Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK.

OBJECTIVE: The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK. DESIGN: A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour. SETTING: Primary schools in nine local education authority areas. SUBJECTS: A total of 4350 students (aged 9-11 years) at baseline and 4472 at follow-up in 111 schools. RESULTS: Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found. CONCLUSIONS: The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children's nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.