Introduction

A healthy diet starting in early childhood is important for growth, development, and physical and mental performance and, moreover, can contribute to prevention of common diseases later in life, such as obesity, type 2 diabetes, and cardiovascular diseases (Dämon et al. 2011; Lehmann et al. 2020).

The primary place to get children accustomed to healthy dietary habits is the family, which is gradually extended to settings like kindergarten and school. In Germany, primary schools are obligatory for children aged 6–10 years. Primary schools therefore provide a low-threshold opportunity for health promotion among young children irrespective of their social status, without social discrimination (van Cauwenberghe et al. 2010).

This could help to mitigate the existing social disparities in Germany in terms of dietary and lifestyle habits and health status, from an early age (Kuntz et al. 2018).

Skipping breakfast has been repeatedly shown to be one of the most prominent poor dietary habits associated with low social status in school children in Europe and beyond (Hallström et al. 2012; Allensbach Institute 2019). Health-wise, skipping breakfast has been associated with a poorer dietary intake during the whole day, with a higher risk of obesity, and with poorer cognitive achievement at school (Rampersaud et al. 2005; Deshmukh-Taskar et al. 2010; Hoyland et al. 2009; Ardeshirlarijani et al. 2019).

Healthy food offers at schools are a major part of nutrition policy in Germany, especially with regard to lunch, including financial support for families in need (Allensbach Institute 2019; State of North Rhine-Westphalia 2022). Breakfast offers have not been an issue so far (Allensbach Institute 2019).

In 2019, the city of Bonn, situated in the western part of Germany, initiated a free breakfast offer for interested primary schools (model project “School Breakfast”), with the vision that improved nutrition should enable all children to stay focused during school lessons and ultimately increase opportunities for social participation of poor children (City of Bonn 2021). The aim of this survey was to assess the feasibility and acceptance of the breakfast project, with a focus on food offer and framework conditions.

Subject and methods

The “School Breakfast” project

The city of Bonn, with 330,000 inhabitants and ranking among the 20 largest cities in Germany (German Federal Statistical Office 2023), comprises districts with very different socioeconomic levels. In 2019, all 54 primary schools (50 regular schools, 4 schools for special educational needs) were invited by the municipal education authority to participate in a new municipal offer for a free school breakfast. This offer was initially planned for 2 years. No specific qualification criteria were given, except that interested schools had to provide a preliminary organizational concept and a cost calculation for the first 2 years. A working group consisting of the municipal authority and the interested schools was created to design the framework conditions.

An evaluation was planned for the municipality in order to decide on the continuation of the project.

Evaluation concept

The evaluation was planned primarily as an on-site assessment of the school breakfast offer, including pupils’ food selection, and an interview of the person mainly responsible for the practical implementation of the project in each of the project schools. Because of the COVID-19 pandemic and the strict contact restrictions, the on-site inspection of the breakfast situation had to be canceled, but the on-site interviews by study personnel remained possible, and were carried out in June 2021. The written informed consent of the interviewed person was mandatory for participation. The assessment was approved by the Ethics Committee of the Medical Faculty of the Ruhr University Bochum (Reg. No. 21-7240).

Data collection

The interviews followed a semi-standardized guided structure, which left room for spontaneous reactions of interviewer and interviewee and allowed flexibility, e.g., in the sequence of the questions. For constructing the questionnaire, experiences of three of the project schools with different types of breakfast organization that had been suggested by the school authority were taken into account. Specifically, the questionnaire addressed the food (food groups) selected by the schools for breakfast and how it was made available to the children. In addition, the questionnaire included questions on breakfast organization and other framework conditions as well as an assessment of the acceptance by pupils and parents.

As the pandemic restrictions still existed when the interviews were carried out, the regular pre-pandemic routines that were relevant for a realistic evaluation had to be asked retrospectively.

Data evaluation

All interviews were recorded. For questions with predefined answer categories, deductive category formation (in advance) was used; for the other questions, the categories were inductively generated directly from the free answers (Mayring and Fenzl 2014).

For the nutritional evaluation of the food offer, the food- and meal-based concept of the Optimized Mixed Diet (OMD) for children and adolescents (1–18 years) in Germany was taken as a reference (Kersting et al. 2017). The OMD is based on a 7-day menu with five meals per day, including a breakfast and a midmorning snack. The foods in these two breakfast meals formed the reference for the school breakfast (Kersting et al. 2022). The foods that the schools had chosen as regular breakfast components were categorized into the four food groups that are recommended for the breakfast meals of the OMD.

Data were analyzed descriptively and are presented as absolute frequencies of the variables in the schools.

Results

School characteristics

Fourteen schools took part in the project (26% of all primary schools in Bonn) and fully answered the interview questions: 13 schools on-site as planned, one school by phone.

General characteristics of the project schools are summarized in Table 1.

Table 1 Characteristics of project schools
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Overall, 59% of the pupils participated in the breakfast offer, with a large variation among the schools: Five schools stated that basically all pupils took part in the project, while at two schools 7% and 5% of pupils participated. Those two schools only intended to supply children who came to school without breakfast. Breakfast was offered on almost all school days. All schools offered full-day care including lunch (data not shown). Compared to the social index of all primary schools in Bonn, which is a countrywide classification of schools based on the social criteria of the pupil community, the project schools (average index 3.9) did not differ substantially from the total of primary schools in Bonn (average index 3.4) (Ministry of School and Education North Rhine-Westphalia 2020).

Figure 1 shows the schools’ motivation for participating in the breakfast project, which was most often the observation that children brought breakfast of poor quality and the opinion that children are hungry or malnourished if they do not eat breakfast. The possibility of getting children accustomed to healthy dietary habits or practical advantages of the breakfast offer, e.g., easy and low-threshold implementation, ranked far behind.

Fig. 1
figure 1

Motivation of schools for participation in the breakfast project (n = 14; multiple responses possible)

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Breakfast composition

The food categories chosen by the schools as regular breakfast components are shown in Fig. 2. All schools regularly offered (raw) vegetables and fruits, 11/14 offered cereal products and dairy products, and 5/14 a beverage. The most frequently offered individual foods within the food groups were common items, easy to handle and available all year-round, such as tomatoes, apples, or hard cheese. Among the cereals, unrefined or minimally refined items were preferred, and beverages were energy-free.

Fig. 2
figure 2

Overview of the most commonly offered foods within the food group (n = 14; multiple responses possible)

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Breakfast provision

Breakfasts were most often prepared by kitchen personnel, but the pupils themselves and volunteers were also involved (Table 2).

Table 2 People involved in breakfast preparation (n = 14)a
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The children could freely decide each day whether they wanted to take advantage of the food offer, as pre-registration (by the parents) was not required in most schools (Fig. 3a). In all schools, breakfast was consumed in the classroom; in three of the schools it was additionally possible to take it outside (data not shown). The children were actively involved in bringing the food to their class in most of the schools (Fig. 3b).

Fig. 3
figure 3

Aspects of the breakfast provision (n = 14)

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Attitudes toward the breakfast offer

The attitudes of the various stakeholders toward the school breakfast, as rated by the schools, are shown in Table 3. Acceptance by the pupils was clearly evaluated positively by the schools (Table 3a). Specifically, the pupils looked forward to the regular offer; they were curious and interested. However, a declining interest was also noted. The majority of schools reported that the breakfast was also positively received by the parents (Table 3b), although they rated the further interest of parents in the breakfast as mixed (data not shown). The schools themselves were also satisfied with the project; most of them had no suggestions for improvement (Table 3c).

Table 3 Attitudes of pupils, parents, and schools toward the breakfast offer as rated by the schools (n = 14)a
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Discussion

Overview

The municipal school breakfast project combines different prerequisites to make it promising for health promotion and prevention in children: (1) it is situated in obligatory primary schools and free of charge for the children, thus enabling low-threshold, effective access to socially disadvantaged children without stigmatization, (2) it focuses on breakfast as a significant component of a healthy and cognition-promoting diet for children, and (3) it leaves room for the schools to organize and establish the program without formal authoritative prescriptions. The food selection was large and in line with the dietary guidelines, and the relevant target groups and stakeholders of children, parents; and schools largely accepted the offer very well.

Feasibility without discrimination

Although the municipal breakfast offer was open to all primary schools, the primary intention was that schools in disadvantaged areas in particular should be motivated to participate. In fact, the evaluation showed that the participating schools are highly representative of the social landscape of primary schools in the city of Bonn, suggesting that schools, regardless of their social status, had addressed the issue of breakfast and seized the chance to participate.

The free access to the breakfast offer could help to prevent stigmatization of children in need (Centers for Disease Control and Prevention 2011). This corresponds to the school’s motivation to take part in the breakfast project, as many children come to school with breakfast of poor quality or with no breakfast at all and do not appear to be well nourished. This impression is confirmed by the fact that breakfast presents a particular challenge for many parents due to time pressure and hectic schedules in the morning (Allensbach Institute 2019).

Food selection

The foods offered for breakfast overall reflected quite well the composition of the recommended OMD breakfast, which consists of four main components: vegetables/fruits, cereals, dairy, and beverage (Research Department of Child Nutrition 2019). This success is probably also due to the schools' commitment to a healthy diet for children as a prerequisite for performance at school (Centers for Disease Control and Prevention 2011; Bartfeld et al. 2019; Hoyland et al. 2009).

While the European “school scheme” supports the free distribution of fruits, vegetables, and milk for children (European Commission 2024), the food offer in the project schools most often also included cereal (products). Whole-grain products were clearly preferred, making the breakfast more nutritious and increasing the potential for cognitive improvement due to their favorable glycemic consequences (Cooper et al. 2012).

National surveys in Germany show that children consume fruits already in amounts close to the OMD, while vegetable consumption ranges far below the recommendation (Mensink et al. 2020). The fact that vegetables were regularly offered and readily available in the project schools could serve as a nudge to subliminally motivate children to spontaneously reach for healthy foods (Bucher et al. 2016).

The lower implementation of milk/dairy in the project schools might be explained by the higher hygienic and organizational challenges and the additional costs for cooling facilities compared to cereals and fresh fruits and vegetables.

An often neglected breakfast food, including in the project schools, is water, although it has been recognized as the most important nutrient, especially for children (Manz et al. 2002). On the other hand, those schools that offered beverages for breakfast used plain water. It has been shown that low-threshold access to drinking water in primary schools in socially deprived areas resulted in increased water consumption and reduced the risk of obesity (Muckelbauer et al. 2009). Sugar-containing beverages, on the other hand, increase the risk of obesity, especially in children of low social status (Mensink et al. 2018). Schools could play an important role in motivating children to drink enough water, also in view of climate change and the more frequent occurrence of heat waves, which require a corresponding adjustment in fluid intake, especially among children (Kalhoff et al. 2023).

Acceptance

Children are the ultimate target group of the project, especially children from socially disadvantaged backgrounds. All schools agreed that the breakfast offer was very well accepted by the children. Only a few schools reported a decline in interest over time. As breakfast was offered regularly several days a week in most schools and as the breakfast was largely composed in line with the OMD recommendations, it can be assumed that the breakfast as practiced could make the expected contribution to a healthy diet for the target groups.

The fact that the schools were completely satisfied with the project and had no suggestions for improvement speaks for the feasibility of the offer under everyday school conditions. In view of the only moderate interest shown by parents in the school breakfast, the schools are all the more important as key stakeholders. The challenge remains to improve the networking of schools and parents in their responsibility for children's nutrition (Centers for Disease Control and Prevention 2011).

Strengths and limitations

One of the strengths of the project is that all project schools took part in the survey and that the schools already had 2 years of experience with the breakfast offer at the time of the survey, including around 1 year under the restrictions of the COVID-19 pandemic. It can be assumed that the range of practical experience is well reflected in the interviews despite the small number of schools.

The flexibility of the interview procedures made it possible to respond to each school individually.

A weakness of the project is the overlap in time with the COVID-19 pandemic, meaning that the pre-pandemic processes that are important for this assessment had to be reflected retrospectively by the interviewed persons. On-site assessments also had to be dispensed with due to the pandemic contact restrictions.

Conclusion

Pupils spend more time at school during the week than in any other non-family environment. Therefore, there is hardly a better setting in which to positively influence children's nutrition and health. The breakfast project and changing breakfast habits show that many children need support with their morning meals. Even though it was not possible to record the quantities consumed, it can be stated that the project schools generally selected foods in line with the OMD and were therefore able to tackle the problem of inadequate breakfast provision at home in a targeted manner. As there is no one-size-fits-all recipe for the success of such a breakfast project, there needs to be room for maneuvering depending on the local circumstances. However, the project schools were united by the common goal of giving all children access to a healthy breakfast and thus contributing to equal opportunities in health and education. Whether the breakfast project actually achieves this goal cannot be answered with this short-term evaluation—but the municipal breakfast offers have the potential to improve children’s nutrition via schools, and ultimately promote children’s health, by combining the healthy food offer with the children's practical participation in breakfast preparation and theoretical nutrition education in the classroom.