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We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice, or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice, or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and 'alternative' evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency’s advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.

National Dietary Guidelines have been published in many countries to support healthier food habits among the public. In Sweden, the guidelines are produced in a process involving experts and stakeholders under the responsibility of the National Food Agency. Stakeholder perspectives on the concept of state dietary advice was explored in this study, by analyzing 40 referral responses on updated guidelines in Sweden 2015. The study focused on ideas about how state dietary advice should be framed and what it should be based on. Thematic analysis was used and resulted in two main themes. 'Securing scientifically proven advice' represented a perspective of the guidelines as to be scientifically correct and verified, and built upon an underlying assumption to present an objective and optimal composition of foods and nutrients that will fit all. Arguments based on nutritional reductionism could be seen, which gave a delimited idea of what healthy food is. 'Getting the message across' represented a perspective of the guidelines to be easily understood by and inclusive to the end user. Clarity in advice was seen to be reached by explaining difficult words, defining amounts and exact mechanisms of why something is a good choice. Also this perspective added to excluding other values of food, especially qualitative ones. The construction of a healthy diet in these remittance responses builds upon a notion of an ideal diet composed on the basis of the best scientific proof and clearly presented so as to be easily understood and practiced. It was clearly based on an individualistic behavioral view making the individual responsible to make informed and good choices for a healthy diet. This approach may be questioned, as it is too simplified to include the complex reality of everyday life.

Purpose

The purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.

Design/methodology/approach

In total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.

Findings

Two main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.

Practical implications

Policymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.

Originality/value

This research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.

Background: East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development.

Objective: This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda.

Methods: A web-based program—OneLearns (Online Education for Leaders in Nutrition and Sustainability)—uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021.

Results: Of the 70 applicants, 25 (36%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80%, 95% CI 64%-96%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68%, 95% CI 50%-86%) and 18 (72%, 95% CI 54%-90%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively.

Conclusions: Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda.

Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students’ study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination.

Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time.

Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course.

Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one’s studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time.

Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was—adding a few words with the page number the student ought to be on to a reminder—we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming.

Since food waste valorisation measures, like energy recovery, have limited possibilities to fully recover the resources invested in food production, there is a need to prevent food waste. Prevention is most important at the end of the value chain, where most sub-processes have already taken place, like in catering facilities. In Sweden, the public catering sector serves a large number of meals through municipal organisations, including schools, preschools and elderly care homes. Many of these organisations quantify food waste, but since Sweden has 290 municipalities with a high degree of independence, the possible variation is significant. This study therefore investigated how food waste is quantified, in order to help formulate a national standard for food waste quantification. Mapping of food waste quantification practices was conducted using a questionnaire and follow-up telephone calls, achieving a response rate of 93%. Of the 290 Swedish municipalities, 55% replied that they quantify food waste on central level. The most common practice at present is to quantify plate- and serving waste from school lunches during two weeks per year, and to compile waste data in spreadsheets and compare the values against the number of plates used, giving a result in grams per portion served. There are many similarities between municipalities, so there is great potential to implement a common standard that many municipalities already fulfil. This is important in order to gain acceptance and fast implementation, thereby speeding up the process of establishing a benchmark for food waste in the Swedish public sector catering sector.

To move towards a sustainable food system, we cannot continue to waste substantial amounts of the food produced. This is especially true for later stages in the food supply chain, where most sub-processes consume resources in vain when food is wasted. Hospitals are located at the end of the food supply chain and the sector has high levels of food waste. This study investigated food waste quantification practices in Swedish hospitals, examined whether a questionnaire is an appropriate methodology for such mapping, and compiled data for the sector in order to determine the amount of food waste and its composition. A questionnaire was sent to all 21 regional authorities, formerly known as county councils, responsible for hospitals in Sweden. The questionnaire responses were supplemented with food waste records from three regions that organize the catering in a total of 20 hospitals. The results showed that it is common practice in most hospitals to quantify food waste, with quantification focusing on lunch and dinner in relation to the number of guests served. It was also clear that waste quantification practices have been established for years, and in the majority of the hospitals studied. The data revealed that, in comparison with other sectors, food waste was still high, 111 g guest(-1) meal(-1), consisting of 42% plate waste, 36% serving waste, and 22% kitchen waste. However, there was great variation between hospitals, which, in combination with well-established, standardized waste quantification routines, meaning that this sector has strong potential to spread best practices and improve overall performance in reducing food waste generation.

Food waste in the food services industry has been identified as an important unsustainability hotspot, but standardised methods for food waste quantification are lacking. Existing studies on waste quantity assessments have several limitations, such as short and infrequent quantifications times, large methodological variations ranging from physical measurements to visual observations, and lack of comparability across catering unit types. Since lack of comparable waste figures can lead to error-prone analysis, a general framework is needed for waste quantification in food services. This paper presents one such framework that allows data comparisons when overlapping observations are included. The framework was tested in six case studies in professional (public and private) catering units in Sweden. Data were collected from different schools, elderly care homes and hotels and fitted into the framework. The results from these case studies indicate that the framework enables catering units to focus waste quantification on their individual problem areas. It also provides the possibility to extend waste quantification over time without any loss of generalisability. A graphical representation of the framework fits the traditional tree structure and was found to act as a suitable foundation for food waste quantification in food services by structuring collected data. In order to fully utilise the potential of the tree structure, it should be supplemented with precise definitions to create a catering food waste quantification standard.

Food waste is a major problem that must be reduced in order to achieve a sustainable food supply chain. Since food waste valorisation measures, like energy recovery, have limited possibilities to fully recover the resources invested in food production, there is a need to prevent food waste. Prevention is most important at the end of the value chain, where the largest number of sub-processes have already taken place and occur in vain if the food is not used for its intended purpose, i.e. consumption. Catering facilities and households are at the very end of the food supply chain, and in Sweden the public catering sector serves a large number of meals through municipal organisations, including schools, preschools and elderly care homes. Since the first step in waste reduction is to establish a baseline measurement in order to identify problems, this study sought to quantify food waste in schools, preschools and elderly care homes in one municipality in Sweden. The quantification was conducted during three months, spread out over three semesters, and was performed in all 30 public kitchen units in the municipality of Sala. The kitchen staff used kitchen scales to quantify the mass of wasted and served food divided into serving waste (with sub-categories), plate waste and other food waste. The food waste level was quantified as 75 g of food waste per portion served, or 23% of the mass of food served. However, there was great variation between kitchens, with the waste level ranging from 33 g waste per portion served (13%) to 131 g waste per portion served (34%). Wasted food consisted of 64% serving waste, 33% plate waste and 3% other food waste. Preschools had a lower waste level than schools, possibly due to preschool carers eating together with the children. Kitchens that received warm food prepared in another kitchen (satellite kitchens) had a 42% higher waste level than kitchens preparing all food themselves (production units), possibly due to the latter having higher flexibility in cooking the right amount of food and being able to chill and save surplus food. The large variation between kitchens indicates that they have different causes of food waste, but also different opportunities to reduce it. Detailed waste quantification for each kitchen can therefore be the first step in the process of waste reduction.

This study used focus group discussions to investigate how a group of Swedish University students (24 women and five men) interpret symbols with claims about health and/or symbols with information about nutrition. The participants mostly talked about farming methods and food processes when asked about health and nutrition symbols. The Swedish Keyhole was the most familiar symbol to the participants but they had scant knowledge of its meaning. Symbols that were judged to be the most useful in guiding food choices were, according to the participants, symbols showing information about number of calories and/or nutrients. However, the most striking finding is still that the food experts' medical discourse, i.e. the focus on physical health and nutritional effects on the individual body, seems to be inconsistent with the participants' perceptions of healthy eating and risk. The participants rather used what we call an “inauthenticity discourse” where health and risks are judged in relation to farming methods, industrial food production, additives and other aspects of the food that are unknown to the individual. Despite limitations considering the number of participations and their relative homogeneity, these findings contribute to a further understanding of the gap between experts and the public when it comes to perceptions of healthy eating and risks. If this is a broader phenomenon, then we argue that this must be acknowledged if information about health and risk is to be communicated successfully.

The aim of this thesis is to study what role the Swedish school meal has as a public meal in Swedish culture. An additional aim is to study the meal patterns of children, including the school meal.

An ethnological questionnaire with 192 informants was used to study people’s perceptions and memories of the school meal. The school meal was seen as part of the Swedish welfare state, but also as a second-class meal, which did not live up to the ideal, which was a meal with the same values as a meal served at home.

Observations in school canteens (25 hours), interviews with the school meal staff (six informants) and focus group interviews with children in grade 4-5 (seven groups with a total of 52 children) were carried out at three schools in central Sweden. Firstly, the data was analysed as to how the teachers interacted with the children in relation to the pedagogic meal. The teachers took on three different roles:  “the sociable teacher role”, “the educating teacher role” and “the evasive teacher role”. Secondly, the children’s understanding of food and meals in the school meal context was analysed. The results showed that the children used ideas from the adult world among their peers in the school meal situation. This included the implementation of institutional commensality, the telling of stories about food and the classification of foods in dichotomies.

A questionnaire covering the meal patterns of the children and intake of some snack foods was also distributed to the children attending grade 4-5 at the three schools and their parents. Matched pairs (n=147) were analysed for agreement. Most children had a regular meal pattern, and there was general agreement between child and parent reports, except for sweets and chocolate.

The expectations on the school meal are high. At the same time, there appears to be a social construction depicting the school meal in a negative way. In order to come to terms with the negative public view of the school meal, the social construction of the school meal needs to be addressed.

Aims: School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children's total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children's school lunch habits were also studied. Methods: Children in grades 2 and 5 (n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits. Results: Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component. Conclusions: Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.

In Sweden, approximately a quarter of upper secondary school students leave school early or do not complete their studies with full grades. Structured leisure time activities have been associated with improved health, enhanced school performance, and future college attendance. Therefore, the aim of this study was to gain an understanding of how adolescents perceive the prerequisites for and the importance of meaningful leisure time. Qualitative interviews and focus groups with adolescents aged 16–19 were conducted and analyzed using content analysis. The results highlighted the importance of autonomy in leisure time, equal opportunities, and social relationships. Adolescents expressed that an optimal balance between leisure time and school can result in a circle of positivity, leading to better school performance, skills development, and overall well-being.

Background: Children are provided with food at school in various ways. In Sweden, free school lunches are provided to all children of compulsory school age. Internationally, Sweden is fairly unique in this sense, which makes the country an important example to study and reflect upon.

Objective: This article aims to describe the welfare ideology that underpins the provision of school meals in Sweden.

Setting: Schools in Sweden.

Method: The ideological underpinnings of the free school lunches provided in Sweden are described using the Seven Elements of Public Meals framework, which comprises the elements of welfare, health, sustainability, learning, social environment, physical environment and food.

Results: Our findings suggest that school meal provision in Sweden is seen as a universal welfare service and a part of public health work. Meals are to be sustainable and are regarded as a learning occasion. The importance of the social and physical environment is accentuated, and when it comes to the quality of the food served, the school meal has improved over the years.

Conclusion: The choice of food in schools is increasingly expected to be guided by personal choice. However, the privilege of being served a shared free school meal comes at the cost of less individual choice.

Background:  Dietary assessment in children is associated with misreporting, which is a problem with both child and parent reports. Therefore, it is of interest to study how children and parents report children's eating, respectively, although comparative studies are rare. The aim of the present article was to study the meal patterns and intake of certain snack foods of 10- to 12-year-old children as reported by the children and their parents, respectively, and to determine whether there was agreement between the child and parent reports. An additional aim was to study what factors might influence rater agreement.

Methods:  School children aged 10-12 years and their parents were given parallel questionnaires regarding the children's meal pattern. Matched pairs (n = 147) were analysed for agreement. Descriptive statistics were used to study all variables. Rater agreement and whether agreement depends on the age and the sex of the child, the sex of the parent and household type were analysed using ordinal regression models. Correlations between the child and parent assessments were estimated as polychoric correlations.

Results:  There was a general agreement between child and parent reports, except with respect to sweets and chocolate, where children reported less frequent consumption than the parents did (P = 0.0001). The sex of the child was a significant factor regarding consumption of in-between meals (P = 0.0001) and soft drinks (P = 0.01). Most children had breakfast, school lunch and dinner every day, whereas it was less common to report daily consumption of in-between meals.

Conclusions:  There was a general agreement between children's and parents' reports, and most children were reported to have a regular meal pattern.

Children come into contact with food in different places and contexts, i.e. ‘foodscapes’. The aim of the paper was to study what knowledge children construct regarding food and meals in the foodscape at school and how they do so, focusing on the school meal context. Observations, interviews and focus group interviews were used. The children appropriated ideas and understandings from the adult world and society as a whole and used it among their peers in the school meal situation. This included the adoption of institutional commensality, the telling of stories about food, and the classification of foods in dichotomies.

The aim of the present article was to gain a deeper understanding of the free school meal as an embedded phenomenon in the Swedish culture. This was achieved by studying perceptions and memories of the Swedish school meal. One hundred and ninety-two informants took part in the study by responding to an ethnological questionnaire. The results showed that the school meal was seen as a second-class meal with regard to the staff, environment and to some extent the food. The school meal was also seen as part of the Swedish welfare state, as it represents universal and equal social benefits for everyone. One interpretation of this is that the informants liked the idea of having a free public school meal, but that the meal does not live up to their expectations, that is, a meal with the same values as one served at home.

Objective: School meals are also a teaching occasion in which children learn about food and meals, which is referred to as "pedagogic meals" in Sweden. The aim of the present article was to study how the pedagogic meal is practiced in preschool and school settings, with focus on how teachers acted when interacting with the children. 

Design: Observations, interviews, and focus group interviews. 

Setting: School canteens. 

Participants: Three schools. 

Phenomenon of Interest: Teaching in the school meal situation. 

Analysis: Social constructionism, new social studies of childhood. 

Results: The teachers took on 3 different roles. The sociable teacher role entailed turning the school lunch into a social occasion, the educating teacher role involved educating the children, and the evasive teacher role was not associated with the definition of a pedagogic meal. The teacher roles, which ranged from adult-oriented to child-oriented, and which varied in the level of interaction with the children, were summarized in a framework named the Adult-to Child-oriented Teacher Role Framework for School Meals (ACTS). 

Conclusions and Implications: To realize the potential of pedagogic meals, teachers must be educated and become aware of the effects of their behaviors. In this situation, the ACTS framework can constitute a useful tool.

Background: In Sweden, school meals are served free of charge and Swedish law states that school meals must be nutritious. Nevertheless, data on children's energy and nutrient intake from school meals are scarce.

Objective: The aim was to describe the contribution of school meals to Swedish children's nutrient and energy intake during weekdays and compare this to the reference values based on the Nordic Nutrition Recommendations (NNR), which have been adopted as the official Swedish recommendations.

Design: A cross-sectional food consumption survey was performed on 1,840 Swedish children attending Grade 2 (mean age 8.6) and Grade 5 (mean age 11.7). The children's nutrient and energy intake was compared to the reference values based on the NNR.

Results: The mean intake from school meals of energy, carbohydrates, dietary fiber, polyunsaturated fatty acids (PUFA), and vitamins D and E did not reach the reference values and the intake of saturated fatty acids (SFA) and sodium exceeded the reference values in both age groups (significant differences, all p <= 0.001). Additionally, the pupils in Grade 5 did not reach the reference values for folate, potassium, calcium, magnesium, iron, selenium, and zinc (significant differences, all p <= 0.001). Standardized for energy, dietary fiber, PUFA, and vitamins D and E did not reach the reference values, whereas the reference values for SFA and sodium were exceeded in both age groups (significant differences, all p <= 0.001).

Conclusions: The study pointed to some central nutrients in need of improvement as regards school meals in Sweden, namely the quality of fat, dietary fiber, sodium, vitamin D, and iron. Some of these results may be attributed to the children not reporting eating the recommended number of calories, the children omitting some components of the meal, or underreporting, as a consequence of which the reference values for several nutrients were not met.

The present article concerns meals from the point of view of children, focusing on structural and sociocultural aspects of meals in a Western context in general, and Sweden in particular. The aim was to study children's perceptions of meals with regard to what, where and with whom meals are eaten and how meals are made. The method used was an internet‐based, ethnological questionnaire, which is a qualitative method in which participants share their experiences and values regarding a certain topic of interest in writing. A hundred and twelve Swedish children were included. The children almost exclusively chose to write about family meals. These meals were described as well‐structured and organized, and were often portrayed in an idealized way, with family members sharing proper meals at home, spending an enjoyable time together with a nice atmosphere and good conversation. The children made a distinction between everyday meals and festive meals, where the main differences were that festive meals were more prone to include extended family and friends besides the nuclear family, and were described in a more exceptional way with regard to what is served and mealtime conditions. The article concludes that the family meal functioned as a way to construct the family and as a site where children acquire norms and values about meals and family identity, but they did so in an active way, by breaking rules and by challenging norms, thereby also contributing to change. The changing nature of the family meal was also seen in an extended proper meal and the commensal aspects surrounding mealtime, as commensality included both commensal eating and commensal foodwork.

Swedish school meals are provided free of charge as a welfare service. Lately, requests for religiously sanctioned school meals have increased, and this has led to debate in society. This chapter aims to illuminate what is expressed on social media about religiously sanctioned school meals. Twelve blogs and seven internet forums were analysed using thematic analysis. Two themes were found: traditional school meals, which entailed a collective, secular school meal where religiously sanctioned food is not provided for, and cultural relativist school meals, which acknowledged individual differences and favoured catering for religiously sanctioned food. The latter theme also comprised secular requests based on modern food ideologies, which in some cases could be characterised as quasi-religious. In both themes, equality, a traditional value of the welfare state, was prominent. From a traditional standpoint, equality was assured by serving the same meal to everyone, and from a cultural relativist point of view, equality was ensured when the food served was catered to everyone’s individual needs and wishes. How the welfare state manages to bring together the traditional and cultural relativist standpoints might lead to either integration or tension in society as a whole and in institutions such as schools.

Public food service organizations are large producers of food waste, which leads to greenhouse gas emissions and the waste of natural resources. The aim of the present article was to gain insight into reasons for food waste and possible solutions for lowering food waste in schools in Sweden. In order to do so, food waste quantification in school canteens in two Swedish municipalities and nine qualitative interviews with key actors were conducted. Both municipalities displayed a high degree of variation in food waste, but the common pattern was that serving waste constituted the largest fraction of food waste, followed by plate waste and storage waste, as well as a gradual decrease in food waste over time. Food waste was mainly a result of old, disadvantageous habits, such as overproduction due to forecasting difficulties, whereas new, better routines such as serving fewer options, better planning, and a less stressful environment are the key to lowering food waste. Because food waste varies from one case to the next, it becomes important to identify and measure the causes of food waste in each school in order to be able to establish tailor-made, conscious, and flexible food waste mitigation routines.

We’ll scrutinize value challenges faced by public food procurement managers to ensure multiple values are met within a limited budget and under current regulations. The current highly complex food system makes informed, conscious and morally justified food choices most challenging. As about three million public meals are served daily in Sweden alone, procurement managers’ and purchasers’ choice of food has considerable impact on worker conditions, animal welfare and the environment. The combination of commodification of farm animals and the environment and the lowest price policy have contributed to downplay ethical values such as animal welfare or sustaining biodiversity in past procurement legislation (2004/18/EG). However, the recent EU directive extends the possibilities for taking such added values into consideration, highlighting the need to include externalised factors in food procurement decisions (Directive 2014/24/EU). Our hypothesis is that even if procurement guides such as the Swedish criteria for public procurement and the ones from the European Commission provide useful factual information about different products and requirements on production it leaves the procurement manager with a difficult task: to balance facts and added values in order to implement an institution’s policy or meet multiple values. We see a need of a new set of digital tools to provide guidance, facilitate ethical decision-making and to relieve the moral stress of procurement managers. In the following we will outline nutritional, animal welfare and environmental related values in food systems, describe ethical aspects of guides for public procurement and some ethical decision-making tools, and finally tentatively suggest a set of digital tools to facilitate handling multiple values to ensure the best possible decisions are made to meet citizens’ interests and work towards food production systems that stay within the planetary boundaries.

We will scrutinize value challenges faced by public food procurement managers to ensure multiple values are met within a limited budget and under current regulations. The current highly complex food system makes informed, conscious and morally justified food choices most challenging. As about three million public meals are served daily only in Sweden, procurement managers’ and purchasers’ choice of food has considerable impact on worker conditions, animal welfare and the environment. The combination of commodification of farm animals and the environment and the lowest price policy have contributed to downplay ethical values such as animal welfare or sustaining biodiversity in past procurement legislation (2004/18/EG). However, the recent EU directive extends the possibilities for taking such added values into consideration, highlighting the need to include externalised factors in food procurement decisions (Directive 2014/24/EU). Our hypothesis is that even if procurement guides such as the Swedish criteria for public procurement (NAPP 2015) and the ones from the European Commission (GPP 2014) provide useful factual information about different products and requirements on production it leaves the procurement manager with a difficult task: to balance facts and added values in order to implement an institution’s policy or meet multiple values. We see a need of a new set of digital tools to provide guidance, facilitate ethical decision-making and to relieve the moral stress of procurement managers. In the following we will outline nutritional, animal welfare and environmental related values in food systems, describe ethical aspects of guides for public procurement and some ethical decision-making tools, and finally tentatively suggest a set of digital tools to facilitate handling multiple values to ensure the best possible decisions are made to meet citizens’ interests and work towards food production systems that stay within the planetary boundaries. 

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3–8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.

Enligt FN:s förklaring om de mänskliga rättigheterna har alla rätt till en levnadsstandard som är tillräcklig för hälsa och välbefinnande, vilket inkluderar tillgång till mat. Även i ett land som Sverige, som länge varit en välfärdsstat, drabbar matfattigdom delar av befolkningen. Vi undersöker i ett forskningsprojekt matdonationer ur ett hållbarhetsperspektiv. Studien innefattar näringsmässiga och andra sociala fördelar med matdonationer till socialt och ekonomiskt utsatta. Preliminära resultat visar att matdonationer kan bidra till en säkrare tillgång till mat. Samtidigt får mottagarna pengar över att lägga på andra nödvändigheter, till exempel ytterligare matinköp, sjukvård, läkemedel, kläder, skor och andra konsumtionsvaror. Matdonationer har därför potential att bidra till en social hållbar utveckling för personer som lever i matfattigdom.

Retailers' food waste, often consisting of edible food, could be reduced, while simultaneously tackling food insecurity, through surplus food donations to vulnerable groups. However, sustainability assessments of food donations covering all three sustainability perspectives are scarce, hampering decision-makers in prioritizing donation as a food waste management measure. This Swedish case study assessed the environmental, economic, and social aspects of surplus food donation and examined trade-offs between the different sustainability perspectives. Methods included life cycle assessment, net economic benefit calculation, social life cycle assessment based on food security questionnaires, and nutritional assessments. The results showed that food donation was a way to reduce food waste benefitting the environment and adding economic and social value, to vulnerable people in particular. Despite substantial rebound effects offsetting some potential environmental savings, food bag donations outcompeted anaerobic digestion as a food waste management option in terms of environmental mitigation effect. Regarding trade-offs, accrued savings causing the rebound effects generated important social value for the donation recipients, by relieving their personal finances. Private and public investment was required to fund the donation units, but positive economic value was generated through valorization of surplus food. Food bag donations also showed potential to alleviate recipients' food insecurity and to contribute positively to recipients' nutrition intake. To realize the potential of surplus food donation, policy measures should be better aligned with the waste hierarchy. Despite some trade-offs and inability to solve the underlying problems of food insecurity, food donations have great short-term potential to contribute to a more sustainable society.

The 260 million publicly funded school meals served annually in Sweden generate 21.000 tons of food waste. At national level, school meals should meet the goal of food waste reduction, together with various other goals such as meeting nutritional requirements, being environmentally friendly and, most importantly, achieving high acceptance among schoolchildren. There is a preconception among kitchen staff that the most popular school meals drive food waste in Swedish school catering and that vegetarian dishes increase food waste, despite being less popular than meat options. By applying mixed methods, this study investigated possible goal conflicts between reduced food waste, high acceptance, and vegetarian options on the lunch menu. An overall aim was to gain knowledge on how lunch menus could be adapted for increased sustainability. Kitchen staff from 10 Swedish primary and secondary schools were interviewed to identify the most popular and unpopular meals, and food waste quantification data and lunch menus from 61 school canteens were analyzed. The results showed that, while the common perception of popular and vegetarian meals creating most waste was held by kitchen staff, it proved to be untrue. In fact, popular school meals and vegetarian options generated less waste than unpopular meals. A vegetarian paradox was detected in interviews, with vegetarian options considered unpopular but with several vegetarian options among the most popular dishes. Thus, school-catering units should stop serving unpopular meals and shift their focus to serving popular nutritious meals, including popular plant-based options, as part of efforts to make school meal schemes more sustainable.

A large proportion of school meals are wasted, leading to missed opportunities to nourish pupils, environmental impacts, and economic losses. This intervention study evaluated the long-term efficacy of three educational approaches (giving feedback to guests via plate waste tracker, pedagogic meals, and kitchen workshops) in reducing plate waste in school canteens across Europe (Austria, Germany, and Sweden). Following the intervention, a sustainability assessment was conducted, including environmental, economic, and social perspectives. The results showed that the plate waste tracker significantly reduced plate waste, by 17% (4 g/guest) from an already lower baseline level of 23 g/guest, while demonstrating long-term efficacy with sustained waste reduction up to 15 months post-implementation. This reduction lowered the environmental impacts (by 212 kg carbon dioxide equivalents per school & year) and nutrient losses (1018 MJ, 12 kg protein, and 4 kg fiber per school & year), while proving cost-effective with a payback period of only 1–2 years. Therefore, despite upfront costs and implementation barriers, food waste reduction measures in school canteens provide substantial long-term benefits across environmental, economic, and social dimensions, making them a valuable investment for sustainable school meal programs.

Surplus food redistribution can be a way to relieve co-existing food insecurity and food waste. The food waste hierarchy ranks surplus food donations for human consumption as the next best strategy, when food waste cannot be prevented. However, the effectiveness of food donation in terms of the amount consumed, or food donation as a food waste management measure have rarely been assessed. The few studies conducted to date report substantial environmental savings, but the results may be sensitive to assumptions regarding substituted food. Rebound effects are also not included, but are likely to offset environmental savings from food donation. Therefore, this study investigated the effectiveness, carbon footprint, and rebound effect of a food donation system run by a charity in Sweden, and compared the results with those of anaerobic digestion. Multiple analytical methods were used, including material flow analysis, life cycle assessment, questionnaire, and 24-hour dietary recall. In the life cycle assessment, carbon footprint of substituted products were credited to the overall results using a system expansion. In addition, direct and indirect rebound effects associated with re-spending of substitution-related monetary savings were included. The results revealed a complex but effective network aimed at salvaging as much of the redistributed food as possible, with 78% of redistributed food eaten, but there was also a substantial rebound effect, offsetting 51% of potential carbon emissions savings from food donation. Nonetheless, the net result of food donation was almost twice the climate benefit of anaerobic digestion (-0.40 vs. -0.22 kg CO2e/FU), supporting the food waste hierarchy.

Background & Aim

Various initiatives have been taken and recommended to improve foodservice and nutritional care to hospitals patients. However, a broad description and analysis of what has been done to reach a better foodservice is lacking. Consequently, the aim of this paper is to map aspects highlighted as important in scientific articles pertaining to the improvement of foodservice for hospital inpatients.

Methods

A scoping review was conducted, including literature searches in four databases (CINAHL, PubMed, Scopus, Web of Science) and an article selection process. Included studies were peer reviewed primary research written in English, published in 2000–2023, focusing on quality and improvement work in organisations and practice concerning provision of food and meals to hospital inpatients. Besides data charting of article characteristics, data were obtained for qualitative synthesis.

Results

Out of the 103 included articles, almost all (n=102) contained aspects associated with systems of different kinds. Foremost were systems for ordering, production, delivery and menus. Additionally, there were systems for structures, evaluation, and control. Other frequently occurring aspects concerned patients (n=84), e.g. considering their nutritional requirements, preferences, and cultural habits, as well as empowering patients with freedom of choice, information and guidance. Aspects concerning professional development, e.g. training, competence and teamwork were scarcer (n=46) and even fewer articles entailed aspects regarding leadership (n=21).

Conclusions

The broad spectrum of aspects that were identified may provide guidance to quality improvement of hospital foodservice. It also indicated research gaps in this field, foremost concerning relational competence and leadership.