Strategies to Improve School Meal Consumption: A Systematic Review.

Juliana F. W. Cohen,Erin R. Hager,Kara Burkholder,Marlene B. Schwartz,Lindsey Turner,Amelie A. Hecht

doi:10.3390/nu13103520

Abstract

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

Highlights

In the United States, approximately 95% of public and non-profit private elementary, middle, and high schools participate in the school meal programs administered by the United States Department of Agriculture (USDA) [1,2]
The primary reasons for exclusion were based on the study objectives; the outcomes assessed; publication type; and the study location
Lunch duration was not associated with consumption

Summary

Introduction

In the United States, approximately 95% of public and non-profit private elementary, middle, and high schools participate in the school meal programs administered by the United States Department of Agriculture (USDA) [1,2]. Both the National School Lunch Program (NSLP) and School Breakfast Program (SBP) provide children and adolescents with healthy, low-cost meals throughout the school year. In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) required the USDA to update many of its regulations for federal school nutrition programs to reflect the concurrent Dietary Guidelines for Americans [5]. Schools were required to update their local school wellness policies to promote healthier school environments [7]

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Discussion

Conclusion