INTRODUCTION: School nutrition policies are a proposed strategy to address the burden of obesity and have been introduced in several countries. This systematic review aimed to determine the impact and feasibility of such policies by reporting the impact of real world policies on the school food environment, and barriers and enablers to their implementation. Given the known socioeconomic inequalities in obesity prevalence, this review also aimed to report the impact of the included policies in relation to socioeconomic position.
METHODS: Seven databases were searched on March 30 2015 using keywords and Medical Subject Headings related to nutrition policies and schools. Before-and-after studies which reported on the impact of real world school nutrition policies on the foods and beverages available in primary schools were eligible for inclusion. The included studies were assessed for quality using a standard quality assessment tool and synthesised using narrative analysis.
RESULTS: 2532 records were screened for relevance. Seven studies met all eligibility criteria and were included. Six of the included studies reported positive changes to the foods and beverages available after policy introduction. Changes included increased availability of healthier foods and decreased availability of less healthy foods. Barriers and/or enablers to implementation were reported in five studies and included difficulty finding compliant foods, potential revenue loss, and perceiving the policy to be of value. Three studies made specific mention of socioeconomic position; findings were mixed across these studies. The majority of studies were of weak quality.
CONCLUSIONS/IMPLICATIONS: Given the opportunity schools provide to influence children’s nutrition habits, school nutrition policies offer a promising strategy to improve diet quality. Further research to establish any differences in policy impact between schools of different socioeconomic position is needed to ensure policies do not widen existing health inequalities.