Nutritional improvements and student food choices in a school lunch program.

This study analyzed data on students' food purchases linked to their school records to examine factors affecting the healthiness of their food choices and the impacts of reforms to promote healthier eating in a high school lunch program. U.S. Department of Agriculture's Healthy Eating Index was used to evaluate the nutritional quality of the foods purchased, as well as an alterative ranking developed by the school dietitian. The new lunch program was associated with an improvement in the nutritional quality of students' food choices. Girls tended to purchase relatively healthier food than boys, but male students had a greater improvement in the healthiness of their food choices.

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Ninety-nine percent of U.S. public schools and 83% of public and private schools combined participate in the National School Lunch Program (NSLP). These schools receive cash subsidies and commodities from the U.S. Department of Agriculture (USDA) for each meal served. In return, they are supposed to satisfy USDA's nutritional requirements and provide free or reduced-price lunch to eligible children. During 2004-2005, the reimbursement rates for free, reduced-price, and paid lunches were $2.24, $1.84, and $0.21, respectively (USDA, Food and Nutrition Service [FNS] 2005b, 2005c). In 2004, U.S. schools served 4.8 billion lunch meals, reaching over 25 million children (Guthrie 2003; USDA, FNS 2005c). For many, especially students from lower-income families enrolled in federally subsidized free and reduced-price lunch programs, these are the main meals of the day. In addition to these federally subsidized meals, millions of students choose foods from a la carte offerings provided by most school food services. These are not part of the NSLP and are referred to as "competitive foods" by USDA.

The American Obesity Association (2005) reported that 30.3% of children ages 6-19 were overweight or obese in 2000. This figure tripled from the early 1970s to 2000. Many factors are behind this trend, but there is evidence that meals served in many schools contributed to poor nutrition and obesity (Cooper and Holmes 2006). In a nationwide assessment, USDA found that the average lunch served in 1998-99 met its dietary guidelines of fewer than 30% of total calories from fat and less than 10% from saturated fat in only one out of seven secondary schools (USDA, FNS 2001). Many secondary students eat high-fat cheeseburgers, French fries, and pizzas on a daily basis. In some cases, they eat only a candy bar and a super-sized soft drink. Two reporters visiting six schools in New York City and Montgomery County, Maryland (an affluent Washington, DC, suburb), observed hundreds of students eating lunch and saw only five who took the green vegetable offered with the full meal (Becker and Burros 2003).

School food service directors often must focus on ease of preparation rather than healthy options because they lack both the skilled staff and facilities necessary to do more. Many schools depend on major food service vendors to supply highly processed foods that require little more than heating to prepare. Faced with tight budgets, food service operations are driven by cost considerations and a need to serve what students will eat. Major fast food chains' products are being served in a substantial number of schools, because that is what students want. School districts have also signed vending contracts with snack and soda companies for the commission generated to fund their programs. Schools have begun to be heavily criticized for not providing healthier food choices and guiding students toward healthy lifelong eating habits (Cooper and Holmes 2006; USDA, FNS 2001).