LCQ9: Nutrition of students' lunches
7.6.2023

âFollowing is a question by the Hon Chan Hoi-yan and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (June 7): Question: In 2010, the Department of Health (DH) introduced the Nutritional Guidelines on Lunch for Students (the Guidelines) to serve as reference benchmarks for providing balanced nutrition to primary and secondary students. However, the results of the Nutrient Testing of School Lunches in Primary Schools in Hong Kong 2018, which was jointly conducted by the Centre for Health Protection of the DH and the Centre for Food Safety of the Food and Environmental Hygiene Department in 2018, showed that the sodium content of samples of primary school lunch boxes was higher than the recommended intake for a seven-year-old student's lunch, and such samples also had other problems such as inadequate dietary fibre and excessive protein. In this connection, will the Government inform this Council: (1) given that the Government launched the Salt Reduction Scheme for School Lunches in the 2017-2018 school year, with a target of reducing the average sodium content of each primary school lunch to not more than 500 milligrams in 10 years, of the implementation situation of the Scheme; (2) apart from the sodium content, whether the DH has monitored other nutritional indicators for school lunch boxes (e.g. the fat and sugar contents, as well as the amount of energy provided); if so, of the details (including the effectiveness); (3) whether it has followed up the situations of excessive sodium, inadequate dietary fibre, excessive protein, etc, in primary school lunch boxes; if so, of the details; if not, the reasons for that; (4) whether it knows the data on the health conditions of Hong Kong school children as a whole in the past five years (e.g. the proportion of those who were overweight, the average body mass index and the physical fitness performance); (5) whether the DH has taken measures to ensure that school lunch suppliers follow the recommendations in the Guidelines or encourage them to do so; if so, of the details; if not, the reasons for that; and (6) whether the Government will consider, by making reference to the practices in other regions, setting specific recommended standards for various nutrient contents in students' diets, or working out recommended recipes that accord with students' lifestyle or social changes (e.g. adding food ingredients such as carrots and blueberries to the recommended recipes in response to the problem of rising myopia incidence) for school lunch suppliers to follow, so as to ensure that students' diets can achieve nutritional balance and meet the targets required for normal development and growth? Reply: President, Healthy eating can promote school children's healthy growth and reduce the risks of chronic diseases, such as heart disease, diabetes and certain types of cancer. The Government attaches great importance to healthy eating and weight problems among school children. The Department of Health (DH) launched the EatSmart@school.hk campaign in the 2006/07 school year to raise public awareness of and attention to healthy eating of children, and to create an environment conducive to healthy eating in schools and the community. Subsequently, the DH launched the Salt Reduction Scheme for School Lunches in the 2017/18 school year with the aim of reducing the sodium content in school lunches in a progressive manner. The reply, in consultation with the Education Bureau (EDB), the Environment and Ecology Bureau (EEB) and the DH, to the questions raised by the Hon Chan Hoi-yan is as follows: (1) The DH launched the Salt Reduction Scheme for School Lunches in the 2017/18 school year. In January 2018, the Nutrient Testing of School Lunches in Primary Schools in Hong Kong 2018 was jointly conducted by the Centre for Health Protection of the DH and the Centre for Food Safety of the Food and Environmental Hygiene Department. Lunch samples were collected randomly from primary schools in Hong Kong to examine the sodium level, amount of energy and content of major nutrients in lunches of lower primary students. Results revealed that the average sodium content of school lunches dropped from 951 milligrams in 2013 to 818 milligrams in 2018, representing an approximate 14 per cent decrease, and continuing to make progress towards the expected sodium reduction goal. However, the provision of school lunches was seriously affected by class suspension and change in study arrangement due to the COVID-19 epidemic since the 2019/20 school year. The DH is actively following up and discussing with lunch suppliers to review the implementation of and next step for the scheme. (2), (3) and (5) The Salt Reduction Scheme for School Lunches launched by the DH mainly focuses on the average sodium content of primary school lunch boxes. Apart from sodium content, the DH also attaches importance to other nutritional indicators. When conducting the Nutrient Testing of School Lunches in Primary Schools in Hong Kong 2018, the DH also reviewed the amount of energy and some of the major nutrients content of primary school lunch boxes. Overall speaking, the results of the Nutrient Testing of School Lunches in Primary Schools in Hong Kong 2018 revealed that the energy, fats and sugar of the lunch samples tested met the recommended standards. Among them, for total fats, saturated fats, trans fats and sugars, more than 90 per cent of the lunch samples were below the upper limits of recommended intake. The average amount of trans fats and sugars per lunch decreased by seven per cent and 15 per cent respectively as compared with a similar survey in 2013. For dietary fibre, the average content was 5.1 grams, higher than the recommended intake of four grams. That said, the amount of dietary fibre in 40 per cent of the samples was lower than the recommended intake. As for protein, the average content in the lunch samples was 21.6 grams, higher than the recommended intake of 13.3 grams. Among them, the average protein content of non-vegetarian lunch samples was even 1.8 times the recommended intake, reaching 23.6 grams. The EDB issued circulars and guidelines to call on schools to refer to the Nutritional Guidelines on Lunch for Students and the Handbook of Selection of Lunch Suppliers issued by the DH, as well as the guidelines issued by other relevant government departments, to formulate and implement a policy on healthy eating; and to pay attention to the nutritional quality of lunches and make suitable arrangement when selecting lunch suppliers. The DH has also discussed with lunch suppliers and advised them to ensure that lunches meet the recommended nutritional requirements according to the Nutritional Guidelines on Lunch for Students, including paying attention to the sodium level of lunches when preparing the recipes and during the cooking process, providing at least one serving of vegetables in lunches, keeping the ratio of grains, vegetables and meat in lunches at a ratio of 3:2:1, increasing the ratio of whole grains (e.g. by adding brown rice or vegetables in rice to at least 10 per cent), etc. To encourage students to adopt healthy eating habits at an early age, the DH also suggested schools to co-operate with lunch suppliers and parents to ensure that students can consume at least one serving of fruits at school every day. Although the sodium reduction measures are voluntary, the DH also strengthened the implementation of relevant salt reduction recommendations through the EatSmart School Accreditation Scheme (ESAS) under the EatSmart@school.hk campaign. For the application of Advanced Level Accreditation (Lunch) under the ESAS, as one of the criteria, the contract signed between the school and lunch supplier must stipulate that all lunch boxes should be prepared in accordance with the Nutritional Guidelines on Lunch for Students issued by the DH. The DH has been encouraging schools to participate in the ESAS through different publicity channels. As at May 31, 2023, 295 primary schools (over 40 per cent of all primary schools in Hong Kong) enrolled in the ESAS and 134 of them achieved various levels of accreditation. In addition, the Committee on Reduction of Salt and Sugar in Food (Committee) under the EEB is committed to promoting the message of salt and sugar reduction. At the school level, the Committee collaborates with the EDB and the DH to raise students' awareness of reducing salt and sugar intake. The DH has been reporting the progress of the Salt Reduction Scheme for School Lunches to the Committee and receiving feedback from the Committee on the scheme. The DH will conduct timely review in accordance with the actual situation and take corresponding follow-up actions jointly with relevant Government departments as appropriate. (4) The Student Health Service (SHS) of the DH arranges annual health assessment for students who have enrolled in the service. Services include physical examinations, use of health assessment questionnaires to screen for psychological health and behaviour problems, face-to-face interviews, counselling, health promotion activities, etc. The detection rates of overweight (including obese) students among those who have attended annual health assessment in the past five years are tabulated below. It is worth noting that the SHS have been disrupted since early 2020 due to the COVID-19 epidemic, with changes in the number and pattern of attendances by the students using the service over the past three school years. Therefore, direct comparison of the data before and after the epidemic should be done with caution. The DH will continue to closely monitor the health conditions of students. Detection rates of overweight (including obese) primary school students from 2017/18 to 2021/22 school year 2017/18 2018/19 2019/20* 2020/21* 2021/22* Detection rates 17.6% 17.4% 19.0% 18.6% 20.6% Notes: The definition of being overweight (including obese): Body weight more than 120 per cent of the median upon weight assessment by the Weight-for-Height Chart (i.e. with the weight adjusted according to the height) for male students with height between 55 and 175 cm and for female students with height between 55 and 165 cm. Body Mass Index reaching 25 or above for male students with height over 175cm and for female students with height over 165cm. * Due to the COVID-19 epidemic, the SHS have been disrupted since early 2020, with changes in the number and pattern of attendances by the students using the service over the past three school years. (6) The DH launched the EatSmart@school.hk campaign since the 2006/07 school year. Nutritional guidelines on lunches for students was produced in the same year. The DH will review the guidelines regularly and revise the relevant content to suit the nutritional needs of students in Hong Kong by making reference to the recommendations made by health authorities in different places and the latest medical research findings.