Meal Programs Research Articles

Expert Opinions: Reform to the National School Meal Programs Regarding Dietary Saturated Fats

The purpose of this study is to determine whether the National School Lunch and Breakfast Programs in the US should be revised to have more relaxed regulations on saturated dietary fat consumption. Controversy over the validity of the diet-heart hypothesis—examined in a review of literature —prompted this inquiry. Qualitative data was collected through eighteen expert interviews. Trends in expert responses were identified using qualitative data coding. Participating experts were of diverse perspectives and came from across the United States. Experts answered in ways that were mostly consistent with the current Dietary Guidelines for Americans. However, most seemed to agree that it would be beneficial to relax regulations on saturated fat in order to allow for some flexibility. There was a widespread and overwhelming concern about ultra processed foods among experts.

Knowledge, Attitude, and Practice of Rafsanjan University of Medical Sciences Students Concerning Fast Food

Background: Lifestyle changes and, consequently, changes in dietary habits have led people, especially young people, to consume more processed and fast food. This study evaluated the knowledge, attitude, and practice of fast-food consumption among medical sciences students in Rafsanjan, Iran. Methods: In this cross-sectional study, data were collected using a researcher-designed self-reported questionnaire, which was distributed among 350 medical sciences students in Rafsanjan, Iran, selected by stratified random sampling from 2019 to 2020. The validity and reliability of this questionnaire were confirmed before commencement. SPSS 20 was used for data analysis. Results: The results showed that university students had above-moderate knowledge (39.7±0.55) and positive attitudes (60.52±0.43) about fast food consumption. The mean number of times students consumed fast food in the past month was 12.41±0.46. There was a statistically significant and positive correlation between attitude and practice. Also, knowledge had a significant inverse correlation with attitude and practice. The level of women’s knowledge was significantly higher (P=0.001) than men’s knowledge, and the knowledge score of dental and medical students was significantly higher (P=0.04) than that of students from other schools. The men’s attitude score was significantly higher (P=0.04) than the women’s. Conclusion: Appropriate interventions should be implemented to improve students’ knowledge, attitude, and practice concerning fast food consumption. Food labeling, teaching healthy cooking and preparation, time management, improving university meal programs, and opening affordable, healthy on-campus restaurants are recommended.

Home-Delivered Medically Tailored Meal Engagement Among Hemodialysis Patients and Providers

Hemodialysis patients face one of the most difficult diets among clinical patient populations. Furthermore, dialysis dietary adherence is generally reported as low with providers generally lacking the time and resources to implement effective behavior change. The purpose of this study was to elucidate measures of patient and provider engagement with home-delivered medically tailored meals (MTMs). We surveyed patients and staff at dialysis centers within the Denver metropolitan area. Surveys focused on 1) patient dietary intake, 2) awareness, support, and utilization of meal programs, and 3) nutritional challenges and barriers (including food security). We surveyed 118 patients (mean age 61.0 ± 14.2 year, 58.5% male, and dialysis vintage of 4.6 ± 4.9 years) and 26 staff across the included dialysis facilities. Patients were 20.3% White/Non-Hispanic, 35.6% Hispanic/Latin and 31.4% Black/African American. Most patients reported eating two meals per day (N=53, 44.9%) and 52.2% reported difficulty with following a kidney diet. The most cited reasons for not following the diet were behavioral or knowledge (38.5%), taste (26.3%), time/convenience (26.9%) and food autonomy (16.9%). Sixty participants (52.2%) reported living in a food desert and 26.3% reported food insecurity. Seventy-one patients (61.2%) were aware of MTMs but only 40.5% had been referred. Most (76.9%) dialysis providers were aware of MTMs but only 15 (57.7%) had actually referred patients to such a service. Black individuals were less likely to be referred for MTMs than White or Hispanics/Latin (29.7% vs 48.1% White and 45.0% Hispanic/Latin) individuals. MTMs represent a potential method to alleviate or bypass some of the many barriers expressed by patients. Our findings reveal a critical need for education around MTMs for both patients and providers. MTMs could potentially demonstrate health kidney dietary patterns that might translate to altered dietary preferences or towards future behavior change.

Challenges and Opportunities for Equity in US School Meal Programs: A Scoping Review of Qualitative Literature Regarding the COVID-19 Emergency.

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families' needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.

Fresh Feature Friday: A Framework for Student Engagement in K-12 Meal Programs

Fresh Feature Friday: A Framework for Student Engagement in K-12 Meal Programs

Involvement of Panchayats in the Development of Primary Schools Located in the Tribal Areas of Wayanad, Kerala

The paper explores the role of Grama Panchayats in advancing the development of primary schools situated in the tribal regions of Wayanad, Kerala. This includes their participation in matters such as student enrollment, reducing dropout rates, teacher training, enhancing infrastructure, managing the midday meal program, and monitoring school activities. The paper's conclusion highlights that the Panchayats' contributions in these areas have been limited and underscores the urgent necessity for their more proactive engagement to enhance the quality of primary school education.

Universal free school meals: the future of school meal programmes?

Universal free school meals: the future of school meal programmes?

USDA’s Summer Meals During the COVID-19 Pandemic: A Mixed-Methods Examination of Participants and Non-Participants in 2021

BackgroundThe US Department of Agriculture's school meal programs have wide reach during the school year, but food insufficiency among households with children increases during summer months. The US Department of Agriculture summer meal programs are designed to fill this gap, yet participation has historically been low. ObjectiveTo examine the facilitators and barriers to participation in a 2021 summer meal program while the COVID-19 pandemic regulation waivers were in place. DesignCross-sectional mixed-methods survey research. Participants/settingAll parents/guardians of children enrolled in a school district in Connecticut were invited to participate in an online survey in December 2021. The respondents included summer meal participants (n = 622) and nonparticipants (n = 294). Main outcome measuresSurvey respondents reported demographic variables, current food sufficiency, communication preferences, satisfaction with the program, reasons for using or not using the program, and whether they found the program helpful financially. The survey included three open-ended questions about barriers to participation. ResultsRespondents who used the summer meal program indicated that the pandemic-related regulatory waivers were key to their decision to participate. Reported barriers included lack of awareness of the program, inability to travel to sites during the times they were open, lack of transportation, concerns about dietary restrictions, and lack of variety in the menu, and concerns about wasting food. Parents/guardians expressed strong preferences for receiving communication about summer meals directly from their child’s school and being able to access meals outside of typical work hours. ConclusionsThe pandemic waivers allowed sponsors to test different models of distribution. Parents/guardians responded positively to the opportunity to access grab-and-go meals, multiple meals at once, and meals without a child present. These findings can be used to inform potential policy changes to reduce barriers and increase participation.

Towards a sustainable agri-food ecosystem: the case study of South Korean public food procurement

PurposePublic food procurement (PFP) plays an important role in establishing agri-food systems. The study explores local food system stakeholders' response to PFP interventions by addressing the question of how PFP transforms agri-food systems and how this new agri-food ecosystem is governed.Design/methodology/approachThis article presents and discusses a unique case study of Jeonbuk, a rural province in South Korea, which successfully transformed its agri-food system into an ecosystem through its sustainability-oriented innovations (SOIs) among born ecopreneur farmers. This case not only offers insights into a novel way to create value chains through legislative, executive and judicial governance but also extends the body of knowledge on agri-food systems by introducing the concept of an agri-food ecosystem.FindingsThe findings indicate the importance of the ecosystem governance and knowledge exchange among internal and external ecosystem stakeholders. In particular, PFP institutions play a crucial role in facilitating the operation of public meal centers and cooperation among actors.Practical implicationsTaking an ecosystem lens to agri-food systems may offer agricultural cooperatives a wider perspective and better understanding of the governance structures necessary to successfully execute public interventions. Lastly, the Korean case differs from other developing countries, but its role model qualities could help to implement successful school meal programs elsewhere.Originality/valueThis paper reviewed and applied a conceptual framework aimed at identifying the role of PFP institutions in the value chain governance by studying a case study of a South Korean local school meal program. The study further extends the agricultural cooperatives research and contributes to a better understanding of the role of a municipality and an agri-food intermediary in the governance process involving producers and kitchens.

The determinants of the nutritional quality of food provided to the homeless population: a mixed methods systematic review protocol

BackgroundStudies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population.MethodsThis mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed.DiscussionResults will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector.Systematic review registrationThis mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.

P14-085-23 Child Body Mass Index and Lunch Meal Consumption: Secondary Analyses of Three Congregate Meal Programs

P14-085-23 Child Body Mass Index and Lunch Meal Consumption: Secondary Analyses of Three Congregate Meal Programs

P17-035-23 Nutrition Insights From the 2021 Global Survey of School Meal Programs

P17-035-23 Nutrition Insights From the 2021 Global Survey of School Meal Programs

Strategies to Increase Student Participation in School Meals in the United States: A Systematic Review.

School meals play a critical role in promoting child nutrition and advancing equity. An understanding of which evidence-based strategies can increase meal participation is needed to improve student school meal consumption and foodservice finances. Our aim was to systematically review the evidence on interventions, initiatives, and policies to increase school meal participation in the United States. Four electronic databases were searched (PubMed, Academic Search Ultimate, Education Resources Information Center, and Thomson Reuters' Web of Science) to identify peer-reviewed and government studies conducted in the United States and published in English through January 2022. Qualitative studies; studies focused on snacks, afterschool meals, or universal free meals as the sole exposure; and studies conducted in schools not participating in the federal school meal programs or outside of the school year were excluded. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. Articles were grouped according to type of intervention or policy and were narratively synthesized. Thirty-four articles met inclusion criteria. All studies examining alternative breakfast models (eg, breakfast in the classroom or grab-and-go breakfast) and restrictions on competitive foods found increases in meal participation. There is also some evidence that stronger nutrition standards do not negatively impact meal participation and, in some cases, may promote meal participation. There is limited evidence on other strategies, including taste tests, modified menu options, changes to the meal period length, changes to the cafeteria environment, and wellness policies. There is evidence that alternative breakfast models and restrictions on competitive foods promote meal participation. There is a need for additional rigorous evaluation of other strategies to promote meal participation.

P19-046-23 Evaluating the Health and Economic Impact of the National School Meal Program in the U.S.

P19-046-23 Evaluating the Health and Economic Impact of the National School Meal Program in the U.S.

Predictors of Participation in the U.S. Department of Agriculture Summer Meal Programs: An Examination of Outreach Strategies and Meal Distribution Methods During COVID-19

Significantly fewer children participate in the U.S. Department of Agriculture-sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17-35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1-15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.

PREREQUISITES FOR THE CREATION OF THE "FROM FARM TO SCHOOL" MODEL IN THE KLAIPEDA REGION: THE STUDY OF TARGET GROUPS’ EXPECTATIONS AND PERCEPTIONS

The focus of the article is on school meal programs that are common throughout the world and are implemented to promote students’ healthy eating habits and bring added value to their learning outcomes. In recent years there has been increasing emphasis on the possibility of improving school meals by including locally grown products, thus contributing to the development of local economic systems. This model has acquired the name "Farm to School" in practice of some countries and, according to its supporters, emphasizes public procurement of locally grown food as a key market opportunity for farmers. The article has been prepared within the BSR Food Coalition project (funded by Interreg Baltic Sea Region Program, contract #S002). The project seeks to create the conditions for the emergence of the "From farm to school" model in the Baltic States. The study presented in the article aims at disclosing the conditions and opportunities for the promotion and use of foods produced by local farmers in general education schools in Klaipeda region, Lithuania as well as at defining necessary educational efforts to increase healthy nutrition, develop general health habits, and agricultural and food system literacy within general education schools and their communities. To achieve the aim the surveys with project target groups (school administration, students and their parents) have been carried out in Klaipeda region. The objectives of the survey were to gather data on target groups’ perceptions of local school food procurement and to disclose their opinion, needs and expectations related to model development. The findings of the study would be helpful for designing the further steps of collaboration between schools and local farmers in Klaipeda region. .

Check It Out! A Proposed Public Library-Based Meal Program to Combat Literacy Struggles in Children

Purpose: To highlight the relationship between hunger in children and struggles with reading and to propose a library-based social program that is directly incorporated within the local libraries’ already established summer reading program to address it. All local libraries throughout the country have an established summer reading program to provide learning stimulus for students when school closed for summer recess. Design/methodology/approach: The method is to analyze the problem using the lens of an economic theory and he research method is the literature review. The theoretical approach or underpinning is that Arthur Laffer’s, trickle-down economic theory has failed our children who go to bed hungry. Findings: School-aged children who are food insecure suffer academically and the problem is worse during the summer months because there is no access to school meals. The local public library is in a unique position to provide social services in the form of a library-based meal program that is incorporated with the summer reading program. Research limitations/implications: Due to the nature of the study, since there were no participants, the findings are only generalizable to a sample of libraries. Future studies could explore topics related to the actual implementation of a library-based meal program that is tracked over a period of three years.

USDA Summer Meals Program: Lack of Program Awareness Contributes to Unmet Need Among Nonparticipants.

Participation in the US Department of Agriculture's summer meals program is consistently lower compared to National School Lunch Program (NSLP) participation, even though the programs target the same population of children. The purpose of this study was to elucidate reasons for participation and nonparticipation in the summer meals program. A nationally representative sample of 4688 households with children ages 5 through 18 years living near a summer meals site in 2018 completed a survey about their reasons for participation or nonparticipation in the summer meals program, features that would help nonparticipants to attend, and household food security status. Almost half of all households living near a summer meal site were food insecure (45%) and most (77%) had incomes at or below 130% of the federal poverty level. Most participant caregivers (74%) sent their children to summer meal sites for the free meals, while 46% of nonparticipant caregivers said they did not attend because they were unaware of the program. Despite a high level of food insecurity among all households, the most reported reason for not attending the summer meals program was unawareness of the program. These findings highlight a need for better program visibility and outreach.

Weight loss is proportional to increases in fasting serum beta-hydroxybutyrate concentrations in adults with severe obesity undergoing a meal replacement programme

Weight loss is proportional to increases in fasting serum beta-hydroxybutyrate concentrations in adults with severe obesity undergoing a meal replacement programme

A systematic review of the economic value proposition for commercially available nonsurgical weight-loss interventions.

The study aim was to review the economic evaluation literature of commercially available and effective nonsurgical weight-loss interventions to investigate whether there is evidence to support claims of cost-effectiveness (i.e., good value for money) or cost savings (i.e., a positive return on investment). Relevant databases were systematically reviewed to identify economic evaluations of commercially available weight-loss products and services shown to result in clinically significant weight loss. Five weight-loss medications (orlistat, liraglutide, naltrexone-bupropion, semaglutide, and phentermine-topiramate), two meal replacement programs (Jenny Craig, Optifast), and one behavioral intervention (Weight Watchers [WW]) that met inclusion criteria were identified. After screening, 32 relevant comparisons of cost-effectiveness or cost savings across 20 studies were identified. Ten of twenty pharmaceutical comparisons showed evidence of cost-effectiveness based on established thresholds. Four of twelve nonpharmaceutical comparisons provided evidence of cost-effectiveness, and five made claims of cost savings. However, methodological concerns cast doubt on the robustness of these claims. Evidence of cost-effectiveness for commercially available, evidence-based, nonsurgical weight-loss interventions is mixed. There is no evidence for cost-saving weight-loss medications and only weak evidence for behavioral and weight-loss interventions. Results provide a call to action to generate more robust evidence of the economic value proposition for these interventions.