables and fruits, let us delve into proteins and carbohydrates.

Proteins and carbohydrates are essential for our bodies

While some people could be vegetarians, the need for proteins in dietary consumption is crucial.

The Dietary Guidelines for Americans, 2020-2025 indicate that proteins could be obtained from animals such as poultry, meat, seafood, and dairy or plant sources for vegetarians (DietayGuidelines.gov., 2020).
Nutrition scholars, Shan et al. (2019) state that proteins are essential to repair body cells besides promoting growth and development in pregnant women, children, and teenagers.
Failure to consume the recommended amounts of protein causes various diseases.
As Shan et al. (2019) explain, insufficient protein in the body leads to impaired mental health, muscle-tissue shrinkage, weak immune system, marasmus, and ultimately, total organ failure.

Carbohydrates

In their article, nutritionists, Shan et al. (2019) note that carbohydrates are needed in the body as a source of the energy we use to perform daily activities.
Therefore, it is important to consume the required portions of carbohydrates for our muscles, brain, and other body parts to function normally.
According to Shan et al. (2019), failure to meet the recommended carbohydrate intake leads to low blood sugar causing hypoglycemia.
Furthermore, Shan et al. (2019) present that carbohydrates deficiency results in ketosis, characterized by bad breath, mental fatigue, joint pains, headache, and nausea.

TRANSITION: Let us now talk about the last major point in my speech, saturated fats, and sugars

It is imperative to avoid saturated fats and sugars

The Dietary Guidelines for Americans, 2020-2025 recommend that people should limit the consumption of saturated fats to live healthy lives.

The food we consume must stay within one’s calorie needs for our bodies to operate normally.
People are not supposed to eat excess calories beyond the levels recommended in the Dietary Guidelines.
The Dietary Guidelines call upon Americans to consume foods with the least amounts of saturated fats (less than 10% of the total calories consumed per day, DietaryGuidelines.gov, 2020).
CDC (2021a) reports that excessive saturated fats cause higher levels of blood cholesterol eventually leading to heart diseases or stroke.

Besides, the Dietary Guidelines recommend that Americans’ choice of beverages and single food should be nutrient-dense but, with no added processed sugars.

A healthy dietary habit limits the amount of processed sugars to fewer than 10% of the total calories consumed daily (DietaryGuidelines.gov, 2020).
CDC (2021a) posits that consumption of sugar is the root cause of type 2 diabetes, well as increased risk of heart disease and obesity among Americans.

TRANSITION TO CLOSE: As I conclude my speech today, I would like to remind you that the principal capital asset in our lives in good health.

Re-State Central Idea

Incorporating healthy eating in our diets is critical but, lack of it increases the risk of developing the various disease.

Today we have talked about strategies of healthy eating, their benefits, and consequences if not properly followed.

First, we talked about vegetables and fruits
Then, we explored proteins and carbohydrates
Finally, we discussed about saturated fats and sugar

Tie Back to Audience

I hope as you leave this place today, you have appropriate information that would encourage you to observe healthy eating habits.

Closure Statement

While most people have the necessary information we need about dietary consumption; nutrition-related diseases are on the rise. From today, everyone must take full responsibility for their eating habits.

Asaduzzaman, M., & Asao, T. (Eds.). (2018). Vegetables: Importance of quality vegetables to human health . BoD–Books on Demand.

Centers for Disease Control and Prevention (CDC, 2021a). Poor nutrition. CDC’s National Center for Chronic Disease Prevention and Health Promotion. Web.

Centers for Disease Control and Prevention (CDC, 2021b). Only 1 in 10 adults get enough fruits or vegetables . Division of Nutrition, Physical Activity, and Obesity. Web.

DietaryGuidelines.gov. (2020). Dietary Guidelines for Americans , 2020-2025. Web.

Shan, Z., Rehm, C. D., Rogers, G., Ruan, M., Wang, D. D., Hu, F. B.,… & Bhupathiraju, S. N. (2019). Trends in dietary carbohydrate, protein, and fat intake and diet quality among US adults, 1999-2016 . Jama , 322 (12), 1178-1187. Web.

World Health Organization. (WHO, 2019). Sustainable healthy diets: guiding principles . Food & Agriculture Org. Web.

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Healthy Food Essay for Students and Children

500+ words essay on healthy food.

Healthy food refers to food that contains the right amount of nutrients to keep our body fit. We need healthy food to keep ourselves fit.

Furthermore, healthy food is also very delicious as opposed to popular thinking. Nowadays, kids need to eat healthy food more than ever. We must encourage good eating habits so that our future generations will be healthy and fit.

Most importantly, the harmful effects of junk food and the positive impact of healthy food must be stressed upon. People should teach kids from an early age about the same.

Benefits of Healthy Food

Healthy food does not have merely one but numerous benefits. It helps us in various spheres of life. Healthy food does not only impact our physical health but mental health too.

When we intake healthy fruits and vegetables that are full of nutrients, we reduce the chances of diseases. For instance, green vegetables help us to maintain strength and vigor. In addition, certain healthy food items keep away long-term illnesses like diabetes and blood pressure.

Similarly, obesity is the biggest problems our country is facing now. People are falling prey to obesity faster than expected. However, this can still be controlled. Obese people usually indulge in a lot of junk food. The junk food contains sugar, salt fats and more which contribute to obesity. Healthy food can help you get rid of all this as it does not contain harmful things.

In addition, healthy food also helps you save money. It is much cheaper in comparison to junk food. Plus all that goes into the preparation of healthy food is also of low cost. Thus, you will be saving a great amount when you only consume healthy food.

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Junk food vs Healthy Food

If we look at the scenario today, we see how the fast-food market is increasing at a rapid rate. With the onset of food delivery apps and more, people now like having junk food more. In addition, junk food is also tastier and easier to prepare.

However, just to satisfy our taste buds we are risking our health. You may feel more satisfied after having junk food but that is just the feeling of fullness and nothing else. Consumption of junk food leads to poor concentration. Moreover, you may also get digestive problems as junk food does not have fiber which helps indigestion.

Similarly, irregularity of blood sugar levels happens because of junk food. It is so because it contains fewer carbohydrates and protein . Also, junk food increases levels of cholesterol and triglyceride.

On the other hand, healthy food contains a plethora of nutrients. It not only keeps your body healthy but also your mind and soul. It increases our brain’s functionality. Plus, it enhances our immunity system . Intake of whole foods with minimum or no processing is the finest for one’s health.

In short, we must recognize that though junk food may seem more tempting and appealing, it comes with a great cost. A cost which is very hard to pay. Therefore, we all must have healthy foods and strive for a longer and healthier life.

FAQs on Healthy Food

Q.1 How does healthy food benefit us?

A.1 Healthy Benefit has a lot of benefits. It keeps us healthy and fit. Moreover, it keeps away diseases like diabetes, blood pressure, cholesterol and many more. Healthy food also helps in fighting obesity and heart diseases.

Q.2 Why is junk food harmful?

A.2 Junk food is very harmful to our bodies. It contains high amounts of sugar, salt, fats, oils and more which makes us unhealthy. It also causes a lot of problems like obesity and high blood pressure. Therefore, we must not have junk food more and encourage healthy eating habits.

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12.4 Annotated Student Sample: "Healthy Diets from Sustainable Sources Can Save the Earth" by Lily Tran

Learning outcomes.

By the end of this section, you will be able to:

Analyze how writers use evidence in research writing.
Analyze the ways a writer incorporates sources into research writing, while retaining their own voice.
Explain the use of headings as organizational tools in research writing.
Analyze how writers use evidence to address counterarguments when writing a research essay.

Introduction

In this argumentative research essay for a first-year composition class, student Lily Tran creates a solid, focused argument and supports it with researched evidence. Throughout the essay, she uses this evidence to support cause-and-effect and problem-solution reasoning, make strong appeals, and develop her ethos on the topic.

Living by Their Own Words

Food as change.

public domain text For the human race to have a sustainable future, massive changes in the way food is produced, processed, and distributed are necessary on a global scale. end public domain text

annotated text Purpose. Lily Tran refers to what she sees as the general purpose for writing this paper: the problem of current global practices in food production, processing, and distribution. By presenting the “problem,” she immediately prepares readers for her proposed solution. end annotated text

public domain text The required changes will affect nearly all aspects of life, including not only world hunger but also health and welfare, land use and habitats, water quality and availability, energy use and production, greenhouse gas emissions and climate change, economics, and even cultural and social values. These changes may not be popular, but they are imperative. The human race must turn to sustainable food systems that provide healthy diets with minimal environmental impact—and starting now. end public domain text

annotated text Thesis. Leading up to this clear, declarative thesis statement are key points on which Tran will expand later. In doing this, she presents some foundational evidence that connects the problem to the proposed solution. end annotated text

THE COMING FOOD CRISIS

public domain text The world population has been rising exponentially in modern history. From 1 billion in 1804, it doubled to approximately 2 billion by 1927, then doubled again to approximately 4 billion in 1974. By 2019, it had nearly doubled again, rising to 7.7 billion (“World Population by Year”). It has been projected to reach nearly 10 billion by 2050 (Berners-Lee et al.). At the same time, the average life span also has been increasing. These situations have led to severe stress on the environment, particularly in the demands for food. It has been estimated, for example, that by 2050, milk production will increase 58 percent and meat production 73 percent (Chai et al.). end public domain text

annotated text Evidence. In this first supporting paragraph, Tran uses numerical evidence from several sources. This numerical data as evidence helps establish the projection of population growth. By beginning with such evidence, Tran underscores the severity of the situation. end annotated text

public domain text Theoretically, the planet can produce enough food for everyone, but human activities have endangered this capability through unsustainable practices. Currently, agriculture produces 10–23 percent of global greenhouse gas emissions. Greenhouse gases—the most common being carbon dioxide, methane, nitrous oxide, and water vapor— trap heat in the atmosphere, reradiate it, and send it back to Earth again. Heat trapped in the atmosphere is a problem because it causes unnatural global warming as well as air pollution, extreme weather conditions, and respiratory diseases. end public domain text

annotated text Audience. With her audience in mind, Tran briefly explains the problem of greenhouse gases and global warming. end annotated text

public domain text It has been estimated that global greenhouse gas emissions will increase by as much as 150 percent by 2030 (Chai et al.). Transportation also has a negative effect on the environment when foods are shipped around the world. As Joseph Poore of the University of Oxford commented, “It’s essential to be mindful about everything we consume: air-transported fruit and veg can create more greenhouse gas emissions per kilogram than poultry meat, for example” (qtd. in Gray). end public domain text

annotated text Transition. By beginning this paragraph with her own transition of ideas, Tran establishes control over the organization and development of ideas. Thus, she retains her sources as supports and does not allow them to dominate her essay. end annotated text

public domain text Current practices have affected the nutritional value of foods. Concentrated animal-feeding operations, intended to increase production, have had the side effect of decreasing nutritional content in animal protein and increasing saturated fat. One study found that an intensively raised chicken in 2017 contained only one-sixth of the amount of omega-3 fatty acid, an essential nutrient, that was in a chicken in 1970. Today the majority of calories in chicken come from fat rather than protein (World Wildlife Fund). end public domain text

annotated text Example. By focusing on an example (chicken), Tran uses specific research data to develop the nuance of the argument. end annotated text

public domain text Current policies such as government subsidies that divert food to biofuels are counterproductive to the goal of achieving adequate global nutrition. Some trade policies allow “dumping” of below-cost, subsidized foods on developing countries that should instead be enabled to protect their farmers and meet their own nutritional needs (Sierra Club). Too often, agriculture’s objectives are geared toward maximizing quantities produced per acre rather than optimizing output of critical nutritional needs and protection of the environment. end public domain text

AREAS OF CONCERN

Hunger and nutrition.

annotated text Headings and Subheadings. Throughout the essay, Tran has created headings and subheadings to help organize her argument and clarify it for readers. end annotated text

public domain text More than 820 million people around the world do not have enough to eat. At the same time, about a third of all grains and almost two-thirds of all soybeans, maize, and barley crops are fed to animals (Barnard). According to the World Health Organization, 462 million adults are underweight, 47 million children under 5 years of age are underweight for their height, 14.3 million are severely underweight for their height, and 144 million are stunted (“Malnutrition”). About 45 percent of mortality among children under 5 is linked to undernutrition. These deaths occur mainly in low- and middle-income countries where, in stark contrast, the rate of childhood obesity is rising. Globally, 1.9 billion adults and 38.3 million children are overweight or obese (“Obesity”). Undernutrition and obesity can be found in the same household, largely a result of eating energy-dense foods that are high in fat and sugars. The global impact of malnutrition, which includes both undernutrition and obesity, has lasting developmental, economic, social, and medical consequences. end public domain text

public domain text In 2019, Berners-Lee et al. published the results of their quantitative analysis of global and regional food supply. They determined that significant changes are needed on four fronts: end public domain text

Food production must be sufficient, in quantity and quality, to feed the global population without unacceptable environmental impacts. Food distribution must be sufficiently efficient so that a diverse range of foods containing adequate nutrition is available to all, again without unacceptable environmental impacts. Socio-economic conditions must be sufficiently equitable so that all consumers can access the quantity and range of foods needed for a healthy diet. Consumers need to be able to make informed and rational choices so that they consume a healthy and environmentally sustainable diet (10).

annotated text Block Quote. The writer has chosen to present important evidence as a direct quotation, using the correct format for direct quotations longer than four lines. See Section Editing Focus: Integrating Sources and Quotations for more information about block quotes. end annotated text

public domain text Among their findings, they singled out, in particular, the practice of using human-edible crops to produce meat, dairy, and fish for the human table. Currently 34 percent of human-edible crops are fed to animals, a practice that reduces calorie and protein supplies. They state in their report, “If society continues on a ‘business-as-usual’ dietary trajectory, a 119% increase in edible crops grown will be required by 2050” (1). Future food production and distribution must be transformed into systems that are nutritionally adequate, environmentally sound, and economically affordable. end public domain text

Land and Water Use

public domain text Agriculture occupies 40 percent of Earth’s ice-free land mass (Barnard). While the net area used for producing food has been fairly constant since the mid-20th century, the locations have shifted significantly. Temperate regions of North America, Europe, and Russia have lost agricultural land to other uses, while in the tropics, agricultural land has expanded, mainly as a result of clearing forests and burning biomass (Willett et al.). Seventy percent of the rainforest that has been cut down is being used to graze livestock (Münter). Agricultural use of water is of critical concern both quantitatively and qualitatively. Agriculture accounts for about 70 percent of freshwater use, making it “the world’s largest water-consuming sector” (Barnard). Meat, dairy, and egg production causes water pollution, as liquid wastes flow into rivers and to the ocean (World Wildlife Fund and Knorr Foods). According to the Hertwich et al., “the impacts related to these activities are unlikely to be reduced, but rather enhanced, in a business-as-usual scenario for the future” (13). end public domain text

annotated text Statistical Data. To develop her points related to land and water use, Tran presents specific statistical data throughout this section. Notice that she has chosen only the needed words of these key points to ensure that she controls the development of the supporting point and does not overuse borrowed source material. end annotated text

annotated text Defining Terms. Aware of her audience, Tran defines monocropping , a term that may be unfamiliar. end annotated text

public domain text Earth’s resources and ability to absorb pollution are limited, and many current agricultural practices undermine these capacities. Among these unsustainable practices are monocropping [growing a single crop year after year on the same land], concentrated animal-feeding operations, and overdependence on manufactured pesticides and fertilizers (Hamilton). Such practices deplete the soil, dramatically increase energy use, reduce pollinator populations, and lead to the collapse of resource supplies. One study found that producing one gram of beef for human consumption requires 42 times more land, 2 times more water, and 4 times more nitrogen than staple crops. It also creates 3 times more greenhouse gas emissions (Chai et al.). The EAT– Lancet Commission calls for “halting expansion of new agricultural land at the expense of natural ecosystems . . . strict protections on intact ecosystems, suspending concessions for logging in protected areas, or conversion of remaining intact ecosystems, particularly peatlands and forest areas” (Willett et al. 481). The Commission also calls for land-use zoning, regulations prohibiting land clearing, and incentives for protecting natural areas, including forests. end public domain text

annotated text Synthesis. The paragraphs above and below this comment show how Tran has synthesized content from several sources to help establish and reinforce key supports of her essay . end annotated text

Greenhouse Gas and Climate Change

public domain text Climate change is heavily affected by two factors: greenhouse gas emissions and carbon sequestration. In nature, the two remain in balance; for example, most animals exhale carbon dioxide, and most plants capture carbon dioxide. Carbon is also captured, or sequestered, by soil and water, especially oceans, in what are called “sinks.” Human activities have skewed this balance over the past two centuries. The shift in land use, which exploits land, water, and fossil energy, has caused increased greenhouse-gas emissions, which in turn accelerate climate change. end public domain text

public domain text Global food systems are threatened by climate change because farmers depend on relatively stable climate systems to plan for production and harvest. Yet food production is responsible for up to 30 percent of greenhouse gas emissions (Barnard). While soil can be a highly effective means of carbon sequestration, agricultural soils have lost much of their effectiveness from overgrazing, erosion, overuse of chemical fertilizer, and excess tilling. Hamilton reports that the world’s cultivated and grazed soils have lost 50 to 70 percent of their ability to accumulate and store carbon. As a result, “billions of tons of carbon have been released into the atmosphere.” end public domain text

annotated text Direct Quotation and Paraphrase. While Tran has paraphrased some content of this source borrowing, because of the specificity and impact of the number— “billions of tons of carbon”—she has chosen to use the author’s original words. As she has done elsewhere in the essay, she has indicated these as directly borrowed words by placing them within quotation marks. See Section 12.5 for more about paraphrasing. end annotated text

public domain text While carbon sequestration has been falling, greenhouse gas emissions have been increasing as a result of the production, transport, processing, storage, waste disposal, and other life stages of food production. Agriculture alone is responsible for fully 10 to 12 percent of global emissions, and that figure is estimated to rise by up to 150 percent of current levels by 2030 (Chai et al.). Münter reports that “more greenhouse gas emissions are produced by growing livestock for meat than all the planes, trains, ships, cars, trucks, and all forms of fossil fuel-based transportation combined” (5). Additional greenhouse gases, methane and nitrous oxide, are produced by the decomposition of organic wastes. Methane has 25 times and nitrous oxide has nearly 300 times the global warming potential of carbon dioxide (Curnow). Agricultural and food production systems must be reformed to shift agriculture from greenhouse gas source to sink. end public domain text

Social and Cultural Values

public domain text As the Sierra Club has pointed out, agriculture is inherently cultural: all systems of food production have “the capacity to generate . . . economic benefits and ecological capital” as well as “a sense of meaning and connection to natural resources.” Yet this connection is more evident in some cultures and less so in others. Wealthy countries built on a consumer culture emphasize excess consumption. One result of this attitude is that in 2014, Americans discarded the equivalent of $165 billion worth of food. Much of this waste ended up rotting in landfills, comprised the single largest component of U.S. municipal solid waste, and contributed a substantial portion of U.S. methane emissions (Sierra Club). In low- and middle-income countries, food waste tends to occur in early production stages because of poor scheduling of harvests, improper handling of produce, or lack of market access (Willett et al.). The recent “America First” philosophy has encouraged prioritizing the economic welfare of one nation to the detriment of global welfare and sustainability. end public domain text

annotated text Synthesis and Response to Claims. Here, as in subsequent sections, while still relying heavily on facts and content from borrowed sources, Tran provides her synthesized understanding of the information by responding to key points. end annotated text

public domain text In response to claims that a vegetarian diet is a necessary component of sustainable food production and consumption, Lusk and Norwood determined the importance of meat in a consumer’s diet. Their study indicated that meat is the most valuable food category to consumers, and “humans derive great pleasure from consuming beef, pork, and poultry” (120). Currently only 4 percent of Americans are vegetarians, and it would be difficult to convince consumers to change their eating habits. Purdy adds “there’s the issue of philosophy. A lot of vegans aren’t in the business of avoiding animal products for the sake of land sustainability. Many would prefer to just leave animal husbandry out of food altogether.” end public domain text

public domain text At the same time, consumers expect ready availability of the foods they desire, regardless of health implications or sustainability of sources. Unhealthy and unsustainable foods are heavily marketed. Out-of-season produce is imported year-round, increasing carbon emissions from air transportation. Highly processed and packaged convenience foods are nutritionally inferior and waste both energy and packaging materials. Serving sizes are larger than necessary, contributing to overconsumption and obesity. Snack food vending machines are ubiquitous in schools and public buildings. What is needed is a widespread attitude shift toward reducing waste, choosing local fruits and vegetables that are in season, and paying attention to how foods are grown and transported. end public domain text

annotated text Thesis Restated. Restating her thesis, Tran ends this section by advocating for a change in attitude to bring about sustainability. end annotated text

DISSENTING OPINIONS

annotated text Counterclaims . Tran uses equally strong research to present the counterargument. Presenting both sides by addressing objections is important in constructing a clear, well-reasoned argument. Writers should use as much rigor in finding research-based evidence to counter the opposition as they do to develop their argument. end annotated text

public domain text Transformation of the food production system faces resistance for a number of reasons, most of which dispute the need for plant-based diets. Historically, meat has been considered integral to athletes’ diets and thus has caused many consumers to believe meat is necessary for a healthy diet. Lynch et al. examined the impact of plant-based diets on human physical health, environmental sustainability, and exercise performance capacity. The results show “it is unlikely that plant-based diets provide advantages, but do not suffer from disadvantages, compared to omnivorous diets for strength, anaerobic, or aerobic exercise performance” (1). end public domain text

public domain text A second objection addresses the claim that land use for animal-based food production contributes to pollution and greenhouse gas emissions and is inefficient in terms of nutrient delivery. Berners-Lee et al. point out that animal nutrition from grass, pasture, and silage comes partially from land that cannot be used for other purposes, such as producing food directly edible by humans or for other ecosystem services such as biofuel production. Consequently, nutritional losses from such land use do not fully translate into losses of human-available nutrients (3). end public domain text

annotated text Paraphrase. Tran has paraphrased the information as support. Though she still cites the source, she has changed the words to her own, most likely to condense a larger amount of original text or to make it more accessible. end annotated text

public domain text While this objection may be correct, it does not address the fact that natural carbon sinks are being destroyed to increase agricultural land and, therefore, increase greenhouse gas emissions into the atmosphere. end public domain text

public domain text Another significant dissenting opinion is that transforming food production will place hardships on farmers and others employed in the food industry. Farmers and ranchers make a major investment in their own operations. At the same time, they support jobs in related industries, as consumers of farm machinery, customers at local businesses, and suppliers for other industries such as food processing (Schulz). Sparks reports that “livestock farmers are being unfairly ‘demonized’ by vegans and environmental advocates” and argues that while farming includes both costs and benefits, the costs receive much more attention than the benefits. end public domain text

FUTURE GENERATIONS

public domain text The EAT– Lancet Commission calls for a transformation in the global food system, implementing different core processes and feedback. This transformation will not happen unless there is “widespread, multi-sector, multilevel action to change what food is eaten, how it is produced, and its effects on the environment and health, while providing healthy diets for the global population” (Willett et al. 476). System changes will require global efforts coordinated across all levels and will require governments, the private sector, and civil society to share a common vision and goals. Scientific modeling indicates 10 billion people could indeed be fed a healthy and sustainable diet. end public domain text

annotated text Conclusion. While still using research-based sources as evidence in the concluding section, Tran finishes with her own words, restating her thesis. end annotated text

public domain text For the human race to have a sustainable future, massive changes in the way food is produced, processed, and distributed are necessary on a global scale. The required changes will affect nearly all aspects of life, including not only world hunger but also health and welfare, land use and habitats, water quality and availability, energy use and production, greenhouse gas emissions and climate change, economics, and even cultural and social values. These changes may not be popular, but they are imperative. They are also achievable. The human race must turn to sustainable food systems that provide healthy diets with minimal environmental impact, starting now. end public domain text

annotated text Sources. Note two important aspects of the sources chosen: 1) They represent a range of perspectives, and 2) They are all quite current. When exploring a contemporary topic, it is important to avoid research that is out of date. end annotated text

Works Cited

Barnard, Neal. “How Eating More Plants Can Save Lives and the Planet.” Physicians Committee for Responsible Medicine , 24 Jan. 2019, www.pcrm.org/news/blog/how-eating-more-plants-can-save-lives-and-planet. Accessed 6 Dec. 2020.

Berners-Lee, M., et al. “Current Global Food Production Is Sufficient to Meet Human Nutritional Needs in 2050 Provided There Is Radical Societal Adaptation.” Elementa: Science of the Anthropocene , vol. 6, no. 52, 2018, doi:10.1525/elementa.310. Accessed 7 Dec. 2020.

Chai, Bingli Clark, et al. “Which Diet Has the Least Environmental Impact on Our Planet? A Systematic Review of Vegan, Vegetarian and Omnivorous Diets.” Sustainability , vol. 11, no. 15, 2019, doi: underline 10.3390/su11154110 end underline . Accessed 6 Dec. 2020.

Curnow, Mandy. “Managing Manure to Reduce Greenhouse Gas Emissions.” Government of Western Australia, Department of Primary Industries and Regional Development, 2 Nov. 2020, www.agric.wa.gov.au/climate-change/managing-manure-reduce-greenhouse-gas-emissions. Accessed 9 Dec. 2020.

Gray, Richard. “Why the Vegan Diet Is Not Always Green.” BBC , 13 Feb. 2020, www.bbc.com/future/article/20200211-why-the-vegan-diet-is-not-always-green. Accessed 6 Dec. 2020.

Hamilton, Bruce. “Food and Our Climate.” Sierra Club, 2014, www.sierraclub.org/compass/2014/10/food-and-our-climate. Accessed 6 Dec. 2020.

Hertwich. Edgar G., et al. Assessing the Environmental Impacts of Consumption and Production. United Nations Environment Programme, 2010, www.resourcepanel.org/reports/assessing-environmental-impacts-consumption-and-production.

Lusk, Jayson L., and F. Bailey Norwood. “Some Economic Benefits and Costs of Vegetarianism.” Agricultural and Resource Economics Review , vol. 38, no. 2, 2009, pp. 109-24, doi: 10.1017/S1068280500003142. Accessed 6 Dec. 2020.

Lynch Heidi, et al. “Plant-Based Diets: Considerations for Environmental Impact, Protein Quality, and Exercise Performance.” Nutrients, vol. 10, no. 12, 2018, doi:10.3390/nu10121841. Accessed 6 Dec. 2020.

Münter, Leilani. “Why a Plant-Based Diet Will Save the World.” Health and the Environment. Disruptive Women in Health Care & the United States Environmental Protection Agency, 2012, archive.epa.gov/womenandgirls/web/pdf/1016healththeenvironmentebook.pdf.

Purdy, Chase. “Being Vegan Isn’t as Good for Humanity as You Think.” Quartz , 4 Aug. 2016, qz.com/749443/being-vegan-isnt-as-environmentally-friendly-as-you-think/. Accessed 7 Dec. 2020.

Schulz, Lee. “Would a Sudden Loss of the Meat and Dairy Industry, and All the Ripple Effects, Destroy the Economy?” Iowa State U Department of Economics, www.econ.iastate.edu/node/691. Accessed 6 Dec. 2020.

Sierra Club. “Agriculture and Food.” Sierra Club, 28 Feb. 2015, www.sierraclub.org/policy/agriculture/food. Accessed 6 Dec. 2020.

Sparks, Hannah. “Veganism Won’t Save the World from Environmental Ruin, Researchers Warn.” New York Post , 29 Nov. 2019, nypost.com/2019/11/29/veganism-wont-save-the-world-from-environmental-ruin-researchers-warn/. Accessed 6 Dec. 2020.

Willett, Walter, et al. “Food in the Anthropocene: The EAT– Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet, vol. 393, no. 10170, 2019. doi:10.1016/S0140-6736(18)31788-4. Accessed 6 Dec. 2020.

World Health Organization. “Malnutrition.” World Health Organization, 1 Apr. 2020, www.who.int/news-room/fact-sheets/detail/malnutrition. Accessed 8 Dec. 2020.

World Health Organization. “Obesity and Overweight.” World Health Organization, 1 Apr. 2020, www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 8 Dec. 2020.

World Wildlife Fund. Appetite for Destruction: Summary Report. World Wildlife Fund, 2017, www.wwf.org.uk/sites/default/files/2017-10/WWF_AppetiteForDestruction_Summary_Report_SignOff.pdf.

World Wildlife Fund and Knorr Foods. Future Fifty Foods. World Wildlife Fund, 2019, www.wwf.org.uk/sites/default/files/2019-02/Knorr_Future_50_Report_FINAL_Online.pdf.

“World Population by Year.” Worldometer , www.worldometers.info/world-population/world-population-by-year/. Accessed 8 Dec. 2020.

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Promoting Healthy Eating among Young People—A Review of the Evidence of the Impact of School-Based Interventions

Abina chaudhary.

1 Independent Researcher, Kastrupvej 79, 2300 Copenhagen, Denmark; moc.oohay@yrahduahcaniba

František Sudzina

2 Department of Materials and Production, Faculty of Engineering and Science, Aalborg University, A. C. Meyers Vænge 15, 2450 Copenhagen, Denmark

3 Department of Systems Analysis, Faculty of Informatics and Statistics, University of Economics, nám. W. Churchilla 1938/4, 130 67 Prague, Czech Republic

Bent Egberg Mikkelsen

4 Department of Geosciences and Natural Resource Management, Faculty of Science, University of Copenhagen, Rolighedsvej 23, 1958 Frederiksberg C, Denmark; kd.uk.ngi@imeb

Intro: Globally, the prevalence of overweight and obesity is increasing among children and younger adults and is associated with unhealthy dietary habits and lack of physical activity. School food is increasingly brought forward as a policy to address the unhealthy eating patterns among young people. Aim: This study investigated the evidence for the effectiveness of school-based food and nutrition interventions on health outcomes by reviewing scientific evidence-based intervention studies amongst children at the international level. Methods: This study was based on a systematic review using the PRISMA guidelines. Three electronic databases were systematically searched, reference lists were screened for studies evaluating school-based food and nutrition interventions that promoted children’s dietary behaviour and health aiming changes in the body composition among children. Articles dating from 2014 to 2019 were selected and reported effects on anthropometry, dietary behaviour, nutritional knowledge, and attitude. Results: The review showed that school-based interventions in general were able to affect attitudes, knowledge, behaviour and anthropometry, but that the design of the intervention affects the size of the effect. In general, food focused interventions taking an environmental approach seemed to be most effective. Conclusions: School-based interventions (including multicomponent interventions) can be an effective and promising means for promoting healthy eating, improving dietary behaviour, attitude and anthropometry among young children. Thus, schools as a system have the potential to make lasting improvements, ensuring healthy school environment around the globe for the betterment of children’s short- and long-term health.

1. Introduction

Childhood is one of the critical periods for good health and development in human life [ 1 , 2 ]. During this age, the physiological need for nutrients increases and the consumption of a diet high in nutritional quality is particularly important. Evidence suggests that lifestyle, behaviour patterns and eating habits adopted during this age persist throughout adulthood and can have a significant influence on health and wellbeing in later life [ 3 , 4 ]. Furthermore, the transition from childhood into adolescence is often associated with unhealthy dietary changes. Thus, it is important to establish healthful eating behaviours early in life and specially focus on the childhood transition period. A healthy diet during the primary age of children reduces the risk of immediate nutrition-related health problems of primary concern to school children, namely, obesity, dental caries and lack of physical activity [ 5 , 6 , 7 ]. Furthermore, young people adopting these healthy habits during childhood are more likely to maintain their health and thus be at reduced risk of chronic ailments in later life [ 7 , 8 , 9 ]. Thus, healthy behaviours learnt at a young age might be instrumental in reaching the goals of good health and wellbeing of the 2030 Sustainability Agenda which has implications at the global level.

Globally, the prevalence of overweight and obesity rose by 47.1% for children and 27.5% for adults between 1980 and 2013 [ 10 ]. A recent WHO (World Health Organization) Commission report [ 10 ] stated that if these same trends were to continue, then by 2025, 70 million children are predicted to be affected [ 11 ]. Hence, the increased prevalence might negatively affect child and adult morbidity and mortality around the world [ 12 , 13 ]. Worldwide the dietary recommendations for healthy diets recommend the consumption of at least five portions of fruits and vegetables a day, reduced intake of saturated fat and salt and increased consumption of complex carbohydrates and fibres [ 14 ]. However, studies show that most children and adolescent do not meet these guidelines [ 15 , 16 ] and, thus, as a result, childhood and adolescent obesity are alarming nearly everywhere [ 17 ]. Recent figures show that the prevalence has tripled in many countries, making it the major public health issue in the 21st century [ 18 , 19 , 20 , 21 ]. According to WHO [ 4 ], 1 in 3 children aged 6–9 were overweight and obese in 2010, up from 1 in 4 children of the same age in 2008.

The increased prevalence of overweight and obesity has fuelled efforts to counteract the development, as seen for instance in the action plan on childhood obesity [ 17 ]. Increasingly policy makers have been turning their interest to the school setting as a well-suited arena for the promotion of healthier environments [ 18 ]. As a result, schools have been the target of increased attention from the research community to develop interventions and to examine the school environment to promote healthful behaviours including healthy eating habits.

Globally, interventions in the school environment to promote healthier nutrition among young people have received considerable attention from researchers over the past years. But there is far from a consensus on what are the most effective ways to make the most out of schools’ potential to contribute to better health through food-based actions. Is it the environment that makes a difference? Is it the education or is it the overall attention given to food and eating that plays the biggest role? School food and nutrition intervention strategies have witnessed a gradual change from knowledge orientation to behavioural orientation [ 22 ] and from a focus on the individual to the food environment. Research evidence has shown that adequate nutrition knowledge and positive attitudes towards nutrition do not necessarily translate to good dietary practices. Similarly, research has shown that the food environment plays a far bigger role in behaviour than originally believed [ 23 , 24 ].

School-based interventions can a priori be considered as an effective method for promoting better eating at the population level. Schools reach a large number of participants across diverse ethnic groups. It not only reaches children, but school staffs, family members as well as community members [ 8 , 25 ]. Schools can be considered a protected place where certain rules apply and where policies of public priority can be deployed relatively easily. In addition, schools are professional spaces in which learning and formation is at the heart of activities and guided by a skilled and professional staff. Schools, as such, represent a powerful social environment that hold the potential to promote and provide healthy nutrition and education. Besides the potential to create health and healthy behaviours, good nutrition at school has, according to more studies, the potential to add to educational outcomes and academic performance [ 26 , 27 , 28 ].

However, taking the growth in research studies and papers in the field into account, it is difficult for both the research community and for policy makers to stay up to date on how successful school-based interventions have been in improving dietary behaviours, nutritional knowledge and anthropometry among children. Also, the knowledge and insights into how it is possible to intervene in the different corners of the school food environment has developed which obviously has influenced over recent decades how programs and interventions can be designed. It has also become clear that food at school is more than just the food taken but includes curricular and school policy components. The findings from school-based studies on the relationship between school, family as well as community-based interventions and health impact suggest that health impacts are dependent on the context in which they have been carried out as well as the methodology. Thus, an updated overview as well as a more detailed analysis of initiatives is needed in order to develop our understanding of the nature of the mechanisms through which the school can contribute to the shaping of healthier dietary behaviour among children and adolescents before more precise policy instruments can be developed. Our study attempted to fill the need for better insight into which of the many intervention components works best. It attempted to look at school food and nutrition interventions reported in the literature that have been looking at healthy eating programmes, projects, interventions or initiatives.

School-based interventions in the Western world are traditionally targeted at addressing obesity and over-nutrition, but school food interventions are also addressing under nutrition and, as such, their role in a double burden of disease perspective should not be underestimated. Many studies have reported on micronutrient malnutrition among school-aged children in developing countries (for instance [ 29 , 30 , 31 ]) but it has also been reported in the context of developed countries [ 32 ]. Against this backdrop, the aim of this study was to provide an analysis of the evidence of the effectiveness of school-based food interventions by reviewing recent scientific, evidence-based intervention studies on healthy eating promotion at school. The specific objectives of the study were to identify which interventions had an effect on primary outcomes, such as BMI, or on secondary outcomes such as dietary behaviour, nutritional knowledge and attitude.

2. Materials and Methods

The functional unit of the review were healthy eating programmes, projects or initiatives that have been performed using the school as a setting. We included only programmes, projects or initiatives that were studied in a research context, in the sense that they were planned by researchers, carried out under controlled settings using a research protocol, and reported in the literature. School-based programmes, projects, interventions or initiatives are, per definition, cluster samples where a number of schools first were chosen for intervention followed by performing an outcome measurement before and after the intervention and, in most cases, also in one or more control schools. The outcome measurement in the studies reviewed was performed on a sample of students that was drawn from each school (cluster).For this, the systematic review and meta-analysis (PRISMA) guidelines and the standardised quality assessment tool “effective public health practice project (EPHPP) quality assessment tool for quantitative studies” were used for analysing the quality assessment of the included studies [ 33 ]. This EPHPP instrument can be used to assess the quality of quantitative studies with a variety of study designs.

2.1. Literature Search

The literature review involved searches in PubMed, Web of Science and Cochrane Library database. The search strategy was designed to be inclusive and focused on three key elements: population (e.g., children); intervention (e.g., school-based); outcome (e.g., diet and nutrition, knowledge, attitude and anthropometrics). The search terms used in PubMed database were: “effectiveness of school food AND nutrition AND primary school children”, “effectiveness of school food AND nutrition AND interventions OR programs AND among primary school children AND increase healthy consumption”, “primary school children and education and food interventions”, “Effectiveness of school-based food interventions among primary school”, “effectiveness of school-based nutrition and food interventions”, “primary school interventions and its effectiveness”, and “obesity prevention intervention among Primary schools”. Search terms such as: “effectiveness of school-based food interventions among primary school”, “effectiveness of school based food and nutrition interventions”, “primary school interventions and its effectiveness” and “obesity prevention interventions”, were used in the Web of Science database. Lastly, search terms such as: “nutrition interventions in primary schools” and “Nutrition education interventions in school” were used in the Cochrane Library database to find the articles. In addition, reference lists of all retrieved articles and review articles [ 34 ] were screened for potentially eligible articles. The search strategy was initially developed in PubMed and adapted for use in other databases. In addition, snowballing of the reference list of the selected articles was conducted.

2.2. Inclusion Criteria

Studies selected for the inclusion were studies which investigated the effectiveness of a school-based interventions targeting food and nutrition behaviour, healthy eating and nutrition education as a primary focus during the intervention. Also, to be included in this review, only articles from 2014 to 2019 were selected and of those inclusion criteria included articles targeting primary school children aged between 5 and 14 years. Participants included both boys and girls without considering their socio-economic background. Study design included randomized controlled trial “RCT”, cluster randomized controlled trial “RCCT”, controlled trial “CT”, pre-test/post-test with and without control “PP”, experimental design “Quasi”. Studies which did not meet the intervention components/exposures, such as information and teaching (mostly for the target group and parents were additional), family focus on social support and food focus (which mainly focuses on the availability of free foods including food availability from school gardening), were excluded. Systematic review papers and studies written in different language except for English were excluded as well. Studies which met the intervention criteria but had after school programs were excluded.

2.3. Age Range

Since the review covers a broad range of different countries and since school systems are quite different, the sampling principle had to include some simplification and standardisation. The goal of the review was to cover elementary (primary) and secondary education and, as a result, the age range of 5–14 was chosen to be the best fit, although it should be noted that secondary education in some countries also covers those 15–18 years of age. In most countries, elementary education/primary education is the first—and normally obligatory—phase of formal education. It begins at approximately age 5 to 7 and ends at about age 11 to 13 and in some countries 14. In the United Kingdom and some other countries, the term primary is used instead of elementary. In the United States the term primary refers to only the first three years of elementary education, i.e., grades 1 to 3. Elementary education is, in most countries, preceded by some kind of kindergarten/preschool for children aged 3 to 5 or 6 and normally followed by secondary education.

2.4. Assessment of Study Eligibility

For the selection of the relevant studies, all the titles and abstracts generated from the searches were examined. The articles were rejected on initial screening if the title and abstract did not meet the inclusion criteria or met the exclusion criteria. If abstracts did not provide enough exclusion information or were not available, then the full text was obtained for evaluation. The evaluation of full text was done to refine the results using the aforementioned inclusion and exclusion criteria. Thus, those studies that met predefined inclusion criteria were selected for this study.

2.5. Analytical Approach

The first step of data collection was aimed at organizing all studies with their key information. In the second step, we created coded columns. A coded column served as a basis for being able to do further statistical analysis. In other words, in a coded column we added a new construct not originally found in the papers as a kind of dummy variable that standardized otherwise non-standardized information, allowing us to treat otherwise un-calculable data statistically. For the impact columns, we used the following approach to construct codes where impacts where put on a 1–4-point Likert scale with 1 being “ineffective”, 2 “partially effective”, 3 “effective” and 4 “very effective”.

For the design column, the following approach was adopted as illustrated in the Table 1 . Quasi experimental/pre–post studies were labelled QED and were considered to always include a baseline and follow-up outcome measurement. As the simplest design with no comparison but just a pre/post study of the same group, we constructed a power column and assigned 1 to this for a QED design. For the controlled trial (CT), we assigned the power 2. A controlled trial is the same as QED but with a comparison/control in which no interventions are made and with no randomization. We considered a study to be of that kind if some kind of controls were made which could be, for instance, matching. All CTs in our study included 2 types of comparisons: pre and post (baseline and follow-up) as well as a comparison between intervention/no intervention. For the RCT/RCCT—a trial that is controlled through the randomization—we assigned the power 3. This “top of hierarchy” design includes the case (intervention) and a control (no intervention) and normally two types of comparisons (pre and post) as well as an intervention/no intervention. For the context of this study, we did not differentiate between RCTs and RCCTs. The latter is sometimes used to stress the fact that the school (or the class) is the sampling unit from which the subjects are recruited. But since in the context of schools RCCT is simply a variation of RCT, we coded them in the same class of power. We simply assumed that when authors spoke about an RCT, they in fact meant an RCCT since they could not have been sampling subjects without using the school as the unit.

Coding table for study designs. The table shows the types of studies examined in the review and the power assigned to them.

Code	Design	Power
PP	Pre-Test/Post-Test	1
OBS	Observational	1
CT	Controlled Trial	2
RCT	Randomized Controlled Trial	3
RCCT	Randomized Controlled Cluster Trial	3

Codes and categorization were used to standardize the information found in the papers for our statistical analysis. Categorisation of the age/class level, such as EA—Early age, EML—Early middle late, EL—Early late, was used.

For the intervention components (“what was done”) we translated all studies into three columns: information and teaching, family and social support and environmental components, food provision and availability. The latter was further expanded into three columns labelled as: focus on and provisioning of F & V; free food availability through school gardening and availability of food and healthier food environment. Our inclusion criteria were that studies should contain at least one of these components. For the environmental component—food provision and availability intervention components—we identified 2 distinct types: either a broad healthier eating focus or a narrow and more targeted fruit and vegetable focus. After the coding, we started to ask questions about the data. Most importantly, we were interested in knowing whether there existed a relationship between “what was done” and “what was the impact”. In other words, we were interested in knowing more whether there was a pattern in the way the studies intervened and the outcomes.

2.6. Queries Made

We performed queries for each intervention component (the independent variable in columns K, L and M) for each single outcome measure.

Is there a relationship between age and outcome? We used the coded column (EA, EML, etc.) to study that relationship.

In addition, we made queries regarding the relationship among study designs. For instance, would the duration of studies influence whether an effect could be found or not? Would more powerful designs result in more impact?

Furthermore, we made queries on the relationship between one intervention and a multi-interventional component and their effect on the outcome measure. Also, the queries on target groups were made. Codes such as S and NS (refer Table 4) in the column were used to study the relationship. In our analysis a distinction was made between “standard” and “extreme” (special cases). From the reviewed papers, it was clear that some studies put little emphasis on the school selected. We classified those as standard (S). However, a few papers used a stratification approach and case/cluster selection that can be classified as an “extreme” or non-standard case. We coded these as non-standard (NS). For instance, studies could be targeted to include only refugees or subjects of low socio-economic status. It can be speculated that being a “special case” or extreme case could have an influence. As a result, we reserved a code for these cases, although it became clear that they represented only a minority.

In our study, availability plays a central role, since it is used in many food-at-school intervention studies. Availability signals that food is “pushed” as opposed to being used in the “pull” mode, where individuals are expected to request food in the sense that is the behaviour of the individual that becomes the driving force rather than the “out thereness”. Availability is in most studies used in combination with the idea of a food environment. The literature shows that availability can be of two types. One is when food is made available for the individual to take where visibility, salience, product placement, etc., are used as factors. The other type of availability is when it is made free and the individual as a result does not have to pay. Free availability has been studied extensively in intervention studies but for obvious reason it is difficult to implement “post-study” since there needs to be a permanent financing present. The only exceptions to this are the collective meal models found in countries such as Sweden, Finland, Estonia and Brazil as well as in the EU scheme where the EU subsidizes the fruit.

Study design and other characteristics are provided in Table 2 , and their findings are provided in Table 3 .

The review sample: study design/characteristics. The table shows the 43 studies of the review Illustrating study design and study characteristics of the included studies.

Author	Year	Title/Reference	Main Aim (from Abstract)	Main Aim in Brief	Program Name	Location & Country	Study Design	Study Design Coded	Power	Intervention Components
					Acronym		Column I	RCT, PP, CT, RCCT, Quasi		Information and Teaching	Food Focus		Family/Social Support
					Acronym		Column I	RCT, PP, CT, RCCT, Quasi		Information and Teaching	Environmental/Food Focus on Healthy Meal Availability	Environmental/Food Focus through School Gardening	Family/Social Support
Harake et al. [ ]	2018	Impact of pilot school-based nutrition intervention on dietary knowledge, attitudes, behaviours and nutritional status of Syrian refugee children in the Bekaa, Lebanon	This study aimed to evaluate the impact of a six-month pilot school-based nutrition intervention on changes in dietary knowledge, attitude, and behavior of Syrian refugee children enrolled in informal primary schools located in the rural region of the Bekaa in Lebanon. A secondary objective of the study was to explore the effect of the intervention on the dietary intake and nutritional status of children.	Nutritional knowledge, attitude, HE & FV	GHATA	Bekaa Lebanon	Quasi experimental	QED	1	x		x
Adab P, et al. [ ]	2018	Effectiveness of a childhood obesity prevention programme delivered through schools, targeting >6 (more than 6 years) and 7 years old cluster randomised controlled trial (WAVES study)	To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compare with usual practice, in preventing childhood obesity.	Anthropometry, HE & FV	WAVES	UK primary schools from the West Midlands within 35 miles of the study centre	Randomized Controlled Cluster Trials	RCCT	3	x
Harley A, et al. [ ]	2018	Youth Chef Academy: Pilot Results From a Plant-Based Culinary and Nutrition Literacy Program for Sixth and Seventh Graders	The study aim was to examine the effectiveness of Youth Chef Academy (YCA), a classroom-based experiential culinary and nutrition literacy intervention for sixth and seventh graders (11- to 13-year-old) designed to impact healthy eating.	HE & FV, Nutritional knowledge	YCA	US (exact location is missing)	Controlled Trial (CT)	CT	2	x
Hermans R.C.J. et al. [ ]	2018	Feed the Alien! The Effects of a Nutrition Instruction Game on Children’s Nutritional Knowledge and Food Intake	The aim of this study was to test the short-term effectiveness of the Alien Health Game, a videogame designed to teach elementary school children about nutrition and healthy food choices.	HE & FV, Nutritional knowledge	AHG	Dutch, Netherland	Pre-test post-test, experimental study design	QED	1	x
Piana N., et al. [ ]	2017	An innovative school-based intervention to promote healthy lifestyles	To describe an innovative school-based intervention to promote healthy lifestyles. To evaluate its effects on children’s food habits and to highlight the key components which contribute most to the beneficial effects obtained from children’s, teachers’ and parents’ perspectives.	HE & FV, Nutritional knowledge, Physical activity	Kidmed test	Spoleto, Umbria	Pre-test post-test	PP	1	x			x
Battjes-Fries M.C.E., et al. [ ]	2017	Effectiveness of Taste Lessons with and without additional experiential learning activities on children’s willingness to taste vegetables	The aim of this study was to assess the effect of Taste Lessons with and without extra experiential learning activities on children’s willingness to taste unfamiliar vegetables, food neophobia, and vegetable consumption.	HE & FV, attitude	TLVM	Dutch province of Gelderland	Quasi experimental design	QED	1	x
Bogart L.M., et al. [ ]	2014	A Randomized Controlled Trial of Students for Nutrition and eXercise (SNaX): A Community-Based Participatory Research Study	To conduct a randomized controlled trial of Students for Nutrition and eXercise (SNaX), a 5-week middle-school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education.	HE & FV, Nutritional knowledge	SNaX	Los Angeles Unified School District	Randomized Controlled Trial	RCT	3	x
Shriqui V.K., et al. [ ]	2016	Effects of a School-Based Intervention on Nutritional Knowledge and Habits of Low-Socioeconomic School Children in Israel: A Cluster Randomized Controlled Trial	Examining the effect of a school-based comprehensive intervention on nutrition knowledge, eating habits, and behaviours among low socioeconomic status (LSES) school-aged children was performed	Anthropometry, HE & FV, Nutritional knowledge	NRI & PA	Beer Sheva, a big metropolis in southern Israel	Randomized Controlled Cluster Trial	RCCT	3	x			x
Sharma S.V. et al. [ ]	2016	Evaluating a school-based fruit and vegetable co-op in low-income children: A quasi-experimental study	The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents.	HE & FV, Nutritional knowledge	BB	Houston, Texas	Quasi-experimental non-randomized controlled study	QED	1	x		x	x
Lawlor A.D. et al. [ ]	2016	The Active for Life Year 5 (AFLY5) school-based cluster randomised controlled trial: effect on potential mediators	To determine the effect of the intervention on potential mediators	Anthropometry, HE & FV	AFLY5	South East of England	Cluster RCT	RCCT	3	x			x
Steyn P.N. et al. [ ]	2016	Did Health kick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?	To promote healthy eating habits and regular physical activity in learners, parents and educators by means of an action planning process	HE & FV, PA	HK	Western Cape (WC) Province	Cluster RCT	RCCT	3	x
Jones M. et al. [ ]	2017	Association between Food for Life, a Whole Setting Healthy and Sustinable Food Programme, and Primary School Children’s Consumption of Fruit and Vegetables: A cross Sectional Study in England	The aim of the study was to examine the association between primary school engagement in the Food for Life programme and the consumption of fruit and vegetables by children aged 8–10 years.	HE & FV, Nutritional knowledge	FLP	England	Cross sectional school matched comparison approach	Cross-sectional study design	1	x		x
Larsen L.A. et al. [ ]	2015	RE-AIM analysis of a randomized school-based nutrition intervention among fourth-grade classrooms in California	To promote healthy eating behaviours and attitudes in children	HE & FV, Nutritional knowledge, Attitude	NPP	California	RCT with pre-, post-, and follow-up assessments	RCT	3	x			x
Shen, Hu and Sun [ ]	2015	Assessment of School-Based Quasi-Experimental Nutrition and Food Safety Health Education for Primary School Students in Two Poverty-Stricken Counties of West China	Aimed to assess the reliability of the knowledge, attitude and behaviour of nutrition and food safety questionnaire for primary school students (Grade 4 to 6) in poverty-stricken counties of China, and evaluate the effectiveness of health education through a quasi experiment, in order to promote policy establishment for child and adolescent health in the future	HE & FV, Nutritional knowledge, Attitude	NFSE	West China (Shaanxi and Yunnan provinces)	Quasi-experimental design	QED	1	x
Gallotta C.M. et al. [ ]	2016	Effects of combined physical education and nutritional programs on schoolchildren’s healthy habits	To evaluate the efficacy of three 5-month combined physical education (PE) and nutritional interventions on body composition, physical activity (PA) level, sedentary time and eating habits of schoolchildren	Anthropometry, HE & FV, Nutritional knowledge, PA	ESFS	Rome (Italy)	Randomised Controlled Cluster Trial	RCCT	3	x			x
Fairclough J.S. et al. [ ]	2013	Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study	To assess the effectiveness of the CHANGE! intervention on measures of body size, PA and food intake	Anthropometry, HE & FV, PA	CHANGE	Wigan Borough in northwest England, UK	Cluster randomised intervention	RCCT	3	x
Cunha B.D. et al. [ ]	2013	Effectiveness of a randomized school-based intervention involving families and teachers to prevent excessive weight gain among Adolescents in Brazil	To evaluate the effectiveness of a school-based intervention involving the families and teachers that aimed to promote healthy eating habits in adolescents; the ultimate aim of the intervention was to reduce the increase in body mass index (BMI) of the students	Anthropometry, HE & FV, PA	PAPPAS	Duque de Caxias, Rio de Janeiro, Brazil	Paired cluster randomized school-based trial	RCCT	3	x
Aviles O.A. et al. [ ]	2017	A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial	The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes)	Anthropometry, HE & FV, PA	ACTIVITAL	Urban area of Cuenca, Ecuador	Pair-matched cluster randomized controlled trial	RCCT	3	x			x
Muros J.J. et al. [ ]	2013	Results of a seven-week school-based physical activity and nutrition pilot program on health-related parameters in primary school children in Southern Spain	To determine the effect of nutrition education combined with sessions of vigorous extracurricular physical activity (VEPA) on the improvement of health-related parameters in children in primary education	Anthropometry, HE & FV, PA	VEPA	Southern Spain	Pilot study, PP	QED	1	x
Moss A et al. [ ]	2013	Farm to School and Nutrition Education: Positively Affecting Elementary School-Aged Children’s Nutrition Knowledge and Consumption Behavior	To introduce the CATCH nutrition curriculum and Farm to School program to assess nutrition knowledge of 3rd grade students, and increase their fruit and vegetable consumption behavior	HE & FV, Nutritional knowledge	CATCH	Southern Illinois	Quasi-experimental design	QED	1	x
Zota D. et al. [ ]	2016	Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial	To evaluate the potential benefits on students’ eating habits, of incorporating healthy nutrition education as part of a school food aid program	Anthropometry, HE & FV	DIATROFI	Greece	Randomised Controlled Trial with the aspects of pre and post intervention questionnarie	RCT	3	x		x	x
Gold A. et al. [ ]	2017	Classroom Nutrition Education Combined With Fruit and Vegetable Taste Testing Improves Children’s Dietary Intake	To test the classroom curriculum, go wild with fruits & veggies! (GWWFV) effectiveness to increase FV intake of third graders in rural and urban communities in North Dakota	HE & VF	GWWFV	North Dakota	Intervention study with RCT aspects (the schools were randomized to control and intervention school)	RCT, Intervention study	3	x
Mbhatsani H.V., et al. [ ]	2017	Development and Implementation of Nutrition Education on Dietary Diversification for Primary School Children	To ensure that people consume a variety of foods that, together, provide adequate quantities of all the essential micronutrients necessary for health	HE & FV, Nutritional knowledge	NET & HBoIF	Vhembe District of Limpopo Province in South Africa	Quasi-experimental, with a one-group pre-test/post-test intervention	QED	1	x
Hutchinson J. et al. [ ]	2015	Evaluation of the impact of school gardening interventions on children’s knowledge of and attitudes towards fruit and vegetables. A cluster randomised controlled trial	To evaluate whether ongoing gardening advice and gardening involvement from the Royal Horticultural Society (RHS) gardening specialists was associated with better fruit and vegetable outcomes in children than those at teacherled schools that obtained standard advice from the RHS Campaign for School Gardening	Nutritional knowledge, Attitude	CFSG	London boroughs, Wandsworth, Tower Hamlets, Greenwich and Sutton	Randomised Controlled Cluster Trial	RCCT	3	x	x
Viggiano A et al. [ ]	2018	Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial	The board game Kaledo seems to improve knowledge in nutrition and helps to promote a healthy lifestyle in children attending middle and high schools. So, this study was conducted to investigate whether similar effects of Kaledo could be found in younger children in primary school.	Anthropometry, HE & FV, Nutritional knowledge	Kaledo	Campania, Italy	Pilot cluster randomized trial	RCCT	3	x
Waters E. et al. [ ]	2017	Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun ‘n healthy in Moreland!	Fun ‘n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing	Anthropometry, HE & FV	FHM	Victoria, Australia	Randomised Controlled Cluster Trial	RCCT	3	x
Xu F et al. [ ]	2015	Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Students: CLICK-Obesity Study	To evaluate whether the lifestyle intervention was able to reduce obesity risk and increase healthy behaviors and knowledge	Anthropometry, Nutritional knowledge	CLICK-Obesity	Mainland China	Randomised Controlled Cluster Trial	RCCT	3	x			x
Jung et al. [ ]	2018	Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children	To examine the effectiveness of a school-based healthy eating intervention program, the Healthy Highway Program, for improving healthy eating knowledge and healthy food choice behavior among elementary school students	Nutritional knowledge, HE & FV	Healthy highway program	Oswego County, New York State	Pre-/post-test	QED	1	x
Jhou W et al. [ ]	2014	Effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in Chongqing, China	To examine the effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in China	Nutritional knowledge, attitude	school-based nutrition and food safety education	Chongqing, China	Pre-/post-test	QED	1	x
Anderson EL, et al. [ ]	2016	Long-term effects of the Active for Life Year 5 (AFLY5) school-based cluster-randomised controlled trial	To investigate the long-term effectiveness of a school-based intervention to improve physical activity and diet in children.	HE & FV, PA	AFLY5	Southwest of England	Randomised Controlled Cluster Trial	RCCT	3	x
Griffin T.L. et al. [ ]	2015	A Brief Educational Intervention Increases Knowledge of the Sugar Content of Foods and Drinks but Does Not Decrease Intakes in Scottish Children Aged 10–12 Years	To assess the effectiveness of an educational intervention to improve children’s knowledge of the sugar content of food and beverages	Nutritional knowledge, attitude	NEMS	Aberdeen, Scotland	Randomised Controlled Cluster Trial	RCCT	3	x
Kipping R.R. et al. [ ]	2014	Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school-based cluster randomised controlled trial	To investigate the effectiveness of a school-based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children	HE & FV, PA	AFLY5	South west of England	Randomised Controlled Cluster Trial	RCCT	3	x
Gaar V.M. et al. [ ]	2014	Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial	Aimed at reducing children’s SSB consumption by promoting the intake of water	Nutritional knowledge, attitude	Water campaign	Rotterdam, Netherland	Controlled trial	CT	2	x
Moore GF et al. [ ]	2014	Impacts of the Primary School Free Breakfast Initiative on socio-economic inequalities in breakfast consumption among 9–11-year-old schoolchildren in Wales	To examine the impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children’s dietary behaviours and cognitive functioning	HE & FV	FSM	Wales, UK	Randomised Controlled Cluster Trial	RCCT	3			x
Nyberg G. et al. [ ]	2016	Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial	To develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas	Anthropometry, HE & FV	A Healthy School Start	Stockholm, Sweden	Randomised Controlled Cluster Trial	RCCT	3	x
Mittmann S., Austel A., and Ellrott T. [ ]	2016	Behavioural effects of a short school-based fruit and vegetable promotion programme: 5-a-Day for kids	To evaluate the acceptance of the scheme as well as the short- and intermediate-term effects of the German “5-a-day for kids” project	HE & FV	5-a-day for kids	Hannover, Germany	Pre-/post-test	PP	1	x		x
Huys N. et al. [ ]	2019	Effect and process evaluation of a real-world school garden program on vegetable consumption and its determinants in primary schoolchildren	To investigate the effectiveness of a school garden program on children’s vegetable consumption and determinants and to gain insight into the process of the program	HE & FV, Nutritional knowledge	Taste Garden	Ghent, Belgium	Non-equivalent pre-test. Post–test control group design	PP	1	x	x
Weber K.S. et al. [ ]	2017	Positive effects of promoting physical activity and balanced diet in a primary school setting with a high proportion of migrant school children	To evaluate the effects of a school-based intervention offering additional hours of supervised physical activity and dietary education for 3rd and 4th graders in primary schools	HE & FV, Nutritional knowledge	‘Be smart. Join in. Be fit.’	Düsseldorf, Germany	Controlled trial	CT	2	x
Llargue’s E. et al. [ ]	2016	Four-year outcomes of an educational intervention in healthy habits in schoolchildren: the Avall 3 Trial	To investigate the impact of the intervention on physical activity, BMI and prevalence of overweight and obesity after 4 years	Anthropometry	The Avall project	Granollers, Spain	Randomised Controlled Cluster Trial	RCCT	3	x
Martins M.L. et al. [ ]	2015	Strategies to reduce plate waste in primary schools—experimental evaluation	To determine and compare the effect of two interventions in reducing the plate waste of school lunches	Nutritional Knowledge	Reduce plate waste	City of Porto, Portugal	Controlled trial	CT	2	x		x
Rosario R. et al. [ ]	2016	Impact of a school-based intervention to promote fruit intake: a cluster randomized controlled trial	To examine the effects of a six-month dietary education intervention programme, delivered and taught by trained teachers, on the consumption of fruit as a dessert in children aged 6–12 years	HE & FV	Dietary education intervention programme	City in north of Portugal	Randomised Controlled Cluser Trial	RCCT	3	x
Zafiropulos V. et al. [ ]	2015	Preliminary results of a dietary intervention among primary school children	To evaluate the effectiveness of the dietary intervention by measuring body composition and dietary behavior of children prior to and after the intervention	Anthropometry, HE & FV	WBDI	central/eastern Crete Greece	RCT with the aspects of pre and post intervention	RCT	3	x

The review sample-findings. The table shows the findings from the 43 studies of the review.

Author	Year	Age	Age Coded			Sample Size, n	Time Duration/Month	Outcome Measures				Effectiveness Among Children				Target Group	Target Group Coded
		Years	EA	EML	EL			Anthropometry	HE/FV	Nutritional Knowledge	Attitude	Anthropometry	HE/FV	Nutritional Knowledge	Attitude		S	NS
Harake et al. [ ]	2018	6–14 years	x	x	x	183	6	x	x	x	x	3	3	4	2	Syrian refugee children in grade 4 to 6 from three informal primary schools (2 intervention and one control)		x
Adab P, et al. [ ]	2018	6–7 years	x			1392	12	x	x			1	1			UK primary schools	x
Harley A, et al. [ ]	2018	11–13 years			x	248	1 and half		x	x			4	4		8 public kindergarten		x
Hermans R.C.J. et al. [ ]	2018	10–13 years		x	x	108	N.A.		x	x			1	1		Dutch children (elementary school children)—3 primary school in the souther part of Netherland	x
Piana N., et al. [ ]	2017	7–9 years	x	x		190	4		x	x			4	4		11 primary school classes in five schools	x
Battjes-Fries M.C.E., et al. [ ]	2017	10–11 years		x	x	1010	3		X		X		1		1	children of 34 elementary school grade 6 and 7	x
Bogart L.M., et al. [ ]	2014	N.A.				2997	41		x	x			4	4		10 schools	x
Shriqui V.K., et al. [ ]	2016	4–7 years	x			240	10	x	x	x		2	4	4		Children attending LSES school classes	x
Sharma S.V. et al. [ ]	2016	N.A. (first grade students)	x			172	24		x	x			3	3		Public or charter schools 1st grade students and their family members		x
Lawlor A.D. et al. [ ]	2016	9–10 years		x		2221 (valid data for the 10 mediators were available for 87% to 96% of participants	36	x	x			1	1			primary school children	x
Steyn P.N. et al. [ ]	2016	Mean age 9.9 years	x			500 intervention and 498 control	36		x				1			primary school children from low income settings	x
Jones M. et al. [ ]	2017	8–10 years		x		2411	24		x	x			4	4		schools engaged with the Food for Life programme	x
Larsen L.A. et al. [ ]	2015	(fourth grade students) average 9 years	x			1713	2		x	x	x		4	4	3	47 fourth-grade California classrooms	x
Shen, Hu and Sun [ ]	2015	10.80 ± 1.14		x		478	8		x	x	x		4	4	1	Twelve primary schools in west China	x
Gallotta C.M. et al. [ ]	2016	8–11 years		x	x	230	5	x	x	x		3	4	3		three primary schools in the rural area in the north of the city of Rome (Italy)	x
Fairclough J.S. et al. [ ]	2013	10–11 years		x	x	318	6	x	x			3	1			12 primary schools	x
Cunha B.D. et al. [ ]	2013	10–11 years		x	x	574	9	x		x		1		3		20 schools with fifth grade classes	x
Aviles O.A. et al. [ ]	2017	12–14 years			x	1430	28	x	x			2	3			20 schools	x
Muros J.J. et al. [ ]	2013	10–11 years		x	x	54	2	x	x			2	2			2 schools from rular environment with same socio economic status	x
Moss A et al. [ ]	2013	N.A. 3rd grade students				65	1		x	x			3	4		3rd grade students	x
Zota D. et al. [ ]	2016	4–11 years	x	x	x	21261	12	x	x	x		3	4	3		students attending both elementary and secondary schools in areas of low socioeconomic status (SES)	x
Gold A. et al. [ ]	2017	8–9 years		x		662	12		x				4			3rd grade children from 26 schools	x
Mbhatsani H.V., et al. [ ]	2017	9–14 years		x	x	172	6		x	x			3	3		2 rural primary schools with similar socioeconomic backgrounds	x
Hutchinson J. et al. [ ]	2015	7–10 years	x	x		1256	12		x	x	x		3	3	2	21 London schools	x
Viggiano A et al. [ ]	2018	7–11 years	x	x	x	1313	2.5	x	x	x		2	3	3		10 primary schools	x
Waters E. et al. [ ]	2017	5–12 years	x	x	x	2965	42	x	x	x		1	3	3		24 schools of Moreland municipality	x
Xu F et al. [ ]	2015	Mean age 10.2		x		1182	10	x		x		2		3		4th grade students from 8 schools of Nanjing, China	x
Jung et al. [ ]	2018	NA (elementry school-kindergarden, 2nd, 3rd, 4th, 5th and 6th graders)	x	x	x	646	12		x	x	x		2	3	2	2 elementary schools	x

The information from abstracts were organized in a table with the following information:

Column A: Authors. The column lists the researchers/authors conducting the study.

Column B: Year. The column shows the year of the publication of the article.

Column C: Title/Reference. The column lists the title of the article.

Column D: Main aim. The column lists the main aim presented by authors in the abstract of each article.

Column E: Main aim in brief. This column is a constructed variable that refers to the main aim of each study. The idea was to give in brief the study idea and which outcome measures was focused on in the study.

Column F: Program name. The column gives the name of the project, program or intervention reported in in the article.

Column G: Location and Country. The column lists the specific place or location where the study was performed.

Column H: Study design. The column shows research design of the study according to authors.

Column I: Study design coded. This column is a constructed variable to capture the research design of the study and used to make an analysis of power possible, see Column J.

Column J: Power. The column was constructed to express the strength of the design. It is a dummy variable that was assigned a numerical value that allowed for a quantitative analytical approach.

Column K, L and M: Intervention components. The column shows which intervention components that was used in the study. We used a model that categorizes components into three different mechanisms of influence: cognitive (K), environmental (L, M, N) and social (O).

The environmental component includes actions where availability of meals—or fruit and vegetable (F & V)—were increased. Either through passive provision (F & V and meals) or through active participation such as gardening. The social category included actions where families and/or peers were actively influencing the participants. The cognitive category included teaching and learning.

Column L: Environmental/food focus on F & V. In this column, interventions which were targeted towards fruits and vegetables were flagged. This includes interventions whose focus was providing cooking lessons and maintaining healthy cafeterias during the intervention periods. Also, maintaining healthy cafeteria here refers to school canteens providing healthy options to its menu where children’s while buying food have healthier options to choose.

Column M: Environmental/food focus on increasing availability through school gardening. In this column, interventions which provided free foods among participants through gardening within the school were listed.

Column N: Environmental/food interventions focused on healthy meal availability. Interventions which provided healthy meals, breakfast, snacks during the school hours and distributed fresh fruits among the participants were listed in this column.

Column O: Family/social support. In this column interventions that included social components were flagged. These interventions included peer and family influence mechanisms.

Column P: Age. The column lists the age of the targeted groups of the intervention expressed in years according to the primary article data provided by authors.

Column Q: Age construct EA. This column shows a constructed variable for the age categorization based on the primary data given by authors. The constructed code was made to make statistical analyses possible. The construct Early Age (EA) was assigned if intervention were carried out in early school.

Column R: Age construct EML. This column shows a constructed variable for the age categorization based on the primary data given by authors. The code Early Middle Late (EML) was assigned if intervention was targeted all age groups.

Column S: Age construct EL. This column shows a constructed variable for the age categorization based on the primary data given by authors. The code EL refers to Early late and was assigned if the intervention was targeted early and early and late school.

Column T: Sample size. The number of young people enrolled in the intervention was listed in this column.

Column U: Time duration. This column shows the length of the intervention expressed in months. It is a constructed variable based on the primary data given by authors and was made to standardize duration and make it ready for cross study analysis.

Columns V, W, X, Y: Outcome measures. In Columns T, U, V, W, the outcome measures named as Anthropometry, HE/FV (healthy eating fruits and vegetables), Nutritional knowledge, and Attitude, respectively, were listed according to our outcome model shown in Figure 1 . Only a few include all outcome measures, but all studies included at least one of them.

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Outcome measures model. The figure illustrates the four types of outcome measures found in the interventions.

Columns X, AA, AB, AC: Effectiveness. The effectiveness as measured by the outcomes measured are listed in this column. Each outcome measure was rated using a Likert scale from 0–4. The effectiveness of outcome measures among participants as measured by the measures in our model ( Figure 1 ): attitude, anthropometry, HE/FV, nutritional knowledge and attitude were listed in the Columns X, Y, Z, AA, respectively.

Column AD: Target group. This column provides information on the target group of interventions such as information on grades of subjects and municipalities.

Columns AE, AF: Target group. This column is a constructed variable created to capture if the intervention had a special ethnic or socio-economic focus. Columns AC and AD consisted of coded target group named as Standard (S) and Non-Standard (NS). The “NS” here represents the target group either from refugees or immigrants or lower socio-economic classes.

Column AG: Keywords. This column lists the keywords found in the interventions.

Ordinary least squares regression was applied in this study; specifically, we used the linear regression function in IBM SPSS 22. We opted for a multi-variate approach; i.e., multiple linear regression was used. Anthropometry, behaviour (healthy eating and food focus), attitude and nutritional knowledge were used as dependent variables. In order to better account for control variables, such as sample size and study length, a dummy variable was introduced for study length of one year and more; and a logarithm of the sample size was used instead of the actual sample size to eliminate scaling effects. We grouped countries by continents (while splitting Europe into North and South as there were enough studies and no countries in between) and introduced related dummy variables. The remaining variables were used as independent variables without any additional manipulations.

Since the aim was to create models consisting only of independent variables that significantly influence the dependent variables, we used the backwards function. Because there were too many independent variables for the backwards function for the attitude model (with only eight observations), the stepwise function was used instead.

Information and teaching was present in all but one study. Free food was found only in two studies and focus on fruit and vegetables in three studies. Therefore, it is not surprising that neither of the three variables were found to be significant in any of the models.

2.7. Study Sample

The search strategy resulted in 1826 titles which were screened for duplicates and potential relevance. After this initial screening, 345 titles and abstracts were assessed against the inclusion and exclusion criteria. Articles that studied school interventions after school hours were excluded. In addition, articles which studied interventions among children in out of school context such as at community level were excluded. The justification is that both “after school” and “out of school” since can be regarded as non-typical school environments. We aimed to study the “school” as an artefact that can be considered as a “standard” across countries despite some national differences. For both “after school” and “out of school”, we argue that there are considerable differences among countries and that an inclusion of such studies would negatively influence our analytical approach. In total, 42 articles were identified as relevant and full papers were obtained as the final sample. Figure 2 below illustrates the search terms and selection process of articles.

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Review flow chart. The figure shows the progress of the literature review process following the PRISMA 2009 approach.

2.8. Intervention Study Characteristics

For all 43 items in our sample, Table 2 provides the information about the study, intervention methodologies, characteristics strategies, etc. In our extract of studies, the sample size ranged from 65-2997 subjects/participants, and the intervention duration ranged from 1 and half month to 36 months. The systematic review locations identified by the author were: 26 from Europe [ 21 , 36 , 38 , 39 , 40 , 44 , 46 , 49 , 52 , 54 , 57 , 58 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ], six from Asia [ 35 , 42 , 48 , 59 , 60 , 62 ], 10 from America [ 37 , 41 , 43 , 45 , 47 , 50 , 51 , 53 , 55 , 61 ] and one from Africa [ 56 ]. We categorized all interventions according to their intervention components. To this end, we had constructed three classes: Information and Teaching, Food Focus and Family/Social support as illustrated. The interventions characteristics of each included study are shown in Table 2 .

Of the total study sample, the majority of studies ( n = 41) involved “Information and Teaching” components consisting mainly of classroom-based activities (e.g., an adapted curriculum and distribution of educational materials, health and nutrition education program). Another 12 studies along with “Information and Teaching” involved a food focus and availability component. These food and availability components which consisted mainly of supervised school gardening, environmental modifications to stimulate a more healthful diet, such as increased availability and accessibility of healthy foods, distributions free food programmes, school provided free breakfast, school lunch modifications and incentives. Only two studies combined all the three intervention components of this study. Family/social support intervention was clearly focused on in nine study. In other studies, even though their interventions were not primarily or secondarily focused on family/social support component, they indirectly acknowledged the importance of parents and included them in their studies.

All of the reviewed studies included intervention components that were delivered in school settings and within school hours. Our sample showed that consumption of fruit and vegetables was the most used intervention component and was include in more than half of the interventions. Most studies were designed and carried in a way where a research assistant was trained by senior researchers/co-authors to ensure that each members of the research team followed same procedures for data collection. Since all studies were “in situ” studies included a close researcher/school staff cooperation component. In most of the listed studies, teachers being the responsible person to implement the interventions were trained beforehand.

2.9. Types of Interventions

Table 2 shows an overview of the programmes and their intervention components. From the table, it can be seen that studies differed according to how broadly they intervened. Some studies have included a narrow intervention (i.e., only one intervention components which targeted behavioural components), whereas others included multicomponent approaches where all three intervention components were used in the study.

Finding the right approach to intervening for healthier eating at school is a major challenge. In other words, which interventions create which impacts and how should the public best invest in new policies, strategies, and practices at school if long term health is the intended end point?

The purpose of this review was to compile the evidence regarding the effectiveness of successful school-based interventions in improving dietary behaviours, nutritional knowledge, attitudes and anthropometry among children. The analysis of the data showed a number of relationships between outcome effect and a number of other characteristics of the intervention (i.e., age, location/region, intervention type, duration). Descriptive statistics are provided in Table 4 .

Descriptive statistics.

		Minimum	Maximum	Mean	Standard Deviation
Power	42	1.00	3.00	2.2619	0.91223
InfoAndTeach	42	0.00	1.00	0.9762	0.15430
FandV	42	0.00	1.00	0.0714	0.26066
FreeFood	42	0.00	1.00	0.0476	0.21554
AvailFood	42	0.00	1.00	0.1667	0.37720
FamilySocialSupport	42	0.00	1.00	0.2143	0.41530
EA—early age	42	0.00	1.00	0.3810	0.49151
EML—early middle late age	42	0.00	1.00	0.7381	0.44500
EL—early late age	42	0.00	1.00	0.5476	0.50376
SampleSize	42	54.00	21261.00	1464.2619	3277.18184
log10SampleSize	42	1.73	4.33	2.7904	0.54986
Months	41	1.00	112.00	14.6585	19.00245
YearOrMore01	41	0.00	1.00	0.4390	0.50243
AnthropometryScale	18	0.00	4.00	2.0000	1.13759
HEFVScale	36	1.00	4.00	2.5556	1.27491
NutritionalKnowledgeScale	26	1.00	4.00	3.1923	0.89529
AttitudeScale	9	1.00	3.00	1.7778	0.66667

The linear regression models carried out for each intervention component is added in the text and the tables have been referred to each associated result. Out of 42 studies, 36 studies reported the outcome on HE/FV behaviour scale while anthropometry and attitude impacts were observed in 18 and six studies, respectively. The item one of the results in this article presents the most general finding from the literature review, item two describes the variable found significant in two cases, while the remaining variables were significant in once case each. Additionally, item four, five and six are related “design” phenomena effects in the sense that they are not related to intervention components but to the study was designed your study. The rest is related to (intervention components rather than designs. In Table 5 , the outcome measures for which an effect could be seen has been listed. The linear regression model describing what influences the attitude is provided in Table 6 .

Linear regression model for attitude.

Model	Unstandardized Coefficients		Standardized Coefficients	t	Significance
Model	B	SE	Beta	t	Significance
(Constant) FamilySocialSupport EA—early age	1.250	0.177		7.071	0.000
	1.000	0.395	0.500	2.530	0.045
	0.750	0.250	0.593	3.000	0.024

Linear regression model for anthropometry.

Model	Unstandardized Coefficients		Standardized Coefficients	t	Significance
Model	B	SE	Beta	t	Significance
(Constant) Power AvailFood YearOrMore log10SampleSize	4.140	1.008		4.109	0.001
	1.511	0.468	0.859	3.231	0.007
	3.432	0.804	0.976	4.267	0.001
	0.870	0.403	0.384	2.161	0.050
	−2.437	0.503	−1.267	−4.846	0.000

With regards to the explanatory power of the model, R 2 = 0.789, R 2 adj. = 0.719, and significance = 0.009.

The linear regression model describing what influences the anthropometry is provided in Table 6 .

With regards to the explanatory power of the model, R 2 = 0.683, R 2 adj. = 0.586, and significance = 0.003.

The linear regression model describing what influences the behaviour is provided in Table 7 .

Linear regression model for behaviour.

Model	Unstandardized Coefficients		Standardized Coefficients		t	Significance
Model	B	SE	Beta		t	Significance
(Constant) FamilySocialSupport	2.321	0.229		10.131	0.000
(Constant) FamilySocialSupport	1.054	0.486	0.348	2.168	0.037

With regards to the explanatory power of the model, R 2 = 0.121, R 2 adj. = 0.096, and significance = 0.037.

An alternative linear regression model describing what influences the behaviour is provided in Table 8 .

Alternative linear regression model for behaviour.

Model	Unstandardized Coefficients		Standardized Coefficients	t	Significance
Model	B	SE	Beta	t	Significance
(Constant) Neurope	3.227	0.205		15.761	0.000
(Constant) Neurope	−1.727	0.328	−0.670	−5.260	0.000

With regards to the explanatory power of the model, R 2 = 0.449, R 2 adj. = 0.432, and significance < 0.001.

3.1. School-Based Interventions in General Create Impact

Looking across the whole study sample, it can be seen that in general the interventions created an impact in one or more ways either on knowledge, intentions, eating habits and/or anthropometry. In other words, it was hard to find studies that created no impact. This finding adds to the body of evidence that suggests that food-based interventions are a well-suited and effective policy tool when it comes to promoting healthier eating among young people.

3.2. Family Support Affects Healthier Eating Behaviour and Attitude

Out of all the included studies, nine studies focused on family support as an intervention component. But out of those, our analysis showed that the family involvement was impactful among participants when it comes to promoting healthier food choices. Parents being influencers and role models in the family in these studies seemed to help to influence children’s dietary habits. Studies which involved participants’ parents in the intervention and provided them with nutritional knowledge and healthy cooking skills (i.e., knowledge about the importance of healthy food and nutrition during the early age of their children), seemed to be able to help young people prepare more healthy and nutritious food at home. As studies showed, this seemed to increase children’s intentions towards eating more fruits and vegetables and eventually resulted in consumption of more healthy foods. However, this did not seem to be the case for all ages. Intention to eat more fruits and vegetables was seen among early age participants (EA) either alone or with family support. It should be noted that the regression models did not include interactions, since the number of analysed studies was only ~40. It was not possible to include age as a continuous variable in the models because (as it can be seen in Table 5 ) age was a range, and sometimes even a wide range, e.g., 8–11 or 4–11. Family support increases the outcome measure by approximately 1 in both cases. Please refer to Table 5 and Table 7 for detailed linear regression model used for attitude and behaviour.

3.3. Interventions Done in Northern Europe (7 Studies) Had a Smaller Impact on Behaviour than the Studies Conducted in the Rest of the World (22 Studies)

The results from the models which was created to measure the efficiency of HE/FV highlighted the fact that HE/FV scale depends only on region where the intervention was done. The behaviour outcome for Northern Europe was on average 1.5 while the average for the rest was 3.2 (please refer to Table 8 ).

3.4. Effect of Anthropometry Measures Increases with Study Power

The results suggested that the design of the study plays a role when it comes to be able to show impact of interventions. From the findings, it was clear that the anthropometry measured among the participants were increasing with the power of the study. That is, the stronger the design the greater the likelihood of being able to measure impact on anthropometric outcomes—a unit increase in the design power is associated with an outcome increase of approximately 1.5 (please refer to Table 6 ). To examine the influence of study design we used the score that was constructed for the purpose (please refer to Table 1 ). This score assigns a higher power to randomized designs than non-randomized ones.

3.5. Study Duration Impacts Anthropometric Outcomes

It was also clear that the intervention duration does have impact on the outcome, i.e., the longer the duration better the anthropometric results among the children. Interventions that lasted a year or more, had the outcome measure on average almost one unit higher than shorter studies (please refer to Table 6 ).

3.6. Larger Samples Impacts Anthropometry Measures

Results showed that anthropometric outcome decreased within the sample size. Increasing the sample size by a factor of 10, from approximately 100 to 1000, decreased the outcome measure by almost 2.5 (please refer to Table 6 ). Thus, bigger the sample size a reverse effect on outcome was obtained. The studies whose intervention was done for long period of time (i.e., couple of months or year and among small participants) were found to be effective in the outcome. It might be the case that it was hard to administer the same thing to large sample size post intervention and thus could have decreased the anthropometry outcome among the participants.

3.7. Food Availability Interventions Influence Anthropometric Outcomes

Our analyses showed that a food focus, specifically healthy meal availability had an impact on the children’s anthropometric outcomes—increasing it by almost 3.5 on average (please refer to Table 6 ).

3.8. Interventions among Younger Students Influence Attitude Among Participants

Results showed that the younger the study subjects were, the more influence interventions had on attitudes (the outcome was on average 0.75 higher than for other age groups). Thus, the result suggests that the participants’ attitude increases when they are in their early age (EA) i.e., 4–7 years old. Furthermore, results suggest that increased family support associated with participants’ attitude towards healthy eating helps in changing the behaviour among them. Early age (EA) and family support seemed to impact positively both alone and together. Meaning that the intervention had positive impacts on participants (i.e., EA participants) attitudes towards healthy eating either with the involvement of their family support or without the involvement of family support. Please refer to Table 5 for detail linear regression model for attitude.

3.9. No Effect of School Based Interventions on Nutritional Knowledge

Findings showed that nutritional knowledge among participants (i.e., of all age group) does not depend on school-based interventions. Thus, none of the collected variables have influences on nutritional knowledge.

4. Discussion

4.1. discussion of results of this review in relation to others.

In the discussion we aim to relate our findings with what has been found in previous studies, discuss our methodological approach and reflect on what are the policy implications. Since the discussion on how to counteract the unhealthy eating pattern and the worrying increase in nutrition related disorders among young people is attracting much attention and since the discussion on how the school could contribute we aim to give policy makers and practitioners an up to date insight into the potentials of the school to act as a hub for promotion of healthier eating and provide inspiration for the development of new types of school-based interventions and strategies.

The huge interest in using the infrastructure of the school to initiate and promote healthier eating among young people has resulted in a large number of interventions studies over the past decades. This research interest per definition as the same time creates a need for syntheses of the findings in order to make them feed into the public health and school policy cycle and to “send the results to work”. Taken the huge investment that better food at school strategies at school will cost for states it is worth appreciating that the Evidence-Informs-Policy pathway seems to be working. At the same time the conceptual approaches and the understanding of what intervention components might work better than others, which age groups might benefit the most etc. as developed considerably which again adds to the rationale for synthesis of intervention study findings. Most recent reviews by Julie et al. [ 76 ], Noguera el al. [ 77 ], Evans et al. [ 78 ], Cauwenberghe et al. [ 34 ] and Brown et al. [ 79 ] has created a time gap of almost five years. Covering the last five years of research our review makes a needed contribution and in addition we argue it makes a needed contribution to a standardization and conceptualization of both sampling and intervention design methodologies.

Overall, the findings from this review suggest that school-based interventions that include intervention components such as information and teaching, food focus and family support are effective in improving the HE/FV, anthropometric measurements and attitude towards healthy dietary behaviour among the participants. On the other hand, nutritional knowledge among participants did not seem to be influenced much by any of the intervention components used.

Impacts on HE/FV behaviours were observed, but mostly among early age children revealing a distinct age pattern in the findings. Thus, age was seen as a significant factor in determining effectiveness in several study [ 35 , 37 , 39 , 42 ]. Impact was greater on young children in the 4–7 year old age range, suggesting that dietary influences may vary with age.

Multicomponent approaches that includes good quality instruction and programs, a supportive social environment both at school and home, family support has been effective in addressing childhood related diseases through focusing on diet and physical activity. Most of the studies in this review implemented with combination of school staff and intervention specialists provide evidence for the effectiveness of the program. Thus, evidence supports that family involvement and nutrition education curriculum delivered by the teacher under supervision of intervention specialists can alter the intake of fruit and vegetables while impacting positively on anthropometric measurements. Teacher led interventions have been effective and can be the most sustainable approach for long term impact of the program. The same conclusion was found in a review done in investigating the effectiveness of school-based interventions in Europe which provided the effectiveness of multicomponent intervention promoting a healthy diet in school aged children in Europe [ 34 ].Studies with a food focus in their intervention approaches showed significant improvements in BMI [ 35 , 54 , 58 ]. Significant improvements in BMI here refers to the studies whose probability value was less or equal to 0.05. This means that the interventions in that case showed reduction in body mass of participants. We looked at studies whose aim was to focus on interventions of obesity prevention or reduction among primary school children’s. Thus, search term such as: “obesity prevention intervention among primary schools”, was used as explained in the methods section. When performing the search for school-based interventions we did not encounter any studies that were focusing on underweight. Making the options for healthy choices of food in the school cafeterias and having the option of free food from the school gardens decreases the sugar sweetened beverages and junk options among the children’s and thus resulting in improvements in BMI. This review evidence further highlights that duration of the intervention, i.e., a year or more has an impact on anthropometric measurements. This is in contrast to reviews of Julie et al. [ 76 ] and Cauwenberghe et al. [ 34 ] review that found that making the better options of food choices and duration of the studies were effective in reducing the sedentary behaviour and noting improvements in BMI. This study also found that larger sample sizes reverse the outcome of anthropometric measurements (i.e., sample size negatively influences the outcome). This might be the case because it might be harder to administer the same thing to more individual. Thus, more studies are needed to examine the effects of bigger sample sizes.

Our study is far from being the first to create overview of the large number of studies that are studying interventions that can promote healthier eating habits and that can counteract the worrying increase in obesity and overweight among young people the general. The huge interest is reflected in the number of studies trying to assess the impact and effectiveness of school-based interventions as well as in the number of reviews aiming to synthesize the findings from the growing body of evidence of the effect of school-based food interventions into actionable school food policies. Our study adds to this body of knowledge and fills a gap since our study looks at the most recent studies.

Comparing our review with others we find that the majority of the studies on school food-based interventions have been conducted in high income countries. This is also the case in our study and this fact is important to keep in mind since it introduces a bias in the insight created from school food effectiveness reviews. It is also important to keep in mind that studies—and as a result also reviews-covers different types of school food cultures. These cultures can roughly be divided in collective, semi collective and non-collective types. In the collective type found in countries such as Sweden, Finland, Estonia and Brazil school food provision is an integrated—and mainly free—part of the school day. In semi-collective approaches food is in most cases traditionally a part of what is offered at school, but due to payment. In the non-collective approach found in countries such as Denmark, Norway and the Netherlands there is little infrastructure and tradition for school organized foodservice. In this approach parents organized lunch boxes as well as competitive foods traditionally play a bigger role.

A further important note to make is the distinction between narrow F & V approaches and broader healthier eating intervention approaches. This classification can also be seen in previous studies and in more recent reviews. The first type of interventions that follow the six-a-day tradition that to some extent has been fuelled by the European School Fruit program introduced by the EU in 2009 was reviewed by Noguera et al. [ 77 ] and by Evans et al. [ 78 ]. In a study by Noguera el al. [ 77 ] a meta-analysis on F&V interventions was done but limited to educational interventions in the sense that it only looked at computer-based interventions and covering mostly European research. The study showed that this targeted but narrowed approach was effective in increasing FV consumption but that broader multicomponent types of interventions including free/subsidized FV interventions were not effective. In the review paper from 2012 by Evans et al. [ 78 ] examined studies done in United Kingdom, United States, Canada, Denmark, New Zealand, Norway and the Netherlands. Evans and co-workers [ 78 ] found that school-based interventions were able to moderately improve fruit intake but that they had only minimal impact on vegetable intake. These reviews and previous ones generally conclude that F&V targeted interventions are able to improve young people’s eating patterns towards higher intake of fruit.

In the category of reviews taking a broader approach to healthier lifestyle promotion we find studies and reviews that looks at promotion of healthier eating in general—and that in some cases include physical activity. A review by Julie et al. [ 76 ] covered studies from United States, United Kingdom, Australia, Spain and the Netherlands. This review also included physical activity as part of broader school-based obesity prevention interventions. In particular, interventions should focus on extending physical education classes, incorporating activity breaks, and reducing sedentary behaviours to improve anthropometric measures. Julie et al. concluded that interventions taking a broader approach should include employing a combination of school staff and intervention specialists to implement programs; that they should include psychosocial/psychoeducational components; involve peer leaders; use incentives to increase fruit and vegetable consumption and should involve family. In a study by Cauwenberghe et al. [ 34 ] intervention studies done in a European union studies were reviewed. This review—as our study do—made an age distinction in the sense that a categorization was done between children and adolescents. Among children the authors found a strong evidence of effect for multicomponent interventions on fruit and vegetable intake. For educational type of interventions Cauwenberghe et al. [ 34 ] found limited evidence of effect as found when looking at behaviour and fruit and vegetable intakes. The study found limited evidence on effectiveness of interventions that specifically targeted children from lower socio-economic status groups. For adolescents Cauwenberghe et al. [ 34 ] found moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In the same way as our review authors distinguished between behaviour and anthropometrics and found that effects on anthropometrics were often not measured in their sample. Therefore, evidence was lacking and resulted in inconclusive evidence. Cauwenberghe et al. [ 34 ] concluded that there was evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet but that evidence for effectiveness on anthropometrical obesity-related measures was lacking. In a review by Brown et al. [ 79 ] studies mostly from Europe but also covering United States, New Zealand, Canada and Chile it was found that intervention components most likely to influence BMI positively included increased physical activity, decreased sugar sweetened beverages intake, and increased fruit intake.

Our review adds to the increasing support for the idea that school should play a role in promoting healthier eating habits among young people. As such the school can be seen as an important actor when it comes to the promotion of human rights. In particular; the right to adequate food, the right to the highest attainable standard of health and right to the education, school plays an integral part which has also been highlighted in the “United Nations System Standing Committee on Nutrition” new statement for school-based and nutrition interventions [ 25 ]. Furthermore, Mikkelsen and colleagues [ 80 ] in their study have also suggested the fact that the international framework of human rights should invoke its strategies, policies, and regulations in the context of school and that national, regional, and local level actors has important roles to play. Additionally, they have highlighted that ensuring healthy eating in school environment can be a good investment in children short- and long-term health and education achievements. Thus, schools, as a system have the potential to make lasting improvements in students nutrition both in terms of quality and quantity and simultaneously contribute to realization of human rights around the globe [ 25 ].

4.2. Discussion of Methods

Strengths and limitations.

All attempts to reduce complexity of research studies in a research field suffers from in built weaknesses. Standardising the work of others in attempts to make generalizations is always difficult. As per definition a review includes attempts to standardize its study material in order to create an overview of “what works” and what “this that works” depends on. For obvious reasons research protocols depends very much on the context of the study: What is doable in one study setting on one country might not work on other settings. Additionally, reporting procedures vary among authors. The aim of a review is to standardize this heterogeneity to something that is homogenous and computable. So, in our case our constructs represent an attempt to make different studies with similar but slightly different approaches and methodologies comparable by making them computable. This has obviously some disadvantages.

Another limitation is that our review restricted itself to cover only published English language articles. Therefore, publication bias cannot be excluded, as it is possible that the inclusion of unpublished articles written in other languages than English will have affected the results of this review. Second, most of the studies included in the present were carried out in countries from Southern and Northern parts of Europe. This raises questions about the generalisability of these results to other countries in Europe, especially because contextual variables were often lacking in the included studies. And the same questions about the generalisability could be raise in other parts of the world i.e., in Latin America, North America, Asia and Africa, as very few studies were reported from this part of the world.

On the other hand, large dropouts were reported in many listed studies and the study follow up were reported in few studies and was for short time period. Among these studies which did follow up, was right after the end of the intervention period and thus this could have affected the effectiveness among this study outcomes. Long-term follows-up post-interventions would help to study the retention of behaviour change and effect on the body composition among the participants. Thus, long terms studies post interventions are needed to draw the conclusion about the sustainability of an intervention. Additionally, in future studies to improve the quality of the evidence of effectiveness in this kind of interventions, studies with high quality, rigorous design, appropriate sample size, post interventions long term follow up, assessment of implementation issues and cost effectiveness of the intervention should be executed.

On the strength side the standardisation approach helps to find patterns and to create overview of a large material within a given field of research. The strength of this study is that it provides a broad up to date overview of what is known about the relationship between school-based intervention and policies and healthy eating outcomes among children and that it contributes to the deeper understanding of the fact that current research findings are quite limited. This is among the very few recent reviews which evaluated the effect of school-based food at nutrition interventions among children only. A systematic review approach of this study attempted efficiently to integrate existing information and provide data for researchers’ rationale in the decision making of future research. Furthermore, the applied explicit methods used in this limited bias and, contributed to improved reliability and accuracy of drawn conclusions. Other advantages are that this study looks specifically at the evidence available in Northern and Southern Europe. Statistical analyses of pooled data have facilitated a more through synthesis of the result is one of the biggest strengths of this study.

4.3. Policy Implications

The evidence of the impact of school intervention derived from our review suggests several topics to be dealt with in future research not only in Europe but also the other part of the world. First, this review highlights the need for researchers to recognize the importance of further investigations on the measures of anthropometrics, nutritional knowledge, and attitude. Among these 42 studies carried out in different regions very few looked upon the effects on participants’ attitudes and anthropometrics measures. And of those showed positive impact if family support was provided, if started at early age and lastly if food focus was part of the intervention. Additionally, most of the included studies were not aiming to contribute to obesity prevention. Thus, it is highly recommendable that there is urgent need for more studies to be done that includes more measures of efficiency of participants’ attitude towards the healthy behaviour and healthy lifestyle and measures for anthropometrics. Second, to increase the comparability between studies and to facilitate the assessment of effectiveness, more agreement is needed for best measures of the diet and questionnaires. Third, more research is needed to be done among specific groups like low socio-economic group, immigrants or minorities. As mention earlier, only few listed studies included this specific group in their studies. Furthermore, evidence suggest that health inequalities such as prevalence of overweight are as a result of dietary habits and ethnicity and socio-economic status are identified as determinants of health eating. Thus, future research should not exclude these specific groups as European countries have become ethnically diverse.

To improve or decrease childhood diseases such as overweight and obesity and other aspects of health, many policy documents have been calling for the development of the effective strategies among children’s and adolescents. Even though the limited to moderate impact and evidence was found among these school-based interventions, it should be noted that interventions were not primarily targeting obesity prevention but, in many cases, had a broader scope. Thus, in order to deliver these evidence-based recommendations to policy makers factors such as sustainability of intervention, context and cost effectiveness should be considered. Additionally, the policy makers should ensure school policies and the environment that encourage physical activity and a healthy diet.

5. Conclusions

Findings from this systematised review suggest that applying multicomponent interventions (environmental, educational, and physical strategies) along with parental involvement and of long-term initiatives may be promising for improving dietary habits and other childhood related diseases among primary school children. Despite being challenging to find experimental studies done in related fields, those studies found showed positive trend. Thus, to conclude, evidence of the effect was found among school-based food and nutrition initiatives among primary school children. However, to strengthen the perspectives of this study, further systematic review targeting the more long-term studies assessing the long-term sustainability of the interventions should be considered. Also, studies with goal to increase efficiency of anthropometric measurements in their future school-based interventions could include increasing PA, increasing fruit and vegetable intake and decreasing sedentary behaviour. This study has provided fundamentals background on which further research could be done in this area of school-based food and nutrition interventions. Thus, the findings from this systematic review can be used as guidelines for future interventions in school settings related to food and nutrition. Also, the categorization of intervention components we see as useful for the planning of future interventions.

Author Contributions

Conceptualization, B.E.M. and A.C.; methodology, B.E.M., A.C. and F.S.; validation B.E.M.; formal analysis, F.S.; investigation, A.C.; resources B.E.M. and A.C.; data curation, A.C. and F.S.; writing—original draft preparation, B.E.M., A.C. and F.S.; writing—review and editing, B.E.M., A.C. and F.S.; project administration, B.E.M. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Home / Essay Samples / Food / Eating Habits / Transforming My Eating Habits: Journey to Better Health

Transforming My Eating Habits: Journey to Better Health

Category: Food , Life
Topic: Eating Habits , Healthy Lifestyle , Personal Experience

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Promoting Healthy Eating among Young People—A Review of the Evidence of the Impact of School-Based Interventions

František Sudzina

Bent Egberg Mikkelsen

1. Introduction

2. Materials and Methods

2.1. Literature Search

2.2. Inclusion Criteria

2.3. Age Range

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2.6. Queries Made

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