Background The importance of a multifactorial whole school approach to healthy eating is gaining much recognition among policy makers; however, there is little conclusive evidence on the effectiveness of such an approach. The main aim of this study was to examine whether there is any association between the number of actions schools are taking to promote healthy eating and the dietary behaviour of schoolchildren.

Methods A multilevel analysis investigated the association between school (n=64) approaches to promoting dietary choice, collected through teacher (n=289) postal surveys, and the reported dietary choices of students collected from students aged 11 to 16 (n=6693) in Wales through the 2005/2006 Health Behaviour in School-aged Children study.

Results Once controlling for all student-level and school-level variables, students in schools with the most actions to promote healthy eating in place had 1.91 (CI=1.13 to 3.24) times the odds of agreeing to eat fruit for lunch, 1.54 (CI=1.07 to 2.22) times the odds of reporting to eating fruit or vegetables on a daily basis and 0.52 (CI=0.29 to 0.95) the odds of agreeing that they eat sweets for lunch, in comparison with students in schools with the lowest number of actions in place.

Conclusion The number of actions that secondary schools have in place to promote healthy eating is significantly associated with healthy food choices made by students. Further research is needed to identify which specific actions are most strongly associated with students' dietary behaviour, and the barriers to more widespread adoption of a whole school approach.