Raising healthy hearts: reimagining school nutrition to tackle childhood hypertension

It is easy to think of high blood pressure as something that happens later in life. A problem for middle-aged adults, not children still in school. But in India, that assumption is starting to look dangerously outdated. More and more children are being diagnosed with elevated blood pressure, and many of them do not even know it. It is not until adolescence or adulthood that the signs become too loud to ignore.

The numbers tell a worrying story. The Comprehensive National Nutrition Survey (CNNS) from 2016–18 found that 7.3% of Indian adolescents had hypertensive blood pressure levels. That number climbs to 9.1% in urban areas. Then there is the National Family Health Survey-5 (NFHS-5), which shows that 12% of teens aged 15–19 already have elevated blood pressure. These are not isolated cases. This is a trend. And it points to one very clear takeaway: if we want to tackle hypertension, we have to start early. Really early.

There are a few things feeding into this trend – rising childhood obesity, less physical activity, and a lifestyle that has shifted indoors and online. But if we had to name the biggest culprit, it would probably be the food our kids are eating.

The processed food problem

Walk into any grocery store or school canteen, and the reality hits you. Bright, attractive, crinkling packets of chips. Instant noodles. Processed snacks that promise flavour and convenience in seconds. For kids, these foods are both tempting and present everywhere .And they are taking a toll. On average, Indian adolescents are consuming more than 8 grams of salt a day. That is almost double the World Health Organization’s recommended limit for adults. Most of it comes from packaged snacks, fast foods, and street-side treats that are heavy on salt and low on nutrition.

These foods are salty and attractive to children, and they are designed to be. They hijack our taste buds with intense flavours, making simple, home-cooked meals seem bland in comparison. Over time, children develop a preference for these hyper-palatable foods, while their tolerance for healthier options drops. They create habits, and those habits are forming early.

Can school meals help?

India’s mid-day meal scheme (PM POSHAN) can become a pathway to break these habits early. As of 2025, the scheme now feeds approximately 120 million children across over 1.27 million schools, making it the largest school meal programme globally. It plays a vital role in reducing hunger, boosting school attendance, and promoting social equity.

And the benefits are clear. The programme ensures that primary school children receive 450 calories and 12 grams of protein per meal, while upper primary students receive 700 calories and 20 grams of protein. In a country where, as of 2022, more than half the population couldn’t afford a healthy diet, this nutritional safety net is critical. Moreover, access to consistent meals has been linked to better enrolment and attendance at school, while also helping bridge social divides by bringing children of all backgrounds to the same table.

That said, as the programme scales, there’s an opportunity to evolve beyond basic nutrition. Can these meals also be a gateway to healthier food habits and greater food literacy? For many children, these meals are not just their main source of nourishment but also their first exposure to structured eating. Yet, meals can be repetitive and lack the variety, flavor, and freshness that engage young palates, especially those used to bolder, snack-like flavors.

What if the next phase of PM POSHAN combined nutritional targets with efforts to cultivate a more joyful, educational relationship with food? Could we introduce regionally-inspired menus, fresh produce, or even involve students in food preparation and learning?

Japan’s food education playbook

For inspiration, we can look to Japan, where the concept of ShoKuiku, food education, is woven into school life. Children help plan meals, learn where their food comes from, and serve lunch to their classmates. They study nutrition and food origins while developing a sense of gratitude for the ingredients and the people who prepare them. Mealtimes are shared, mindful experiences that build connection and respect.

Schools offer freshly cooked, seasonal meals with no vending machines or processed snacks in sight. This daily routine teaches kids to eat in balance, make thoughtful choices, and value food as part of a healthy, connected life. It’s a simple yet powerful approach, which helps children understand how to make better choices. They learn about portion size, sodium intake, and even cultural traditions around food. And the results speak for themselves: lower rates of childhood obesity and a healthier relationship with eating.

Vietnam’s adaptation of ShoKuiku

If Japan seems too far removed from India’s realities, consider Vietnam. Their Ministry of Education teamed up with Ajinomoto to improve school lunches by adapting the ShoKuiku model in 2012. The programme included tailored recipe development, inculcating nutrition education to student’s curriculum and specialised training for school cooks.

The result? By October 2022, the project expanded to 62 of Vietnam’s 63 provinces and cities, with 4,262 schools adopting the programme and utilising the menu-planning software.

This enabled more variety in meals, better acceptance of healthy options, and increased awareness among both students and parents. This model did not require massive structural changes, it just required collaboration, planning, and a genuine commitment to improving children’s nutrition.

What can we do differently?

We need to bring that same ambition into our schools. Not just calories on a plate, but food that speaks to taste, texture, culture, and nutrition. We can do this by:

• Elevating PM POSHAN into a food-literacy engine, and reshaping habits, palates, and minds.

• Elevating PM POSHAN into a food-literacy engine, and reshaping habits, palates, and minds.

• Elevating PM POSHAN into a food-literacy engine, and reshaping habits, palates, and minds.

Taking notes from Japan and Vietnam. Structured food education, trained school cooks, and thoughtful, balanced menus can transform lunch into a launchpad for lifelong health.

Here, public-private partnerships could also make a difference. Nutrition scientists, chefs, and behavioural experts, all have a role to play. We do not need to reinvent the wheel. We just need to build a system that puts children at the heart of it.

We tend to think of high blood pressure as a problem for later. But the evidence is clear, it is already here. And it is affecting children in ways we are only beginning to understand.

We have a window of opportunity. If we act now, we can reshape the way a generation eats, grows, and lives. School nutrition may not be the flashiest reform out there. But it could be one of the most powerful.

Let us raise healthy kids, with healthier hearts.

(Dr. Anuja Agarwala is a senior genetic metabolic nutrition consultant and national vice president, Indian Dietetic Association Email: [email protected])