Cardiometabolic diseases (CMDs) – including cardiovascular disease, hypertension, and type 2 diabetes – are now the leading cause of death worldwide. A primary driver of these illnesses is obesity, which is rising fastest among children. 

According to a recent study in The Lancet, if current trends continue, more than one third of children and adolescents worldwide will be living with obesity by 2050. Many of these will go on to develop a life-threatening cardiometabolic disease. 

Typically, symptoms start showing in middle age and require lifelong medical treatment to slow their worsening over time. Even with such medical intervention, those affected are disproportionately more likely to die prematurely before the age of 75. This reality is no longer confined to high-income countries: more than 80% of premature CMD deaths now occur in low- and middle-income countries (LMICs), where CMD mortality is rising faster than anywhere else in the world.

The costs are not only human. Cardiometabolic diseases are now the single largest financial burden faced by health systems worldwide. Countries are spending vast sums managing conditions that are, in large part, preventable. 

The question facing policymakers is simple: if we are serious about prevention, where do we intervene?

Diet is central to the story, yet changing population diets has proven remarkably difficult. Food environments influence dietary behaviours long before individuals exercise personal agency, and growing evidence suggests that dietary habits are shaped early in life and persist into adulthood. 

If childhood is a critical window for prevention, then any meaningful intervention must meet three conditions: it must reach children at scale, operate within existing systems, and be politically and financially feasible.

School meal programmes may be one of the few platforms that meet those criteria.

Globally, school meals already reach at least 466 million children and are supported primarily by domestic national budgets. In fact, more children are now receiving a daily school meal than at any other point in history, with many countries – including Canada, Denmark, and Indonesia – launching a national programme for the first time in 2025, in recognition of the unique value of school meals as an investment in the health and wellbeing of future generations. 

The infrastructure exists. The political commitment exists. The question is not whether to build something new – but whether we are fully using what is already in place.

Can school meals, when delivered with sufficient quality and consistency, contribute to the prevention of diet-related noncommunicable diseases?

A forthcoming White Paper from the Research Consortium for School Health and Nutrition is set to explore this question. 

Led by the London School of Hygiene & Tropical Medicine in collaboration with a global, multi-author, multi-institution writing team, the paper will examine a sequence of immediate and measurable steps to lay the groundwork for further research and identify key opportunities for governments wanting to act quickly:

1. Do school meals improve children’s nutrition in the short term?
2. Do they shape food preferences and dietary habits beyond the school gate?
3. Do they influence the biological markers that predict later cardiometabolic risk?
4. And under what conditions do programmes achieve these effects?

The logic is cumulative. If school meals improve diet quality during childhood, influence longer-term behaviour, and positively affect early metabolic indicators, then there is reason to view them as a credible preventive strategy – not only an educational or social protection intervention, but a public health investment.

The urgency of the global CMD crisis demands that we strengthen the systems already within reach. School meal programmes represent a rare alignment of political feasibility, existing infrastructure and biological plausibility.

On World Obesity Day, as attention turns once again to rising rates of obesity, the conversation should extend beyond individual responsibility. The real opportunity may lie in the institutions that shape children’s daily environments – and the policies that govern what is placed on their plates.

The White Paper is supported by the Novo Nordisk Foundation and will be formally launched at the Novo Nordisk Science Summit in June 2026. 

The Research Consortium welcomes input from collaborators in all regions. To express your interest in joining the White Paper writing team, please contact Dr Patricia Eustachio Colombo, Lead Penholder: [email protected].