benefits of eating healthy food essay pdf

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• Published: 06 December 2017

Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments

• Deborah R. Wahl 1   na1 ,
• Karoline Villinger 1   na1 ,
• Laura M. König   ORCID: orcid.org/0000-0003-3655-8842 1 ,
• Katrin Ziesemer 1 ,
• Harald T. Schupp 1 &
• Britta Renner 1  

Scientific Reports volume  7 , Article number:  17069 ( 2017 ) Cite this article

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• Human behaviour

Research suggests that “healthy” food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across eight days using smartphone-based ecological momentary assessment. Three main findings emerged: First, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Second, sweets on average provided comparable induced eating happiness to “healthy” food choices such as fruits or vegetables. Third, dinner elicited comparable eating happiness to snacking. These findings are discussed within the “food as health” and “food as well-being” perspectives on eating behaviour.

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Introduction.

When it comes to eating, researchers, the media, and policy makers mainly focus on negative aspects of eating behaviour, like restricting certain foods, counting calories, and dieting. Likewise, health intervention efforts, including primary prevention campaigns, typically encourage consumers to trade off the expected enjoyment of hedonic and comfort foods against health benefits 1 . However, research has shown that diets and restrained eating are often counterproductive and may even enhance the risk of long-term weight gain and eating disorders 2 , 3 . A promising new perspective entails a shift from food as pure nourishment towards a more positive and well-being centred perspective of human eating behaviour 1 , 4 , 5 . In this context, Block et al . 4 have advocated a paradigm shift from “food as health” to “food as well-being” (p. 848).

Supporting this perspective of “food as well-being”, recent research suggests that “healthy” food choices, such as eating more fruits and vegetables, have not only physical but also mental health benefits 6 , 7 and might be a long-term investment in future well-being 8 . For example, in a nationally representative panel survey of over 12,000 adults from Australia, Mujcic and Oswald 8 showed that fruit and vegetable consumption predicted increases in happiness, life satisfaction, and well-being over two years. Similarly, using lagged analyses, White and colleagues 9 showed that fruit and vegetable consumption predicted improvements in positive affect on the subsequent day but not vice versa. Also, cross-sectional evidence reported by Blanchflower et al . 10 shows that eating fruits and vegetables is positively associated with well-being after adjusting for demographic variables including age, sex, or race 11 . Of note, previous research includes a wide range of time lags between actual eating occasion and well-being assessment, ranging from 24 hours 9 , 12 to 14 days 6 , to 24 months 8 . Thus, the findings support the notion that fruit and vegetable consumption has beneficial effects on different indicators of well-being, such as happiness or general life satisfaction, across a broad range of time spans.

The contention that healthy food choices such as a higher fruit and vegetable consumption is associated with greater happiness and well-being clearly contrasts with the common belief that in particular high-fat, high-sugar, or high-caloric foods taste better and make us happy while we are eating them. When it comes to eating, people usually have a spontaneous “unhealthy = tasty” association 13 and assume that chocolate is a better mood booster than an apple. According to this in-the-moment well-being perspective, consumers have to trade off the expected enjoyment of eating against the health costs of eating unhealthy foods 1 , 4 .

A wealth of research shows that the experience of negative emotions and stress leads to increased consumption in a substantial number of individuals (“emotional eating”) of unhealthy food (“comfort food”) 14 , 15 , 16 , 17 . However, this research stream focuses on emotional eating to “smooth” unpleasant experiences in response to stress or negative mood states, and the mood-boosting effect of eating is typically not assessed 18 . One of the few studies testing the effectiveness of comfort food in improving mood showed that the consumption of “unhealthy” comfort food had a mood boosting effect after a negative mood induction but not to a greater extent than non-comfort or neutral food 19 . Hence, even though people may believe that snacking on “unhealthy” foods like ice cream or chocolate provides greater pleasure and psychological benefits, the consumption of “unhealthy” foods might not actually be more psychologically beneficial than other foods.

However, both streams of research have either focused on a single food category (fruit and vegetable consumption), a single type of meal (snacking), or a single eating occasion (after negative/neutral mood induction). Accordingly, it is unknown whether the boosting effect of eating is specific to certain types of food choices and categories or whether eating has a more general boosting effect that is observable after the consumption of both “healthy” and “unhealthy” foods and across eating occasions. Accordingly, in the present study, we investigated the psychological benefits of eating that varied by food categories and meal types by assessing complete dietary behaviour across eight days in real life.

Furthermore, previous research on the impact of eating on well-being tended to rely on retrospective assessments such as food frequency questionnaires 8 , 10 and written food diaries 9 . Such retrospective self-report methods rely on the challenging task of accurately estimating average intake or remembering individual eating episodes and may lead to under-reporting food intake, particularly unhealthy food choices such as snacks 7 , 20 . To avoid memory and bias problems in the present study we used ecological momentary assessment (EMA) 21 to obtain ecologically valid and comprehensive real life data on eating behaviour and happiness as experienced in-the-moment.

In the present study, we examined the eating happiness and satisfaction experienced in-the-moment, in real time and in real life, using a smartphone based EMA approach. Specifically, healthy participants were asked to record each eating occasion, including main meals and snacks, for eight consecutive days and rate how tasty their meal/snack was, how much they enjoyed it, and how pleased they were with their meal/snack immediately after each eating episode. This intense recording of every eating episode allows assessing eating behaviour on the level of different meal types and food categories to compare experienced eating happiness across meals and categories. Following the two different research streams, we expected on a food category level that not only “unhealthy” foods like sweets would be associated with high experienced eating happiness but also “healthy” food choices such as fruits and vegetables. On a meal type level, we hypothesised that the happiness of meals differs as a function of meal type. According to previous contention, snacking in particular should be accompanied by greater happiness.

Eating episodes

Overall, during the study period, a total of 1,044 completed eating episodes were reported (see also Table  1 ). On average, participants rated their eating happiness with M  = 77.59 which suggests that overall eating occasions were generally positive. However, experienced eating happiness also varied considerably between eating occasions as indicated by a range from 7.00 to 100.00 and a standard deviation of SD  = 16.41.

Food categories and experienced eating happiness

All eating episodes were categorised according to their food category based on the German Nutrient Database (German: Bundeslebensmittelschlüssel), which covers the average nutritional values of approximately 10,000 foods available on the German market and is a validated standard instrument for the assessment of nutritional surveys in Germany. As shown in Table  1 , eating happiness differed significantly across all 14 food categories, F (13, 2131) = 1.78, p  = 0.04. On average, experienced eating happiness varied from 71.82 ( SD  = 18.65) for fish to 83.62 ( SD  = 11.61) for meat substitutes. Post hoc analysis, however, did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.22. Hence, on average, “unhealthy” food choices such as sweets ( M  = 78.93, SD  = 15.27) did not differ in experienced happiness from “healthy” food choices such as fruits ( M  = 78.29, SD  = 16.13) or vegetables ( M  = 77.57, SD  = 17.17). In addition, an intraclass correlation (ICC) of ρ = 0.22 for happiness indicated that less than a quarter of the observed variation in experienced eating happiness was due to differences between food categories, while 78% of the variation was due to differences within food categories.

However, as Figure  1 (left side) depicts, consumption frequency differed greatly across food categories. Frequently consumed food categories encompassed vegetables which were consumed at 38% of all eating occasions ( n  = 400), followed by dairy products with 35% ( n  = 366), and sweets with 34% ( n  = 356). Conversely, rarely consumed food categories included meat substitutes, which were consumed in 2.2% of all eating occasions ( n  = 23), salty extras (1.5%, n  = 16), and pastries (1.3%, n  = 14).

Left side: Average experienced eating happiness (colour intensity: darker colours indicate greater happiness) and consumption frequency (size of the cycle) for the 14 food categories. Right side: Absolute share of the 14 food categories in total experienced eating happiness.

Amount of experienced eating happiness by food category

To account for the frequency of consumption, we calculated and scaled the absolute experienced eating happiness according to the total sum score. As shown in Figure  1 (right side), vegetables contributed the biggest share to the total happiness followed by sweets, dairy products, and bread. Clustering food categories shows that fruits and vegetables accounted for nearly one quarter of total eating happiness score and thus, contributed to a large part of eating related happiness. Grain products such as bread, pasta, and cereals, which are main sources of carbohydrates including starch and fibre, were the second main source for eating happiness. However, “unhealthy” snacks including sweets, salty extras, and pastries represented the third biggest source of eating related happiness.

Experienced eating happiness by meal type

To further elucidate the contribution of snacks to eating happiness, analysis on the meal type level was conducted. Experienced in-the-moment eating happiness significantly varied by meal type consumed, F (4, 1039) = 11.75, p  < 0.001. Frequencies of meal type consumption ranged from snacks being the most frequently logged meal type ( n  = 332; see also Table  1 ) to afternoon tea being the least logged meal type ( n  = 27). Figure  2 illustrates the wide dispersion within as well as between different meal types. Afternoon tea ( M  = 82.41, SD  = 15.26), dinner ( M  = 81.47, SD  = 14.73), and snacks ( M  = 79.45, SD  = 14.94) showed eating happiness values above the grand mean, whereas breakfast ( M  = 74.28, SD  = 16.35) and lunch ( M  = 73.09, SD  = 18.99) were below the eating happiness mean. Comparisons between meal types showed that eating happiness for snacks was significantly higher than for lunch t (533) = −4.44, p  = 0.001, d  = −0.38 and breakfast, t (567) = −3.78, p  = 0.001, d  = −0.33. However, this was also true for dinner, which induced greater eating happiness than lunch t (446) = −5.48, p  < 0.001, d  = −0.50 and breakfast, t (480) = −4.90, p  < 0.001, d  = −0.46. Finally, eating happiness for afternoon tea was greater than for lunch t (228) = −2.83, p  = 0.047, d  = −0.50. All other comparisons did not reach significance, t  ≤ 2.49, p  ≥ 0.093.

Experienced eating happiness per meal type. Small dots represent single eating events, big circles indicate average eating happiness, and the horizontal line indicates the grand mean. Boxes indicate the middle 50% (interquartile range) and median (darker/lighter shade). The whiskers above and below represent 1.5 of the interquartile range.

Control Analyses

In order to test for a potential confounding effect between experienced eating happiness, food categories, and meal type, additional control analyses within meal types were conducted. Comparing experienced eating happiness for dinner and lunch suggested that dinner did not trigger a happiness spill-over effect specific to vegetables since the foods consumed at dinner were generally associated with greater happiness than those consumed at other eating occasions (Supplementary Table  S1 ). Moreover, the relative frequency of vegetables consumed at dinner (73%, n  = 180 out of 245) and at lunch were comparable (69%, n  = 140 out of 203), indicating that the observed happiness-vegetables link does not seem to be mainly a meal type confounding effect.

Since the present study focuses on “food effects” (Level 1) rather than “person effects” (Level 2), we analysed the data at the food item level. However, participants who were generally overall happier with their eating could have inflated the observed happiness scores for certain food categories. In order to account for person-level effects, happiness scores were person-mean centred and thereby adjusted for mean level differences in happiness. The person-mean centred happiness scores ( M cwc ) represent the difference between the individual’s average happiness score (across all single in-the-moment happiness scores per food category) and the single happiness scores of the individual within the respective food category. The centred scores indicate whether the single in-the-moment happiness score was above (indicated by positive values) or below (indicated by negative values) the individual person-mean. As Table  1 depicts, the control analyses with centred values yielded highly similar results. Vegetables were again associated on average with more happiness than other food categories (although people might differ in their general eating happiness). An additional conducted ANOVA with person-centred happiness values as dependent variables and food categories as independent variables provided also a highly similar pattern of results. Replicating the previously reported analysis, eating happiness differed significantly across all 14 food categories, F (13, 2129) = 1.94, p  = 0.023, and post hoc analysis did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.14. Moreover, fruits and vegetables were associated with high happiness values, and “unhealthy” food choices such as sweets did not differ in experienced happiness from “healthy” food choices such as fruits or vegetables. The only difference between the previous and control analysis was that vegetables ( M cwc  = 1.16, SD  = 15.14) gained slightly in importance for eating-related happiness, whereas fruits ( M cwc  = −0.65, SD  = 13.21), salty extras ( M cwc  = −0.07, SD  = 8.01), and pastries ( M cwc  = −2.39, SD  = 18.26) became slightly less important.

This study is the first, to our knowledge, that investigated in-the-moment experienced eating happiness in real time and real life using EMA based self-report and imagery covering the complete diversity of food intake. The present results add to and extend previous findings by suggesting that fruit and vegetable consumption has immediate beneficial psychological effects. Overall, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Thus, in addition to the investment in future well-being indicated by previous research 8 , “healthy” food choices seem to be an investment in the in-the moment well-being.

Importantly, although many cultures convey the belief that eating certain foods has a greater hedonic and mood boosting effect, the present results suggest that this might not reflect actual in-the-moment experiences accurately. Even though people often have a spontaneous “unhealthy = tasty” intuition 13 , thus indicating that a stronger happiness boosting effect of “unhealthy” food is to be expected, the induced eating happiness of sweets did not differ on average from “healthy” food choices such as fruits or vegetables. This was also true for other stereotypically “unhealthy” foods such as pastries and salty extras, which did not show the expected greater boosting effect on happiness. Moreover, analyses on the meal type level support this notion, since snacks, despite their overall positive effect, were not the most psychologically beneficial meal type, i.e., dinner had a comparable “happiness” signature to snacking. Taken together, “healthy choices” seem to be also “happy choices” and at least comparable to or even higher in their hedonic value as compared to stereotypical “unhealthy” food choices.

In general, eating happiness was high, which concurs with previous research from field studies with generally healthy participants. De Castro, Bellisle, and Dalix 22 examined weekly food diaries from 54 French subjects and found that most of the meals were rated as appealing. Also, the observed differences in average eating happiness for the 14 different food categories, albeit statistically significant, were comparable small. One could argue that this simply indicates that participants avoided selecting bad food 22 . Alternatively, this might suggest that the type of food or food categories are less decisive for experienced eating happiness than often assumed. This relates to recent findings in the field of comfort and emotional eating. Many people believe that specific types of food have greater comforting value. Also in research, the foods eaten as response to negative emotional strain, are typically characterised as being high-caloric because such foods are assumed to provide immediate psycho-physical benefits 18 . However, comparing different food types did not provide evidence for the notion that they differed in their provided comfort; rather, eating in general led to significant improvements in mood 19 . This is mirrored in the present findings. Comparing the eating happiness of “healthy” food choices such as fruits and vegetables to that of “unhealthy” food choices such as sweets shows remarkably similar patterns as, on average, they were associated with high eating happiness and their range of experiences ranged from very negative to very positive.

This raises the question of why the idea that we can eat indulgent food to compensate for life’s mishaps is so prevailing. In an innovative experimental study, Adriaanse, Prinsen, de Witt Huberts, de Ridder, and Evers 23 led participants believe that they overate. Those who characterised themselves as emotional eaters falsely attributed their over-consumption to negative emotions, demonstrating a “confabulation”-effect. This indicates that people might have restricted self-knowledge and that recalled eating episodes suffer from systematic recall biases 24 . Moreover, Boelsma, Brink, Stafleu, and Hendriks 25 examined postprandial subjective wellness and objective parameters (e.g., ghrelin, insulin, glucose) after standardised breakfast intakes and did not find direct correlations. This suggests that the impact of different food categories on wellness might not be directly related to biological effects but rather due to conditioning as food is often paired with other positive experienced situations (e.g., social interactions) or to placebo effects 18 . Moreover, experimental and field studies indicate that not only negative, but also positive, emotions trigger eating 15 , 26 . One may speculate that selective attention might contribute to the “myth” of comfort food 19 in that people attend to the consumption effect of “comfort” food in negative situation but neglect the effect in positive ones.

The present data also show that eating behaviour in the real world is a complex behaviour with many different aspects. People make more than 200 food decisions a day 27 which poses a great challenge for the measurement of eating behaviour. Studies often assess specific food categories such as fruit and vegetable consumption using Food Frequency Questionnaires, which has clear advantages in terms of cost-effectiveness. However, focusing on selective aspects of eating and food choices might provide only a selective part of the picture 15 , 17 , 22 . It is important to note that focusing solely on the “unhealthy” food choices such as sweets would have led to the conclusion that they have a high “indulgent” value. To be able to draw conclusions about which foods make people happy, the relation of different food categories needs to be considered. The more comprehensive view, considering the whole dietary behaviour across eating occasions, reveals that “healthy” food choices actually contributed the biggest share to the total experienced eating happiness. Thus, for a more comprehensive understanding of how eating behaviours are regulated, more complete and sensitive measures of the behaviour are necessary. Developments in mobile technologies hold great promise for feasible dietary assessment based on image-assisted methods 28 .

As fruits and vegetables evoked high in-the-moment happiness experiences, one could speculate that these cumulate and have spill-over effects on subsequent general well-being, including life satisfaction across time. Combing in-the-moment measures with longitudinal perspectives might be a promising avenue for future studies for understanding the pathways from eating certain food types to subjective well-being. In the literature different pathways are discussed, including physiological and biochemical aspects of specific food elements or nutrients 7 .

The present EMA based data also revealed that eating happiness varied greatly within the 14 food categories and meal types. As within food category variance represented more than two third of the total observed variance, happiness varied according to nutritional characteristics and meal type; however, a myriad of factors present in the natural environment can affect each and every meal. Thus, widening the “nourishment” perspective by including how much, when, where, how long, and with whom people eat might tell us more about experienced eating happiness. Again, mobile, in-the-moment assessment opens the possibility of assessing the behavioural signature of eating in real life. Moreover, individual factors such as eating motives, habitual eating styles, convenience, and social norms are likely to contribute to eating happiness variance 5 , 29 .

A key strength of this study is that it was the first to examine experienced eating happiness in non-clinical participants using EMA technology and imagery to assess food intake. Despite this strength, there are some limitations to this study that affect the interpretation of the results. In the present study, eating happiness was examined on a food based level. This neglects differences on the individual level and might be examined in future multilevel studies. Furthermore, as a main aim of this study was to assess real life eating behaviour, the “natural” observation level is the meal, the psychological/ecological unit of eating 30 , rather than food categories or nutrients. Therefore, we cannot exclude that specific food categories may have had a comparably higher impact on the experienced happiness of the whole meal. Sample size and therefore Type I and Type II error rates are of concern. Although the total number of observations was higher than in previous studies (see for example, Boushey et al . 28 for a review), the number of participants was small but comparable to previous studies in this field 20 , 31 , 32 , 33 . Small sample sizes can increase error rates because the number of persons is more decisive than the number of nested observations 34 . Specially, nested data can seriously increase Type I error rates, which is rather unlikely to be the case in the present study. Concerning Type II error rates, Aarts et al . 35 illustrated for lower ICCs that adding extra observations per participant also increases power, particularly in the lower observation range. Considering the ICC and the number of observations per participant, one could argue that the power in the present study is likely to be sufficient to render the observed null-differences meaningful. Finally, the predominately white and well-educated sample does limit the degree to which the results can be generalised to the wider community; these results warrant replication with a more representative sample.

Despite these limitations, we think that our study has implications for both theory and practice. The cumulative evidence of psychological benefits from healthy food choices might offer new perspectives for health promotion and public-policy programs 8 . Making people aware of the “healthy = happy” association supported by empirical evidence provides a distinct and novel perspective to the prevailing “unhealthy = tasty” folk intuition and could foster eating choices that increase both in-the-moment happiness and future well-being. Furthermore, the present research lends support to the advocated paradigm shift from “food as health” to “food as well-being” which entails a supporting and encouraging rather constraining and limiting view on eating behaviour.

The study conformed with the Declaration of Helsinki. All study protocols were approved by University of Konstanz’s Institutional Review Board and were conducted in accordance with guidelines and regulations. Upon arrival, all participants signed a written informed consent.

Participants

Thirty-eight participants (28 females: average age = 24.47, SD  = 5.88, range = 18–48 years) from the University of Konstanz assessed their eating behaviour in close to real time and in their natural environment using an event-based ambulatory assessment method (EMA). No participant dropped out or had to be excluded. Thirty-three participants were students, with 52.6% studying psychology. As compensation, participants could choose between taking part in a lottery (4 × 25€) or receiving course credits (2 hours).

Participants were recruited through leaflets distributed at the university and postings on Facebook groups. Prior to participation, all participants gave written informed consent. Participants were invited to the laboratory for individual introductory sessions. During this first session, participants installed the application movisensXS (version 0.8.4203) on their own smartphones and downloaded the study survey (movisensXS Library v4065). In addition, they completed a short baseline questionnaire, including demographic variables like age, gender, education, and eating principles. Participants were instructed to log every eating occasion immediately before eating by using the smartphone to indicate the type of meal, take pictures of the food, and describe its main components using a free input field. Fluid intake was not assessed. Participants were asked to record their food intake on eight consecutive days. After finishing the study, participants were invited back to the laboratory for individual final interviews.

Immediately before eating participants were asked to indicate the type of meal with the following five options: breakfast, lunch, afternoon tea, dinner, snack. In Germany, “afternoon tea” is called “Kaffee & Kuchen” which directly translates as “coffee & cake”. It is similar to the idea of a traditional “afternoon tea” meal in UK. Specifically, in Germany, people have “Kaffee & Kuchen” in the afternoon (between 4–5 pm) and typically coffee (or tea) is served with some cake or cookies. Dinner in Germany is a main meal with mainly savoury food.

After each meal, participants were asked to rate their meal on three dimensions. They rated (1) how much they enjoyed the meal, (2) how pleased they were with their meal, and (3) how tasty their meal was. Ratings were given on a scale of one to 100. For reliability analysis, Cronbach’s Alpha was calculated to assess the internal consistency of the three items. Overall Cronbach’s alpha was calculated with α = 0.87. In addition, the average of the 38 Cronbach’s alpha scores calculated at the person level also yielded a satisfactory value with α = 0.83 ( SD  = 0.24). Thirty-two of 38 participants showed a Cronbach’s alpha value above 0.70 (range = 0.42–0.97). An overall score of experienced happiness of eating was computed using the average of the three questions concerning the meals’ enjoyment, pleasure, and tastiness.

Analytical procedure

The food pictures and descriptions of their main components provided by the participants were subsequently coded by independent and trained raters. Following a standardised manual, additional components displayed in the picture were added to the description by the raters. All consumed foods were categorised into 14 different food categories (see Table  1 ) derived from the food classification system designed by the German Nutrition Society (DGE) and based on the existing food categories of the German Nutrient Database (Max Rubner Institut). Liquid intake and preparation method were not assessed. Therefore, fats and additional recipe ingredients were not included in further analyses, because they do not represent main elements of food intake. Further, salty extras were added to the categorisation.

No participant dropped out or had to be excluded due to high missing rates. Missing values were below 5% for all variables. The compliance rate at the meal level cannot be directly assessed since the numbers of meals and snacks can vary between as well as within persons (between days). As a rough compliance estimate, the numbers of meals that are expected from a “normative” perspective during the eight observation days can be used as a comparison standard (8 x breakfast, 8 × lunch, 8 × dinner = 24 meals). On average, the participants reported M  = 6.3 breakfasts ( SD  = 2.3), M  = 5.3 lunches ( SD  = 1.8), and M  = 6.5 dinners ( SD  = 2.0). In comparison to the “normative” expected 24 meals, these numbers indicate a good compliance (approx. 75%) with a tendency to miss six meals during the study period (approx. 25%). However, the “normative” expected 24 meals for the study period might be too high since participants might also have skipped meals (e.g. breakfast). Also, the present compliance rates are comparable to other studies. For example, Elliston et al . 36 recorded 3.3 meal/snack reports per day in an Australian adult sample and Casperson et al . 37 recorded 2.2 meal reports per day in a sample of adolescents. In the present study, on average, M  = 3.4 ( SD  = 1.35) meals or snacks were reported per day. These data indicate overall a satisfactory compliance rate and did not indicate selective reporting of certain food items.

To graphically visualise data, Tableau (version 10.1) was used and for further statistical analyses, IBM SPSS Statistics (version 24 for Windows).

Data availability

The dataset generated and analysed during the current study is available from the corresponding authors on reasonable request.

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Acknowledgements

This research was supported by the Federal Ministry of Education and Research within the project SmartAct (Grant 01EL1420A, granted to B.R. & H.S.). The funding source had no involvement in the study’s design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit this article for publication. We thank Gudrun Sproesser, Helge Giese, and Angela Whale for their valuable support.

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Deborah R. Wahl and Karoline Villinger contributed equally to this work.

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Department of Psychology, University of Konstanz, Konstanz, Germany

Deborah R. Wahl, Karoline Villinger, Laura M. König, Katrin Ziesemer, Harald T. Schupp & Britta Renner

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B.R. & H.S. developed the study concept. All authors participated in the generation of the study design. D.W., K.V., L.K. & K.Z. conducted the study, including participant recruitment and data collection, under the supervision of B.R. & H.S.; D.W. & K.V. conducted data analyses. D.W. & K.V. prepared the first manuscript draft, and B.R. & H.S. provided critical revisions. All authors approved the final version of the manuscript for submission.

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Wahl, D.R., Villinger, K., König, L.M. et al. Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments. Sci Rep 7 , 17069 (2017). https://doi.org/10.1038/s41598-017-17262-9

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Healthy Living Guide 2020/2021

A digest on healthy eating and healthy living.

As we transition from 2020 into 2021, the COVID-19 pandemic continues to affect nearly every aspect of our lives. For many, this health crisis has created a range of unique and individual impacts—including food access issues, income disruptions, and emotional distress.

Although we do not have concrete evidence regarding specific dietary factors that can reduce risk of COVID-19, we do know that maintaining a healthy lifestyle is critical to keeping our immune system strong. Beyond immunity, research has shown that individuals following five key habits—eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking— live more than a decade longer than those who don’t. Plus, maintaining these practices may not only help us live longer, but also better. Adults following these five key habits at middle-age were found to live more years free of chronic diseases including type 2 diabetes, cardiovascular disease, and cancer.

While sticking to healthy habits is often easier said than done, we created this guide with the goal of providing some tips and strategies that may help. During these particularly uncertain times, we invite you to do what you can to maintain a healthy lifestyle, and hopefully (if you’re able to try out a new recipe or exercise, or pick up a fulfilling hobby) find some enjoyment along the way.

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Healthy Food Essay

The food that we put into our bodies has a direct impact on our overall health and well-being. Eating a diet that is rich in nutritious, whole foods can help us maintain a healthy weight, prevent chronic diseases, and feel our best. It is important to make conscious, healthy food choices to support our physical and mental well-being. By incorporating a variety of fruits, vegetables, whole grains, and lean proteins into our diets, we can ensure that our bodies are getting the nutrients they need to thrive. Here are a few sample essays on healthy food.

100 Words Essay On Healthy Food

Healthy food is essential to maintaining a healthy and balanced lifestyle. First and foremost, healthy food is food that is nutritious and good for the body. This means that it provides the body with the vitamins, minerals, and other nutrients it needs to function properly. Healthy food can come in many forms, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Healthy food is important for maintaining a healthy body and mind. It provides the nutrients and energy the body needs to function properly and can help to prevent a wide range of health problems. So, if you want to feel your best, be sure to make healthy food a priority in your life.

200 Words Essay On Healthy Food

Healthy food is not just about what you eat – it’s also about how you eat it. For example, eating fresh, whole foods that are prepared at home with love and care is generally considered to be healthier than eating processed, pre-packaged foods that are high in salt, sugar, and unhealthy fats. Additionally, eating in moderation and avoiding excessive portion sizes is key to maintaining a healthy diet.

There are many reasons to eat healthy food, but the most obvious one is that it can help to prevent a wide range of health problems. Eating a diet rich in fruits, vegetables, and other healthy foods can help to lower your risk of heart disease, stroke, obesity, and other chronic conditions. Additionally, healthy food can help to boost your immune system, giving your body the tools it needs to fight off illness and infection. But the benefits of healthy food go beyond just physical health. Eating well can also have a profound impact on your mental and emotional well-being. A healthy diet can help to reduce stress and anxiety, improve mood, and increase energy levels. It can also help to improve cognitive function and memory, making it easier to focus and concentrate.

500 Words Essay On Healthy Food

Healthy food is an essential aspect of a healthy lifestyle. It is not only crucial for maintaining physical health, but it can also have a significant impact on our mental and emotional well-being. Eating a balanced diet that includes a variety of fruits, vegetables, whole grains, and lean proteins can help us feel energised, focused, and happy. But for many people, eating healthy can be a challenge. In a world where fast food and processed snacks are readily available and often more convenient than cooking a meal from scratch, it can be tempting to choose unhealthy options. And with busy schedules and hectic lives, it can be difficult to find the time and energy to plan and prepare healthy meals.

However, the benefits of eating healthy far outweigh the challenges. Not only can it help us maintain a healthy weight and reduce our risk of chronic diseases like heart disease, diabetes, and cancer, but it can also improve our mood, energy levels, and overall quality of life.

My Experience

As I sat down at my desk with a bag of chips and a soda for lunch again, I realised that I had been making unhealthy food choices all week. I had been so busy with work and other obligations that I hadn't taken the time to plan and prepare healthy meals. I decided then and there to make a change. I started by making a grocery list of nutritious, whole foods and meal planning for the week ahead. I also made a commitment to myself to cook at home more often instead of relying on takeout or fast food. It wasn't easy at first, but over time, I started to notice a difference in my energy levels and overall mood. I felt better physically and mentally, and I was able to maintain a healthy weight. Making healthy food choices became a priority for me, and I am now reaping the numerous benefits of a nutritious diet.

One of the key components of a healthy diet is variety. Eating a diverse range of fruits, vegetables, whole grains, and lean proteins can provide our bodies with the nutrients, vitamins, and minerals we need to function at our best. It's important to try to incorporate a rainbow of colours into our diets, as each colour group represents different nutrients and health benefits. For example, orange and yellow fruits and vegetables are rich in vitamin C and beta-carotene, which can support healthy skin and eyesight. Green leafy vegetables like spinach and kale are packed with antioxidants and can help support a healthy immune system. And blue and purple fruits and vegetables, like blueberries and eggplants, are high in flavonoids and can help support brain health and cognitive function.

In addition to eating a variety of fruits and vegetables, it's also important to include whole grains in our diets. Whole grains, like quinoa, brown rice, and oatmeal, are a great source of fibre, which can help keep us feeling full and satisfied. They can also help regulate our blood sugar levels, which can keep our energy levels steady and prevent unhealthy cravings.

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• Healthy Food Essay

Essay on Healthy Food

Food is essential for our body for a number of reasons. It gives us the energy needed for working, playing and doing day-to-day activities. It helps us to grow, makes our bones and muscles stronger, repairs damaged body cells and boosts our immunity against external harmful elements like pathogens. Besides, food also gives us a kind of satisfaction that is integral to our mental wellbeing, but there are some foods that are not healthy. Only those food items that contain nutrients in a balanced proportion are generally considered as healthy. People of all ages must be aware of the benefits of eating healthy food because it ensures a reasonably disease-free, fit life for many years. 

Switching to a healthy diet doesn't have to be a one-size-fits-all approach. You don't have to be perfect, you don't have to eliminate all of your favourite foods and you don't have to make any drastic changes all at once—doing so frequently leads to straying or abandoning your new eating plan.

Making a few tiny modifications at a time is a recommended approach. Maintaining modest goals will help you achieve more in the long run without feeling deprived or overwhelmed by a very drastic diet change. Consider a healthy diet as a series of tiny, accessible actions such as including a salad in your diet once a day. You can slowly add additional healthy options as your minor modifications become habitual.

Cultivating a positive relationship with food is also crucial. Rather than focusing on what you should avoid, consider what you may include on your plate that will benefit your health such as nuts for heart-healthy, predominant fat that reduces low-density lipoprotein levels called monounsaturated fatty acids(raspberries) for fibre and especially the substances that inhibit oxidation which we call antioxidants.

Why is Healthy Food Important?

Living a healthy lifestyle has immense payback. Over time, making smart eating choices lowers your risk of cardiovascular disease, certain malignancies, type 2 diabetes, obesity, and even anxiety and depression. Daily, you will have more energy, feel better and possibly even be in a better mood.

It all boils down to how long and how good your life is. According to several surveys, A healthy diet consists of whole grains, vegetables, fruits, nuts, and fish. A higher diet of red or processed meats on the other hand doubled the chance of dying young.

Types of Healthy Food: 

Following are the various types of healthy foods and their respective nutritional value:

Cereals,potatoes,bread and other root vegetables- These are the main sources of carbohydrates. The calories obtained from them enable us to do work. 

Pulses, milk and milk products, eggs, bird meat, animal meat in limited quantities - these are great sources of protein. They build muscles and repair the damaged cells of our body, i.e., they are important for our immunity. 

Ghee, butter, nuts and dry fruits, edible oil used in restrained quantities- These are rich sources of good fat. They provide more energy to our body than carbohydrates but should be consumed in a smaller amount. 

Fresh fruits, vegetables and leafy vegetables, fish, egg, milk-these are good sources of vitamins, minerals and antioxidants are essential for normal functioning of the body. Though they are needed in small amounts, nowadays, nutrition experts prescribe their higher consumption as they help to fight lifestyle diseases like diabetes, obesity and even cancer. 

Different types of healthy food when included in our daily diet in the right proportions along with water and roughage comprise a balanced diet. However, a balanced diet is not the same for all individuals considering many factors. It depends on a person’s age, gender, condition of the body-healthy or suffering from any disease and the type of work or physical activity a human  does.

Benefits of Eating Healthy

Healthy food intake nourishes both our physical and mental health and helps us stay active for many years. One who break downs this broad benefit into micro-benefits will see that eating healthy:

Helps us in weight management

Makes us agile and increases our productivity 

Decreases the risk of heart diseases, stroke, diabetes mellitus, poor bone density, and some cancers, etc. 

Helps in uplifting mood

Improves memory

Improves digestion and appetite

Improves sleep cycle

Healthy food habits are inculcated in children by their parents early on. These habits along with the right education and physical exercise lead to an overall development of an individual which ultimately becomes the greatest resource of a country.

What is Unhealthy Food or Junk Food?

To fully understand the prominence of healthy food in our diet, we must also be aware of unhealthy food, that is, the food that we must avoid eating. These are mainly junk food items which are low in nutritional value and contain an excessive amount of salt, sugar and fats which is not healthy for a human body.

Junk food is one of the unhealthy intakes in the present day scenario. It makes us more unfit than ever before. It is high time that one realised this and adopted a healthy food habit for a sustainable lifestyle.

Steps to improve Eating Habits:

Make a detailed plan; break down the timings; kind of food to be included in each meal and keep the plan weekly and avoid making the process dull and repetitive. 

Cook your food, minimise eating from outside. It helps keep the ingredients, quality and measurements in check as well as saves money.

Stock your kitchen with healthy snacks for your cravings rather than processed food so that your options are reduced to consuming unhealthy food.

Take the process slowly. You do not have to have a strict plan; ease yourself into a healthy mindset. Your mind and body will adjust gradually. Consistency is important. 

Track your eating habits to understand the intake of food, items, portions etc. This motivates you to see the progress over time and make changes according to your needs.

Myths About Healthy Food:

Carrots affect eyesight: According to historic times, during World War II, there was a popular belief that eating a lot of veggies would assist maintain the pilot's eyes in good repair. In actuality, the fighter pilot's eyesight was aided by advanced technology. However, the myth has persisted since then and many parents still use this narrative to get their children to eat more veggies. Carrots are high in vitamin A and make a terrific supplement to any healthy diet, but they don't usually help you see better.

Fat-Free Food : Health foods continue to dominate grocery store shelves but it's always a good idea to look beyond the label before buying. This is especially true when it comes to "fat-free," "low-fat," and "non-fat" foods. It's generally true that anything with less fat is preferable for some dairy and meat items. 

Lower fat alternatives in packaged and processed foods contain other dangerous additives as fat substitutes. Manufacturers compensate for the loss of fat in packaged cookies, for example, by adding other undesirable elements like sugar.

Protein shakes: Pre-made smoothie beverages and protein powder mixes which typically claim to contain less sugar than milkshakes, slushies and diet sodas are likely to be the popular choice among customers because of the above mentioned reason. They both have the same amount of sugar and artificial sweeteners. 

However, this is not true of all pre-made protein shakes and smoothies. Many of them, particularly the plant-based mixtures, are still nutritious additions to a balanced diet. Check the nutrition label to be sure there are no added sugars or artificially sweetened mixtures.

Organic food is better: Foods that are grown organically are better for you. Nutritionists labelling a product as organic doesn't mean it's superior to non-organic foods. It's a popular misperception that organic produce is nutritionally superior to non-organic produce. Organic produce has the same caloric and nutritional value as non-organic produce since it is grown and prepared according to federal rules.

FAQs on Healthy Food Essay

1) Is sugar unhealthy?

Sugar is considered to be harmful for a healthy diet. Since it tastes so good in many foods, humans tend to increase it’s intake. It is also hidden in foods you wouldn't expect. It makes body organs fat, depresses well-being and also leads to heart diseases. However, to maintain a healthy diet, it is necessary to distinguish between natural and added sugars. Sugars are carbs that provide an essential source of energy and nourishment, nevertheless, sugar is often added to many popular dishes, which is when sugar becomes unhealthy. Natural sugars found in fruits and vegetables are regarded as healthy when consumed in moderation. Still added sugars give little nutritional benefit and contribute considerably to weight gain, compromising your healthy diet. As a result, it's critical to double-check the label.

2) What is Omega 3?

Omega-3 is the superfood of the fat group, which is particularly useful for various conditions, since the term "superfood" was coined. Omega-3 fatty acid is a medicine used in treating  nutritional deficiencies. It is one of the essential nutrients with good antioxidant properties. Depression, memory loss, heart problems, joint and skin disorders and general improvement of physical and mental health and wellness are among them. Omega-3 which is abundant in fish-based diets is considered a necessary fatty acid for good health.

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.

Get the huge list of more than 500 Essay Topics and Ideas

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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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.

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.

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

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.

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.

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.

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.

Linear regression model for anthropometry.

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.

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.

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.

Healthy Food Essay

Healthy food essay teaches kids the importance of eating healthy food every day. You can provide the children with BYJU’S importance of healthy food essay.

Food is a fundamental part of our life. It is the fuel that helps us go about our daily routine, and it is the meal that makes us feel good at every minute of the day. Food plays an important role in staying healthy.

The food we eat determines the health of our body, and some foods are better for our bodies than others. Healthy food contains a lot of fibre, has a low glycemic index, and is high in nutrients. Furthermore, the consumption of healthy food benefits our mental and physical health.

This short essay on healthy food helps us understand its significance, along with a healthy lifestyle.

Advantages of Healthy Food

People often consider eating healthy because it helps them look and feel better. There are many reasons to eat healthy food as it has numerous advantages. Some of the most important advantages include reducing the risk of cancer, heart disease, obesity and diabetes, which eventually improves the quality of life.

There are also people who prefer healthier options for themselves. This can be for various reasons, including not wanting to gain weight, not spending a lot of money on food that would eventually go to waste, or just because they want to make sure their diet is as healthy as possible.

A portion of healthy food can help prevent disease. Moreover, healthy foods can help keep us away from getting sick from all of the chemicals in processed and junk foods.

When we eat healthily, we stay healthy.

Healthy Food vs Junk Food

We are in an era of dominance of the fast-food industry. There is a lot of information on the internet that shows people how they can live healthier and less expensive lives. One of the ways to do this is by purchasing healthy food instead of junk food. Many restaurants and grocery stores have received backlash for their unhealthy options.

It is high time to understand the difference between healthy food vs junk food by reading the healthy food vs junk food essay available at BYJU’S and adapting ourselves to healthy eating habits.

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Frequently Asked Questions on Healthy Food Essay

What are the benefits of healthy food.

There are many health benefits to consuming healthy food. Some of the benefits are it helps increase metabolism, enhances the immune system, lessens inflammation associated with heart disease, reduces the risk of cancer, obesity, diabetes, blood pressure, cholesterol, helps control body weight, etc.

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• Achieving healthy growth and weight includes healthy eating, physical activity, optimal sleep, and stress reduction.
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Healthy eating, physical activity, optimal sleep , and stress reduction are important to achieving optimal health and managing weight as you age. Several other factors may also affect weight gain.

People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions .

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Eat healthy foods

Healthy eating means incorporating a variety of healthy foods into your eating pattern. Fad diets promise fast results. However, such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. See these tips instead:

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Manage your weight.

You can use the body mass index (BMI) calculator as a screening tool for your weight. See more information to help manage your weight.

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Healthy Habits: Fruits and Vegetables to Manage Weight

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Preventing Childhood Obesity: 6 Things Families Can Do

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