A Trial to Improve the Healthiness of Packed Lunches in Primary School Aged Children
Condition: Obesity, Childhood; Diet Modification
MeSH terms: Pediatric Obesity
Study type: Interventional

Summary: 
      Public Health England's (PHE) Behavioural Insights Team are leading and fully funding a
      randomised controlled research trial in collaboration with Derby City Council's Public Health
      Team and the Health and Social Care Research Centre at Derby University to test an
      intervention designed to help families provide healthier packed lunches for Primary School
      aged children.
    

Detailed description: 
      Children in Derby gain more weight during primary school than the national average. For 4-5
      year olds, Derby is in the best performing quartile of English councils, with 20% having
      excess weight. However, by the age of 10-11 Derby drops to the second lowest quartile, with
      35% of children having excess weight . In order to reduce childhood obesity in Derby, primary
      schools are a key area to focus on. Furthermore, it is a priority to focus on children living
      in deprived areas, as there is a strong relationship between deprivation and childhood
      obesity.

      Research shows that packed lunches are higher in sugar, salt and saturated fat than school
      meals. , Furthermore, the nutritional gap between packed lunches and school meals has widened
      since the introduction of the food-based standards for school meals in 2006. A cross
      sectional survey, assessing packed lunches of 1,294 children in 87 primary schools, found
      only 1% met the standards for school meals in England, with 82% containing restricted snacks,
      i.e., crisps or confectionary, and 61% including sugar sweetened drinks. Therefore,
      significantly improving the quality of packed lunches could be an important step to reducing
      childhood obesity rates in Derby.

      Previous research has highlighted that improving the quality of packed lunches can be
      challenging. For example, a UK-wide randomised controlled trial found that a "SMART lunch
      box" intervention had a positive impact on certain food groups but failed to reduce the
      overall calories in lunchboxes. The intervention, which included an extensive set of
      approaches, e.g., lunch bags, food boxes, wall charts, food games and stickers, increased
      vegetables packed by 11% and decreased savoury snacks packed by 14%, but failed to reduce
      confectionary and sweetened drinks . Other interventions, using educational videos and
      incentives aimed at children, had similar small, yet positive effects over a 12-month period
      . However, research has shown that relatively small, sustained behavioural changes can have a
      big cumulative impact: reducing calorie consumption by just 30-100 calories a day would have
      a considerable effect on obesity levels . The small effects of previous studies also
      highlight the importance of robustly evaluating any approach that is introduced.

      In order to reduce childhood obesity in Derby, primary schools are a key area to focus on.
      Research shows that packed lunches are higher in sugar, salt and saturated fat than school
      meals, and a survey found only 1% of packed lunches met the standards for school meals in
      England . Therefore, significantly improving the quality of packed lunches could be an
      important step to reducing childhood obesity rates in Derby.

      This trial is designed to test whether a multiple component intervention, focused on parents
      and developed with an understanding of the drivers behind behaviour, can increase the
      healthiness of packed lunches brought into school by reducing the presence of unhealthy
      items.
    

Intervention name(s): Behaviourally Informed Intervention Materials
Intervention type(s): Behavioral
Intervention description(s): The intervention consists of 7 separate components. The intervention components are to be delivered at three time-points (referred to as bundles). The bundles consist of:
Bundle 1a - Letter to parents of children bringing a packed lunch to school, 'spot the difference' lunch box tag (attached to all lunchboxes) and a Handy Swaps Card.
Bundle 1b - Letter to parents of children only having school meals and a Handy Swaps Card.
Bundle 2 - Lunch box mixer with ideas for creating nutritious packed lunches. Bundle 3 - Shopping list, packed lunch planner and reward chart to support planning and monitoring progress.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: cluster randomised controlled trial
Masking: Single (Participant)
Primary purpose: Prevention