Nutrition Education in Greek Secondary School Textbooks: A Content Analysis of Coverage and Thematic Orientation

Background: In Greece, nutrition education is not taught as an independent subject but is incorporated across multiple disciplines. Objective: To evaluate the extent, distribution, and thematic orientation of nutrition-related content in Greek secondary school textbooks. Methods: A systematic content analysis was conducted on all officially approved textbooks used in Greek secondary education during the academic year 2022-2023. A total of 164 textbooks (26,914 pages) were analyzed. Nutrition-related references were systematically identified using predefined keywords and categorized into thematic domains. Coding was performed independently by two researchers (Cohen's κ = 0.84). Results: A total of 1426 nutrition-related references were identified. Nutrition-related content was unevenly distributed, with 57.1% in Gymnasium textbooks and 42.9% in Lyceum textbooks. When normalized, Gymnasium textbooks contained 7.47 references per 100 pages compared with 3.82 in Lyceum. Content was primarily focused on biological concepts (27.1%) and health/disease prevention (20.3%), while behavioral (16.5%), psychosocial (16.2%), and sustainability-related (19.8%) dimensions were less represented. No references addressed skills-based nutrition education. Conclusions: Nutrition education in Greek textbooks is present but fragmented and predominantly biologically oriented. The lack of behavioral and skills-based content suggests the need for more comprehensive and interdisciplinary educational approaches.