Abstract
Objective To gain an understanding of children's perceptions of the healthiness of foods commonly served at school lunches and how these relate to their preferences in order to assist school caterers and those involved in nutrition education to help children to choose a nutritionally balanced meal. Design A quantitative study whereby 123 9 to 11-year-old children ranked the perceived healthiness of foods and their preference for the same foods, supplemented by qualitative descriptions of reasons for preference or perceived healthiness. Setting Interviews were carried out within the child's school. A total of 14 schools in the south-east of England took part. Method Data were collected in a one-to-one interview with each child. Photographs of foods commonly served for school lunches were used for the ranking of preference and perceived healthiness. Ranked data were analysed using Wilcoxon's Pairs Signed Rank test and qualitative data were analysed by assigning them to categories. Results Children were found to have a clear perception of the healthiness or otherwise of the foods and nutritional knowledge was generally sound except for some difficulty in identifying 'invisible' fat. Any understanding of the relationship between foods or nutrients and health was only occasionally evident, as was the idea of moderation or balance. It was also found that there was a strong inverse relationship between children's perceptions of the healthiness of foods and their preferences for them. Taste and texture were much more important influences on food choice than perceived healthiness. Conclusion Teaching about food in primary schools needs to focus on helping children of this age make balanced food choices. It was suggested that the 'tilted plate' model, adapted to use foods that children frequently eat and enjoy, could be the basis of such teaching. Such a model could also be used to help caterers plan menus and as the basis of co-operation between nutrition educators and caterers.