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Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation barriers have been reported. T...
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Purpose of Review
The global epidemic of youth-onset obesity is tightly linked to the rising burden of cardiometabolic disease across the lifespan. While the link between childhood obesity and cardiovascular disease is established, this contemporary review summarizes recent and novel advances in this field that elucidate the mechanisms and impact o...
Citations
... Finally, this study's deliberate selection of the individuals primarily responsible for food purchases refines the scope of inquiry, making the sample size of 511 participants especially appropriate for delving into the intricacies of this specific facet of local food consumption behavior [39,40]. ...
Promoting local food consumption for economic growth is a priority; however, defining “local” remains challenging. In Nova Scotia, Canada, this pioneering research establishes a comprehensive framework for assessing local food consumption. Employing three data collection methods, our study reveals that, on average, Nova Scotians allocate 31.2% of their food expenditures to locally sourced products, excluding restaurant and take-out spending, as per the provincial guidelines. The participants estimated that, in the previous year, 37.6% of their spending was on local food; this figure was derived from the most effective method among the three. However, the figure was potentially influenced by participant perspective and was prone to overestimation. To enhance accuracy, we propose methodological enhancements. Despite the limitations, the 31.2% baseline offers a substantial foundation for understanding local food patterns in Nova Scotia. It serves as a replicable benchmark for future investigations and guides researchers with similar objectives, thereby establishing a robust research platform.
... Systems-led work in schools in Canada suggests that there are three key factors that may influence the ability of school food interventions to have an impact, including the actions of key staff ("Actors and Elements"), the implementation of different school food policies ("System Regulation and Interconnections") and priorities of stakeholders ("Purpose and Values") [18]. This is likely to resonate with school food systems in the UK, where existing implementation evaluation of the School Food Plan suggests that the skill and will of head teachers is a strong predictor of success [19]. ...
... To the best of our knowledge, this is the first primary school food systems map for children aged 4 to 11 years that has been developed alongside key stakeholders in this area. Our thematic and network analysis findings also support (and extend) the systems work conducted within the Canadian school food system in which leadership, school food policies and priorities of stakeholders were deemed key factors [18]. Our CONNECTS-Food systems map builds on this by considering wider external factors that influence children's food choice in schools; notably the influence of family circumstances, which has the potential to directly and indirect influence via multiple pathways (e.g. ...
... Although there have been calls for the adoption of whole school approaches to food from the WHO [5], from national governments [6,7,13,32] and other organisations [20,33] here is limited evidence that this is embedded within the majority of schools. Given the potential extent of interventions associated with delivering whole school approaches to food, a lack of implementation is likely due to the associated perceived burden and cost against a background of lack of macro-level support and policy enforcement [18,34]. However, research in this area suggests that, when well implemented, whole school approaches can have a substantial impact on diet, health [35] and food insecurity [36]. ...
Background:
Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice.
Methods:
Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion.
Results:
The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'.
Conclusions:
Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
... The ILF comprises (from highest to lowest impact): paradigm, goals, system structures, feedbacks and delays, and structural elements. Specific to school settings, McIssac [28] further summarised data aligned to the ILF into three themes of intervention points within the school food system (from highest to lowest impact): purpose and values, system regulation and interconnections, and actors and elements. The ILF has been used successfully utilised to code pre-conference reading, and high-level documents (i.e. government, health, medical reports) related to obesity efforts/strategies to help influence future policy and planning [18]. ...
... However, the ASM shares the same drawback in the ILF in that by reducing M12 to four categories for the sake of simplification, nuanced insights from the original M12 are lost. Given the work of Malhi [20], Johnston [18], McIssac [28] and Nobles [19] to operationalise M12 with the specified intent to improve usability for public health and policy practitioners with each iteration, why create something new? We argue that we have not created something new but translated the M12 into language useful for public health practice. ...
Background
Systems science approaches have demonstrated effectiveness in identifying underlying drivers of complex problems and facilitating the emergence of potential interventions that are locally tailored, feasible, sustainable and evidence informed. Despite the potential usefulness of system dynamics simulation modelling and other systems science modelling techniques in guiding implementation, time and cost constraints have limited its ability to provide strong guidance on how to implement complex interventions in communities. Guidance is required to ensure systems interventions lead to impactful systems solutions, implemented utilising strategies from the intersecting fields of systems science and implementation science. To provide cost-effective guidance on how and where to implement in systems, we offer a translation of the ‘Meadows 12 places to act in a system’ (Meadows 12) into language useful for public health.
Methods
This translation of Meadows 12 was informed by our experience in working with 31 communities across two complex large scale randomised control trials and one large whole of community case study. These research projects utilised systems science and implementation science to co-create childhood obesity prevention interventions. The team undertaking this translation comprised research academics, implementation specialists and practitioners, practice-based researchers and a systems dynamicist. Our translation of each of the Meadows 12 levels to act in the system maintains the fidelity and nuance of the 12 distinct levels. We provide examples of each level of the Public Health 12 framework (PH12) drawn from 31 communities. All research was conducted in Victoria, Australia between 2016 and 2020.
Results
PH12 provides a framework to guide both research and practice in real world contexts to implement targeted system level interventions. PH12 can be used with existing implementation science theory to identify relevant strategies for implementation of these interventions to impact the system at each of the leverage points.
Conclusion
To date little guidance for public health practitioners and researchers exists regarding how to implement systems change in community-led public health interventions. PH12 enables operationalisation Meadows 12 systems theory into public health interventions. PH12 can help research and practice determine where leverage can be applied in the system to optimise public health systems level interventions and identify gaps in existing efforts.
Trial registration
WHO STOPS: ANZCTR: 12616000980437 . RESPOND: ANZCTR: 12618001986268p .
... Other practices, such as the use of foods and beverages for classroom celebrations and rewards, are also widespread, with the latter more common in secondary schools. Although this study was limited in its investigation, literature from North America illustrates that students consume mainly low-nutrient, energy-dense items during celebrations [51], that there is a lack of alternatives to using unhealthy food in fundraising, and that 'special treats' undermine the move towards healthier food environments in schools [52]. The variability in such practices between teachers and schools has resulted in scant research investigating its impact on health. ...
The school food environment plays an important role in shaping students’ dietary choices, which often influence future dietary behaviours. We surveyed primary and secondary schools in Hawke’s Bay, New Zealand, to measure the comprehensiveness and strength of food policies, describe the culture of food provision, and identify barriers to improving school food environments. Fifty-one schools were included in the final analysis, with 58.8% having a food policy, most of which used a generic template. Schools with food policies and those participating in the free and healthy lunch programme were more likely to have a strong culture around healthy eating. Common barriers to healthy eating were food outlets near school and resistance from students. Secondary schools reported facing more barriers to implementing healthy eating cultures, were more likely to use food as classroom rewards and to sell food to students, most of which was unhealthy. Hawke’s Bay schools participating in food provision programmes are successfully improving their food environments through improved culture and delivery of healthy food; however, more action is needed to strengthen the wording and guidance in food policies and reduce the provision of unhealthy food in schools before effective change can be achieved.
... For example, the Iceberg Model 15 is used predominantly within the private sector to facilitate change management efforts, and the ILF 16 has been adopted by researchers in the public health field to evaluate interventions, policies and systems change. 2,10,29,31 We hope that the ASM can be used for several purposes: to understand why the system works as it does, to identify and subsequently appraise actions and finally, to guide elements of an evaluation. Thus, the purpose and use of the ASM differs from previous models in that its application is broader, but due to the simplicity of the model and the ease of understanding, it can be applied without the expertise of a third party. ...
Background:
Systems thinking is integral to working effectively within complex systems, such as those which drive the current population levels of overweight and obesity. It is increasingly recognised that a systems approach - which corrals public, private, voluntary and community sector organisations to make their actions and efforts coherent - is necessary to address the complex drivers of obesity. Identifying, implementing and evaluating actions within complex adaptive systems is challenging, and may differ from previous approaches used in public health.
Methods:
Within this conceptual article, we present the Action Scales Model (ASM). The ASM is a simple tool to help policymakers, practitioners and evaluators to conceptualise, identify and appraise actions within complex adaptive systems. We developed this model using our collective expertise and experience in working with local government authority stakeholders on the Public Health England Whole Systems Obesity programme. It aligns with, and expands upon, previous models such as the Intervention Level Framework, the Iceberg Model and Donella Meadows' 12 places to intervene within a system.
Results:
The ASM describes four levels (synonymous with leverage points) to intervene within a system, with deeper levels providing greater potential for changing how the system functions. Levels include events, structures, goals and beliefs. We also present how the ASM can be used to support practice and policy, and finish by highlighting its utility as an evaluative aid.
Discussion:
This practical tool was designed to support those working at the front line of systems change efforts, and while we use the population prevalence of obesity as an outcome of a complex adaptive system, the ASM and the associated principles can be applied to other issues. We hope that the ASM encourages people to think differently about the systems that they work within and to identify new and potentially more impactful opportunities to leverage change.
... A systems approach has been employed in other settings to understand the interrelationship of all circumstances, conditions, and influencers on the implementation of nutrition programs 12 and foodservice operations. 13 Foodservice systems models are commonly used to evaluate, manage, and adjust foodservice operation and achieve goals within a range of settings. ...
Background
Major sporting event catering is a significant undertaking for foodservice providers, particularly with an increasing focus on sustainability, global health, and nutrition demands of athletes. Yet, the inclusion of nutrition expertise in catering varies significantly between events. Foodservice systems models are commonly used to evaluate foodservice operations but to date have not been applied to catering and nutrition at major sporting events.
Objective
The aim of this exploratory case study was to gain in-depth insights of key stakeholders (catering management, chefs, organizers, and dietitians) regarding the integration of nutrition into the catering operation of a major global sporting event, with a focus on future continuity, and map this to the foodservice systems model using a program logic model.
Setting
Semistructured interviews were conducted with 12 stakeholders during and after the 2018 Commonwealth Games, Gold Coast, Australia.
Results
The 8 themes that emerged were related to planning and preparation, refining processes, improvement of the menu, better technology, increase in food allergies/intolerances, organization controls, experience of the workforce, and increased client knowledge of nutrition. The logic model demonstrated that the system is driven by policy and budget at the level of control prior to and during the planning phase but modified by the environment during operation.
Conclusions
Despite recognition by stakeholders on the importance of change, there are barriers to the provision of suitable food. Integration of nutrition expertise into tender documents and budgets in major event catering will help ensure nutritionally adequate, culturally suitable, and safe menus for future events.
... Not only as a moment to look for ideas through image-making (Wheadon et al, 2017). However, it is supported by coordination with related parties related to related parties to discuss ideas that have been made so there is no misperception between the implementation team (McIsaac et al, 2019). ...
A flyover is known as a facility on the road as an option to drive to reach the destination. On the streets, signage is known as a medium to explain the direction or purpose of someone to be able to know the direction and purpose. As street furniture, signage is one of the facilities that are not infrequently present somewhere. So someone can find out where he is. By using the consultation method and including interviews with partners, solving the problem through community service programs will be carried out in the form of signage design that will be made on any part that requires information about the place or crossroads in the basement area of the flyover in the area of West Jakarta. The signage design of the consultation results as a guide can be continued to the stage of making the object by taking into account the elements of the environment and the people in the area. So that in its application, signage design can help the general public to know the direction and the area to be addressed.
Many are calling for transformative food systems changes to promote population and planetary health. Yet there is a lack of research that considers whether current food policy frameworks and regulatory approaches are suited to tackle whole of food systems challenges. One such challenge is responding to the rise of ultra-processed foods (UPF) in human diets, and the related harms to population and planetary health. This paper presents a narrative review and synthesis of academic articles and international reports to critically examine whether current food policy frameworks and regulatory approaches are sufficiently equipped to drive the transformative food systems changes needed to halt the rise of UPFs, reduce consumption and minimise harm. We draw on systems science approaches to conceptualise the UPF problem as an emergent property of complex adaptive food systems shaped by capitalist values and logics. Our findings reveal that current food policy frameworks often adjust or reform isolated aspects of food systems (e.g., prices, labels, food composition), but under-emphasise the deeper paradigms, goals and structures that underlie the rise of UPFs as a systems phenomenon, and its socio-ecological implications. We propose that a ‘leverage points’ framework illuminates where to intervene in food systems to generate multi-level changes, while the theory of ecological regulation highlights how to respond to complex multi-factorial problems, like the rise of UPFs, in diverse ways that respect planetary boundaries. More research is needed to better understand the transformative potential of ecological regulation to advance food systems transformation and attenuate whole of food systems challenges.
In this perspective piece I reflect on the importance of considering the place of schools within broader systems for critical school food study and intervention. These reflections are based on my study of school food in Newfoundland and Labrador from a systems perspective which helped reveal to me how assumptions about school food tend to get in the way of deep understanding about the impact and sustainability of programs.
Progressively more countries are reportedly incorporating school-based food and nutrition education (SFNE) into their education, nutrition and school feeding policies, acknowledging its role in impacting children’s food outlooks and practices, and that of their parents, families and the community. Despite this increasing interest and global recognition, there is no clear picture of SFNE implementation at school level, which makes it challenging to identify gaps, take corrective measures, make reforms or introduce new policy initiatives.
Framed under FAO’s school food and nutrition work, the aim of the survey was to determine the current role, approach, scope and linkages of government run SFNE in a sample of low- and middle-income countries. In particular, this survey is part of the package of outputs that FAO developed to establish the foundation for reshaping and carrying the SFNE work forward, in terms of effectiveness and scope.
