Energy Balance–Related Behavior and Anthropometric Measures Among Adolescents Across Three Educational Levels: A Cross-Sectional Study in Dutch Schools

Abstract

Energy balance-related behavior on schooldays and beliefs about school-based interventions may differ between students in different educational levels, sexes, and BMI (body mass index) categories. In Zwolle (the Netherlands), 1,084 adolescents (13-15 years) at 9 secondary schools completed a questionnaire. Overweight prevalence (boys 18.1%, girls 19.3%) increased with decreasing educational level, especially in boys. Girls reported healthier behavior than boys regarding daily consumption of fruit (35% vs. 29%), vegetables (58% vs. 48%), ≤1 snack/candy (36% vs. 26%), ≤3 glasses of sugared drinks (80% vs. 73%; all p < .05). Unhealthier dietary behaviors were associated with lower educational level, except for eating sugary and savory snacks. Snacks and sugared drinks consumed at school were mostly brought from home (61.6% and 68.5%, respectively). Overweight students reported less frequent consumption of daily breakfast, snacks, and sugared drinks than nonoverweight students. Of all students, 40% spent ≥1 hour per day cycling to school. Lower educational level students reported less organized sports activities than higher level students, but more outside play and other activities. Overweight was associated with cycling to school (boys) and participating in organized sports (girls). More girls than boys were interested in lessons about healthy nutrition (44.4% vs. 31.7%). To stimulate physical activity, boys suggested more physical education classes (63%), girls advised more variation (47%) and choice (43%). A healthy school canteen (57%) and offering free fruit (67%) were suggested as promising interventions to stimulate healthy behavior. Educational and environmental interventions to tackle unhealthy dietary and physical activity behavior should be developed in collaboration with parents and tailored to educational level and gender.

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria

“…Results in comparable studies show a positive impact of knowledge on food consumption and nutritional behaviour in children and adolescents: Intake of foods considered to be healthy, such as vegetables, fruits and starchy foods, was often higher when nutrition knowledge was higher, while consumption of unhealthy foods such as sweets, snacks, fried foods and sugary drinks was negatively associated with nutrition knowledge (7,30) . Similar to our study, studies have also shown a significant difference between boys and girls, demonstrating boys having lower nutrition knowledge and lower consumption of vegetables and fruits but a higher consumption of meats, fats and soft drinks compared with girls (7,65,66) . On the other hand, there are also several studies with no significant associations between nutrition knowledge and dietary behaviour, which confirms again that dietary behaviour and lifestyle are a multifactorial result of various influences of psychological, behavioural, genetic, environmental, socio-economic and sociodemographic origin (32,33) .…”

“…Furthermore, our findings illustrate a positive association between nutrition education hours per week and healthier food choices, for example, a higher intake of whole grains and a lower intake of meat and energy drinks. Current studies investigating the association of nutrition education as part of the curriculum and dietary behaviour are rare but there are numerous studies showing that nutrition interventions at school, targeting the improvement of the consumption of healthy foodstuffs such as vegetables and fruits in children and adolescents, accompanied by adjustments of the school food environment, can be successful (65,(68)(69)(70)(71)(72)(73)(74) . Nonetheless, a review found that the lack of fidelity in peer-led interventions, lack of behaviour support for environmental interventions and too-short duration (under 5 months) were factors that contributed to the failing of some of the reviewed interventions (75) .…”

Fruit and vegetable intakes, associated characteristics and perceptions of current and future availability in Dutch university students

“…The most popular proposed intervention strategies were offering affordable F&V in the university canteen and university supermarket. Similar results were found in a Dutch study which reported that students aged between 13 and 15 years expected that free fruit at school would stimulate healthy dietary behaviours ( 34 ) . Moreover, Australian university students reported that they would like an increased availability of fresh fruit on the university campus ( 35 ) .…”

The Healthy Supermarket Coach: Effects of a Nutrition Peer-Education Intervention in Dutch Supermarkets Involving Adolescents With a Lower Education Level

“…This outcome confirms the notion that supermarkets constitute an important setting for food or drink purchases during school hours. In line with previous studies, most of the adolescents in our sample reported purchasing unhealthy foods or drinks during school hours (He et al, 2012; Ridder et al, 2017). In one study, almost one third of all Dutch adolescents between the ages of 13 and 15 years purchased unhealthy snacks and sugary drinks within the school (19.7% and 11.2%, respectively) or in stores nearby the school (17.9% and 14.4%, respectively) at least 3 days per week (Ridder et al, 2017).…”