How healthy and affordable are foods and beverages sold in school canteens? A cross-sectional study comparing menus from Victorian primary schools

Abstract Objective: Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools; and associations with school characteristics. Design: Dietitians classified menu items (main, snack, beverage) using the red, amber, green traffic light system defined in the Victorian government’s school canteens and other school food services policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics, and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government, Catholic/independent), size, and socio-economic position. Setting: State of Victoria, Australia Participants: A convenience sample of canteen menus drawn from three previous obesity prevention studies in 48 primary schools between 2016-2019. Results: On average, school canteen menus were 21% ‘green’ (most healthy – ‘everyday’), 53% ‘amber’ (‘select carefully’), 25% ‘red’ (‘occasional’) and 2% ‘black’ (banned) items, demonstrating low adherence with government guidelines. ‘Black’ items were more common in schools in regional population centres. ‘Red’ main meal items were cheaper than ‘green’ (mean difference -$0.48 (95%CI -0.85, -0.10)) and ‘amber’ -$0.91 (-1.27, -0.57)) main meal items. In ∼50% of schools, the mean price of 'red’ main meal, beverages and snack items were cheaper than ‘green’ items; or no ‘green’ alternative items were offered. Conclusion: In this sample of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of ‘black’ (banned) items compared to all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of ‘red’ food options, and ‘black’ (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines.