Despite access to free school meals, some adolescents eat outside school during the school day. A new study from Karolinska Institutet, published in BMC Public Health, found that meals consumed outside school is more often classified as unhealthy compared to food consumed at school. The findings highlight the importance of both school meals and the food environment surrounding schools.
Researchers at Karolinska Institutet have investigated where adolescents eat during the school day and what types of food they choose. The study was conducted by the IMPACT research group at the Department of Medicine, Huddinge, led by Ioannis Ioakeimidis .
A total of 483 students aged 13 to 19 from two schools in central Stockholm took part in the study. During the data collection periods, conducted between 2019 and 2021 and again in 2024, participants reported a total of 4,562 photographs of food and drinks using research apps. Each time a photograph was taken, the time and GPS location were also recorded, enabling researchers to map what students ate, when they ate, and whether the food was consumed inside or outside school.
The results showed that 21 per cent of all reported meals and drinks consumed during the school day were eaten outside the school grounds. The proportion of meals classified as unhealthy was also higher outside school than within the school premises, at 65 per cent compared to 43 per cent.
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“We found that a considerable proportion of adolescents’ food and drink consumption during the school day takes place outside school. This highlights the importance of considering the surrounding food environment when studying the choices adolescents make,” says Hanna Wieslander , doctoral student at the Department of Medicine, Huddinge , Karolinska Institutet.
School meals more complete
The researchers also observed clear differences between school meals and meals consumed outside school. Meals eaten at school more often comprised several components of a complete meal and contained higher proportions of vegetables and fish. They also contained higher proportions of red and processed meat than meals eaten outside school. At the same time, snacks were often classified as unhealthy regardless of where they were consumed.
Differences were also seen in beverage choices. Sugar-sweetened drinks were significantly more common among beverages reported outside school, while water was the predominant drink consumed at the school.
The findings indicate that the availability of free school meals does not necessarily mean that all students choose to eat their meals at school.
“To support healthy eating habits, we need a better understanding of why adolescents choose to eat in or outside school and what role the school food environment plays,” says Hanna Wieslander.
The results may contribute to future public health initiatives and research on how school settings and surrounding food environments can be designed to encourage healthier eating habits among adolescents. The next step is to investigate the factors influencing adolescents’ choices and how the method can be applied in larger and more diverse population groups.
The research was funded by the European Union’s Horizon 2020 and Horizon Europe research programmes, as well as Forte. Three of the study’s authors are part-owners of Arbisense AB, which developed the Mobile Sense data collection tool used in the study. The remaining authors declare no conflicts of interest.
Publication
Wieslander H, Spolander S, Papapanagiotou V, Papadopoulos A, Patterson E, Ioakimidis I.
BMC Public Health, 22 September 2026, doi: 10.1186/s12889-026-29555-8.
