Promoting Nutrition in Schools: Evidence-Based Strategies and Program Plan

This article discusses the need for promoting healthy eating habits among young children to prevent obesity and chronic diseases. It proposes evidence-based strategies such as the Nutrition-Friendly Schools Initiative and the Health Promoting School approach, and provides a program plan for implementation. The targeted goals include reducing energy intake, increasing high-nutrient food intake, limiting sugar consumption, and enhancing nutritional knowledge.

Nutrition Promotion
Name
Addres
Date
Name
Address
Date
Dear, Sir/ Madam
I would like to bring to your attention the need for addressing the current prevalence of
overweight and obese cases among young children. As a Masters Graduate in in Nutrition, the
emergence of this pandemic has largely been brought about by poor health and nutritional
behaviors among the young population.
The Australian National Health and Medical Research Council designates that children should be
accorded optimum nutrition for the purpose of bolstering healthy growth and development.
Healthy eating in this case will ensure that children are able to maintain healthy weight and have
a guaranteed protection against premature mortality that may arise from chronic illnesses such as
diabetes, high blood pressure, cardiovascular diseases and cancer amongst others Dudley. (1)
On the contrary, if children are subjected in an environment where unhealthy eating
characterized by high consumption of energy dense foods and poor intake of fruits and
vegetables, is regarded as a societal norm, then their health is put at high risk. In such a case and

at such an early stage of their life, they are likely to succumb to non-communicable diseases
Farinelli. (2) As such, it is of primary concern that children become exposed to healthy eating
behaviors at an early stage of their life.
Further evidence also suggests that developing healthy eating practices at childhood can have
beneficial effects as the young generation transition into adulthood. For one, they are likely to
inculcate such behaviors or eating patterns in later years of their lives. Also, the risk of the
aforementioned diseases becomes significantly reduced as they age Katz. (3) Schools, provide
the ideal setting to instill such desirable practices in children not only because they act as the
epicenter of connecting parents, community, teachers and children, but also because they have
the infrastructure, physical environment, curricular and teaching that can foster health and
nutrition promotion UNSCN. (8)
To conclude, the urgency for obesity pandemic and related chronic diseases cries for action
necessitating evidence-based intervention strategies which can ideally be fully implanted within
a school setting. The targeted healthy outcomes for this program would be to reduce the
consumption of energy dense foods, reduce sugar consumption, increase fruit and vegetable
intake, and most importantly to increase nutritional knowledge.

Program Plan
1.0 Introduction and Purpose
Primary school children require good health and development and this can primarily be
achieved through healthy eating. Schools have a great role to play in the promotion of healthy
eating among children due to a number of factors. For one, school settings act as access points
for engaging students, parents and the community in health and nutrition promotion WHO.(4)
Furthermore, schools have vast infrastructure, curricula and policies, teaching and learning
resources, committed staff and a physical environment that can foster and influence children
positively to develop healthy eating for nutritional purposes. (1) Nonetheless, it should be noted
that the efficacy and success of any nutritional-based program relies on teachers and the
community as the key agents in enhancing health and nutrition among children.
The current prevalence of obesity is worrying with evidence indicating that one in three
children is either overweight or obese thereby creating the issue of obesity epidemic.
Furthermore, this weight increase constitutes disposition of visceral fat that further leads to
metabolic distress as well as chronic diseases. Research indicates that obesity is major risk factor
in type 2 diabetes and significant contributor to chronic diseases such as cardiovascular diseases,
hypertension, cancer and stroke. (2) Alternatively, children who are overweight or obese
experience diminished quality of life and other psychological implications such as decreased
self-esteem and depressive symptoms, and being socially ostracized. (3)
In light of such evidence, there is dire need to ensure that children are exposed to a school
setting that supports health and nutrition promotion by implementing evidence-based action plan.

A substantially confluent program that promotes health and eradicates associated effects of
unhealthy eating is therefore warranted. The targeted goals for such a program should include;
I. Reduce energy intake by minimizing consumption of energy-dense foods
II. Increase the intake of high-nutrient foods such as fruits and vegetables
III. Limit consumption of foods that have high content of sugar
IV. Enhance nutritional knowledge
2.0 Evidence-Based Strategies
2.1 Nutrition-Friendly Schools Initiative (NFSI)
The NFSI approach was confounded on the need to address the global public health and
its success lies within school-based programs that offer direct access to children in a bid to
promote healthy dietary and physical habits. In this light, this strategy basically serves as a
framework to interconnect developed school-based programs that are aimed towards health
promotion. It thus connects the local community, teachers, parents, associated private and public
organizations, and children. Additionally, this program has the ability to create an enabling
environment that can promote health and nutritional well-being of children who are engaged in
the program. (4)
There are several core components associated with this approach including; a well-
written nutrition-friendly school policy, creating a supportive school environment, developing
health and nutrition promoting curriculum and providing supportive nutrition services. A
nutrition policy in this case should cover healthy diets and desirable eating practices which
ideally revolve around the consumption of fruits and vegetables and limited intake energy dense

foods. A rationale for eating such food intake should also be provided within the policy to enable
students understand the nutritional benefits associated with eating such food Rodrigo et al. (5)
Aside from a mandatory policy, the school setting needs to create an enabling and
supporting environment which takes into account the efforts of the entire stakeholders including;
parents, teachers, children and the community. At the community level also, cafes and fast food
areas are the point of purchase for energy-dense foods and foods that are rich in calories. (4)
Provision of nutrition information at this point of purchase including energy/calorie labeling and
nutrient profiling should also be made mandatory. Ideally, research indicates that labeling of
packaged foods have a strong impact on increasing the sales and consumption of healthy foods.
(1) Alternatively, it limits the selection of foods that have high energy levels as well as sugary
and sweetened foods. (3)
Another environmental component utilized under NFSI is changing the availability of
unhealthy foods. This can be done by changing the pricing structure in cases where unhealthy
foods are made pricy while healthy food options become less expensive. This initiative will
dispel the misconception that healthy eating is associated with higher costs of food. Rodrigo et
al. (5) findings illustrate that such interventions which have incorporated the entire community in
modifying the school environment have been the most effective in promoting health and
nutrition promotion.
2.2 The Health Promoting School (HPS)
HPS is an approach that focuses on the health and educational outcomes related with
nutrition promotion among children. Likewise, emphasis within this program is placed on
learning and teaching experiences that are primarily initiated by the school. The success of this

program is reliant on the developed nutrition-based school policies, the physical and social
environment, and community links. (4) HPS, therefore, ensures that there is coherence between
the school’s policies and other related practices that promote social inclusion and the
commitment to educational outcomes as well as reduced health risk behaviors.
Several learning or educational strategies are proposed under this approach and basing on
the available evidence, such practices have proven to be effective in enhancing educational levels
among children in regards to nutrition promotion Chen et al. (6) Notably, this school-based
intervention will rely on several key approaches tailored and supported by teachers including;
curriculum initiatives, health or nutrition education and environmental school-change strategies.
(1)
Enhanced curriculum approaches where special nutrition education that is beyond the
school’s health curricula was thus proposed and would be delivered by teachers or nutrition
specialists. Cross-curricular approaches are deemed to be an effected teaching practice that can
be used in this approach. (6) This subdivision under the HPS would ideally involve incorporating
nutrition education programs that is delivered across more than one traditional primary school
subjects. Also, this program requires parental involvement which basically requires parents to
provide assistance in educating the child outside of the school environment. (2) In addition,
experiential learning approaches inclusive of school or community garden, food preservation and
cooking activities should also be included.
Available evidence indicates that curriculum based approaches are the most popular in
promoting food consumption and minimizing energy intake. However, study by Dudley et al. (1)
suggests that the utilization of such a strategy alone does not provide the best influence in

reducing the intake of energy-dense foods. Experiential learning approaches were subsequently
proposed to counter this limitation. Implementation of this teaching practice was highly
associated with reduced food consumption and energy intake especially in areas where children
were involved in lessons of cooking and food preparation. According to this study however,
curriculum based-approaches were the most effective and popular in encouraging the
consumption of fruits and vegetables among young children within a school setting. (1)
Experiential learning strategies are the most effective in increasing nutritional knowledge
of primarily school children because the learners become highly engaged in health and nutrition
promotion activities Lawrence et al. (7) Activities such as garden-enhanced learning objectives
will have a positive influence on the preference of foods that rich in nutrients such as vegetables
and fruits. This is mainly because school gardens increase access to vegetables while gardening
practices reduces children’s reluctance to try new foods. Hence, experiential learning strategies
will improve children’s experiences or exposure to foods and also increase the availability and
accessibility of such foods. Eventually a child’s willingness to taste the food becomes enhanced.
(3)
Available evidence indicates that HPS is a pivotal approach in addressing health related
issues within an educational context since it improves both health and educational outcomes.
Student-teacher and teacher-teacher interactions are the key factors that affect learning process
among children within a school setting. Through such interaction, primary school children can be
able to enhance their knowledge regarding the best nutritional foods that should be consumed
NAHIC. (9)
3.0 Program Timeline

The program will be subdivided into three phases with the first phase primarily revolving
around development and implementation of NFSI, the second phase will encompass
implementation of HPS while the third phase will involve the two approaches running
concurrently. In the first phases, main activities included are; collaboration to develop school
policy, community engagement to relay the plan, review of policy to incorporate all stakeholders,
implementation and evaluation. In the second phase, training teachers, pretesting curricula,
parent engagement, seeking nutritional specialists, making amendments based on teacher
proposals and implementation. The program will run between mid-2019 and the end of 2021.
Phase 1 (NFSI) Phase 2 (HPS) Phase 3
Timeline Activities/ Milestones Activities/Milestones Activities/Milestones
01/06/2019 – 15/09/2019 School collaboration to
develop policy
Teachers training.
Curricula pretesting.
16/09/2019 – 05/02/2020 Community
involvement and Policy
review
Parent engagement.
Sourcing specialists.
06/02/2020 – 20/07/2020 Policy implementation Amending policy (if
necessary).
Fine-tuning curricula
Information dissemination
21/07/2020 – 30/11/2020 Policy implementation.
Policy review and
feedback engagement.
Feedback and data
gathering
07/01/2021 – 20/05/2021 Stakeholder
collaboration for HPS
and NFSI
Stakeholder collaboration
for HPS and NFSI
23/05/2021 – 12/08/2021 NFSI Policy evaluation HPS policy evaluation Implementation and
Evaluation
23/05/2021 – 12/08/2021 Overall evaluation
3.1 Order of Implementation
Nutrition education which is the main component under HPS should be an ongoing
activity one which is expected to be carried out by children as they track into adulthood. This is
one of the main reasons why the HPS program should succeed NFSI. (4) Even so, HPS is

confounded on a well-documented school policy that stipulates the health and nutrition curricula
which is ideally under NFSI. (9)Therefore, NFSI will act as the primary guide for the two
approaches and all the initiatives under this program should be the preliminary strategies that are
implemented before focusing on a comprehensive learning and teaching experience in the form
of HPS.
4.0 Stakeholder Engagement
At the top-most level, the school’s administration is tasked with developing and
overseeing the implementation of the two approaches. In the first approach, the leaders of the
institution are expected to liaise with the teachers and parents in formulating health and nutrition
policy that will guide children on their food consumption behaviors. (8) Such interactions and
final decision making can be conducted through forums and parent-teacher meetings.
Influencing the pricing strategies used by private vendors within the school environment
will depend on the collaboration between the school’s administration and these private entities.
In such a case, the school should have an upper negotiating hand since it provides the primary
market for such business needless to say that such business activities are conducted within the
school’s premises. (7) It can alternatively be noted that community members will be expected to
leverage resources and participate in community level forums such as advocacy groups and the
media in enhancing awareness regarding health and nutrition promotion. (10)
Implementation of the HPS program will depend on the willingness of the burdened staff
to undertake the educational and teaching strategies to enhance nutritional knowledge.
Furthermore, resources provided by the administration of the school including educational
materials and support by program leaders will be valuable in enhancing the efforts put in by the

teachers. The teachers should also be allowed the chance to pretest the curriculum before full
implementation. Such freedom will enable the teachers’ efficient adaptation and making
improvements in the design and time of the curricula before gaining acceptance. (10)
Parents are similarly considered as important carriers of health information under the
cross-curricular approach. Parental will therefore, be required to assist in the education process
of their children especially in an environment that is not within the school setting. (1) In addition
teacher-to-teacher interactions will also be essential at an individual level in changing the
perceptions, attitudes and beliefs regarding nutrition promotion. In such cases, they will be
expected to engage in in discussions concerning risks and benefits associated with healthy eating,
and the findings should likewise be transfused among children.
5.0 Evaluation and Dissemination Plan
The evaluation of the program will be based on regular monitoring of children within the
school to check the growth and development. Any health related issues should also be noted to
dictate future amendments to the program. The success of the monitoring tool will depend on an
effective feedback system for parents and children regarding the findings. Collaboration from all
associated stakeholders would also be crucial in evaluation of the program. Sensitive issues
should be addressed at every point of occurrence with efficiency and accuracy before making
any necessary amendments. Nonetheless, the progress of the program should be gauged against
the targeted goals and arising results should be used in evaluating the process for purposes of
encouraging future improvements on the two approaches.

6.0 References
1) Dudley A, Cotton WG, Peralta LR. Teaching Approaches and Strategies that Promote
Healthy Eating in Primary School Children: A Systematic Review and Meta-Analysis.
International Journal of Behavioral Nutrition and Physical Activity. 2015; 12:28.
2) Farinelli MA. Nutrition Promotion to Prevent Obesity in Young Adults. Healthcare
(Basel). 2015; 3(3): 809-829.
3) Katz DL. School Based-Interventions for Health Promotion and Weight Control: Not Just
Waiting on the World to Change. Annual Review of Public Health. 2009; 30: 253-272.
4) (WHO) World Health Organization. A School-Based Program to Address the Double
Burden of Malnutrition. Available from
https://www.who.int/nutrition/topics/NFSI_Briefing_presentation.pdf
5) Rodrigo CP, Aracenta J. Nutrition Education in Schools: Experiences and Challenges.
2013; 57(1): 82-85.
6) Chen, SB, Crawford P, Omar RD, Drewnowski A, Hanifa N, Schneeman B, Towsend M.
Building Effective Nutrition Policy Demands Strong Scientific Base.
7) Lawrence, SL, Young I, Blanchard C, Perry M. Promoting Health in Schools from
Evidence to Action. 2010.
8) (UNSCN) United Nations System Standing Committee on Nutrition. Schools as a System
to Improve Nutrition. 2017. Available from
https://www.unscn.org/uploads/web/news/document/School-Paper-EN-WEB-8oct.pdf
9) (NAHIC) The National Adolescent and Young Adult Health Information Center. A
Guide for Evidence-Based Programs for Adolescent Health: Programs Tools and More.
2014.

10) (CDC) Centers for Disease and Control Prevention. Creating Supportive School Nutrition
Environments. 2013. Available from
https://www.cdc.gov/healthyschools/npao/pdf/LWP_SchoolNutrition_Brief_2012_13.pdf