Increasing Frequency of Lower-Fat Entrees Offered at School Lunch: An Environmental Change Strategy to Increase Healthful Selections

Abstract

Objective A two-phase study was conducted to determine the effect of an environmental intervention aimed to increase the selection of low- and moderate-fat entrees at school. Design An evaluation of a school-wide intervention followed for two semesters. Subjects Two schools of similar size and demographic data were randomly assigned to either intervention or control. Participants were the children in these schools. Intervention In Phase 1, the rotation of existing entrees was modified such that one of three entree choices was low or moderate in fat. In Phase 2, the number of competing high-fat entrees was reduced from two choices to one. Main Outcome Measures Data were: (a) entree fat content (determined by a registered dietitian) and (b) the aggregate entree selections compiled from daily selection reports. Statistical Analyses Performed Frequency distributions were used to describe entree availability. Two-way analysis of variance indicated differences in the mean daily selection of low-, moderate-, and high-fat entrees. Results In Phase 1 in the intervention school, the number of days that a low-fat entree was offered increased by 70%, with no increase in the rate of selection of the low- or moderate-fat entrees. In Phase 2, both low- and moderate-fat entrees were selected at a higher rate in the intervention school (32.1% and 26.4%, respectively) than the control school (13.8% and 7.5%, respectively), P<0.01. Conclusions Increasing the availability of low- and moderate-fat entrees is not sufficient to increase their rate of selection. However, their rate of selection is increased as the availability of high-fat entree choices is reduced.