The Effect of School Lunch Interventions and Policy Changes on Student Food Behavior 2006-2016: A Systematic Review

Abstract

Childhood obesity is a global epidemic. One approach addressing childhood obesity is through federally subsidized school meals programs. The U.S. National School Lunch Program mandates school nutrition standards aligned with the Dietary Guidelines for Americans. As students consume a significant proportion of their total intake during the school day, increasing access to healthy foods at school is proposed to improve student dietary outcomes. The purpose of this review is to assess how school lunch interventions and policy changes in the last ten years (namely the 2006-2007 Wellness Policies and the Healthy, Hunger-Free Kids Act of 2010) affected student food behavior. PubMed, Web of Science, and Science Direct were searched for primary research studies evaluating student food behavior in the U.S. school lunch setting. Only policy evaluations and interventions implemented during specified policy time periods were included. A total of twenty-nine studies meeting inclusion criteria were identified and reviewed. Plate waste, intake, selection, and purchasing patterns. Seventeen studies reported improved food behavior changes (increased selection, intake, and sales of healthy foods, and decreased plate waste). Twelve studies reported negative food behavior outcomes (decreased selection, intake, and sales of healthy foods, and increased plate waste). The majority of studies indicated that increasing access to healthy foods during school lunch improved students’ dietary outcomes. However, these findings are not consistent across the literature. Study Design, adaptation period, sample size, food culture, quality of foods, and policy implementation challenges contribute to the success/failure of school lunch. Ongoing evaluation of these programs is warranted.