In this study we found that implementation of breakfast in a lower secondary school class was well received by the students and almost all students took advantage of this service every day. In the male group we found a significant improvement in a healthy eating index and in school satisfaction following the intervention, whereas, the improvement seen in the females did not reach statistical significance. We found no increase in BMI in the breakfast group during the study period, whereas, BMI increased significantly in the control group. Hence, mere information about healthy eating did not have a significant impact on dietary habits.
The finding that BMI did not increase statistically significant in the breakfast group during the study period, compared with the control group is noteworthy in this small pilot study. It is known that body weight has increased in Norwegian school children the last decade , and it is also shown that poor nutrient and energy intake in the morning contribute to an increased body weight [14–17]. Introducing a breakfast meal in school might be one way to fight obesity among adolescence and young adults.
Changes in school performance as a result of breakfast offering were not found in this study. This is in accordance with results from other studies, where dietary manipulations has been investigated in well nourished children [2, 18], whereas, improvement has been reported in low-income communities [2, 19, 20]. However, the shortcomings of this study, i.e. short time period and the small sample size, gives this pilot study too little statistical power to detect small to mediocre improvement. The teachers reported improvement in school attention among the students in the intervention group, but there were too few teachers involved in the two classes to make it possible to calculate statistical differences. Furthermore, the students were asked about their own school performance, and no objective measurement was included, because the investigators had not asked for permission on beforehand to examine the schools' evaluation of the students.
For this project a special lower secondary school was investigated, because the teachers asked for assistance with poor school attendance and antisocial behaviour among the students. This might have had an impact on the results, because the antisocial pattern was already well established and a more comprehensive strategy would have been required to break the pattern. The teachers had already tried out different disciplinary strategies without any luck, and hence the breakfast serving was a last attempt to improve the class situation. The teachers, however, did not attend the school breakfast, and gave little attention to the project. This might have contributed negatively to the result, but on the other hand if a breakfast meal would have major impact on school performance, there was room for improvement among these 10th graders.
Several important factors seemed to have failed during the completion of the study; firstly the conscientious objector was not well enough trained for the project and the implementation of food supplement failed. As a consequence hardly any students complied with this part. Secondly, serving of fruit was not done as instructed. Whole fruit was served instead of fruit cut into slices. Intake of fruit has been documented to increase if the fruit is served in slices . The students reported satisfaction with the breakfast meal and reported that they sadly missed the morning meal when no longer available. However, the teachers were not all satisfied with the practical solution of the breakfast serving, because the breakfast had to be served and eaten in the classroom, which resulted in a delay in the first school lesson. The breakfast setting would have been better if breakfast could have been served in the cafeteria or at least in a separate room.
This was a small pilot study performed in an attempt to improve dietary habits, school attention and social behaviour among students in a lower secondary school. In this study we saw improved food intake, reduction in weight gain and increased satisfaction with the school day, but the study suffers from too little statistical power. Increasing the statistical power by increasing the number of students, improving the methods to measure social behaviour and being able to objective measurements of school performance should be applied to future studies.