Evaluation of school food policies for secondary schools in Europe: Results for health, acceptance, and affordability from a scoping review

Introduction: All European Union (EU) countries have established national school food policies. However, evaluations of those policies for secondary schools remain limited. This scoping review aims to synthesize the evidence of school food policies in secondary schools on child health, acceptance, and affordability in the EU, UK, Switzerland, Norway, and Iceland. Methods: The scoping review adheres to the PRISMA-ScR guideline. Searches were conducted in four databases from 2000 to September 2023 without language and methods restrictions following a published protocol. After a two-stage screening process, reviewers extracted data using a standardized and predefined coding scheme. Results: The search identified 185 records with N = 10 articles meeting the inclusion criteria (n = 7 UK, n = 1 each in Norway, Sweden, and Portugal). Among the included articles, n = 7 addressed school meal acceptance, n = 6 addressed health impacts, and n = 3 addressed affordability. Findings indicate low acceptance rates of school meals. Results of several studies showed that the reformulated menus did not meet nutritional standards and were not accepted because of taste, quality, and pupils' different food preferences. Affordability was reported as a barrier across the three articles addressing this topic. Conclusion: The existing literature highlights challenges in interpreting the impact of school food policies on health, acceptance, and affordability. Further research is needed to strengthen the methodological approaches and increase the evidence to inform policy development and implementation.