Skip to main content Accessibility help

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

  • Simon Murphy (a1), GF Moore (a1), K Tapper (a2), R Lynch (a1), R Clarke (a1), L Raisanen (a1), C Desousa (a3) and L Moore (a1)...

The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.


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.


Primary schools in nine local education authority areas.


A total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.


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.


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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1.Smithers, G, Gregory, J, Bates, C et al. (2000) The National Diet and Nutrition Survey: young people aged 4–18 years. Nutr Bull 25, 105111.
2.McCann, D, Barrett, A, Cooper, A et al. (2007) Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 370, 15601567.
3.Foresight (2007) Tackling Obesity: Future Choices. London: Government Office for Science.
4.Balding, J (2001) Food choices and weight control. In Young People in 2000, pp. 1–12 [J Balding, editor]. Exeter: Schools Health Education Unit.
5.Berkey, CS, Rockett, HRH, Gillman, MW et al. (2003) Longitudinal study of skipping breakfast and weight change in adolescents. Int J Obes 27, 12581266.
6.Bruno-Ambrosius, K, Swanholm, G & Twetman, S (2005) Eating habits, smoking and tooth brushing in relation to dental caries: a 3-year study in Swedish female teenagers. Int J Paediatr Dent 15, 190196.
7.Fujiwara, T (2003) Skipping breakfast is associated with dysmenorrhea in young women in Japan. Int J Food Sci Nutr 54, 505509.
8.Nicklas, TA, Bao, W, Webber, LS et al. (1993) Breakfast consumption affects adequacy of total daily intake in children. J Am Diet Assoc 93, 886889.
9.Sjoberg, A, Hallberg, L, Hoglund, D et al. (2003) Meal pattern, food choice, nutrient intake and lifestyle factors in The Goteborg Adolescence Study. Eur J Clin Nutr 57, 15691578.
10.Pollitt, E (1995) Does breakfast make a difference in school? J Am Diet Assoc 95, 11341139.
11.Pollitt, E, Gersovitz, M & Gargiulo, M (1978) Educational benefits of the United States school feeding program: a critical review of the literature. Am J Public Health 68, 477481.
12.Rampersaud, GC, Pereira, MA, Girard, BL et al. (2005) Review – breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 105, 743760.
13.Elgar, FJ, Roberts, C, Moore, L et al. (2005) Sedentary behaviour, physical activity and weight problems in adolescents in Wales. Public Health 119, 518524.
14.Keski-Rahkonen, A, Kaprio, J, Rissanen, A et al. (2003) Breakfast skipping and health-compromising behaviors in adolescents and adults. Eur J Clin Nutr 57, 842853.
15.Moore, GF, Tapper, K, Murphy, S et al. (2007) Associations between deprivation, attitudes towards eating breakfast and breakfast eating behaviours in 9–11 year olds. Public Health Nutr 10, 582589.
16.O’Dea, JA & Caputi, P (2001) Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6 to 19-year-old children and adolescents. Health Educ Res 16, 521532.
17.James, J, Thomas, P, Cavan, D et al. (2004) Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 328, 1237.
18.Moore, L, Tapper, K, Dennehy, A et al. (2005) Development and testing of a computerised 24-h recall questionnaire measuring fruit and snack consumption among 9–11 year olds. Eur J Clin Nutr 59, 809816.
19.Mikkila, V, Rasanen, L, Raitakari, OT et al. (2004) Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study. Eur J Clin Nutr 58, 10381045.
20.Birch, LL & Marlin, DW (1982) I don’t like it; I never tried it: effects of exposure on 2-year-old children’s food preferences. Appetite 3, 353360.
21.Birch, LL, McPhee, L, Shoba, BC et al. (1987) What kind of exposure reduces children’s food neophobia? Looking vs tasting. Appetite 9, 171178.
22.Sullivan, SA & Birch, LL (1990) Pass the sugar, pass the salt – experience dictates preference. Dev Psychol 26, 546551.
23.Wardle, J, Herrera, ML, Cooke, L et al. (2003) Modifying children’s food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable. Eur J Clin Nutr 57, 341348.
24.Bellisle, F (2004) Effects of diet on behaviour and cognition in children. Br J Nutr 92, S227S223.
25.Shemilt, I, O’Brien, M, Thoburn, J et al. (2003) School breakfast clubs, children and family support. Child Soc 17, 111112.
26.Friedman, BJ & Hurd-Crixell, SL (1999) Nutrient intake of children eating school breakfast. J Am Diet Assoc 99, 219221.
27.US Department of Agriculture (2007) The School Breakfast Programme. Alexandria, VA: US Department of Agriculture.
28.Fox, MK, Hamilton, W & Lin, BH (2004) Food Assistance and Nutrition Research Report no. FANRR19-3. Washington, DC: USDA, Economic Research Service.
29.Murphy, J (2007) Breakfast and learning: an updated review. Curr Nutr Food Sci 3, 336.
30.Bernstein, LS, McLaughlin, JE, Crepinsek, MK et al. (2004) Evaluation of the School Breakfast Program Pilot Project: Final Report. Nutrition Assistance Program Report Series Report no. CN-04-SBP. Alexandria, VA: The Office of Analysis, Nutrition, and Evaluation.
31.Crensek, M, Singh, A, Bernstein, L et al. (2006) Dietary effects of universal free school breakfasts: findings from the evaluation of the school breakfast program pilot project. J Am Diet Assoc 106, 17961803.
32.Belderson, P, Brandon, M, Camina, Met al. (2001) A National Evaluation of School Breakfast Clubs. Final Report. Norwich: University of East Anglia.
33.Bro, RT, Shank, L, Williams, R et al. (1994) The effects of an in-class breakfast program on attendance and on-task behaviour of high school students. Child Fam Behav Ther 16, 18.
34.Murphy, JM, Pagano, ME, Nachmani, J et al. (1998) The relationship of school breakfast to psychosocial and academic functioning. Arch Pediatr Adolesc Med 152, 899907.
35.Shemilt, I, Harvey, I, Shepstone, L et al. (2004) A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysis. Child Care Health Dev 30, 413427.
36.Ani, C & Grantham-McGregor, S (1999) The effects of breakfast on children’s educational performance, attendance and classroom behaviour. In Fit for School: How Breakfast Clubs Meet Health Education and Childcare Needs, pp. 1117 [N Donovan and C Street, editors]. London: New Policy Institute.
37.Roberts, J & Murphy, S (2005) A Study of the Preliminary Phase of the Welsh Assembly Government ‘Primary School Free Breakfast Initiative’. Cardiff: Welsh Assembly Government.
38.Lynch, R & Murphy, S (2007) A Process Evaluation of the Welsh Assembly Government’s Primary School Free Breakfast Initiative. Cardiff: Welsh Assembly Government.
39.Moore, L, Moore, GF, Tapper, K et al. (2007) Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the primary school free breakfast initiative in Wales (ISRCTN18336527). BMC Public Health 7, 258270.
40.Smith, AP, Kendrick, AM & Maben, AL (1993) Effects of breakfast and caffeine on performance and mood in the late morning and after lunch. Neuropsychobiology 26, 198204.
41.Benton, D & Sargent, J (1992) Breakfast, blood-glucose and memory. Biol Psychol 33, 207210.
42.Moore, GF, Tapper, K, Murphy, S et al. (2007) Validation of a self-completion measure of breakfast foods, snacks and fruits and vegetables consumed by 9–11 year old schoolchildren. Eur J Clin Nutr 61, 420430.
43.Tapper, K, Murphy, S, Lynch, R et al. (2007) Development of a scale to measure 9–11 year olds’ attitudes towards breakfast. Eur J Clin Nutr 62, 511518.
44.Goodman, RPD (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40, 13371345.
45.Benton, D & Jarvis, M (2007) The role of breakfast and a mid-morning snack on the ability of children to concentrate at school. Physiol Behav 90, 382385.
46.Donner, A & Klar, N (2000) Design and Analysis of Cluster Randomised Controlled Trials in Health Research. London: Arnold.
47.Jowell, R (2003) Trying it Out: The Role of ‘Pilots’ in Policy-Making: Report of a Review of Government Pilots. London: Strategy Unit.
48.Creegan, C & Hedges, S (2007) Towards a Policy Evaluation Service: Developing Infrastructure to Support the Use of Experimental and Quasi-Experimental Methods. London: Ministry of Justice.
49.Campbell, M, Fitzpatrick, R, Haines, A et al. (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321, 695696.
50.Pawson, R & Tilley, N (1997) Realistic Evaluation. London: Sage Publications.
51.Grantham McGregor, S (2005) Can the provision of breakfast benefit school performance? Food Nutr Bull 26, 144158.
52.Department of Health (2005) Choosing a Better Diet: A Food and Health Action Plan. London: Department of Health.
53.Welsh Assembly Government (2006) Appetite for Life. Cardiff: Welsh Assembly Government.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed