ArticleThe international journal of behavioral nutrition and physical activity2024
Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children's lunches in England and Scotland: a natural experiment.
Article in The international journal of behavioral nutrition and physical activity, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Inequities in Children's Food Environment: A Comparison between Slum and Non-slum Settings in Urban Bangladesh.Journal of urban health : bulletin of the New York Academy of Medicine · 2026Article
- Lunches in UK early years education and care settings: cross-sectional analysis of food processing, provision and intake.Research square · 2026Article
- Do children in food-insecure households in England access free school meals? A cross-sectional analysis of the UK Family Resources Survey.BMJ public health · 2026Article
- The "pro-inflammatory imprint" of ultra-processed food exposure: a review of mechanisms affecting child and adolescent health and development via the gut microbiome-inflammation axis.Frontiers in nutrition · 2026Review
- Unraveling Future Trends in Free School Lunch and Nutrition: Global Insights for Indonesia from Bibliometric Approach and Critical Review.Nutrients · 2025Review
- Predictors of short stature in Israeli children aged 6-7 years: a retrospective cohort study.Israel journal of health policy research · 2025Article
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10 authors.
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Abstract
backgroundThe Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.
methodsData from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.
resultsBefore UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.
conclusionsThis study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet.
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