Dentists call for positive action on school meals

21 Sep 2018

The lunchtime menu in Scottish schools should be improved to reduce excess sugar and ensure children and young people eat more fruit and vegetables, according to the Faculty of Dental Surgery of the Royal College of Physicians and Surgeons of Glasgow. The call comes in the Faculty’s submission to the Scottish Government’s national consultation on the nutritional requirements for food and drink in schools, which closed last month.

The Faculty, which represents over a thousand dentists and trainees, called for schools to take unhealthy puddings off their lunchtime menus, and instead offer pupils a healthier choice of soup or fruit.

Publishing their submission to the consultation, Faculty Dean Professor Graham Ogden welcomed the overall process, but called for a bolder approach from the Scottish Government. Professor Ogden said:

“We fully support the positive intention of these proposed regulations, but we feel that the Scottish Government should take a bolder approach if it’s to ensure that our young people have the healthiest possible start in life.

“For example, we all agree that children should have greater access to more fruit and vegetables as part of their school day, but increasing access does not necessarily increase consumption. The guidance must include an evidence based plan to ensure any increase in provision also ensures that our young people consume larger amounts of healthier food during school meals.

“In addition, our membership also welcome the intention to reduce the free sugar content of school meals. However, we totally oppose the inclusion of sugar free drinks on the list of permitted drinks for secondary school as this could see the reintroduction of diet fizzy drinks. This intention is a mistake and we suggest that it must not be permitted. Some will argue sugar free is a harm reduction approach, but it has all of the well-known disadvantages of that tactic. We also know that diet drinks cause dental erosion, in addition to being a gateway to sugar. We should aim to ensure that our children’s oral health gets off to the best possible start in life.”

The Faculty’s submission also calls for action to ensure that all children and young people have access to facilities in schools to brush their teeth after meals.

Professor Ogden added:

“Although this consultation only covers nutrient and food and drink standards, we would urge the Scottish Government to ensure that other factors involved in school meals that could influence a long term shift in food culture and improve children’s food choices and health are also addressed.

“ ‘Childsmile’ primary schools already provide excellent facilities where pupils can brush their teeth with fluoride toothpaste after eating school meals, and so we feel that this approach should be available more widely. We also need to take tangible steps to empower school children so that they are fully engaged in the process of improving nutritional quality of school meals themselves.”

“Around a third of Scottish children currently suffer from dental decay. That’s why we need to take action now. This consultation process is a good start by the Scottish Government, but it doesn’t go far enough if we’re to effectively tackle this serious problem.”

The Dental Faculty’s submission to the Scottish Government Consultation on “Nutritional requirements for food and drink in schools: consultation”

Increase access to fruit and vegetables

1. What are your views on our intention to amend the current school food and drink Regulations to ensure children and young people are able to access more fruit and vegetables as part of their school day?

The Dental Faculty of RCPSG and RCPSG fully support this intention but the guidance must stress the need to increase our vegetable intake. The consultation document refers to increasing access to fresh fruit and vegetables. Increasing access does not necessarily increase consumption.

The guidance must include an evidence based plan to ensure any increase in provision also increases consumption. One extra approach is to further restrict access to unhealthy junk food alternatives in Scottish Schools. Legislating to stop branding of foods and advertising aimed at children would be another approach we fully support, to hand control back to parents and carers.

The Dental Faculty and RCPSG also suggests school menus must be structured to lead to increased consumption of vegetables. For example the choice of “soup or pudding” on menus is common. Freshly made, locally sourced ingredients for soup can provide portions of vegetables, while puddings only provide excess free sugar, salt and fat. This menu choice should be stopped along with any other practices that undermine the healthier choice. An alternative might be “soup or fresh fruit”, as both/either will provide at least one additional portion of fruit or vegetables.

Reduce the sugar content of school food and drink provided in schools

2. What are your views on our intention to amend the current school food and drink Regulations to ensure the amount of sugar children and young people can access over the course of the school day is reduced?

The Dental Faculty and RCPSG welcome the intention to reduce the free sugar content of school meals. However, we totally oppose the inclusion of sugar free drinks on the list of permitted drinks for secondary school as this could see the reintroduction of diet fizzy drinks. This intention is a mistake and we suggest that it must not be permitted. Some will argue sugar free is a harm reduction approach, but it has all of the well-known disadvantages of that tactic.

A. Sugar free drinks normalise users to a very sweet taste, with implications for other subsequent food and drink choices. So childhood tooth decay and obesity are not addressed.
B. They may be sugar free in secondary schools but all retail outlets will have sugared varieties of those brands, further confusing healthy choices.
C. Allowing them in schools will also be seen as an endorsement of fizzy drinks. This must be avoided.
D. Sugar free fizzy drinks (carbonic acid) typically also contain phosphoric and citric acids to give an astringent taste. However, these acids cause dental erosion. As with many harm reduction approaches it simply substitutes one condition for another, in this case dental decay to dental erosion.
E. There continue to be drinks manufacturers who use health claims such as no added sugar which again undermines the ease of making healthy choices. While labelling must be made clearer for both caterers and children, they should not be available in schools.

From an oral health standpoint, the safest drinks are plain water and milk.

Provision of red and red processed meat

3. What are your views on our intention to amend the school food and drink Regulations to set a maximum for red and red processed meat in primary school lunches and for overall provision in secondary schools?

The Dental Faculty and RCPSG support the intention to set a maximum for red and processed meat in schools to shift our diet towards less processed food. However, we urge inclusion of processed poultry products within that restriction (poultry nuggets, etc). We question the need for any processed meat at all in children’s diets and feel that highly processed foods and drinks should be eliminated from school meal menus. Salting, curing, fermentation, smoking or other processes to improve flavour and improve preservation increase carcinogenic substances (for example heterocyclic amines (HCA) or polycyclic aromatic hydrocarbons (PAHs) formed in high temperatures).

The maximum red meat consumption must be set at the correct level. The maximum is also not a target but what should be the highest level of a range. The actual level of red meat consumed should be a mean or median value along with the maximum.

A change to the application of nutrient standards in secondary schools

4. What are your views on our intention to amend the school food and drink Regulations to enable caterers to provide a service which better supports secondary age pupils to make balanced and nutritious food and drink choices as part of their school day?

Our view is that proper kitchens should be established in all schools and food should be cooked from first principle, favouring local food producers. This will avoid processed and ultraprocessed foods.

Any other comments

5. Do you have anything else you wish to comment on in relation to the nutritional content of food and drink provided in local authority, and grant maintained, schools in Scotland via the School food and drink Regulations?

We welcome this review of school food and drink regulations. We still face significant challenges in Scotland with 29% of children overweight or obese and a third of children suffering from dental decay. Our childhood and adult (65%) rates of overweight and obesity make it clear that we must instil better eating habits and work hard to change the diet of our nation if we want to ensure that associated health consequences such as diabetes and cancer are avoided. School meals offer significant potential to improve the diet of children in Scotland provided we can offer the very best nutritional standards in a way that encourages uptake.

If the public sector is to be an exemplar of good practice school meals offer a key opportunity – the recently published Public Health Priorities for Scotland identified a healthy diet as a key priority and highlighted the need for strong collective leadership across sectors; and A Healthier Future – Scotland’s Diet and Healthy Weight Delivery Plan presented a vision where Scotland’s public sector is leading the way in promoting healthier food and indicated that improved school nutritional standards would be a key action in achieving change. It is only through bold and ambitious action that Scotland will achieve the change needed.

In general, the proposed regulations seem to be very complicated. Nutrient standards and food and drink standards seem to be two approaches to achieve the same goal: better quality food and drink available at Scottish schools.

Finally, while this consultation covers nutrient and food and drink standards only, we would urge you to ensure that other factors involved in school meals that could influence a long term shift in food culture, increase uptake of school meals, improve children’s food choices and health are also addressed:

– physical environment of schools (children should have access to excellent facilities in schools to brush their teeth with fluoride toothpaste after eating school meals. This currently happens in Childsmile primary schools). – social environment of the school dining halls.

– approaches that take account of local variation in deprivation and social/cultural context (avoid stigmatisation).

– empowering school children so that they are fully engaged in the process of improving nutritional quality of school meals.

Category: Wellbeing