Universal FSM and obesity, the evidence 

 

Last weekend, the MailTelegraph and Independent all published stories about free school meals making children fatter, given the sensationalist headlines,  I though it an appropriate time to make public some analysis I have been doing.

My thought process

Towards the end of last year, we saw huge coverage of the latest HSCIC data on children’s weight. Rightly there was outrage at the fact that around a third of our children were leaving primary school obese or overweight. It is clear that as a nation, we have a huge problem with children’s health and the amount of weight our children put in from the age of four to eleven. What was less well publicised is that these obesity and overweight rates have actually been fairly static for a number of years.

As someone who has long questioned the appropriateness of the state paying for universal free school meals, I started to re-evaluate my position. What if providing a healthy school meal made a difference and cut obesity rates, what if a universal free school meals policy was the elusive silver bullet to address the issue. After all a number of learned Health experts wrote to The Times suggesting the policy could pay for itself.

I looked again for evidence to back up the proposition that universal free school meals improve health and help fight obesity.

The Times letter was frankly hopeless, filled with lots of might’s, coulds and mays. Disappointingly there wasn’t a shred of evidence in there. It seemed little more than a PR exercise designed to garner sensationalist headlines, which is particularly shameful given the names and organisations on there.

I looked again at the only real research, the 2009/12 universal free school meal pilot, which states “There was no evidence that the FSM pilot led to significant health benefits during the two year pilot period. For example, there was no evidence of any change in children’s Body Mass Index.” Not a particularly helpful line if we are hoping to conclude UIFSM improves health.

I couldn’t find anything else, there was no evidence.

But one thing I am not, is a quitter.  So I looked again at the National Child Measurement Programme data and discovered they banded children within LAs. This only really becomes interesting when the knowage that two LAs; Islington and Newham, run their own universal free school meal policy and have done for a number of years. The NCMP also helpfully took measurements in reception as well as in year six, providing a baseline for the current cohort, effectively we have a ready made longitudinal study.

Expected results

If universal free school meals improve the health of children, then within these two LAs, we should expect a gradual increase in the number of healthy weight children over time as they are exposed to the policy for increasing amounts of time.

Equally if UFSM impact on obesity it would seem obvious that the obesity rates in these two LAs should be significantly lower than other similar LAs.

Results

I initially went into great detail explaining my methodology and process, but it’s all a bit boring, so I added it as a note (1)

These are the Yr6 obesity rates for the last 6 years for the two LAs running universal FSM and for London and England as a whole

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
ENGLAND 18.3% 18.7% 19.0% 19.2% 18.9% 19.1% 19.1%
LONDON 21.3% 21.8% 21.9% 22.5% 22.4% 22.4% 22.6%
Newham 24.6% 25.9% 24.7% 25.6% 27.3% 25.1% 27.4%
Islington 21.4% 24.8% 21.8% 22.1% 21.8% 21.4% 22.8%

 

There are the Yr6 rates for pupils who have healthy BMIs for the last 6 years for the two LAs running universal FSM and for London and England as a whole

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
ENGLAND 66.1% 65.4% 65.3% 64.9% 65.4% 65.1% 65.3%
LONDON 62.4% 61.6% 61.3% 60.9% 61.0% 60.7% 61.1%
Newham 58.7% 57.5% 58.1% 57.6% 55.9% 57.2% 55.2%
Islington 61.9% 60.3% 60.2% 60.6% 62.6% 60.9% 59.6%

 

Compared to London as a whole, England and to other LAs, I found no statistically significant change in obesity levels for Islington or Newham. If anything Newham has seen MORE obese children, though it’s not significant (though the increase is enough to give the Mail it’s headline)

Compared to London as a whole, England and to other LAs, I found no statistically significant increase in levels of healthy children for Islington or Newham. If anything Newham has LESS healthy children. (there was no significant difference in the number of underweight children either)

In simple terms this is proof that on their own, universal Free School Meals do not make any difference to children’s BMI.

In addition to my own analysis, I asked both councils for any internal assessments done on the policy, Newham and Islington both confirmed they hadn’t done any assessment of any kind. I find this lack of monitoring  remarkable, given these LAs  spend considerable amounts of money on the project. It doesn’t seem unreasonable to expect someone would check to see if the policy managed to lower obesity rates, especially given that tackling obesity seems to be the main justification for the policy.

Conclusion

Whilst I would never claim universal FSM makes children fatter, I think its fair to state the evidence shows that the provision of universal free school meals have made no significant impact on childhood obesity rates as measured by BMI.

Why does it matter

It shouldnt come as any real surprise that universal free school meals do not make any difference to health or obesity. The drivers of eating badly and lack of exercise will have much greater impact than free provision of 190 meals a year. It should also be noted that these meals are often not as healthy as many would have us believe. The new standards are not nutritional standards, they are food based standards that place no limits on a meals fat, sugar or salt content. Even then, these standards are not applicable to all schools and even if they were, they are not monitored.

Sadly  we are stuck with an underfunded UIFSM policy and landscape increasingly run by the multinational catering companies.  School catering has become dominated by cheap labour and even cheaper ingredients.

The vested interests within the catering industry are incredibly keen to see this policy continue. They consider Uifsm to be a “Financial bonanza” and have gone to great lengths to pursue and promote their agenda.  Whilst I have long shared their newly found concern about lack of evidence and the governments decision not to research benefits, their concern is driven more by a fear that the policy might get cut and damage their profits than any real desire to provide any new insight.

I believe, for the first time we have gone from having no evidence that UIFSM makes a difference on health or obesity, to being able to clearly demonstrate that Universal meals make no difference to children’s BMI.

This entirely contradicts unjustified and misleading claims about the health benefits of UIFSM, which is why this evidence is so important. More so given the recent changes to the SATs tests. meaning there is no longer a comparable baseline, making it impossible to measure any changes in attainment that may accrue as a result of the policy. This leaves  “health” as the only justification supporters can use, meaning the catering industry continually jump on the obesity bandwagon to promote the UIFSM policy.

Politicians appear to have fallen for this line, to the extent that in saving the policy the former Chancellor placed UIFSM under the headline “security” as if it was protecting our children (2)

In these days of evidence based policy, we need to look closely at the benefits, I believe this is new and compelling proof that unioversal free school meals does not combat obesity, the next decision now lies Justine Greening ,who needs to set out some success criteria and check it offers VFM before throwing yet more money at the scheme.
(1) Initially I looked at the latest data to see if Newham and Islington had significantly lower obesity rates than anywhere else, as it happens they both have extremely high rates, so I obviously had to compare them against similar areas.

I then looked at a couple of London boroughs with similar demographics and similar 2015 profiles to see if Newham and Islington had significantly different outcomes.

I then went further, looking back at the 2014\15 yr 6 cohorts’ baseline data from 2008/9 when the children were in reception, to see if there were differences.

In all of these exercises it was clear that whilst Newham had amongst the highest obesity rates and lowest healthy children rate in the country, Islington fared slightly better, though still at the high end of the scale.

Finally in order to use a fair start point for any comparison I looked at the 2008/9 reception data, found a number of LAs with similar 2008/9 baseline figures and similar demographics (I looked at transiency,  mobility and  ethnicity) to both Islington and Newham. In addition I used the 5 LAs used by the UFSM pilot to compare against Newham as well as the data for the whole of England and London. I looked only at the 2008/9 reception data so as not to influence selection based on the year six outcomes I would then measure.

Using the reception data to direct my selection, I then tracked the year six data from 2008/9 to look for any significant differences and to look at trends.

Individually the picture looks fairly chaotic, with various bumps and jumps from year to year, but looking at trends for each of the chosen LAs, it became fairly obvious that they were all fairly level and that overall, the percentage figures for London and for England as a whole give a good indication of overall trend, though with different start points.

It is important to note that this is a substantial sample, with around 95% of all relevant schoolchildren taking part each year. Well over a million children are measured with confidence intervals over 95%.  Along with the careful selection of control groups who haven’t offered universal FSM, the scale will mitigate many of the variances, like pupils leaving, or a particular poor or especially good caterer.

Now, this isn’t a full scientific trial, it isn’t an RCT and I don’t clai t to be scientific research, I am not a professional statistician and would add the caveat that I may have missed something, but I have run my process and findings past a number of educational data experts who are all satisfied with my methodology and with my workings.

Saying all that, I have some statistical knowledge and have done my best to be as thorough and unbiased in my choice of data and how it is compared as possible.  I am more than willing to provide my files to anyone who wants to go through them.

If anyone has any better suggestions of how we can analyse the benefits of the UIFSM policy, do contact me and explain.

i believe this is as good and thorough an analysis of the data as anyone can do, short of spending millions on an entirely new research program.

One last thing, I understand that BMI isn’t the best way to measure health, but it’s simple, commonly understood and gives historically comparable figures via the base data. I am looking specifically at the benefits of universal FSM on their own, as opposed to being healthy, adding in exercise or school food systems in other countries with different standards and funding.

 

 

(2) 2.57 Investing in education and skills will help deliver economic security. In addition to providing 600,000 additional school places, funding for universal infant free school meals will be maintained, supporting healthy eating and saving families around £400 for every infant each year.

This is the full table of LAs I used and their obesity rates, over the next week or so I will post links to all the data.I collated (if there is a demand for it)

Obese Year 6 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
ENGLAND 18.3% 18.7% 19.0% 19.2% 18.9% 19.1% 19.1%
LONDON 21.3% 21.8% 21.9% 22.5% 22.4% 22.4% 22.6%
Newham 24.6% 25.9% 24.7% 25.6% 27.3% 25.1% 27.4%
Enfield 23.0% 22.7% 25.1% 23.8% 24.1% 24.6% 25.3%
Haringey 20.7% 23.0% 21.1% 23.8% 23.4% 22.8% 22.6%
Manchester 22.6% 24.0% 23.7% 23.6% 24.7% 25.0% 24.1%
Redbridge 20.7% 19.5% 23.2% 23.2% 21.3% 22.7% 23.0%
Wandsworth 20.0% 21.4% 20.9% 20.0% 20.2% 20.3% 20.7%
Southwark 26.7% 26.0% 26.5% 28.5% 26.7% 26.7% 27.9%
Westminster 23.6% 28.6% 22.8% 24.8% 25.3% 25.6% 24.5%
ENGLAND 18.3% 18.7% 19.0% 19.2% 18.9% 19.1% 19.1%
LONDON 21.3% 21.8% 21.9% 22.5% 22.4% 22.4% 22.6%
Islington 21.4% 24.8% 21.8% 22.1% 21.8% 21.4% 22.8%
Newcastle upon Tyne 21.9% 21.9% 24.9% 25.0% 22.8% 23.0% 24.0%
St. Helens 21.7% 21.7% 21.9% 19.7% 21.5% 22.1% 18.3%
Sandwell 24.6% 23.5% 25.9% 25.2% 24.8% 24.5% 25.8%
Luton UA3 21.3% 21.9% 23.2% 23.1% 23.7% 23.6%
Hammersmith and Fulham 22.4% 24.0% 23.7% 25.8% 20.1% 22.4% 23.3%
Hounslow 23.5% 24.6% 23.4% 23.3% 24.6% 23.9% 22.8%
Barking and Dagenham 24.2% 23.6% 24.2% 26.9% 24.4% 26.2% 25.3%
Tower Hamlets 25.7% 25.7% 25.6% 25.1% 26.5% 25.1% 26.7%

 

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Is this the best we can do to promote the SFP?

Yet again is has been an interesting couple of days for those of us concerned with free school meals.

With the policy start date just four weeks away, we are beginning to see a concerted effort to promote universal infant free meal policy in every way possible, most noticeably via the Department of Education and suprisingly The Cabinet Office (i.e. Nick Clegg)

I have already blogged on the laughable efforts to promote the policy on the back of the report from January 2013.

I find it ridiculous that the DfE twitter feed is still continuing to promote the reports from the three papers daft enough to run with the rehashed report as “news”. DfE should know many of the claims are false, after all they commissioned and published the research.

Despite that, on Monday we saw what appears to be the start of a frankly embarrassingly amateur attempt by the Cabinet office and its regional twitter feeds, to persuade sports stars and organisations to use the hashtag #freeschoolmeals under the pretence of promoting healthy food.

Now I have no problem with sport stars endorsing healthy food, however by linking the campaign to the free school meals policy this is clearly drifting into politics (it also reminds me of a Brass Eye type spoof)

Some of the tweets confirm the drive is basically to promote the UIFSM policy,

@RNNLondonSE: In just four weeks’ time, all school children aged 4 to 7 will receive healthy #freeschoolmeals

“@RNN_NorthWest: Infant school parents could soon save up to £400 a yr on packed lunches with Universal #freeschoolmeals”

Using the “£400 saving” tag line so commonly repeated by Nick Clegg and David Laws.

 

Whilst other tweets beg or pressure individuals, clubs and organisations to join in.

@RNNNorthEast: We’re urging sports stars to share nutritional advice to support #freeschoolmeals Any top tips @FCseahamredstar @crooktown_afc (no offence to these clubs, but it isn’t aiming high)

@RNNNorthEast: We’re urging sports stars to share nutritional advice to support #freeschoolmeals Any top tips @NUFCOfficial @FalconsRugby (slightly better)

 

By asking sportsmen and women to tweet ideas for nutritional advice, hints on “healthy food” or “Brain food ” (whatever that is), they are encouraging these athletes to think they are lending their name and support to a drive for healthy eating. However, by using the tag #freeschoolmeals, they are conflating the healthy meals and UIFSM.

 

It appears to me that there is some intent to use these “names” to promote the impending policy implementation. At best there is ineptitude and a good deal of confusion, at worst there is deliberate misrepresentation in order to gain headlines from having recognisable names being linked to the policy, that this is this an effort to publicise the Lib Dem’s UIFSM policy on the cheap via that new-fangled social media.

 

All this could be purely supposition, it could be a cock up rather than conspiracy, but there are two key reasons for suspecting these are deliberate political shenanigans,

 

Firstly is the fact that it’s the cabinet office that appears to be driving this, not DfE or the health department, but Nick Clegg’s “pet” department. Also worth noting that the cabinet office don’t appear to have a history of promoting DfE policies, but for some reason they have tweeted on this topic over 100 times in two days.

 

Secondly is the fact these healthy food standards that suddenly need advertising, don’t actually start in September but come into force in January. This means this Healthy meals initiative would have to be part of a very, very long PR game, or alternatively you might conclude it is actually about Clegg’s impending UIFSM policy

 

So there we have it, supposedly independent civil servants pestering people to promote healthier meals with the sole intention of using the publicity to promote the Lib Dem’s free school meal policy. I think that’s fairly devious and despicable, bordering on deception, but then again I am not a politician!

 

 

Notes for people contacted to contribute

Do some investigation, some due diligence, as to what you are being asked to support, is it a healthy eating initiative or the free school meals policy?

Treat this with great caution, Free school meals are highly political at the moment, ask yourself why your support is required now?

 

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£17 million and the School Food Plan

The latest instalment of my blog focuses on the £17 million pound tendering process opened by the DfE before Christmas. This money is specifically to “establish service contracts to implement the School Food Plan” 

There are three problems with this
Firstly the governments use of the SFP as a driver of this policy is inappropriate,
Secondly that the SFP itself is flawed,
And thirdly that the DfE are spending quite so much on promotion.

Perhaps it is worth starting with a quick history lesson for those who dont know about the Schools Food Plan.  

After Jamie Oliver highlighted the poor state of school dinners, there was pressure on government to do something, Tony Blair helped set up the charity School Food Trust (now renamed the Children’s Food Trust)  to advise schools and develop food policy. In 2010, the new coalition government came in and made a number of changes to school food policy, many of which were publicly criticised by Oliver.

Still under pressure to act, Michael Gove commissioned a new report. To many peoples surprise the publicly funded School Food Plan (SFP) was to be written by Henry Dimbleby and John Vincent, two restaurateurs with no prior history or involvement with school meals, but with the undoubted advantage of sharing a holiday in Marrakech with Sarah Vine and her husband Michael Gove.

The plan was launched in July this year, then in September, out of the blue and with great fanfare, Nick Clegg announced to the Lib Dem conference the years flagship policy would be to provide every infant school child a Free Hot lunch. 
 
He repeatedly linked the policy to the recommendations within SFP and the £17m spend  is specifically to “implement the SFP” tying the report and policy together. 
 
So to reiterate Clegg was proposing a top down policy whereby every reception, Yr 1 and Yr2 child was to be offered a free hot school lunch.  Unfortunately for Clegg some of us who had read the SFP, noticed that at no point did the SFP suggest this action, this is the closest it gets

 

“We have also recommended that free school meals should be extended to all primary school children, starting with the most deprived areas. “

You may note this differs from the stated policy? Targeting deprived areas, phased implementation, all primary aged children, fundamental and practical differences.

Just to be clear, at no point does the plan suggest providing universal free school meals to infants, yet the DfE bizarrely committed £17 million into “implementing the School Food Plan”  whilst instigating a policy that is fundamentally different. 

The way the policy is being driven by politicians is also a worry, to its credit, the SFP repeatedly and sensibly argues that “Increasing take-up is not something that can be done from the top-down” and Dimbelby himself was quoted as saying “the point of the whole plan which is that it is the duty of the head teacher to decide what they want to do about school food. Good school food – in fact good school food – is not created by state decree.” yet this is exactly what is being attempted by Clegg, a top down, state decreed policy.

It is also worth noting that the decision to abandon ” hot meals for all” for the more achievable “the majority of children will receive a hot meal” also appears to contradict the whole basis of plan.  Throughout the SFP, the meals they refer to are HOT meals, the benefits derived are all from HOT meals, SFP make no claims on a school packed lunch being of benefit, yet with this policy, it is clear a significant minority will end up with just that, a sandwich and an apple eaten in class.

I am no politician, so I remain confused as to how the government can base a policy on a report  that has entirely different recommendations?
My second concern is with the the plan itself
Whilst there are some great points made in the SFP, it obviously builds on the work done by Oliver and the 2010 free school meals pilots, I can’t get over the fact a report into school meals can gloss over the lack of infrastructure to the point it didnt even merit a mention. They also seem to underestimate the issues relating to the role of the private sector as well as having a fairly cavalier attitude to schools shifting funding to meals.
 
I have no interest in going though the report picking up on every single point I disagree with, not least because it does make some interesting and positive contributions. I’m just amazed that none of the people involved considered the impact of school facilities or more importantly, the lack of them,  I can’t be the only person to realise that many schools don’t have the necessary infrastructure to provide universal hot meals?  Sharing best practice, which to my mind is the most valuable aspect of the report, does not overcome the fundamental issues with space and equipment faced by many schools. 
 
The report also seems to overplay the cost savings created by the economies of scale. Minor inflationary pressures can have major impact on the figures the report is reliant on, making the whole policy unsustainable. I also have concerns that they assume the private sector will step up, as the investment in equipment is significant, the margins are very tight, the funding uncertain ( I have kept this brief as I will be blogging on this soon)
 
I suppose it’s to be expected from a report on school food, that it plays up the benefits of school food, but there seems to be a naive expectation that schools should be prioritised food above every other method of improving attainment.  Sadly the realities of tightening budgets mean that for many schools the priorities are fixing leaking roofs, maintaining buildings and finding qualified teachers. It is unrealistic to expect schools to top up and subsidise universal FSM, which seems to be the ultimate solution if the figures don’t add up.  
 
This is not to suggest school leaders wouldn’t like to provide universal free school meals, but most would like world peace and an end to war, sadly it is all about priorities. Governors will have to decide if spending school funds on subsidising wealthy childrens lunch is in the best interests of the school, I suspect for many it may not be their first choice.
 
My final point is concerned with how much money being spent promoting all this.  As I mentioned above £17 million is being pumped into promoting the SFP, effectively PR for the Policy.
 
This just seems incredible amount of money to spend on promoting a plan which is actually really available for school leaders to read. There are also a number of charities like the aforementioned children’s food trust who provide almost all the information contained within the SFP and looking at the site costs nothing. 
 
We really must question the benefits of transferring  £17 million to organisations outside the education sector to promote this plan. (The make up of the winners will be very interesting, I look forward to seeing who will be profiting from all this)
 
To put it into context, the  £17 million penciled in for PR could provide the 17,000 primary schools in England with £1000 each to set up a breakfast club! 
 
Just think about that, £1000.00 to each school………   Now think about the priorities at play in all this?
 
My next blog will be on the private sectors role in all this, or it might be on the politics at play.  Either way there is more to come on this FSM fiasco.

 

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