The Third School Nutrition Dietary Assessment Study: Summary and Implications

Questions have arisen as to whether the school environment is currently a contributing factor to the increase in childhood obesity, and whether changes in school policies could help curb the increase. In this chapter, we discuss key aspects of the literature on the role of the school food environment, and the role of the school activity environment in effecting the caloric intake and expenditure of children. We also simulate the effect of a range of reasonable changes in weekly minutes spent being active in school, and changes in weekly calories consumed in school.

USDA Nutrient Standard Menu Planning option, one of two National School Lunch Program options for school meal planning, has no requirements for fruit/vegetable servings and enables foodservice to serve nutrient-poor foods while remaining compliant with nutrition requirements. The objective of this research was to compare student reported preferences, meals offered, and meals selected over nine days. A preference survey was administered to 151 ninth grade students attending a low-income northern California high school. School lunch observations were conducted daily for an average of 418 to 584 students by trained researchers. Observation data demonstrated that 66% of students chose no servings of fruit or vegetables over the nine day period. In addition, 37% consistently selected the same one or two meals out of the 32 meals offered daily over a five day period. There was a discrepancy between reported meal preferences and observed meal selections. While 10% selected pizza as their most preferred entrée, pizza comprised almost 30% of all daily entrée sales. This discrepancy is possibly due to the increased availability of pizza and/or limited availability of the more preferred entrees that either contain or are served with a fruit/vegetable. Findings indicate that a significant proportion of students may complete high school without ever selecting a serving of fruit or vegetables. A considerable gap between available food items and student preferences resulted in nutrient-poor food selection practices among 9th graders.

Background/ObjectivesValidation-study data were analyzed to investigate the effect of retention interval (time between the to-be-reported meal and interview) on accuracy of children's school-breakfast reports and school-lunch reports in 24-hour recalls, and to compare accuracy of children's school-breakfast reports for two breakfast locations (classroom; cafeteria).Subjects/MethodsEach of 374 fourth-grade children was interviewed to obtain a 24-hour recall using one of six conditions from crossing two target periods (prior 24 hours; previous day) with three interview times (morning; afternoon; evening). Each condition had 62 or 64 children (half boys). A recall's target period included one school breakfast and one school lunch, for which the child had been observed. Food-item variables (observed number; reported number; omission rate; intrusion rate) and energy variables (observed; reported; report rate; correspondence rate; inflation ratio) were calculated for each child for school breakfast and school lunch separately.ResultsAccuracy for school-breakfast reports and school-lunch reports was inversely related to retention interval. Specifically, as indicated by smaller omission rates, smaller intrusion rates, larger correspondence rates, and smaller inflation ratios, accuracy for school-breakfast reports was best for prior-24-hour recalls in the morning, and accuracy for school-lunch reports was best for prior-24-hour recalls in the afternoon. For neither school meal was a significant sex effect found for any variable. For school-breakfast reports, there was no significant school-breakfast location effect for any variable.ConclusionsBy shortening the retention interval, accuracy can be improved for school-breakfast reports and school-lunch reports in children's 24-hour recalls.

Who Are America's Poor Children? Examining Food Insecurity Among Children in the United States

The Theory of Planned Behavior and the USDA Summer Food Service Program

Background: Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States. Methods: Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003–2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order. Results: The two top ranked food/food group sources of energy and nutrients were: energy—milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein—milk (13.2%) and poultry (12.8%); total carbohydrate—soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars—soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars—soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber—fruit (10.4%) and yeast bread/rolls (10.3%); total fat—cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids—cheese (16.3%) and milk (13.3%); cholesterol—eggs (24.2%) and poultry (13.2%); vitamin D—milk (60.4%) and milk drinks (8.3%); calcium—milk (33.2%) and cheese (19.4%); potassium—milk (18.8%) and fruit juice (8.0%); and sodium—salt (18.5%) and yeast bread and rolls (8.4%). Conclusions: Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children’s diets.

Competitive foods/beverages are those in school vending machines, school stores, snack bars, special sales, and items sold à la carte in the school cafeteria that compete with United States Department of Agriculture (USDA) meal program offerings. Grouping à la carte items with less nutritious items allowed in less regulated venues may obfuscate analysis of the school competitive food environment. Excluding à la carte items from competitive foods, the objectives were to: (1) assess competitive food use by gender, ethnicity, eligibility for free or reduced-price meals, and participation in school meals programs, (2) determine differences between grade levels in energy intakes obtained from food sources, (3) determine the nutrient intake derived from competitive foods for students who consumed them, and (4) determine energy-adjusted differences in 24-hour nutrient intakes of protein, calcium, iron, and other selected nutrients between competitive food consumer and nonconsumers. Competitive foods/beverages use, excluding à la carte items, was examined using the third School Nutrition Dietary Assessment Study (SNDA III), a nationally representative sample of 2309 schoolchildren in grades 1 to 12. Mean nutrient intakes were adjusted for energy intake and other covariates, and differences between consumers and nonconsumers of competitive items were determined using analysis of variance and sudaan. Excluding à la carte items, 22% of schoolchildren consumed competitive items in a representative school day and use was highest in high school. Consumers of competitive items other than à la carte had significantly higher mean energy, sugar intakes, and lower sodium, dietary fiber, B vitamins, and iron intakes than nonconsumers. Use of competitive foods/beverages, excluding à la carte, was detrimental to children's diet quality.

Government agencies have the authority to improve public health through laws and policies. Childhood obesity is one of the most pressing health issues today, and government policies are a critical strategy to improve children’s nutrition and health. This chapter reviews evidence-based policies that can be implemented at local, state, and federal levels to improve children’s nutrition and weight. We discuss (a) why policy change may be more cost-effective and impactful than programs aimed at individuals; (b) how to strengthen federal child-feeding programs; and (c) which policies have potential to improve and change food industry practices.

Contribution of food provision in primary schools to the prevention of childhood obesity

Summer vacation is a time when youth gain excessive weight. A key driver of unhealthy weight gain is poor dietary quality. The absence of consistent structure (e.g., school), is hypothesized to be one of the reasons for lower diet quality during summer. This study examined differences in school and summer dietary quality among a diverse cohort of children across three years. We also examined the impact of attending structured programs on children's diets. Parents of 1,298 children (age 5-14 years, 48% girls) completed a time use diary each day for 14-days during school (April/May) and again in summer (July) from 2021 to 2023, for a total of 6 timepoints. The daily diary collected information on the child's location and dietary intake for that day. Mixed-effects models examined the odds (OR) of consuming a food/beverage (e.g., fruit, vegetable, soda, salty snacks) on a given day during school vs. summer, overall and by income. Models also examined the impact of attending structured programming during summer (e.g., summer day camp) on the likelihood of consumption. A total of 39,983 time use diaries were completed. Overall, children were less likely to consume fruit, vegetables, milk, 100% juice, and salty snacks (OR range 0.63 to 0.87), and they were more likely to consume non-carbonated sweetened beverages, soda, frozen desserts, and fast food (OR range 1.17 to 1.63) during the summer compared to school. On summer days with structured programming, children were more likely to consume fruits, vegetables, milk, salty snacks, sweetened beverages (OR range 1.13 to 1.45), and they were less likely to consume frozen desserts, fast food, and soda (OR range 0.63 to 0.90). Few differences were observed between income groups. Children were less likely to report consumption of more healthful foods/beverages and more likely to report consumption of less healthful foods/beverages during summer compared to school. Attending structured programming during summer is associated with improved diet - suggesting such settings have potential to modify dietary intake.