Examination of Witnesses(Questions 83
- 99)
WEDNESDAY 10 NOVEMBER 1999
MS IMOGEN
SHARP, MS
MAGGIE SANDERSON
AND DR
MICHAEL NELSON
Chairman
83. A warm welcome for coming and giving your
time to contribute to the evidence which the Committee is receiving
at the present time, and your particular detailed evidence will
be of value. First, would you like to introduce yourselves please
with your particular backgrounds?
(Ms Sharp) I am Imogen Sharp and I am the Director
of the National Heart Forum, which is a coalition of over 40 agencies
workin gto reduce the risk of coronary heart disease which has
campaigned on school meals for a number of years. I am also Honorary
Secretary of the School Meals Campaign, a coalition of 50 agencies
working towards the improvement of school meals, and I also wrote
the Caroline Walker Trust Nutritional Guidelines for School
Meals so I welcome the Government's draft standards.
(Ms Sanderson) I am Maggie Sanderson. I am the Honorary
Secretary of the National Heart Forum. I am also Chair of the
Caroline Walker Trust which commissioned the report on school
meals. I earn my living as Principal Lecturer in Nutrition and
Dietetics at the University of North London.
(Dr Nelson) I am Michael Nelson, a Senior Lecturer
at King's College London Department of Nutrition and Dietetics.
I have had a longstanding interest in child nutrition, particularly
in relation to poverty and under-nutrition in the United Kingdom.
I have worked with both Maggie and Imogen on the Caroline Walker
Trust guidelines for school meals and am very anxious to see guidelines
brought back in again.
84. Can I ask you all just how important the
school meal is in the totality of a child's health? We have just
heard it is 190 meals a year as compared to a thousand or more
in total, so should we be spending so much time on this particular
aspect of a child's diet?
(Ms Sharp) It contributes about a third of a child's
energy in a day. For many children, as you know, it is the main
meal of the day particularly for low income children many of whom
go home to no hot meal in the evening. What we are concerned about
here really is a health, welfare and education issue. From a health
point of view, obviously school meals contribute to the nutritional
content of children's diet. We know that school meals tend to
be high in fat, high in sugar, as children's diets are, but nevertheless
they are making a significant contribution, and are also low in
iron and calcium, and when we drew up the nutritional guidelines
we looked at that and boosted the iron and calcium guideline and
lowered the fat and sugar guidelines for that reason. On a welfare
issue, there is a particular issue for the low income children.
At the moment of 2.8 million children living in poverty, only
1.8 million are currently entitled to a free school meal. On an
education issue, we can talk about what children learn from advertising
and what they learn from parents and so on, but the school is
a place of education and I think we cannot forget that. We should
be seeing a whole school approach and particularly to meet the
Government's new healthy school standard. We should be promoting
education on food, on nutrition, on health, and school meals should
set an example of that.
(Ms Sanderson) I think it is important for three reasons.
Disease processes begin early in life and we ought to be introducing
children to nutritionally well balanced meals early in life, and
that starts right at the under-5s. Eating habits are learned in
childhood and if they are not learned at home, and we have heard
earlier about how that fits into the social structure, this is
one opportunity to introduce children to foods that they will
not otherwise have access to. The third reason is that children
need a nutrient-dense diet for growth and development and the
school meal can provide some of those nutrients in greater quantities
than the traditional third to compensate for what is happening
outside the school.
(Dr Nelson) I certainly support what Maggie and Imogen
have to say. There are two principal issues. I would be in favour
of having a strong school meal service and that would include
not only school lunches but for many children school breakfasts.
There are long term consequences for health, the development of
sensible eating habits, but some of the recent research that I
have been doing is looking at the relationship between cognitive
function and learning ability at school and children's nutritional
status. There are two branches to this research. One concerns
iron status, primarily in adolescent girls, and we have good evidence
now that children with poor iron status, not necessarily anaemia
but poor iron stores, do worse on cognitive function tests and
have poorer scholastic achievement, and that that can be rectified
through supplementation either individually through schools, through
primary care or through catering. The second issue is to do with
attention early in the day for children who do not have breakfast.
There is a very substantial proportion of children, in some reports
reported as high as 40 per cent, arriving at school without breakfast
and this affects both primary and secondary school children, and
those children are very clearly at a disadvantage in terms of
their short term memory and their ability to concentrate early
in the day before having had anything to eat. Scholastic achievement
again is directly associated with participating in the school
breakfast programmes. Those children that do that perform better
at school.
85. I am sure we want to take up some other
aspects of your research later. Can I put the question on its
head perhaps and ask: if we get the school meal wrong, are there
ways in which we could detrimentally affect young people's health
in the long term as a result of the school meal?
(Ms Sharp) Yes. We come from a position of heart disease
as the National Heart Forum, which is of course the leading single
cause of death in this country. Estimates vary but about a third
of that can be attributed to poor nutrition which includes a diet
very high in fat, high in saturated fat, low in fruit and vegetables
and some of the minerals and other nutrients. We also know that
poor nutrition accounts for about a third of cancers, also a leading
cause of death in this country. That is the long term. The short
term consequences include obesity, due to the high energy content
which is also associated with high fat content of the diet, and
we know that levels of obesity in this country are increasing.
Those are the short and long term health problems.
(Ms Sanderson) I would agree with Imogen there. It
is very important that we should take this opportunity as part
of the education process of the child to use the school meals
as an education source and if we do get it wrong, yes, we are
setting patterns for later life which could contribute to many
of the degenerative diseases which are becoming more common.
(Dr Nelson) In many instances we have been getting
it wrong. It simply emphasises the powerful need for guidelines
both in terms of foods and in terms of nutrients. Listening to
the comments before from the caterers, while they may have feelings
about over-prescription concerning specific food portion sizes,
it is important to take a look at the broader picture and ensure
that the nutrient content of the food that is being provided at
schools is also set out in the guidelines.
Mr Marsden
86. What you were saying, Dr Nelson, about nutrition,
and I think you referred to the iron situation in teenage girls,
is on the face of it very disturbing. It might be stating it rather
strongly, but the implications of what you are saying are that
junk food produces Dumbos. Would that be a fair assessment?
(Dr Nelson) Those are your words, not mine!
87. You are obviously not going to be drawn
on that. Can I take that on a bit further? We have discussed what
is eaten at breakfast and at lunch and dinner. We have also had
some discussion on what may be eaten in the meantime or alternatively
what may be eaten instead of lunch, breakfast and dinner. Are
you happy with the proposed situation in terms of controls that
are in the guidelines so far? If you are not happy with that,
and maybe your colleagues would like to comment as well, how would
you like to see those controls or suggested regulations extended
to cover vending machines, tuck shops and the like?
(Dr Nelson) I think it is very important to look at
the school as a learning environment, and if the children are
learning about healthy eating in a biology class or in a nutrition
class, that they do not then get conflicting messages when they
go out into the corridor and they see Coke machines, or even extending
it outside the school environment, if there are ice cream vans
in the street or local shops that sell only snack foods which
we know are less nutrient-dense. There is even a role for thinking
about extending the school environment in terms of food to include
the outlets that exist off the school premises.
(Ms Sharp) I would echo what Mike says in terms of
the whole school approach, and certainly what the Government is
already introducing in its national healthy school standard which
has three guidelines on healthy eating, which covers the tuck
shops and the vending machines as well as school meals and the
provision of school meals. Certainly those schools that have introduced
some form of school food committee seem to have made particular
progress on that. I do not think there is enough progress and
I understand the competing pressures on head teachers, on governors,
to have vending machines in the schools, but as long as we continue
in schools to give conflicting messages, children will pick up
those messages and will not perhaps have the best learning environment.
(Ms Sanderson) I would agree that there really ought
to be a whole school approach and it is not only ice cream vans
outside the school grounds but sometimes within the school grounds
that confirm the message, so I would agree with that. I believe
also that it ought to be much more firmly embedded within the
curriculum and that there ought to be more practical applications
of nutrition education within the curriculum. I recently did a
survey of primary school teachers and found that their knowledge
of practical applications and knowledge of nutrition was extremely
poor[27]
We need to concentrate throughout the school on getting this education
right in the practical aspects. Children know what to do in terms
of knowing that certain nutrients are not good for them, but they
not often know how to put that right in practical terms.
88. We talk about healthy eating. It is also
again a question of healthy drinking as well, is it not, and the
whole issue of milk availability in school, the impact of calcium
in long term diseases like osteoporosis, for example. Is that
an area which you feel we are giving sufficient attention to,
either in terms of the guidelines or in terms of the whole school
policy? I am thinking again particularly about the difficulties
of persuading perhaps children to drink fresh fruit juice or indeed
the availability of fresh fruit juices when we have other things
in the supermarkets like Sunny Delight. What are the conflicting
pressures there? What more do we need to have in these guidelines
to get pupils drinking more milk, more fresh fruit juices?
(Ms Sanderson) I believe that guidelines on drinking
water should be available because in some schools you see the
children coming out of school and they are absolutely parched
and they drink enormous quantities when they come out because
water is not available to them in the school in a convenient form.
There might be some drinking fountains but for the very small
children sometimes those are too high for them, especially the
younger ones. It is too difficult to get to. I think it is very
important that we should be encouraging children to drink more
water, for instance, and make it freely available. As for milk,
milk is an extremely important contributor to many of the nutrients
in the diet but we do have to remember that many children in this
country have a lactose intolerance and so we have to be mindful
of that.
(Ms Sharp) In terms of the milk scheme, there has
recently been an assessment of the milk scheme across Europe and
the subsidies, and one of the key things that came out was that
in those countries where alternatives were available, such as
fizzy drinks and so on, the milk was less likely to be taken up,
possibly not a surprising finding, but nevertheless an important
piece of research.
89. Perhaps we need fizzy milk.
(Ms Sharp) Do you think it would taste as good though?
I do think that is worth bearing in mind if you give alternatives.
You can restrict and McDonalds has been mentioned earlier. One
of the successful things McDonalds does is something called restrictive
choice. You do not give endless choice. You actually restrict
it. Children know what they are going to get on a particular tray
when they order a particular meal. There is a level of restrictive
choice. You know what you are going to get when you walk into
McDonalds. It is a very successful strategy. You mentioned fresh
fruit juice. Just to clarify it, because this is a point that
comes through occasionally, in terms of nutrition we would advocate
any type of fruit and vegetables, whether it is tinned, whether
it is frozen, whether it is fresh, whether it is dried and so
on. The overall nutritional quality of that is such that it can
be of any sort and that is quite important because people often
get stuck on the idea that fruit and vegetables must be fresh.
One of the things we are advocating is a National School Fruit
and Vegetable Scheme but maybe there will be an opportunity to
come back to that later. The last thing I would like to say is
about the cooking skills in the classroom. Somebody mentioned
that people spend more time watching cooking programmes than actually
doing it. I think one of the things I am struck by is the success
of Delia Smith's book called How to Cook and the television
programme . Now, if our children were learning how to cook in
school I do not think that book would be such a best seller. I
think if we are having to learn how to boil an egg in adult life
there is something seriously wrong with what is going on in our
classrooms. The Government introduced a cooking skills initiative
but it was in the holidays as a demonstration project. Cooking
skills have been gradually eroded from the curriculum and really
I do not think holiday learning to cook is quite where it is at.
Charlotte Atkins
90. Why does the National Heart Forum disagree
with the approach based on food groups, as set out in Ingredients
for Success?
(Ms Sanderson) One of the reasons why in our submission
we disagreed with that approach was that it is very difficult,
we think it will be very difficult to monitor. If we are looking
at trying to improve the nutrition of children, it does not achieve
the objective in that it would be quite difficult to say from
food portion sizes whether or not you are achieving the nutritional
objectives. They are very useful in planning menus which are going
towards achieving some nutritional objectives but I believe the
monitoring of those nutritional objectives should be through nutrients
rather than food groups. Just to give you an example: if you look
at food groups as they stand at the moment, there appears to be
very little to regulate the amount of fat and sugar that the menus
contain. This is one of the major problems we have at the moment.
The high fat intake amongst school children means obesity is increasing.
I believe we will not be able to monitor properly using food groups.
Also, using nutritional guidelines there is far more flexibility
because within any area of the country the caterer can use the
foods, the local customs, to achieve the same nutritional guidelines.
So it increases the flexibility by using nutrients.
91. Does anyone else want to come in on that?
(Ms Sharp) Just really to echo the same point. If
the goal is to improve health we need to reduce fat, that is a
simple equation. In order to reduce fat and know that we are reducing
fat in children's diets, we need to be able to measure what is
being provided and what children are eating from that. We need
to be able to measure that and we cannot measure that if we just
say "not more than three portions of chips a week".
As Maggie says, it gives the flexibility to then interpret those
nutritional guidelines in whatever way the caterer wants to. You
can still provide not more than 35 per cent of energy from fat.
I think one of our main points is until we really have those in
place we will not achieve improvements.
92. What is your view of the use by school meal
providers of highly processed foods like dinosaurs, burgers and
that sort of thing? The impression I get—and I will be interested
in your impression—is that in some local authorities school
meals are largely based on these things which are just warmed
up rather than the school meal service being delivered from start
to finish by school meal staff on the school premises. What impact
does that have on nutritional standards and what are the practical
difficulties of getting away from that if that is what you think
we should be doing?
(Ms Sanderson) One of the problems I believe with
many of these highly processed foods is the type of fat in these
highly processed foods. Many of them are very high in trans fatty
acids which the body deals with in practically the same way as
it does saturated fats. We are trying to reduce saturated fats.
On the face of it it might be chicken or something like it which
you think of as a fairly low fat product but the actual processing
does change some of these products. I do worry that the special
foods that we are giving school children are not as nutritious
as we are giving an adult.
93. Do you think this is a general concern?
I do not know if you have looked at school meals in general but
the impression I get from parts of the country is this is an increasing
trend because it cuts down in terms of preparation hours.
(Ms Sanderson) Yes.
94. Therefore, it has the advantage of putting
something on the plate relatively quickly. We have been to schools
where the food is produced from first principles but, of course,
what school cooks have said to me is, "Well, that is what
children like and we know that they will eat them".
(Ms Sanderson) But the school is an educational establishment
and so I think, yes, of course we must try to provide something
that children will eat but children can be educated into new tastes.
This is one of the opportunities we have of educating children
into new tastes. They are notoriously conservative.
Chairman
95. With a small "c" I trust.
(Ms Sanderson) With a small "c", in their
eating habits at some stages of their life, so this is an opportunity
to educate them.
(Dr Nelson) I was going to say, if you are going to
be prescriptive, and I think we need to be prescriptive, then
it is very important to have the children and the caterers and
the teachers all on board together. The experience I have had
recently at a school in North London where we were trying to increase
both the adolescent girls, awareness of the iron in the diet and
also increase the iron content of the foods they were being offered
was that it was very important that the girls themselves were
in discussion with the caterers. The point the caterers themselves
made was that if you introduce something once or twice then because
you are talking about margins of profit, your profits fall because
the children are not yet used to that item on the menu. By the
third time it is part of the range of foods that they think of
as being normally on offer and the profits go up and the food
becomes more accepted. If you are dealing with a simple service
that is really concerned only about the deliverability of processed
foods you are not going to get nearly the same response nor the
same benefits as having a locally based school feeding system
which has very clear guidelines. Again, I would echo what Maggie
was saying in terms of the nutrient guidelines giving you flexibility
that a prescriptive food group guideline does not.
Charlotte Atkins
96. Looking at primary schools, the Department
for Education has recognised there is a problem getting children
maybe to take a portion from the dairy product side every day.
Short of force feeding, them how do you get children to eat that?
Have you got any practical suggestions because obviously the caterers,
as we heard earlier on, would recognise they do not want to put
all the food into pig swills?
(Dr Nelson) Have tasting sessions with the children
and get them to understand that when they are learning that something
is good for them there are a variety of ways in which that goodness
can be delivered. If children are confronted then they are going
to be stubborn and not participate. If you give them an opportunity
to say what they like, opportunities to taste a variety of different
foods, then there is scope for improvement. We know that has implications
for adult good health as well.
(Ms Sharp) Can I come in? One of the projects we have
been working with, a project about fruit and vegetables in schools
in Wales, has been doing precisely that. It has been introducing
children to new fruits and vegetables that they may never have
had before, that they did not know about or whatever, through
tasting systems, through a reward based system. At the moment
there is on-going research to look at the level of sustainability
of that and whether you could introduce that across the board
in schools. But it did find a remarkable increase in uptake with
a bit of intervention, a bit of encouraging, but allowing children
to taste and test and try out for themselves rather than just
assume they did not like it because they had not seen it before
or whatever.
Charlotte Atkins: One of my concerns, especially
about fruit in schools, is that certainly where I am a Governor,
they used to provide a child with only half an apple or half a
banana and I think there was something about that which deterred
children wanting that because it was small even for the smallest
and it did not look like a very acceptable product, maybe half
a slightly browning apple was not exactly number one on the list.
Mr St Aubyn
97. That neatly leads me into the next point
which is in your paper you reminded us you advocate a National
School Fruit and Vegetable Scheme. Would you like briefly to outline
how you think that might work?
(Ms Sharp) Yes. We have been saying this for a couple
of reasons. One is we have a precedent which is the milk scheme.
Although the National Milk Scheme has been cut it has been funded
through the European subsidies so across Europe we have Milk Schemes
to varying degrees. Importantly we have a Government which has
one of their main objectives in health to reduce the inequalities
in health and particularly to improve the health of the worst
off as well as the whole population. Fruit and vegetables, interestingly,
are one of the main components of the diet where you see huge
social class differences with those in social class one eating
about 50 per cent more or half as much again as those in social
class five. This is a pattern that research has shown follows
through children as well as adults and to an extent reflects the
social class differences in heart disease, and in cancers later
in life. It is a component that I think people are really only
waking up to the full consequences of what this means. One of
the things I am delighted to see in the new Health Strategy is
that the nutritional focus is largely on fruit and vegetables,
fat is there but less important than fruit and vegetables. We
feel—and in fact our recommendation has also been echoed
by Sir Donald Acheson who did the Independent Inquiry into
Inequalities in Health—a National School Fruit and Vegetable
Scheme could be a way of redressing this. It is modern, it addresses
modern nutritional issues. It could have the support of the food
industry as well as health professionals as well as Government.
It is a win/win situation, win for health, win for business. It
is why the dairy industry has always been in support of the Milk
Scheme, if you get children young they may become milk drinkers
for later life as well. At the moment there is the semblance of
a pilot possibility but we have real fruit mountains which are
available from the Intervention Board from September to April
in certain produce growing regions of the UK. A region that is
taking it up at the moment is Kent. Of the apples and pears that
are available only a tiny fraction are being taken up at the moment
by schools, most are being taken up by prisons or other institutions
or by charities. One of the reasons for that was because schools
could not reclaim transport costs which now the EU regulations
have changed, they can get some of that back.
98. So in practical terms you are confident
you could deliver the fruit and vegetables fresh to the school
and they would not have a reputation of having rotten tomatoes?
(Ms Sharp) I am not sure we could deliver that, we
do not have a stock of tomatoes back at the office. I am confident
that it could be worked out. People have said that there is an
issue of perishability which is different from milk and there
is an issue that if you have large quantities you have to deal
with storage problems, you have to deal with perishability and
deterioration. There are creative ways around that. One of mine
is apple juice: what is wrong with turning apples into apple juice?
Obviously what needs to be looked at, but I know industry is relatively
keen on this as well to the point that they are doing some of
their own research too, are the distribution and transportation
issues and the supply issues but also I think we need to look
at creative ways. If there are these surpluses let us do something
with them because they could be improving the health in a particular
area.
99. Do you think that the delegated budgets
for schools should give them the resources needed if necessary
to try to introduce such schemes locally? Is that how it will
happen?
(Ms Sharp) I suspect the delegated budget would not
at the moment go as far as to cover that.
27 Educating the Educators: papers given at the British
Dietetic Association Diamond Jubilee Conference, Stratford-on-Avon,
April 1996. Back
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