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BACKGROUND:Addressing the increasing obesity rates in children living in the United Kingdom has become a priority. A public health level approach as opposed to an individual approach is potentially one way forward. The wider food environment should be designed so that the 'healthier choice' is the easiest choice; this includes public sector settings such as hospitals. Many hospital outlets sell and promote food and drinks high in sugar, fat and salt undermining health messages developed by the UK National Health Service. Financial incentives have been provided to encourage hospitals to promote healthier food choices; however, few outlets have complied with the targets. The aim of this qualitative interview study was to determine the dietary perceptions and needs of parents whose children attend a large children's hospital in the North East of England and to identify potential barriers and facilitators to eating healthily in a hospital setting. METHODS:Eighteen parents whose children attended the hospital as an in- or out-patient were recruited through either ward research nurses, information posters or a parent hospital Facebook page to participate in a one-to-one in-depth interview. RESULTS:Parents reported a lack of affordable healthy options for sale both for themselves and visiting children. Although parents wanted to see more healthy options available for sale they did not feel it was appropriate to ban or restrict sales of any food types. Parents of frequent or long-term in-patients found it difficult to adequately feed themselves. CONCLUSIONS:The ways in which visitors and staff can be encouraged to choose the healthier option in an NHS hospital setting warrants further investigation. The use of 'nudge theory', which has gained particular momentum in areas such as health promotion, may be a tool which can be utilised by hospitals to facilitate the promotion of healthy eating.

INTRODUCTION:In September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children's lunchtime and total dietary intake. METHODS:We undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999-2000 and 2009-10. Dietary data were collected from 11-12 y olds (n = 298 in 1999-2000; n = 215 in 2009-10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children's mean total dietary intake. RESULTS:We found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (-0.5%; p = 0.02), and a lower intake of sodium (-143 mg; p = 0.02), and calcium (-81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999-2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009-10, they had slightly less (-0.2%) (year by lunch type interaction p

In 2005, the nutritional content of children's school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children's total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4-7 years (n = 385 in 2003-4; n = 632 in 2008-9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children's mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change -128 mg, 95% CI: -183 to -73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (-1.8%, -2.8 to -0.9) and saturated fat (-1.0%; -1.6 to -0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children's diet.