School Meals in Denmark

School Meals in Denmark: Evaluation of a National School Meal Pilot Program on Children's Health, Learning and Well-being - a Natural Experiment

This study looks at how a national school meal program affects the health, well-being, and learning of Danish schoolchildren aged 10 to 15 years.

The study is part of the Danish National School Meal Pilot Program (2025-2028), which provides free school meals at selected public schools. Some school classes receive free school meals, while other classes do not and are used for comparison.

Children are followed for about 1.5 years. Information is collected before and after the program using simple health measurements, questionnaires about well-being, and age-appropriate cognitive tests.

The study also uses information from Danish national registers to better understand the children's background and to study longer-term outcomes related to health, education, and social conditions. In addition, the study examines whether school meal programs are cost-effective by comparing their costs with potential benefits for children and society.

The goal of the study is to find out whether free school meals can improve children's health, well-being, and learning, and help reduce social differences.

Study Overview

• Status: Not yet recruiting
• Conditions: Healthy; Childhood Obesity; Diet Habits; Cognitive Abilities; Childhood Obesity Pevention; Well-being/Quality of Life
• Intervention / Treatment: Behavioral: School meal classes

Detailed Description

School Meals in Denmark is a prospective, open-label, matched-pair cluster-randomized controlled study conducted as a natural experiment alongside the Danish National School Meal Pilot Program. As allocation to the national program is determined by the Danish Ministry of Children and Education and not by the investigators, the study evaluates the effects of school meals under real-world conditions without introducing an additional experimental intervention.

Approximately 3,200 children in grades 3, 4, and 7 from 32 public schools are included. Participating schools are matched in pairs based on socioeconomic and geographic characteristics using national statistical data. Recruitment includes schools implementing the program either at the middle grades or at the lower secondary level. At each school, intervention classes are identified at the grade level receiving school meals.

Control classes are recruited pragmatically from the same schools but at a different grade level than the intervention classes. Intervention effects are estimated by comparing classes at the same grade level across matched schools, where one school implements the school meal program at that grade and the matched school does not. This approach allows for within-school control recruitment while preserving between-school comparisons at the same grade level.

Data are collected at two time points over a follow-up period of approximately 1.5 years using a pre-post design. Outcomes include anthropometric measures (height, weight, body composition assessed by bioelectrical impedance), cardiovascular indicators (blood pressure and resting heart rate), tablet-based cognitive performance tests, and child-reported questionnaires on well-being and psychosocial functioning. Parents complete brief electronic questionnaires addressing their child's psychosocial functioning and dietary habits.

In addition, observations of school meal settings are conducted to assess food intake and food waste, and menu plans from meal providers are collected to evaluate nutritional quality and compliance with dietary guidelines.

The study is designed to generate robust evidence on the real-world effects of school meal programs on children's health, well-being, and learning outcomes.

• Study Type: Interventional
• Enrollment (Estimated): 3200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nikolai N Nordsborg, PhD; Phone Number: +4528751612; Email: nbn@nexs.ku.dk
• Study Contact Backup: Name: Paulina S Melby, PhD; Phone Number: +4527266039; Email: paulina@nexs.ku.dk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All children attending 3rd, 4th or 7th grade in the recruited schools

Exclusion Criteria:

• No exclusion criteria will be applied

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Control classes; The classes will continue with their regular meals, e.g. lunch packages

Behavioral: School meal classes; Natural experiment embedded within the Danish National School Meal Pilot Program (2025-2028), which offers free school meals to selected public schools. Children receive a free school-provided meal (typically lunch) five days per week. Meals vary across schools, as each school selects its own meal provider. All meals must comply with the Nordic Nutrition Recommendations and the Danish Food-Based Dietary Guidelines, with a focus on fish, whole grains, fruits and vegetables, access to drinking water, and the promotion of children's food literacy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Well-being/health related quality of life	Between group difference in change in the total summary score of health-related quality of life measured with the KIDSCREEN 27 child self-report questionnaire. Data is collected using an adapted video and speech assisted electronic version with a smiley scale for each answer. The questionnaire assesses the child's physical well-being (5 items), psychological well-being (7 items), peers and social support (4 items), and school environment (4 items). Autonomy and parent relation (7 items) are not used.	Baseline, 16-22 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychological functioning	Between group difference in change in the total difficulties score of the Strengths and difficulties questionnaire. Assessed using child reported version of the Strengths and Difficulties Questionnaire. An overall total difficulties score is calculated, along with five subscale scores: emotional symptoms, conduct problems, hyperactivity/Inattention, relationship problems, and prosocial behavior.	Baseline, 16-22 months
Internalizing problems	Between group difference in change in the internalizing problem score of the Strengths and difficulties questionnaire, calculated as the sum of the emotional symptoms and peer problems scales scores. Assessed using the child-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
Externalizing problems	Between group difference in change in the externalizing behavior score of the Strengths and difficulties questionnaire, calculated as the sum of conduct problems, hyperactivity/Inattention subscales scores. Assessed using the child-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
Prosocial Behavior	Between group difference in change in the prosocial behavior score of the Strengths and difficulties questionnaire. Assessed using the child-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
Psychological functioning (2)	Between group difference in change in the total difficulties score of the Strengths and difficulties questionnaire. Assessed using parent reported version of the Strengths and Difficulties Questionnaire. An overall total difficulties score is calculated, along with five subscale scores: emotional symptoms, conduct problems, hyperactivity/Inattention, relationship problems, and prosocial behavior.	Baseline, 16-22 months
Externalizing problems (2)	Between group difference in change in the externalizing behavior score of the Strengths and difficulties questionnaire, calculated as the sum of conduct problems, hyperactivity/Inattention subscales scores. Assessed using the parent-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
Internalizing problems (2)	Between group difference in change in the internalizing problem score of the Strengths and difficulties questionnaire, calculated as the sum of the emotional symptoms and peer problems scales scores. Assessed using the parent-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
Prosocial Behavior (2)	Between group difference in change in the prosocial behavior score of the Strengths and difficulties questionnaire. Assessed using the parent-reported version of the Strengths and Difficulties Questionnaire.	Baseline, 16-22 months
WHO-5 Well-Being Index	Between group difference in change in the 5-question self-report tool from the World Health Organization measuring subjective mental well-being over the past two weeks, assessing feelings like cheerfulness, calmness, and interest.	Baseline, 16-22 months
School environment	Between group difference in change in the school environment (4 items) score of the KIDSCREEN 27 child self-report questionnaire. Data is collected using an adapted video and speech assisted electronic version with a smiley scale for each answer.	Baseline, 16-22 months
Peers and social support	Between group difference in change in the peers and social support (4 items) score of the KIDSCREEN 27 child self-report questionnaire. Data is collected using an adapted video and speech assisted electronic version with a smiley scale for each answer.	Baseline, 16-22 months
Psychological well-being	Between group difference in change in the psychological well-being (7 items) score of the KIDSCREEN 27 child self-report questionnaire. Data is collected using an adapted video and speech assisted electronic version with a smiley scale for each answer.	Baseline, 16-22 months
Physical well-being	Between group difference in change in the physical well-being (5 items) score of the KIDSCREEN 27 child self-report questionnaire. Data is collected using an adapted video and speech assisted electronic version with a smiley scale for each answer.	Baseline, 16-22 months
Resting blood pressure in mmHg	Between group difference in change in systolic and diastolic blood pressure.	Baseline, 16-22 months
Resting heart rate beats/min	Between group difference in change in heart rate.	Baseline, 16-22 months
Fat mass in kg	Between group difference in change in fat mass measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
Fat free mass in kg	Between group difference in change in fat free mass measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
Fat mass index in kg/m2	Between group difference in change in fat mass index measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
Fat free mass index in kg/m2	Between group difference in change in fat free mass index measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
Fat-Free-Mass-to-Fat-Mass ratio	Between group difference in change in FFM-to-FM ratio measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
% Fat Mass	Between group difference in change in % FM in kg measured by a bioimpedance analysis (InBody 270).	Baseline, 16-22 months
Weight status in %	Between group difference in change in prevalence of children with underweight, normalweight, overweight and obesity, based on the cutoffs defined by Cole et al. and the International Task Force of Obesity. Body weight is measured by a bioimpedance analysis (InBody 270) and height by using a portable stadiometer.	Baseline, 16-22 months
BMI z-score	Between group difference in change in BMI z-score based on WHO references. Weight and height is measured using weight from the bioimpedance analysis (InBody 270) and a portable stadiometer, respectively.	Baseline, 16-22 months
Sustained attention	Performance in neuropsychological assessment of sustained attention ability assessed as errors during a sustained test procedure (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months
Spatial working memory	Performance in neuropsychological assessment of spatial working memory assessed as errors and strategy during the test procedure (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months
Inhibitory control	Performance in neuropsychological assessment of inhibitory control assessed as errors during the test procedure (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months
Cognitive flexibility	Performance in neuropsychological assessment of cognitive flexibility assessed as errors during the test procedure (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months
Fine motor control	Performance in neuropsychological assessment of fine motor control assessed as endpoint accuracy during the test procedure (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months
Processing speed	Performance in neuropsychological assessment of processing speed as choice reaction time (Cambridge Neuropsychological Test Automated Battery, Cambridge cognition, UK).	Baseline, 16-22 months

Collaborators and Investigators

• Sponsor: University of Copenhagen
• Collaborators: The Novo Nordic Foundation; University of Southern Denmark
• Investigators: Principal Investigator: Nikolai B Nordsborg, PhD, University of Copenhagen

Study record dates

Study Major Dates

• Study Start (Estimated): February 11, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: January 28, 2026
• First Submitted That Met QC Criteria: January 28, 2026
• First Posted (Actual): February 5, 2026

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: January 28, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: well-being; learning; diet; physical health
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Behavior, Animal; Pediatric Obesity; Feeding Behavior
• Other Study ID Numbers: H-25070631

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: If yes: De-identified individual participant data (only collected data, never registry data) will be made available upon reasonable request, subject to approval by the data controllers and in accordance with Danish data protection legislation.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No