The Impact of the Universal Infant Free School Meals Policy on the Ultra-Processed Food Content of Children’s Lunchtime Intake in England and Scotland ^†

Abstract

Background: A universal infant free school meals (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years; as a result, school meal uptake rose sharply. School food in the UK is known overall to be healthier and less processed than food brought from home (packed lunches), but it is unknown as to how UIFSM impacted the level and type of ultra-processed food (UPF) consumed. Therefore, this study aimed to evaluate the impact of the UIFSM policy on the processing levels of food consumed during the school lunchtime period among schoolchildren in England and Scotland. Methods: Data from the National Diet and Nutrition Study (NDNS), a nationally representative repeated cross-sectional survey, were used to conduct a difference-in-difference study. The average intake of UPF (% of total lunch grams and % total lunch Kcal) using the NOVA classification was calculated for each school lunch. The lunchtime intakes in the intervention group (4–7 years, n = 866) were compared to the control (8–11 years, n = 808) pre- (2008–2014) and post-intervention (2014–2019) using linear regression, adjusting for sociodemographic variables and total lunchtime intake (grams). Inverse probability weights were used to balance the characteristics across the intervention groups. Results: Before UIFSM, the consumption of UPFs as a proportion of total lunch energy (UPF % Kcal) was similar in the intervention and control groups (67% Kcal vs. 69% Kcal). After adjustment for covariates, UPF consumption decreased by 6.3 pp (95% CI −11.3, −1.3) after UIFSM. The findings were similar for UPF as the percentage of total lunch grams. These effects were driven by increases in minimally processed dairy and eggs and starchy foods and decreases in salty snacks and ultra-processed bread and drinks consumption. The greatest reduction in UPF consumption was in low-income children (−17.2% Kcal; 95% CI −26.5, −7.8), compared to mid- (0.5% Kcal; 95% CI −4.0, 1.0) or high-income children (−5.3% Kcal; 95% CI −13.6, 2.9). Conclusions: This study builds on previous evidence and shows that UIFSM improved children’s dietary intake at school by minimising exposure to UPFs. These results indicate that universal free school meal policies could be an important policy for long-term equitable improvements in children’s diet and subsequent health.