Eating vegetables at school lunchtimes: Pilot and feasibility studies testing strategies to improve intake.

Vegetable provision at schools in the UK has increased over recent years; however children still eat few of the vegetables that are served to them. Two experimental pilot and feasibility studies implemented a vegetables-served-first (study 1) plus experiential learning (study 2) approach to increase children's (3-5 years and 4-7 years respectively) vegetable consumption at school lunchtimes. Both studies involved vegetables-served-first 10-min before the rest of the meal, with experiential learning techniques (repeated exposure, "veg-first" dinner plates, vegetable songs, videos, and nutrition education) complementing the vegetable service in study 2. Study 1 (n = 38) found that vegetables-served-first, compared with serving all foods together, increased vegetable intake by ∼12 g. Study 2 (n = 69) found that vegetable consumption depended on individual schools. Schools where vegetable intake was low showed increases in consumption during intervention weeks, whereas schools with high vegetable intake showed little change. Acceptability of interventions was found to be good for children and schools that participated, although concerns about time to serve vegetables first and COVID-related environmental restrictions reduced feasibility for some schools. Child engagement could also be improved by offering a wider variety of vegetables during repeated exposure to reduce monotony. Future research should design interventions using co-design methods including schools to suit their context best, whilst also addressing the problem with a systems approach. Interventions which focus on child learning through experience need to take account of specific school environments including curricular needs, resources available for school lunch (including both time and space), provision of food, support from teachers and parents, and the culture around eating (e.g. encouragement, pressure to eat, lunchtime competing with playtime). Joined-up systems approaches could enhance both provision and uptake of vegetables at school meals.