Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review.

Juliana F W Cohen,Marlene B Schwartz,Gabriella M Mcloughlin,Amelie A Hecht,Lindsey Turner

doi:10.3390/nu13030911

Abstract

The school environment plays an important role in children’s diets and overall health, and policies for universal free school meals have the potential to contribute to positive child health outcomes. This systematic review evaluates studies examining the association between universal free school meals and students’ school meal participation rates, diets, attendance, academic performance, and Body Mass Index (BMI), as well as school finances. The search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A search for studies published in economically developed countries published through December 2020 was performed in PubMed, Education Resources Information Center (ERIC), Thomson Reuters’ Web of Science, and Academic Search Ultimate, followed by examining the references in the resultant literature. A total of 47 studies were identified and the Newcastle-Ottawa Scale (NOS) was applied to assess bias. Nearly all studies examining universal free school meals found positive associations with school meal participation. Most studies examining universal free school meals that included free lunch found positive associations with diet quality, food security, and academic performance; however, the findings of studies examining only universal free breakfast were mixed. Research findings were similarly mixed when examining attendance as an outcome. Concerns about adverse outcomes on student BMI were not supported by the literature; in fact, several studies detected a potentially protective effect of universal free school meals on BMI. Research examining the impact of universal free meals on school finances was limited, but suggest that lower-income school districts in the U.S. may have positive financial outcomes from participation in universal free school meal provisions. Additionally, providing free meals to students may be associated with improved household incomes, particularly among lower-income families with children. Further research is needed to examine the financial implications of universal free meals for both school districts and families. Overall, universal free school meals may have multiple benefits for students and countries should consider universal free school meal provisions with strong nutrition guidelines. (PROSPERO registration: CRD42020221782).

Highlights

Schools are recognized as an important setting to promote healthy behaviors, as children typically spend a substantial amount of their waking hours at school [1,2,3]
(1) Attendance: percent of school days attended and low attendance measured among student in grades 1–5 (2) Academic Performance: test scores in reading and math measured among student in grades 3–5 In Community Eligibility Provision (CEP) schools, foods selected had on average 11.2 g of added sugar and beverages had on average 11.0 g of added sugar
Students consumed on average 6.6 g of added sugar from foods and 3.6 g of added sugar from beverages (~10% of calories consumed from foods and ~35% calories consumed from beverages; ~2.5% of added sugars consumed out of the 10% recommend by the Dietary Guidelines for Americans)

Summary

Introduction

Schools are recognized as an important setting to promote healthy behaviors, as children typically spend a substantial amount of their waking hours at school [1,2,3]. As children’s eating preferences often persist into adulthood, schools can provide meaningful opportunities to promote and establish healthier diets through access to nutritious foods, including breakfast and lunch [1,4,5,6,7]. Among countries with developed economies, school meals are a common feature of national safety net programs and typically provide students with breakfast and/or lunch with a focus on improving diet quality, among low-income populations [1]. Many countries have nutrition standards for school meals, which can have important short- and long-term health implications for children, including promoting optimal growth and cognitive development and reducing the risk of food insecurity and obesity [8,9,10,11,12,13,14,15,16,17,18]. Policies that support universal free school meals (i.e., meals provided at no cost to all children who wish to participate) are gaining attention as a strategy to reduce stigma and diet-related disparities among lower-income students, promote children’s nutrition more broadly (school meals are often healthier than meals brought from home), and potentially lower administrative costs for schools [19,20,21,22,23,24,25,26,27,28]

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