Eating School Lunch Research Articles

Outcome Evaluation of a Pilot Study Using “Nudges”

Background: Every school day, over 31 million U.S. children eat school lunches. Unfortunately, students often do not choose the healthy options in the school cafeteria. This paper describes outcome results of a pilot study using “nudges” to improve elementary school students’ fruits and vegetables selections. Methods: A pilot study was conducted from January to May 2012, in six intervention schools and 2 control schools. A behavioral economics-based intervention was conducted using “nudges” or cues from the cafeteria (staff encouragement to select fruit and vegetables, food labels, “Harvest of the Month” posters), school (morning announcement messages, prompts regarding cafeteria food selections), and parents (school newsletter articles, parent listserve messages) to promote students’ selection of fruits and vegetables in the school cafeteria. The serving data from the point-of-service machine provided fruits and vegetables served per student per day. Results: There were no significant differences in the number of servings of fruits and vegetables served per student per day, averaged over the study period. Process data revealed low implementation of the intervention components, which may partially explain results. Conclusions: Low implementation of nudges led to non-significant results in this pilot study. However, providing environmental cues are important and warrant further research with full implementation. Starting 2012, the new meal pattern includes two vegetables and a fruit serving for lunch; and two fruit servings for breakfast. Minimal cost interventions should be explored to facilitate successful implementation of new school meal guidelines.

Lunch, recess and nutrition: Responding to time incentives in the cafeteria

ObjectivesIn this study, we evaluate if moving recess before lunch has an effect on the amount of fruits and vegetables elementary school students eat as part of their school-provided lunch. MethodsParticipants were 1st–6th grade students from three schools that switched recess from after to before lunch and four similar schools that continued to hold recess after lunch. We collected data for an average of 14days at each school (4days during spring 2011, May 3 through June 1, 2011 and 9days during fall 2011, September 19 through November 11, 2011). All of the schools were in Orem, UT. Data was collected for all students receiving a school lunch and was based on observational plate waste data. ResultsWe find that moving recess before lunch increased consumption of fruits and vegetables by 0.16 servings per child (a 54% increase) and increased the fraction of children eating at least one serving of fruits or vegetables by 10 percentage points (a 45% increase). In contrast, the schools in our control group actually experienced a small reduction in fruit and vegetable consumption during the same time period. ConclusionsOur results show the benefits of holding recess before lunch and suggest that if more schools implement this policy, there would be significant increases in fruit and vegetable consumption among students who eat school lunch as part of the National School Lunch Program.

Training Program Tailored for Instructors of Eat Smart, Live Strong Nutrition Education Program for Older Adults

Conclusions and Implications: Despite many criticisms, children who eat school lunches eat fewer calories at lunch compared to students who bring lunch from home. Interestingly, though, students who bring lunch from home may be front-loading their calories earlier in the day when compared to NSLP students. Thus student consumption patterns outside of school should be better understood to identify solutions to help reduce childhood obesity. Funding: None

Serving Vegetables First: A Strategy to Increase Vegetable Consumption in Elementary School Cafeterias

The objective of this study was to determine if offering vegetables before other meal components would increase the overall consumption of vegetables at school lunch. We served kindergarten through fifth grade students a ¼ cup portion of a raw vegetable while they waited in line to receive the rest of their lunch meal. They then had the options to take more of the vegetable they were just served, a different vegetable, or no vegetable from the lunch line. Vegetables were cut to have the same dimensions, and the same number of pieces was placed in all cups. We measured the amount of each vegetable consumed by each child. Broccoli and sweet bell peppers were tested separately. Serving vegetables first increased the number of students eating vegetables from 41 of 544 students on broccoli control days to 209 of 515 students on broccoli first days and from 34 of 533 students on pepper control days to 149 of 528 students on peppers first days. The mean weight of vegetables consumed per student eating school lunch also increased from control to intervention days in tests for both broccoli (1.9 to 3.1 grams) and peppers (4.2 to 5.4 grams). On intervention days, 70% of the broccoli consumed and 75% of the peppers consumed came from the vegetables first portions. Serving vegetables first is a viable strategy to increase vegetable consumption in elementary schools. Long-term implementation of this strategy may have a large impact on healthy eating habits, vegetable consumption, and the health consequences of vegetable intake.

Chocolate milk consequences: a pilot study evaluating the consequences of banning chocolate milk in school cafeterias.

ObjectivesCurrently, 68.3% of the milk available in schools is flavored, with chocolate being the most popular (61.6% of all milk). If chocolate milk is removed from a school cafeteria, what will happen to overall milk selection and consumption?MethodsIn a before-after study in 11 Oregon elementary schools, flavored milk–which will be referred to as chocolate milk–was banned from the cafeteria. Milk sales, school enrollment, and data for daily participation in the National School Lunch Program (NSLP) were compared year to date.ResultsTotal daily milk sales declined by 9.9% (p<0.01). Although white milk increased by 161.2 cartons per day (p<0.001), 29.4% of this milk was thrown away. Eliminating chocolate milk was also associated with 6.8% fewer students eating school lunches, and although other factors were also involved, this is consistent with the notion of psychological reactance.ConclusionsRemoving chocolate milk from school cafeterias may reduce calorie and sugar consumption, but it may also lead students to take less milk overall, drink less (waste more) of the white milk they do take, and no longer purchase school lunch. Food service managers need to carefully weigh the costs and benefits of eliminating chocolate milk and should consider alternative options that make white milk more convenient, attractive, and normal to choose.

The Impact of Food and Nutrient-Based Standards on Primary School Children’s Lunch and Total Dietary Intake: A Natural Experimental Evaluation of Government Policy in England

In 2005, the nutritional content of children’s school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children’s total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4–7 years (n = 385 in 2003–4; n = 632 in 2008–9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children’s mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change −128 mg, 95% CI: −183 to −73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (−1.8%, −2.8 to −0.9) and saturated fat (−1.0%; −1.6 to −0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children’s total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children’s diet.

Gender Differences in Physiologic Markers and Health Behaviors Associated With Childhood Obesity

Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention. Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ(2) analysis. Univariate associations with P < .10 were included in a stepwise logistic regression model to determine independent predictors for obesity by gender. Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01-1.64; OR 1.27, 95% CI 1.00-1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07-1.32; OR 1.19, 95% CI 1.06-1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82-0.98; OR 0.77, 95% CI 0.64-0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67-0.98). Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.

担任教諭が主体となる社会科および総合的な学習の時間における食に関する指導の実施可能性と学習成果の検討

担任教諭が主体となる社会科および総合的な学習の時間における食に関する指導の実施可能性と学習成果の検討

Effects of Nutrition Health Intervention on Pupils' Nutrition Knowledge and Eating Habits

The purpose of this investigation was to evaluate the effects of nutrition health intervention on pupils' nutrition knowledge and eating habits from grade seven to grade nine. The study was part of the ENHPS (since 2008, Schools for Health in Europe (SHE)) program in Finland, and more specifically its sub-project titled From Puijo to the World with Health Lunch. This study was conducted among the pupils of two experimental schools and two control schools by means of a paper questionnaire. The results show that the experimental school pupils' knowledge of nutrition increased positively during the intervention. Furthermore, the pupils of the experimental schools were found to improve their eating habits and eat school lunch on a more regular basis during the intervention than the control school pupils.

Higher Quality Intake From School Lunch Meals Compared With Bagged Lunches

Studies show that nutritional quality of lunches brought from home is poor when compared with school lunches. Most of these studies were conducted in the United Kingdom, while studies of this type are limited in the United States. Therefore, this study compared lunch food, nutrient, and energy intake by lunch type (school lunch vs bagged lunch) in 2 schools in a Midwest metropolitan area of the United States. Food intake data were collected from 129 children with meal observation procedures. Energy, food, and nutrient intakes were estimated using Nutrition Data System for Research software and compared with t tests by lunch type. Children eating school lunches had higher intakes of protein; vitamins A, D, and K; and calcium and lower intakes of energy, fat, carbohydrate, vitamin E, and sugar compared with children eating bagged lunches. The ratios of mean protein and calcium consumption to minimum required values tended to be greater for children eating school lunches compared with those eating bag lunches. Children eating bag lunches had lower vegetable intake and higher whole grain and fruit intakes and higher meal energy density compared with children eating school lunch. Findings support parent nutrition education to improve the nutritional quality of bagged lunches.

Would Students Prefer to Eat Healthier Foods at School?

This study sought to elucidate students' perceptions of school food environments and to assess correlations between perceptions and purchasing and consumption behaviors at school. Seventh and ninth graders (n = 5365) at 19 schools in multiethnic, low-income California communities participating in the Healthy Eating Active Communities program completed questionnaires assessing their attitudes and behaviors regarding school food environments during spring 2006. Most students (69%) reported that fresh fruit was important to be able to buy at school; more than chips (21%), candy (28%), or soda (31%). Reported importance of food offerings was correlated with the consumption of those items. Most students did not perceive foods/beverages offered at school to be healthy; fewer than a quarter reported eating fruits or vegetables (FV) at school. Students eating school lunch were more than twice as likely to consume FV, though if they also purchased from competitive venues, their consumption of candy, chips, and soda was similar to their peers who purchased only competitive foods. Students report healthy foods to be important to be able to buy at school, but do not perceive their school food environment to be healthy and consume more unhealthy foods at school. Students served healthy items via school lunch are more likely to consume them; however, they also purchase and consume unhealthy items if available. Findings suggest that modifying school food environments to facilitate consumption of healthy foods and limit unhealthy foods will better match students' preferences and could lead to improved dietary intake.

Psychosocial, Socioeconomic, Behavioral, and Environmental Risk Factors for BMI and Overweight Among 9-to-11-Year Old Children

This study explored the risk factors for higher BMI and overweight in 9- to 11-year-old children using the 2007 California Children’s Healthy Eating and Exercise Practices Survey. A total of 741 children completed a two-day food and activity diary. Of these, 299 children participated in the follow-up telephone interview, reporting attitudes and beliefs. Linear regressions identified risk factors related to BMI z-scores; logistic regressions were used for binomial overweight status. Independent variables included children’s diet, activity, screen time, food modeling, family norms/rules, home environment, poverty, and parent education, adjusting for race/ethnicity. Parent education was the strongest risk factor with a clear gradient towards reduced risk as parent education improved. Children were .3 BMI z points lower and one-third less likely to be overweight as education level rose. Each serving of fried vegetables consumed was related to .3 point increase in BMI z. Children were 1.2-1.3 times more likely to be overweight with each increase in school lunch participation. Low-cost overweight prevention efforts targeting children with less parent education, school lunches, and consumption of fried vegetables may reduce BMI and help prevent childhood overweight. Additional investigation should determine the underlying factors contributing to the relationship between eating school lunch and overweight.

Availability and Consumption of Competitive Foods in US Public Schools

Background With ongoing efforts to develop and implement school wellness policies, there is a need for information about the availability and consumption of competitive foods in schools. Objective To describe the availability of competitive foods in US public schools, consumption of competitive foods by children, and contributions of competitive foods to energy intakes. Design The study used data from the third School Nutrition Dietary Assessment Study, a cross-sectional study that included a national sample of public school districts, schools, and children in the 2004-2005 school year. On-site observations were used to document the availability of competitive foods and a 24-hour recall was used to assess children's consumption of competitive foods. Subjects/setting The study included 287 schools and 2,314 children in grades 1 through 12. Statistical analyses performed Most analyses were limited to estimation of means and proportions. Two-tailed t tests were used to test the significance of differences between children who did and did not eat a school lunch. Results In school year 2004-2005, competitive foods were widely available in public schools. Overall, 40% of children consumed one or more competitive foods on a typical school day. The most commonly consumed competitive foods were foods and beverages that were low in nutrients and energy-dense. Children who ate a school lunch were significantly less likely than children who did not eat a school lunch to consume competitive foods (36% vs 45%; P<0.01); however, the leading competitive food choices for both groups of children were foods that were low in nutrients and energy-dense. On average, competitive food consumers who ate school lunches obtained 159 calories from competitive foods that were low in nutrients and energy-dense, compared with 201 calories for competitive food consumers who did not eat school lunches ( P<0.05). Conclusions In school year 2004-2005, competitive foods were widely available and consumed in US public schools and the most commonly consumed competitive foods were low in nutrients and energy-dense. These data support the need for improvements in school food environments and policies and provide a useful baseline for monitoring change as schools work to make these improvements.

The Third School Nutrition Dietary Assessment Study: Summary and Implications

Bringing school meals in line with the 2005 Dietary Guidelines will involve more than changing nutrient standards and revising menu planning regulations. SNDA-III provides evidence that, despite the hard work of many individuals, schools, and organizations, SMI goals were not fully achieved. Strategies are needed to enhance the ability of schools to offer healthier meals.

Nutrient and food group intake from school meals and bag lunches consumed by school‐aged children

School meals can be an important source of energy and specific nutrients as well as fruits and vegetables. Studies comparing intake from lunch provided at school and lunches carried from home are limited. The purpose of this study was to examine the contribution that school meals made to nutrient, fruit and vegetable intake and meal energy density of children. Lunchroom meal observation procedures were used to collect food intake data from 129 children (ages 8–12 yr) in a suburban Midwestern school. Dietary analyses were completed using Nutrition Data System for Research software and t‐test and general linear models analysis were used to compare nutrient, and fruit and vegetable intake. Children eating school lunch (n=85) had a higher intake of protein, vitamins A, D, and K, and calcium, and a lower intake of energy, fat, carbohydrate, vitamin E and added sugars compared to those who brought a bag lunch from home (n=44). The ratios of mean protein and calcium consumption per minimum values required by USDA regulations for school lunch tended to be higher for children eating school lunch than those eating bag lunches. Children eating bag lunches had a lower fruit and vegetable intake and higher energy density than children eating school lunch. Overall, children who ate school lunch had a more favorable macro and micronutrient and fruit and vegetable intake compared to those who brought a bag lunch from home.

Food Practices and Preferences in Youth With Diabetes

Objectives. To determine where children with type 1 diabetes eat and with whom, how foods are prepared, their favorite foods, and food issues or conflicts regarding both portioning foods and types of food eaten and to examine the multiple factors that influence food intake in this population. Methods. Parent-child pairs (n = 299) completed a questionnaire that focused on where and with whom children eat and how their food is prepared. χ2 tests and ANOVA were calculated to determine differences between child and parent responses. Results. As reported by parents, children (78%) eat meals at home with the family 4–6 or more meals per week; 21% eat at home alone 4–6 or more meals per week; 27% eat at fastfood restaurants 2–3 or more meals per week, and 72% eat school lunch 2–3 or more times per week(58% almost every day). Confusion regarding portion skills was reported by 13%, 52% measure by “eye balling” only (estimating portions sizes), and 47% would like more information on portioning. Among parents, 37%reported disagreements with children over choices of food, and 28% reported disagreements over food portion sizes; 5% did not care about food portioning at all. Cooking from scratch was reported by 71% to occur ≥ 4 times per week (out of 21 meals per week), and 65% reported cooking prepackaged meals at least 2–3 times per week. Conclusions. Suggestions for eating at fast-food restaurants and schools; food-portioning skills for home, school, restaurants, and homes of friends; cooking from scratch and from prepackaged foods; incorporating favorite foods; and reading labels on prepackaged foods should be addressed for effective educational sessions.

Lifestyles, social background and eating patterns of 15‐year‐old boys and girls in Finland

The aim was to investigate whether lifestyles or social background have stronger impact on eating patterns among young people. A school‐based survey carried out in 1998 among 15‐year‐old pupils (n=2388) in Helsinki was used as data. The lifestyle dimensions of leisure‐time activities used were street‐oriented lifestyle, commercialised lifestyle, home‐oriented lifestyle, and arts‐oriented and hobby‐oriented lifestyle. Social background was indicated by father's educational level. Three family‐related and school‐related eating measures (eating school lunch, having dinner at home and consumption of recommended foods) and two peer‐related eating measures (consumption of fast food and consumption of sweets) were analysed. Those from households with higher educational level more often took part in meals at home (boys) and at school (all), and also consumed recommended food items more often. A more street‐oriented lifestyle and a more commercialised leisure time were associated with higher intake of fast food and sweets. The results suggest that structural factors such as social background continue to have more influence than lifestyles on young people's daily diet

Associates of obesity and weight dissatisfaction among Finnish adolescents

We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents. A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects. Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories. Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

Accuracy by meal component of fourth-graders’ school lunch recalls is less when obtained during a 24-hour recall than as a single meal

This retrospective analysis compared accuracy by meal component of fourth-graders’ school lunch recalls (Study 1) to the school lunch portion of 24-hour recalls (Study 2). For Study 1, 148 children were randomly selected, observed eating school lunch, and interviewed about lunch the previous day. For Study 2, 104 children were randomly selected, observed eating school breakfast and school lunch, and interviewed to obtain a 24-hour recall of the previous day. Results indicated that omission and intrusion rates for every meal component were greater for Study 2 than Study 1. The cognitive burden of recalling items eaten at school lunch as part of a 24-hour recall is greater than that of recalling school lunch items as a single meal and thus negatively impacts fourth-graders’ ability to report their intake. Validated studies are needed to guide the development of interview protocols which maximize the accuracy of children’s dietary recalls.

Fourth-Grade Children's Consumption of Fruit and Vegetable Items Available as Part of School Lunches Is Closely Related to Preferences

Objective To use data from observations and interviews to document fourth-graders' preferences for, and consumption of, fruits compared to vegetables available as part of school lunches. Design Observations and interviews were conducted for studies regarding the impact of time interval between eating and reporting on the accuracy of children's school lunch recalls. Subjects Children were recruited from up to 4 schools in one district during 3 school years; 63% agreed to participate. Randomly selected children (n = 237) were each observed eating school lunch once and were interviewed (regarding items eaten and preferences for items eaten) within 1½ hours or the next morning. Main Outcome Measures Observed consumption of servings of items available as part of school lunch was recorded as none, taste, little bit, half, most, and all. Response options for preferences for items available as part of school lunch were liked not at all, a little, and a lot. Statistical Analyses Performed Mixed-model analysis of variance. Results Preferences were higher for fruits than vegetables. As preferences increased, consumption increased ( P < .0001). Consumption of fruits compared to vegetables was similar after adjusting for preferences. Implications Research is needed to understand how to increase children's preferences for vegetables as a means of increasing consumption.