Making sense of healthy and sustainable food: adolescents’ voices on what it means, why it matters, and future change

Despite growing research on school food interventions aimed at promoting sustainable and healthy diets, the perspectives of adolescents regarding those interventions remain underexplored. This study explores adolescents' understanding, perceived importance, and proposed strategies for (facilitating) healthy and sustainable food choices. A mixed-methods study was conducted among 296 adolescents (aged 12-16) at four Dutch secondary schools. Data was gathered through four consecutive methods: a questionnaire, focus group discussions, classroom discussions, and a group poster assignment. Quantitative data were analysed using descriptive statistics and ordinal logistic regression analyses. Qualitative data were analysed inductively through thematic analysis. Adolescents primarily associated healthy and sustainable food with vegetables, fruit, and organic products. Two-thirds of the sample perceived eating healthy food as (very) important, compared to 21% for sustainable food, while 12% indicated not knowing what sustainable food entails. Proposed strategies to facilitate healthy and sustainable food were grouped in four main categories: 'strategies to change the food environment' (e.g. price), 'strategies to change the food system' (e.g. sustainable food production), 'strategies for communication and social support' (e.g. advertisements), and 'individual behaviour change strategies' (e.g. grocery planning). Most strategies targeted the food environment and/or the food system. While health aspects of food were well understood and perceived as important by adolescents, future approaches should emphasize the relevance of sustainable food for adolescents by addressing values they care about. Adolescents call for structural changes, particularly requiring governmental and organizational actions to improve the offer of healthy, sustainable, and affordable food, requiring collaboration of diverse stakeholders.