A study using myfood24 found that only 2 in 100 primary school children eat a packed lunch that meets children’s nutritional standards. With no rules or guidance to advise parents on what to include in packed lunches, this article discusses the study findings and how this affects diet quality and obesity in children. 

According to the National Child Measurement Programme (NCM) data, childhood obesity in the UK is rising and it has become an increasingly profound concern within public health on a global scale. 

The current statistics from NCM show: 

• 10% of reception children aged 4 to 5 are obese, and a further 13% are overweight. 
• 21% of children aged 10 to 11 are obese, and 14% are overweight,  

As with many obesity prevention programmes, interventions are a significant area of focus. For children, improving the school food environment to effectively reduce the risk of obesity has been suggested. 

The government had responded by making statutory nutritional recommendations for free school meals, guiding schools to serve foods of high-quality meat, fruit and vegetables, and limiting drinks with added sugar, crisps, chocolate, and sweets. 

However, when it comes to children’s packed lunches, there is no government guidance for parents on what foods should or shouldn’t be included. With approximately 50% of school children in the UK taking a packed lunch to school, it’s thought that the majority of school lunches will fail to meet nutritional standards for school meals by the Public Health Agency. 

About the study: 

A study published in the BMJ, involving our founder Professor Janet Cade, used myfood24 to analyse the nutritional quality of contents in packed lunches in England during 2006 and 2016. The aim of the study was to determine whether children’s packed lunches have improved in nutritional quality between 2006 and 2016 and whether any difference was due to frequency of specific foods or portion sizes.  

In 2006, data was collected from 1148 children from 76 schools across England aged between 8 and 9 who regularly ate a packed lunch prepared at home. Data in 2016 was collected from 323 children aged between 8 and 9 attending 18 schools across England. Trained administrators collected data using a standard questionnaire on a single day for each school detailing foods in the lunchboxes. Food portions were weighed before and after lunch to determine how much food each child ate. The portions were calculated using two different methods to determine the mean weights of foods provided for the whole sample of children and the mean weights of food calculated for the children only eating that food type. 

To determine the nutritional content, the data was inputted into myfood24 to analyse the nutritional composition of each food item, which was then extracted into Excel and Stata to show the analysis. 

Foods were categorised according to the School Food Plan, the school meal standards used were a set of recommendations for 8 food types, 5 to be encouraged: (i) protein-rich, (ii) low-fat starchy, (iii) dairy, (iv) fruits (v) vegetables and the following food types restricted: (i) sweetened drinks, (ii) confectionery, (iii) savoury snacks. The results were then compared to emphasize any changes in the nutritional quality of packed lunches over 10 years and measured against individual and combined school meal standards.  

The Results:  

Due to school closures, the study couldn’t directly compare the 2006 and 2016 studies. Initially starting with 1,148 pupils from 76 schools in 2006, the 2016 study only included 323 pupils from 18 schools.  

Weight, proportion, and portion sizes:  

The study compared the components of packed lunches by weight and found that for most foods, average weights were similar in 2006 and 2016. Some exceptions included a decrease in weight of milk-based desserts, sweetened drinks, and confectionary. Naturally, the weight of permitted cakes and biscuits increased. 

Although most food types were provided at a similar degree; there were 3 food types that were provided to a different percentage of children, this includes confectionary, which decreased by 10% (95% CI −20.0% to 0.2%), along with sweetened drinks which saw a reduction by 14% (95% CI −24.8% to −4.0%) and non-chocolate cakes and biscuits; which increased by 10% (95% CI 3.0% to 16.3%). Vegetables were the least common foods that were packed in children’s lunches throughout both years, and vegetable provision was very low.  

In terms of portion size, there was no increase for any of the foods measured; however, there was a decrease in specific foods including fruit (−15 g), cheese snacks (−14 g), milk-based desserts (−21 g), and sweetened drinks (−56 g).  

Food Standards:

Although the percentage of lunches meeting the five healthy standards did not change, the percentage of lunches that did not contain any restricted foods increased from 9% to 16% and the percentage of packed lunches meeting all eight standards slightly increased from 1.1% to 1.6%.  

Nutritional standards of packed lunches:  

The study found that 98 in every 100 packed lunches failed to meet nutritional standards in 2006. Many lunchboxes contained high sugar sandwich fillings, such as chocolate spread and jam, and often filled lunches with crisps and confectionery instead of fruit and vegetables. It was shown that less than 2% of packed lunches met all school food plan standards in 2016. 

The most provided foods in lunch boxes in 2006 and 2016 were almost identical, with a sandwich being the main component of a child’s lunch. The most common sandwich filling was ham; however, some children had a low intake of protein-based fillings, and very few had a plant-based alternatives such as hummus or vegetable spreads. 

More than half of children met the nutrient-based standards for protein, total fat, total carbohydrate, and calcium, and other findings showed that some improvements were made to reduce the sugar content of packed lunches and few children met the standards for essential micronutrients including fibre, vitamin A, iron, or zinc.  

Results from the 2016 survey have shown that though children’s packed lunches have improved, the levels of other nutrients still exceed current nutritional recommendations, such as saturated fat, NMES, and sodium. 

Nutrient	School meal standards for England	2006	2016	P value of difference
Energy (Kcal)	530	626	591	0.075
Protein (g)	7.5	18.1	18.5	0.983
Total Carbohydrate (g)	70.6	96.4	85.4	0.003
NMES (g)	15.5	39.5	24.0	<0.001
Total fat (g)	20.6	21.0	21.8	0.452
Saturated Fat (g)	6.5	8.2	8.0	0.178
Calcium (mg)	193	277	267	0.778
Iron (mg)	3.0	2.44	2.50	0.686
Folate (µg)	53.0	76.9	57.0	0.683
Zinc (mg)	2.5	2.1	1.9	0.027
Sodium (mg)	499	869	797	0.877

NMES, non-milk extrinsic sugar

What should the following steps be? 

The authors recommend implementing policies that increase fruit and vegetable provision for children’s packed lunches, including incorporating more fruits and vegetables into other foods such as yoghurts and cakes. It is also recommended to reduce portion sizes of energy-dense snacks to avoid children filling up on less nutritious foods. Policies to encourage drinking more water are also recommended, while simultaneously reducing the amount of sugary drinks through policies that restrict them in schools.  

With childhood obesity becoming increasingly prevalent, the focus to ensure high-quality and nutritious diets for children alongside physical activity is imperative, and it makes the contents of children’s packed lunches even more significant to change.