From School Meals to Care Homes
Diabetes is often discussed in clinical settings, but far less frequently through the lens of catering and food service. Yet for millions of people living with diabetes in the UK, daily food environments play a significant role in blood glucose management, long-term health and quality of life. As diabetes prevalence continues to rise across all age groups, the role of food service across all sectors has become more than simply “providing meals”.
Currently, more than 5.8 million people in the UK are living with diabetes or pre-diabetes, with around 90% of diagnosed cases being Type 2 diabetes. Diabetes is associated with various long-term complications, including cardiovascular disease, kidney disease, neuropathy and visual impairment, placing significant pressure on both healthcare and social care systems.
While Type 1 diabetes is an autoimmune condition unrelated to lifestyle, food provision still plays a vital role in supporting safe blood glucose management. Type 2 diabetes, meanwhile, is strongly influenced by increasing obesity rates, sedentary lifestyle, and changing dietary patterns. This means catering providers increasingly sit at the intersection between public health guidance and everyday dietary behaviour.
School Food & Children
The school food environment plays a significant role in shaping children’s dietary habits and behaviours that often continue into adulthood. In areas of socioeconomic deprivation, school meals may provide the most nutritionally balanced meal of the day. For children living with Type 1 diabetes, access to consistent carbohydrate provision is essential for safe day-to-day blood glucose management. For the wider school population, access to nutritionally balanced meals influences long-term health outcomes.
Current UK dietary data highlight several ongoing concerns among children and adolescents. The National Diet and Nutrition Survey (NDNS) reports that only around 9% of children aged 11–18 meet the recommended 5 A Day fruit and vegetable target, and only 4% meet fibre recommendations. Adolescents also have the highest intake of sugar-sweetened beverages of any age group.
Low fibre intake is particularly concerning as fibre contributes to satiety, digestive health and improved cardiometabolic health. Meanwhile, diets high in free sugars and energy-dense, poor-nutrient foods are associated with increased obesity risk, and the likelihood of developing Type 2 diabetes amongst other chronic health conditions.
However, promoting healthier eating in schools is not simply about removing sugar or restricting foods. For pupils living with diabetes, overly limiting approaches may risk unnecessary stigma or exclusion. Instead, the focus should be on balanced, enjoyable and inclusive menus, that promote steady energy release and overall nutritional quality.
School caterers can support healthier dietary patterns through practical adjustments such as:
- Increasing wholegrains, pulses and vegetables
- Reducing reliance on high free sugar desserts and drinks
- Offering balanced carbohydrate portions
- Improving staff awareness around hypoglycaemia and dietary inclusion
As proposed updates to School Food Standards continue to focus on reducing foods high in fat, salt and sugar, school caterers will likely play an even greater role in shaping healthier food environments for future generations.
Hospitality & Adults
Eating out has become a routine part of modern life, yet hospitality settings can present challenges for adults living with diabetes. Portion sizes, hidden sugars, refined carbohydrates and heavily processed foods can influence blood glucose regulation and overall diet quality.
Research suggests that frequent out-of-home eating is associated with higher calorie intake, higher consumption of ultra-processed foods (UPFs), saturated fat and sodium. UPFs in particular, have been increasingly linked with adverse metabolic health outcomes and an increased risk of Type 2 diabetes.
For adults living with diabetes, managing blood glucose levels is not necessarily about avoiding certain foods entirely, but rather understanding portion sizes, carbohydrate quality and overall dietary balance. Inconsistent portioning, large serving sizes and limited transparency can make this difficult when eating out, creating both a challenge and an opportunity for the catering industry.
Small practical changes that can make meaningful difference include:
- Offering flexible portion sizes
- Increasing availability of high-fibre carbohydrates and vegetables
- Reducing added sugars in sauces and desserts
- Expending low-sugar and non-alcoholic beverage options
Importantly, healthier hospitality should not feel clinical or restrictive. Adults living with diabetes generally do not want separate “diabetic menus”, rather meals that allow them to make informed choices while still enjoying the social and cultural experience of eating out.
As consumer interest in health and nutrition grows, hospitality providers may increasingly find themselves balancing customer expectations for both enjoyment and nutritional quality.
Care Homes & Older Adults
Diabetes management becomes increasingly complex in older age. In care home settings, nutritional priorities often extend beyond blood glucose management alone and must also consider frailty, malnutrition risk, hydration, appetite, swallowing difficulties and quality of life.
Older adults living with diabetes are at an increased risk of poor wound healing, dehydration, hospitalisation, sarcopenia and functional decline. At the same time, appetite loss and reduced food intake are common in ageing populations, particularly among residents living with multiple long-term conditions.
Current nutrition guidance increasingly supports a more individualised approach in elderly care settings. For some residents, maintaining adequate nutritional intake and preventing weight loss may be more clinically important than strict dietary restrictions.
Protein intake becomes especially important in older age because inadequate intake can accelerate muscle loss and frailty. Hydration support is equally critical. The combination of reduced thirst perception associated with ageing, and increased fluid losses caused by diabetes places older adults at significantly greater risk of dehydration and its complications, including cognitive decline, falls, kidney disfunction and poorer health outcomes.
Care home catering teams therefore play a key role in supporting both nutritional adequacy and dignity. Practical approaches may include:
- Offering smaller, more frequent meals
- Providing nourishing snacks
- Supporting hydration throughout the day
- Using texture-modified meals where appropriate
- Ensuring meals remain enjoyable and socially meaningful
Texture-modified meals, in particular, should still be visually appealing and nutritionally balanced rather than purely functional. Food enjoyment remains an important component of wellbeing, regardless of age or medical condition.
As the population continues to age, care home catering is likely to become increasingly clinically complex, requiring closer collaboration between catering teams, healthcare professionals and care staff.
Public Health Recommendations vs Catering Reality
Across schools, hospitality and care homes, caterers are increasingly expected to support public health goals through healthier food provision. However, these expectations often fail to fully consider the operational realities faced by the industry.
Food inflation, labour shortages, increasing dietary complexity and growing compliance demands all create significant operational challenges for catering providers. At the same time, public health guidance continues to discourage consumption of foods high in fat, salt and sugar, while emphasising the importance of a whole food diet rich in fibre, fruits, vegetables.
Ultimately, diabetes prevention and management cannot sit solely with healthcare professionals or individuals. From school meals to restaurants and care homes, the catering industry has the potential to support healthier outcomes for millions of people living with diabetes. However, meaningful progress will require not only public health ambition, but realistic support for the teams responsible for delivering it.
Implementation of evidence-based recommendations require a whole system approach, and the addressing of the bridge between expectation and reality.
Published by Fanni Fazekas ANutr – Nutritionist at AVE
