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Children's Health

A new study offers hints that healthier school lunches may help reduce obesity.

The Associated Press

A seventh grader carries her plate of three-bean chili, rice, mandarins and cherry tomatoes and baked chips during her lunch break at a local public school, on Feb. 10 in the Brooklyn borough of New York. Wong Maye-E/AP hide caption

A seventh grader carries her plate of three-bean chili, rice, mandarins and cherry tomatoes and baked chips during her lunch break at a local public school, on Feb. 10 in the Brooklyn borough of New York.

A 2010 federal law that boosted nutrition standards for school meals may have begun to help slow the rise in obesity among America's children — even teenagers who can buy their own snacks, a new study showed.

The national study found a small but significant decline in the average body mass index of more than 14,000 schoolkids ages 5 to 18 whose heights and weights were tracked before and after implementation of the Healthy, Hunger-Free Kids Act of 2010 .

The USDA wants to limit added sugars and sodium in school meals

The study is new evidence that improving the quality of school meals through legislation might be one way to help shift the trajectory of childhood obesity, which has been rising for decades and now affects about 1 in 5 U.S. kids.

Whether the program has begun to turn the tide for the whole country, and not just the groups of kids studied, is still unclear. About 30 million children in the U.S. receive school lunches each day.

"You have the potential to really impact their excess weight gain over the course of their entire childhood," said Dr. Aruna Chandran, a social epidemiologist with the Johns Hopkins Bloomberg School of Public Health. She led the study published Monday in the journal JAMA Pediatrics.

The Healthy, Hunger-Free Kids Act of 2010, championed by former first lady Michelle Obama , was the first national legislation to improve school meals in more than 20 years. It increased the quantity of fruits, vegetables and whole grains required in school meals.

End of nationwide federal free lunch program has some states scrambling

The new study analyzed nationwide data from 50 cohorts of schoolchildren from January 2005 to August 2016, before the law took effect, and data from September 2016 to March 2020, after it was fully implemented. Researchers calculated kids' body-mass index, a weight-to-height ratio.

It found that a body mass index for children, adjusted for age and gender, fell by 0.041 units per year, compared to before the law took effect. That amounts to about a quarter of one BMI unit per year, Chandran said. There was a slight decline in kids who were overweight or obese, too, the study showed.

Seventh graders sit together in the cafeteria during their lunch break at a public school on Feb. 10 in the Brooklyn borough of New York. Wong Maye-E/AP hide caption

One way to think of the change is that for a 10-year-old boy with an elevated body-mass index, the decline would amount to a 1-pound weight loss, noted Dr. Lauren Fiechtner, director of nutrition at MassGeneral Hospital for Children in Boston, who wrote an editorial accompanying the study.

"This is important as even BMI flattening over time is likely important," she said. Holding kids' weight steady as they grow can help keep obesity in check.

Previous studies have shown weight-related effects of the federal law among children from low-income families. The new study is the first to find lower BMI in kids across all income levels.

At the same time, significant decreases in BMI measures were seen not only in kids ages 5 to 11, but also in those age 12 to 18.

"That's an incredible shift," Chandran said. "These are kids who potentially have their own autonomy to buy their own snacks."

The new results come within days of the release of updated standards for school meals , including the first limits on added sugars, decreased sodium and increased flexibility for whole grains. Agriculture Secretary Tom Vilsack said the study shows that healthy school meals are "critical for tackling diet-related conditions like obesity."

New childhood obesity guidance raises worries over the risk of eating disorders

But some researchers cautioned against interpreting the study's findings too broadly. Some of the children included in the study might not have been enrolled in school meals programs, or their district may not have fully implemented the nutrition requirements, said Kendrin Sonneville, associate professor of nutritional sciences at the University of Michigan School of Public Health.

Significantly, measures like BMI, even when adjusted for children, "should not be used as a proxy for health," she added.

A slight reduction in those measures, she said, "doesn't tell us whether the health, well-being, concerns related to food security of children participating in the school breakfast or lunch program improved."

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Healthier School Lunches May Have Curbed Childhood Obesity, New Study Finds

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Changes to the national school lunch program in the last decade that cracked down on sodium and fat content in school meals and required more fruits and vegetables could have reduced children’s likelihood of becoming overweight, according to a new research paper.

In 2010, as education advocates sounded the alarm over increasing childhood obesity—a health condition that can have major long-term consequences for young people—lawmakers passed a bill allowing the U.S. Department of Agriculture to overhaul the National School Lunch Program for the first time in decades. The department’s new rules under the Healthy, Hunger-Free Kids Act set minimum nutrition standards for school meals and reduced portion sizes. The rules also called for more fruits, vegetables, and whole grains, and limited sodium, sugar, and fat.

While the Trump administration initially gave schools more time to comply with those Obama-era rules before attempting to largely roll them back, school meals changed, and those changes have likely made a difference, the research found. The conclusion potentially offers hope after the U.S. Centers for Disease Control and Prevention found last year that childhood obesity had gone up over the course of the COVID-19 pandemic as kids spent more time on screens and less time exercising.

“One thing is clear from the research, and that is that it really is helpful—the improvements to school meals have really made a difference,” said Geri Henchy, director of nutrition policy for the Food Research & Action Center, an anti-hunger advocacy group.

Before the new nutrition standards, participation in school meal programs had been linked to higher rates of obesity due to fatty, carbohydrate-packed choices. But the new working paper published last month by researchers at Northwestern University finds little proof that participation in school meal programs after the federal government tightened nutrition standards led to weight gain.

“These results suggest that improvements in the nutritional content of school lunches have been largely successful in reversing the previously negative relationship between school lunches and childhood obesity,” the researchers concluded.

School meals reach lots of kids

To assess whether school meals make children more or less likely to become obese, the researchers evaluated data on the quality of school meals between 1991 and 2010, before the Obama administration’s tighter nutrition standards took effect. They then tracked a nationally representative group of children from when they entered kindergarten in 2010 and completed 5th grade in 2016, controlling for children who already entered kindergarten overweight.

That period covered the start of the stricter nutrition standards, which were largely phased in over a three-year period starting with the 2012-13 school year.

It is difficult to detect whether a single change in children’s lives has much of an impact on childhood obesity, the researchers acknowledged, but school meals are a key policy lever simply because of their reach.

“The National School Lunch Program (NSLP) serves meals to over half of the nation’s school-aged population each school day, so improvements to the nutritional quality of school meals could have important impacts on obesity—particularly in light of research that found participating in school lunch increased children’s caloric intake and body weight,” the report said.

The researchers, Therese Bonomo and Diane Whitmore Schanzenbach, analyzed two waves of school lunch menus prior to and after the nutrition guidelines were changed. They found that the number of calories served per meal was generally lower in the later wave of menus, regardless of school characteristics.

Then, they estimated the relationship between school lunch participation and the rate of students’ weight gain from the beginning of kindergarten through 5th grade.

After the nutrition standards changed, they found, students who ate school lunches were no more likely to be overweight than students who brought their food from home.

“This indicates that there were substantial changes in content of school lunches over time, perhaps due to [the changes] and/or the momentum leading up to it,” the report concludes. “Thus, there is reason to believe that the relationship between school lunch participation and obesity may have also changed.”

From Obama to Trump to Biden, uneven implementation

Despite its apparent success, the implementation of the Healthy, Hunger-Free Kids Act has faced a rocky road.

The changes the legislation brought on were initially met with some criticism and resistance, as students across the country took to social media to criticize the smaller portion sizes and different food choices.

One video Kansas high school students produced— a parody song called “We Are Hungry” to the tune of the song “We Are Young” by Fun—racked up more than 1.5 million views on YouTube and caught the attention of national policymakers. Even more students complained on platforms like Twitter under the hashtag #ThanksMichelleObama.

Some research found there was more food waste following the rollout of the new nutrition guidelines, while other research came to the opposite conclusion . Participation in school lunch programs also decreased as the new guidelines were implemented, USDA data show.

The Trump administration relaxed the Obama-era nutrition standards on milk, sodium, and whole grains after it took office in 2017 before attempting to largely roll them back the next year .

Then, in 2020, the Trump administration announced plans to further roll back the nutrition guidelines, targeting the fruit and vegetable requirements, to allow schools more flexibility and reduce food waste, USDA officials said at the time.

Soon after, a federal judge overturned the 2018 Trump rollback , finding the final rule differed too much from the version the Trump administration put out for public comment.

Earlier this year, the Biden administration announced plans to limit school meals’ sodium and sugar content and require that school meals primarily contain whole grains, detailing a phased implementation of the rules to give schools more time to comply, largely due to complications caused by the COVID-19 pandemic, FRAC’s Henchy said.

“It hasn’t progressed in a straight line—there’s been a lot of back-and-forth,” Henchy said. “But we’re moving forward again.”

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Healthy School Lunches Can Reduce Childhood Obesity and Diabetes

World health day 2016 spotlights nutrition education—and the cafeteria’s role is a hands-on classroom.

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Children consume up to 50 percent of their daily calories at school, so cafeteria meal and snack options are fundamental to a healthy lifestyle.

Parents across the world over want their children to grow up healthy. Type 2 diabetes used to be unheard of in children, but rates have been climbing in recent years: By 2050, the number of people under age 20 in the U.S. with the disease is expected to almost quadruple .  The problem is so pressing that the World Health Organization has chosen “beat diabetes” as the theme of World Health Day 2016 . 

In the United States, this is a timely and urgent call to action. Obesity increases the risk of diabetes, and 1 in 6 U.S. children is obese, up from less than 1 in 10 three decades ago, according to the Centers for Disease Control and Prevention . Ensuring that kids get sound nutrition and instilling healthy habits early are crucial to reversing these trends and to lowering their risk for disease, including diabetes.

How school meals and snacks can help

Schools play an important and unique role in influencing children’s eating habits and lifelong behavior through the food and drink choices offered in cafeterias, hallway vending machines, and elsewhere on campus. Kids consume up to 50 percent of their daily calories at school : More than 30 million students eat school lunches, and 14 million eat school breakfasts.

Research shows that availability of healthier school lunches has already improved kids’ eating habits. One study found that offering more variety led to healthier choices ; each additional fruit option was associated with a 9.3 percent increase in the number of fruit servings selected by students.

Click on the image above to expand.

What does a healthy school lunch look like?

U.S. nutritional guidelines recommend that a variety of fruits and vegetables fill half the plate, as in this appetizing elementary school lunch from Maine.

Congress strengthened the nutrition standards for the national school lunch and breakfast programs in 2012 and helped spark a nationwide effort to expand the variety of healthy options that schools provide for their students. Each lunch that meets the guidelines provides about a third of the daily calories and nutrients a child needs to grow up healthy and is based on the Dietary Guidelines for Americans, including the following nutrition guidance:

• Fill half your plate with fruits and vegetables.  Eat one to two cups of fruit and 1½ to three cups of vegetables daily. The 2012 school meal standards require that each lunch include at least a half cup of fruits or vegetables for elementary students and more for teens. Many schools go even further, offering children unlimited amounts of these healthful foods.
• Eat a rainbow. Consume vegetables with a range of colors—purple, orange, yellow, etc.—to get an array of nutrients. Under today’s meal guidelines, schools must offer vegetables from several color categories over the course of a week.
• Incorporate more whole grains. Most Americans do not eat enough whole grains, which provide healthy amounts of fiber and important minerals. School meal standards require that all grain items served be made from at least 50 percent whole grains.
• Avoid excess sodium. Nine in 10 school-age children, like most people in the country, eat too much salt . Current school nutrition standards require that schools gradually decrease the salt in meals so that by 2022, students will get no more than a third of the recommended daily maximum amount of sodium from school lunches.

How parents can get involved

Nearly all school meal programs—more than 98 percent—serve lunches that meet national nutrition standards, but decisions about the menu, snack programs, food-based fundraising policies, and other issues are made by school nutrition staff or other district leaders. Parents can make their voices heard to reinforce healthy changes already underway and prompt even more improvements.

Here are some steps that parents can take to support their kids’ access to healthy school food options:

• Make a lunch date to eat at your child’s school.
• Learn how other districts have helped students make healthier choices .
• Browse these healthy recipes —configured for cafeteria-size batches—and share the ones your family likes with your school.
• Get informed about the national standards for school meals .
• Work with the local PTA to make healthy school food a priority.

How to Support Healthier School Food for Your Kids

More than 30 million American children eat school lunches each day. Parents can feel good about this fact because these meals are healthier than ever, which means that kids get the good nutrition they need to learn and do their best in school.

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Vital Signs

Childhood: Obesity and School Lunches

By Roni Caryn Rabin

• Feb. 4, 2011

Researchers say they have identified another risk factor for childhood obesity: school lunch.

A study of more than 1,000 sixth graders in several schools in southeastern Michigan found that those who regularly had the school lunch were 29 percent more likely to be obese than those who brought lunch from home.

Spending two or more hours a day watching television or playing video games also increased the risk of obesity, but by only 19 percent.

Of the 142 obese children in the study for whom dietary information was known, almost half were school-lunch regulars, compared with only one-third of the 787 who were not obese.

“Most school lunches rely heavily on high-energy, low-nutrient-value food, because it’s cheaper,” said Dr. Kim A. Eagle, director of the University of Michigan Cardiovascular Center, and senior author of the paper , published in the December issue of American Heart Journal. In some schools where the study was done, lunch programs offered specials like “Tater Tot Day,” he said.

Help is on the way, though. Under a federal law passed in December, Department of Agriculture guidelines will limit the number of calories served at every school meal and require programs to offer a broad variety of fruits and vegetables — not just corn and potatoes.

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Benefits of School Lunch

School lunch is critical to student health and well-being, especially for low-income students—and ensures that students have nutrition they need throughout the day to learn. Research shows that receiving free or reduced-price school lunches reduces food insecurity, obesity rates, and poor health. In addition, the new school meal nutrition standards are having a positive impact on student food selection and consumption, especially for fruits and vegetables.

Quick Facts

• Reimbursable meals must meet federal nutrition standards. National School Lunch Program lunches provide one-third or more of the recommended levels for key nutrients.
• Reimbursable meals must provide no more than 30 percent of calories from fat and less than 10 percent of calories from saturated fat.
• New nutrition standards phased in since the 2012-2013 school year required schools to increase whole grains, fruits, and vegetables served through the National School Lunch Program.

School Lunch Participation:

• According to one estimate using national data, receiving free or reduced-price school lunches reduces food insecurity by at least 3.8 percent.
• Among a sample of low-income children entering kindergarten, receiving a free or reduced-price school lunch reduces the probability of household food insecurity at school entry, whereas paying full price for school lunch is associated with a higher probability of household food insecurity.
• Rates of food insecurity among children are higher in the summer — a time when many do not have access to the good nutrition provided by the school meal programs available during the academic year.
• Children participating in school meals are less likely to have nutrient inadequacies and are more likely to consume fruit, vegetables, and milk at breakfast and lunch.
• Low-income students who eat both school breakfast and lunch have significantly better overall diet quality than low-income students who do not eat school meals.
• The new school meal nutrition standards are having a positive impact on student food selection and consumption, especially for fruits and vegetables.
• Packed lunches brought from home by pre-kindergarten and kindergarten students have more calories, fat, saturated fat, and sugar than school lunches, and less protein, fiber, vitamin A, and calcium, according to a study conducted after implementation of the new school meal nutrition standards.
• Few packed lunches and snacks brought from home meet National School Lunch Program standards.
• Participation in federally-funded child care nutrition or school meals provided in child care, preschool, school, or summer settings is associated with a significantly lower body mass index (BMI) among young, low-income children. These findings lead researchers to conclude that “subsidized meals at school or day care are beneficial for children’s weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.”
• Based on national data, economists estimate that the receipt of a free or reduced-price school lunch reduces obesity rates by at least 17 percent.
• Receiving free or reduced-price school lunches reduces poor health by at least 29 percent based on estimates using national data.
• Behavioral, emotional, and mental health, and academic problems are more prevalent among children and adolescents struggling with hunger.
• Children and adolescents experiencing hunger have lower math scores and poorer grades.
• Children experiencing hunger are more likely to be hyperactive, absent, and tardy, in addition to having behavioral and attention problems more often than other children.
• Teens experiencing hunger are more likely to have been suspended from school and have difficulty getting along with other children.
• Children with hunger are more likely to have repeated a grade, received special education services, or received mental health counseling, than low-income children who do not experience hunger.

Research Brief Shows That School Breakfast and Lunch Programs Continue to Have Multiple Positive Effects on Students’ Health, Learning, and Well-Being

Read the brief

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As an organization whose mission is to improve the nutrition, health, and well-being of people struggling against poverty-related hunger in the United States through advocacy, partnerships, and by advancing bold and equitable policy solutions, our work has a commitment to Racial, Equity, Diversity, and Inclusion or as we call it REDI. I co-chair the REDI committee at FRAC and the values embedded in Juneteeth are aligned with our commitment to REDI all year long.

The first Older Americans Month in May 1963 celebrated the contributions of older adults as well as the unique challenges that they face. Special attention to older Americans inspired policy changes like Medicare, which facilitated older adults’ independence, health, and dignity.1

This month, we celebrate the strides made to support older Americans and acknowledge that older adults still face many barriers to active aging and wellness, including food insecurity.

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How the quality of school lunch affects students’ academic performance

Subscribe to the brown center on education policy newsletter, michael l. anderson , mla michael l. anderson associate professor of agricultural and resource economics - university of california, berkeley justin gallagher , and jg justin gallagher assistant professor of economics - case western reserve university elizabeth ramirez ritchie err elizabeth ramirez ritchie ph.d. graduate student - university of california-berkeley, department of agricultural and resource economics.

May 3, 2017

In 2010, President Barack Obama signed the Healthy, Hunger-Free Kids Act. The main goal of the law was to raise the minimum nutritional standards for public school lunches served as part of the National School Lunch Program. The policy discussion surrounding the new law centered on the underlying health reasons for offering more nutritious school lunches, in particular, concern over the number of children who are overweight. The Centers for Disease Control estimates that one in five children in the United States is obese.

Surprisingly, the debate over the new law involved very little discussion as to whether providing a more nutritious school lunch could improve student learning. A lengthy medical literature examines the link between diet and cognitive development, and diet and cognitive function. The medical literature focuses on the biological and chemical mechanisms regarding how specific nutrients and compounds are thought to affect physical development (e.g., sight), cognition (e.g., concentration, memory), and behavior (e.g., hyperactivity). Nevertheless, what is lacking in the medical literature is direct evidence on how nutrition impacts educational achievement.

We attempt to fill this gap in a new study that measures the effect of offering healthier public school lunches on end of year academic test scores for public school students in California. The study period covers five academic years (2008-2009 to 2012-2013) and includes all public schools in the state that report test scores (about 9,700 schools, mostly elementary and middle schools). Rather than focus on changes in national nutrition standards, we instead focus on school-specific differences in lunch quality over time. Specifically, we take advantage of the fact that schools can choose to contract with private companies of varying nutritional quality to prepare the school lunches. About 12 percent of California public schools contract with a private lunch company during our study period. School employees completely prepare the meals in-house for 88 percent of the schools.

To determine the quality of different private companies, nutritionists at the Nutrition Policy Institute analyzed the school lunch menus offered by each company. The nutritional quality of the menus was scored using the Healthy Eating Index (HEI). The HEI is a continuous score ranging from zero to 100 that uses a well-established food component analysis to determine how well food offerings (or diets) match the Dietary Guidelines for Americans. The HEI is the Department of Agriculture’s preferred measure of diet quality, and the agency uses it to “examine relationships between diet and health-related outcomes, and to assess the quality of food assistance packages, menus, and the US food supply.” The average HEI score for the U.S. population is 63.8, while the median HEI score in our study is 59.9. In other words, the typical private company providing public school lunch in CA is a bit less healthy than the average American diet.

We measure the relationship between having a lunch prepared by a standard (below median HEI) or healthy (above median HEI) company relative to in-house preparation by school staff. Our model estimates the effect of lunch quality on student achievement using year-to-year changes between in-house preparation of school meals and outside vendors of varying menu quality, within a given school . We control for grade, school, and year factors, as well as specific student and school characteristics including race, English learner, low family income, school budget, and student-to-teacher ratios.

We find that in years when a school contracts with a healthy lunch company, students at the school score better on end-of-year academic tests. On average, student test scores are 0.03 to 0.04 standard deviations higher (about 4 percentile points). Not only that, the test score increases are about 40 percent larger for students who qualify for reduced-price or free school lunches. These students are also the ones who are most likely to eat the school lunches.

Moreover, we find no evidence that contracting with a private company to provide healthier meals changes the number of school lunches sold. This is important for two reasons. First, it reinforces our conclusion that the test score improvements we measure are being driven by differences in food quality, and not food quantity. A number of recent studies have shown that providing (potentially) hungry kids with greater access to food through the National School Lunch Program can lead to improved test scores. We are among the very few studies to focus on quality, rather than food quantity (i.e., calories). Second, some critics of the Healthy, Hunger-Free Kids Act worried that by raising the nutritional standards of school lunches that fewer children would eat the food, thereby unintentionally harming the students that the law was designed to help. Our results provide some reassurance that this is not likely to be the case.

Finally, we also examine whether healthier school lunches lead to a reduction in the number of overweight students. We follow previous literature and use whether a student’s body composition (i.e. body fat) is measured to be outside the healthy zone on the Presidential Fitness Test . We find no evidence that having a healthier school lunch reduces the number of overweight students. There are a few possible interpretations of this finding, including that a longer time period may be necessary to observe improvements in health, the measure of overweight is too imprecise, or that students are eating the same amount of calories due to National School Lunch Program calorie meal targets.

Education researchers have emphasized the need and opportunity for cost-effective education policies . While the test score improvements are modest in size, providing healthier school lunches is potentially a very cost-effective way for a school to improve student learning. Using actual meal contract bid information we estimate that it costs approximately an additional $80 per student per year to contract with one of the healthy school lunch providers relative to preparing the meals completely in-house.

While this may seem expensive at first, compare the cost-effectiveness of our estimated test score changes with other policies. A common benchmark is the Tennessee Star experiment , which found a large reduction in the class size of grades K-3 by one-third correlated with a 0.22 standard deviation test score increase. This reduction cost over $2,000 when the study was published in 1999, and would be even more today. It is (rightfully) expensive to hire more teachers, but scaling this benefit-cost ratio to achieve a bump in student learning gains equal to our estimates, we find class-size increases would be at least five times more expensive than healthier lunches.

Thus, increasing the nutritional quality of school meals appears to be a promising, cost-effective way to improve student learning. The value of providing healthier public school lunches is true even without accounting for the potential short- and long-term health benefits, such as a reduction in childhood obesity and the development of healthier lifelong eating habits. Our results cast doubt on the wisdom of the recently announced proposal by Agriculture Secretary Sonny Perdue to roll back some of the school lunch health requirements implemented as part of the Healthy, Hunger-Free Kids Act.

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Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity.

Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed.

Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch.

Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.

Progress in addressing childhood obesity will require the coordinated and collective efforts of many different stakeholders working in multiple sectors and settings. Schools are identified as a key setting for public health strategies to lower or prevent the prevalence of overweight and obesity ( IOM 2005 ; U.S. Department of Health and Human Services 2001 ). While the schools alone cannot solve the childhood obesity epidemic, it also is unlikely that childhood obesity rates can be reversed without strong school-based policies and programs to support healthy eating and physical activity. Children spend more time in schools than in any other environment away from home. More than 48 million students attend 94,000 public elementary, middle, and secondary schools each day, and an additional 5.3 million students attend 30,000 private schools ( Frumkin 2006 ). More than 95 percent of American youth aged five to seventeen are enrolled in school, and no other institution has as much continuous and intensive contact and influence on children during their first two decades of life. The school system's primary role is to educate students in both academic subjects and the civic values and social responsibilities that will prepare them to reach their full potential ( Frumkin 2006 ). Health and education success are intertwined: schools cannot achieve their primary mission of education if students are not healthy and fit. Schools have an unparalleled opportunity to promote children's health by creating an environment in which children eat healthy foods, engage in regular physical activity, and learn lifelong skills for healthy eating and active living.

In this article, we discuss the role of schools in obesity prevention efforts, current issues in schools' food and physical activity environments, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environment and policies, (3) school body mass index measurements, and (4) school wellness policies. Finally, we offer recommendations for future research.

School Food Environment and Policies

The school food environment has the potential to have a large impact on children's and adolescents' diets because they consume a substantial proportion (between 19 and 50 percent) of their total daily calories at school ( Gleason and Suitor 2001 ). Food and beverages at school fall into two main categories: (1) federal school lunch and breakfast programs and (2) foods and beverages sold outside the formal meal programs, specifically à la carte items available in the school cafeteria and venues outside the cafeteria, such as vending machines, snack bars, school stores, and fund-raisers. This latter category is called competitive foods because they compete with the nutritionally regulated school meal program.

School Foods Sold Outside Meals (Competitive Foods)

Availability of competitive foods.

The rise in obesity over the past few decades has been accompanied by an increase in the number of food options available throughout the school day ( IOM 2007 ). The national 2006 School Health Policies and Programs Study (SHPPS) ( O'Toole et al. 2007 ) conducted by the Centers for Disease Prevention and Control (CDC) found that 33 percent of elementary schools, 71 percent of middle schools, and 89 percent of high schools had a vending machine or a school store, canteen, or snack bar where students could purchase food or beverages. The most common beverages sold were sports drinks, sodas, and fruit drinks (not 100 percent juice), and the most common foods sold were higher-fat salty snacks. High schools and middle schools were more likely to sell competitive foods than were elementary schools. Since the previous SHPPS in 2000, U.S. schools have made strides in improving the school food environment. For example, from 2000 to 2006, the percentage of school districts prohibiting vending machines offering high-calorie, low-nutrition foods and beverages rose from 4 to 30 percent; schools selling water in vending machines or school stores increased from 30 to 46 percent; and schools selling cookies, cake, or other high-fat baked goods in vending machines or school stores fell from 38 to 25 percent ( O'Toole et al. 2007 ). SHPPS 2006 data indicate that while some progress has been made, much more is needed. SHPPS 2006 provides a disconcerting picture of the continued widespread availability of low-nutrition, high-fat, and high-sugar foods in U.S. schools, especially high schools. For example, more than three-fourths of high schools sold sodas or high-sugar fruit drinks, and almost half of high schools allow students to buy food and beverages from vending machines or school stores ( O'Toole et al. 2007 ).

The third School Nutrition and Dietary Assessment study (SNDA-III) ( Finkelstein, Hill, and Whitaker 2008 ; Gordon and Fox 2007 ) also confirmed that schools' current offerings do not fully support a healthy diet for children and adolescents. The study found vending machines in 17 percent, 82 percent, and 97 percent of elementary, middle, and high schools, respectively, and à la carte items were sold in 85 percent of schools. These sources often contain low-nutrient, energy-dense foods. Unhealthy foods were much more pervasive in high schools than in elementary schools and in rural schools more often than in urban and suburban schools, but there were no significant differences between low-income and higher-income schools ( Finkelstein, Hill, and Whitaker 2008 ). Fund-raisers that focused on food or beverage sales also were common, being held in 37 percent of elementary schools and 50 to 60 percent of middle and high schools ( Gordon and Fox 2007 ).

Impact of Competitive Foods on Child Nutrition

SNDA-III found that students consumed more than 150 calories from competitive, low-nutrition, energy-dense foods. Competitive foods were consumed by fewer National School Lunch Program (NSLP) participants than nonparticipants ( Gordon and Fox 2007 ). Several studies have related the availability of snacks and drinks sold in schools to higher intakes of total calories, soft drinks, total fat and saturated fat, and lower intakes of fruits and vegetables, milk, and key nutrients ( Cullen et al. 2000 ; Cullen and Thompson 2005 ; Cullen and Zakeri 2004 ; Kubik et al. 2003 ). Kubik and colleagues (2003) examined the association between seventh- and eighth-grade students' dietary behaviors and schools' vending machines and à la carte programs. School à la carte availability was inversely associated with daily fruit and vegetable consumption and positively associated with daily total fat and saturated fat intake. Snack vending machines were negatively associated with fruit consumption. In a longitudinal study, Cullen and Zakeri (2004) found that middle school students who gained access to school snack bars consumed fewer fruits and nonstarchy vegetables, less milk, and more sweetened beverages and high-fat vegetables compared with the previous school year, when they were in elementary schools and had access only to lunch served at school. In schools with food policies restricting access to less nutritious competitive foods, middle and high school students consumed less of these foods during the school day ( Cullen et al. 2006 ; Hartstein et al. 2008 ; Neumark-Sztainer et al. 2005 ). Kubik, Lytle, and Story (2005) examined the association between body mass index (BMI) in young adolescents and schools' food practices, such as foods used in school fund-raising and in the classroom as rewards. Students' BMI increased by 0.10 BMI units for every additional food practice permitted in their school. This study suggests that regular exposure to common school food practices may increase students' risk for weight gain.

Impact of Competitive Foods on School Revenue

Many school districts are hesitant to enact policies that restrict competitive food offerings, fearing that such actions will result in substantially decreased revenue. A recent systematic review of the literature examined seven studies, and the evidence to date suggests that the majority of schools have been able to improve the nutritional value of competitive foods without their changing overall revenue ( Wharton, Long, and Schwartz 2008 ). Thus, even though the available data are limited, they do not support the concern that improving the nutritional quality of competitive foods will hurt school revenue.

Furthermore, a few of the studies assessed NSLP participation before and after the changes in competitive food offerings and found that the number of students choosing the school lunch increased over time. An important area for further study is the hypothesis that when competitive foods are limited, participation in the school meal program increases, effectively compensating for revenue losses in snack sales.

Federal Policies

Federally subsidized school meals are required by Congress and the U.S. Department of Agriculture (USDA) to meet nutrition standards and comply with the Dietary Guidelines for Americans. However, foods and beverages sold outside the federally reimbursable school meal programs are largely exempt from such requirements. The USDA currently does not have the authority to regulate foods or beverages sold outside the cafeteria or outside mealtimes. Federal requirements for competitive foods, established in 1979, are based on “foods of minimal nutritional value” and apply only to foods sold in the cafeteria during mealtimes. These standards are weak, outdated, and arbitrary; for example, candy bars, chips, and fruitades (with little juice) are allowed for sale in the cafeteria, but jelly beans and seltzer water are not. Currently, federal regulations do not cover competitive foods sold outside the cafeteria. Several organizations have called for federal efforts to update nutrition standards for school foods sold outside school meals to ensure that they conform with the Dietary Guidelines for Americans ( National Alliance for Nutrition and Activity 2008 ).

In 2007, the Institute of Medicine (IOM) (2007) released a report with recommendations for national standards for competitive foods. It concluded that federally reimbursable school nutrition programs should be the main source of nutrition at schools and that opportunities to obtain competitive foods should be limited. But if competitive foods are available, they should consist only of fruits, vegetables, whole grains, and nonfat milk and dairy products, the food groups least represented in the diets of youth. To date, the only state that has adopted most of the IOM recommendations is West Virginia, which has perhaps the country's strongest state regulations for competitive foods.

In 2004, Congress passed the Child Nutrition and WIC Reauthorization Act of 2004, which requires that all school districts develop a wellness policy, including goals for nutrition education and nutrition guidelines for all foods available at schools. In a later section, we discuss this important federal initiative to improve the school food environment.

State Policies

State agencies can impose restrictions on the sale of all foods and beverages sold at schools participating in federal school meal programs. Since 2004, state legislative activity in the area of school nutrition has been brisk, due to concerns about childhood obesity. About half of all states (27) have adopted competitive food policies that are more restrictive than the USDA regulations, although the restrictions differ greatly in type and extent ( IO M 2007 ). Eleven states have taken legislative action to require higher nutritional standards for school meals than the “minimum” USDA requirements; sixteen states have set nutrition standards for foods sold outside the school meal programs; and twenty-five states limit when and where foods that are not part of the school meal programs can be sold during school hours. State policies for competitive foods tend to be most restrictive for elementary schools and least restrictive for high schools. This is worrisome, since middle and high schools have the poorest school food environments in regard to the availability of unhealthy competitive foods ( IOM 2007 ; O'Toole et al. 2007 ).

In 2007, the Center for Science in the Public Interest released a report that evaluated all fifty states' school nutrition policies regarding foods and beverages sold outside school meals ( Center for Science in the Public Interest 2007 ). The report found that while many states had strengthened their school nutrition policies, the changes, albeit positive, were fragmented and incremental. It concluded that the nation has a patchwork of policies addressing the nutritional quality of school foods and beverages and that two-thirds of states have weak or no policies. With so many different state standards, specifying differing amounts of fats, sugars, calories, and portion sizes, food companies will have difficulty packaging and formulating products. The report emphasized that a uniform national policy is needed to establish nutrition standards for foods and beverages in schools.

National School Breakfast and Lunch Programs

The NSLP was started in 1946 in response to congressional concerns about the great number of young men who could not qualify for the World War II draft because of poor nutritional health: one-third were rejected for military service because of nutritional deficiencies ( Martin 2008 ). Accordingly, the National School Lunch Act in 1946 was “created as a measure of national security, to safeguard the health and well-being of the nation's children.” Now, more than sixty years later, in the midst of a childhood obesity epidemic with one-third of U.S. children being overweight or obese, we are again faced with a major health crisis that could threaten “national security” in new ways. With more than 30 million youth participating in the school lunch program every school day, the NSLP offers a potent policy tool to improve the diets of American children. Furthermore, obesity and poor diet disproportionately affect low-income and minority children, and almost two-thirds (59 percent) of school lunches served are free or at a reduced price for students from low-income families ( USDA Economic Research Service 2008 ). An average of 10 million children participate in the School Breakfast Program (SBP) each school day, and 81 percent of these breakfasts are provided free or at a reduced price to low-income students ( USDA Food and Nutrition Service Office of Research, and Nutrition and Analysis 2008 ). Thus, school meals can have a large impact on children's diets, especially those of low-income youth, who are most likely to be the recipient of school meals. In addition, both obesity and hunger may coexist in low-income families, which presents a challenge for school nutrition programs in balancing the need to prevent hunger as well as obesity.

Meals served in the NSLP and SBP must meet federally defined nutrition standards in order for schools to be eligible for federal subsidies (cash reimbursements and commodity foods). Schools participating in the NSLP and SBP are required by the USDA to meet certain nutrition criteria and, since 1995, also must adhere to the Dietary Guidelines for Americans. In the past fifteen years, although schools have substantially improved the nutrition profile of school meals, most notably reducing the percentage of calories from fat and saturated fat ( Fox et al. 2001 ), stronger efforts are needed. For example, the recent SNDA-III study ( Gordon and Fox 2007 ) showed that although the majority of U.S. schools offer breakfasts and lunches that meet the standards for key nutrients, such as protein, vitamins A and C, calcium, and iron, fewer than one-third of public schools meet the USDA standards for total fat and saturated fat. Reducing fat in school meals to meet the Dietary Guidelines for Americans recommendations can help cut excess calories. The USDA federal regulations also have nutrition standards for appropriate calorie levels for school meals averaged over a school week ( USDA Food and Nutrition Service 1988 ). Elementary (K through 6) lunches must have a minimum of 664 calories, and secondary (7 through 12) lunches, 825 calories. SNDA-III found that 79 percent of elementary schools met the regulatory calorie standards for lunches but that only about one-half of high schools offered lunches that were adequate in calories ( Gordon et al. 2007 ). The current USDA standards for calories have not been revised since the early 1990s and are based on the old 1989 Recommended Energy Allowance for active children and not on the updated Dietary Reference Intakes or the 2005 Dietary Guidelines for Americans. The Institute of Medicine has recently undertaken a study sponsored by the USDA to review and provide recommendations to revise the meal patterns and nutrition standards of the National School Lunch Program and School Breakfast Program. The report will be completed in 2010.

Financial Issues

Financial pressures are major barriers to providing more nutritious meals ( U.S. General Accounting Office 2003 ). School food service programs, which once were regular line items in local school budgets, now must often be completely self-supporting. To try to break even financially, many food service directors are compelled to sell popular, lower-nutrition foods in the cafeteria, foods that are frequently found in other school venues (e.g., vending machines) and compete with school meals ( IOM 2007 ). The current federal reimbursement rate for a “free” lunch is $2.47, which the School Nutrition Association believes is not adequate to cover the cost of producing a school meal. The costs of food, transportation, labor and benefits, and indirect expenses have increased rapidly, and reimbursement has not kept pace ( SNA 2008 ). The Omnibus Budget Reconciliation Acts of 1980 and 1981 cut federal reimbursement levels for school meals, and when adjusted for inflation, the original funding cut has never been restored ( Martin 2008 ). The Food Service Equipment Program that provided funding to help low-resource schools purchase institutional food service was eliminated, and funding for the Nutrition Education and Training program was severely cut as well. Interestingly, when the federal budget was cut in the early 1980s, the availability of competitive foods increased. A recent USDA cost study report found that on average, school food service revenues barely cover the reported costs of producing reimbursable meals and fall short of covering the full costs incurred by the school districts, such as the salaries of food service staff ( USDA Food and Nutrition Service Office of Research, and Nutrition and Analysis 2008 ). The SNDA-III study found that 42 percent of schools did not offer on a daily basis any fresh fruits or raw vegetables in the reimbursable school lunch. Only 5 percent of breads and rolls were made from whole grains ( Gordon et al. 2007 ). The reason is that fresh fruits, vegetables, and whole grains cost more ( Weber 2008 ). We need, therefore, to consider increasing reimbursement rates for school meals to help schools serve meals that meet the current Dietary Guidelines for Americans. Eliminating à la carte and vending machine foods and restricting open campuses could increase school meal participation and thereby raise school nutrition revenues to purchase and serve healthier foods.

Supportive polices could also be enacted at the local level. School nutrition services are required to operate on a nonprofit basis, but there is considerable variation at the local level to obtain profits from food service operations through “indirect costs.” Indirect costs are not related to meal production but include rent, utilities, building maintenance, janitorial services, administration, and other costs shared with the school district. Indirect costs vary widely by states and districts. School boards exert a large degree of control over the food service program and can allow the school district's general fund to encompass food service revenues ( Wagner, Senauer, and Runge 2007 ). A recent economic analysis study found that indirect costs, paid by food service to the school district, hurt the quality of school meals by cutting funds to upgrade kitchens and train staff to prepare more nutritious meals ( Wagner, Senauer, and Runge 2007 ). Not all school districts charge indirect costs to the school meal program, though, thereby allowing the school nutrition program to put all revenue back into the program's operation. Local school district policies regarding indirect charges to the school meal programs should be explored ( Miller 2009 ).

Other Policy-Relevant School Efforts to Improve Children's Diets

Nutrition education curriculum standards.

Nutrition education is an important component of a coordinated school health approach ( Kann, Telljohann, and Wooley 2007 ). Eating patterns are more likely to improve when changes in the school environment are integrated with classroom nutrition education ( Lytle et al. 2004 ). Only two states, Colorado and Oklahoma, do not require schools to provide health education ( Robert Wood Johnson Foundation 2008 ).

The national CDC 2006 SHPPS found that 70 percent of states required the topic of nutrition and dietary behavior to be taught at the elementary, middle, and high school levels as part of the health education curriculum ( Kann, Telljohann, and Wooley 2007 ). The majority of school districts (83 percent) required nutrition to be taught. Although nutrition education appears to be common in schools, the amount offered is limited. The median number of hours per year that schools devote to teaching nutrition education and dietary behavior is 3.4 hours for elementary schools and 5 hours for middle and high schools. In the 2006 SHPPS of fourteen broad health topics listed, teachers ranked nutrition and dietary behavior as the topic for which they most wanted staff development and training ( Kann, Telljohann, and Wooley 2007 ). This shows the interest in nutrition and the need for more teacher training.

Farm-to-School Programs and School Gardens

Farm-to-school programs link local farmers providing fresh locally grown produce to school food service cafeterias. These programs provide high-quality local produce, promote and support locally based agriculture, and often directly connect farmers and children, as many of these programs include visits to farms and visits from farmers to the classroom, enabling students to learn how and where food is produced. Even though farm-to-school programs cannot produce the amount of fruits and vegetables needed for school meals throughout the country, they can contribute to meeting these needs. Farmers benefit from increased sales to institutions and a sense of community involvement. Farm-to-school programs have existed for nearly ten years and now number more than 1,100 ( Joshi, Misako Azuma, and Feenstra 2008 ). A recent review of fifteen studies of farm-to-school programs pointed out that only four of the studies appeared in peer-reviewed publications ( Joshi, Misako Azuma, and Feenstra 2008 ). Although the findings are preliminary, they suggest some promise in the greater number of school salad bars, higher school meal participation, changes in students' attitudes and behaviors in trying new foods, and increased fruit and vegetable intake ( Martin 2008 ). The main concern with farm-to-school programs is cost, as these programs generally cost school districts more money in labor costs to prepare raw foods and arrange visits with local growers.

There also is increasing interest in school-garden programs. As outdoor “learning laboratories,” these programs offer multiple opportunities for students to gain knowledge and skills regarding food systems and to realize the connections between food and the environment, to promote healthy eating, specifically fruits and vegetables, and to serve as a setting for positive youth development. School-garden programs provide an opportunity for youth to plant, harvest, and prepare vegetables and some fruits (e.g., berries, melons) and are frequently linked to the school's academic curriculum (e.g., biology, nutrition, writing). While school gardens may be a good way of improving students' fruit and vegetable intake and preferences, few studies have evaluated their impact ( Ozer 2007 ). As with farm-to-school programs, there is a need for rigorous, well-designed research and evaluation studies. School-garden programs can be labor intensive and expensive, and sustainability is an issue. Policy considerations for both farm-to-school and school-garden programs involve issues of impact, sustainability, and cost. Additional research and evaluation in both these areas could help guide policymakers and decision makers.

Federal Fruit and Vegetable Program

The 2002 Farm Bill created an innovative pilot program to provide free fresh fruit and vegetable snacks to students in twenty-five schools in six states. Separate and distinct from the schools' existing meals programs, the intent of the snack program was to increase children's consumption of fruits and vegetables. Implemented by the USDA, the program gives grants to schools to purchase fruits and vegetables. In 2004, Congress made the program permanent and expanded it to eight states and three Native American territories. The 2008 Farm Bill again expanded the program but limited it to elementary schools, especially lower-income schools. The program will be phased in over the next four years with new cohorts of schools each year and will reach a policy goal of $150 million per year in 2011. There has been relatively little evaluation of the program's impact, even though the 2008 Farm Bill allocates $3 million for this purpose.

School Physical Activity Environment and Policies

Physical activity and academic performance.

Longitudinal data have shown that for each weekday that normal weight adolescents participated in physical education, the odds of becoming an overweight adult decreased by 5 percent ( Menschik et al. 2008 ). Physical education, physical activity, and sports in schools all are associated with students' better physical fitness. The connection between participation in these educational and activity programs and students' academic performance is, however, less straightforward. A review of studies concludes that up to an hour of daily physical activity programs can be added to a school curriculum by taking time from other subjects without hurting students' academic achievement in those subjects ( Trudeau and Shephard 2008 ). Conversely, taking time from physical education and adding it to the academic curriculum does not enhance either the students' grades in these subjects or their physical fitness ( Marsh 1992 ).

The suggested reason for this effect is that physical activity improves students' learning efficiency. Other ways in which activity opportunities in schools, like extracurricular activities, are indirectly associated with academic achievement are lower dropout rates, better classroom behavior and self-esteem, and more engagement in and connectedness to school and on-task behavior ( Mahar et al. 2006 ; Trudeau and Shephard 2008 ).

Promoting Physical Activity Standards in Schools

Several organizations have tried to aid schools by offering high-quality physical education and activity programming by recommending standards, providing funding, and supporting research. The National Association for Sport and Physical Education (NASPE) leads these efforts and has published standards defining quality physical education for elementary, middle, and high schools ( National Association for Sport and Physical Education and American Heart Association 2006 ). The standards support a comprehensive school physical activity program and emphasize daily and minimum time requirements, curriculum and assessment standards, and certified educators with appropriate class sizes and equipment. Between 2000 and 2006, the percentage of school districts that had adopted a policy stating that schools will follow national, state, or district physical activity standards rose from 66.5 to 81.4 percent ( Lee et al. 2007 ). The CDC currently funds education and health agencies in twenty-three states to support coordinated school health programs emphasizing the prevention of health-risk behaviors such as physical inactivity ( Lee et al. 2007 ). In 2006, the CDC released the Physical Education Curriculum Analysis Tool (PECAT), which helps school districts evaluate curricula based on the NASPE's standards for physical education. In 2007, twenty states considered legislation to encourage safe physical activity and active transportation ( Robert Wood Johnson Foundation 2008 ).

Federal School Physical Education and Activity Standards

There is no federal law requiring physical education to be provided to students in the American education system or any incentives for offering physical education programs ( NASPE and AHA 2006 ). Federally sponsored policies regarding physical education and activity in schools include encouraging students' participation in and equal access to programs for both boys and girls, providing funding for equipment and staff training, and requiring local districts to set programming goals and conduct evaluations. Inconsistent with the NASPE's recommendations, there is no federal-level sponsorship of policies promoting standards for instructors' qualifications, fitness testing, or performance.

The Carol M. White Physical Education Program, also known as PEP, was established in 2001 under No Child Left Behind (NCLB) and is administered by the Education Department. Its purpose is to “award grants and contracts to initiate, expand, and improve physical education programs for all K–12 students.” Funds are available for equipment purchases, student participation, and teacher and staff training and education. In 2007, 58 new awards, averaging $312,587, and 291 continuing awards were given to local education agencies. Some critics cite the NCLB as the reason that physical education has been eliminated from schools, because the list of core academic subjects graded for achievement omits physical and health education. Another missed opportunity for physical education is alleged to be the NCLB's insistence on “highly qualified” teachers, from which physical education also is exempted because it is not listed as a core subject ( NASPE and AHA 2006 ). Legislation has been introduced to amend the NCLB to require states to draw up plans for physical education and activity content and performance and to tie achievement standards for students to the NCLB's goals.

Under Title IX of the Education Amendments of 1972, federal law requires public schools to provide equal athletic opportunities to all students, regardless of gender:

No person shall, on the basis of sex, be excluded from participation in, be denied the benefits of, be treated differently from another person or otherwise discriminated against in any interscholastic, intercollegiate, club or intramural athletics offered by a recipient, and no recipient shall provide any such athletics separately on such basis.

Despite these federal efforts, boys continue to have the best school-based education and activity participation rates ( U.S. Department of Health and Human Services 2006 ).

In 2004, federal legislation was passed requiring districts with federally funded school meal programs to develop and implement wellness policies, including goals for physical activity, by the beginning of the 2006/2007 school year. It is hoped that the implementation of these wellness plans will increase the number of school-based opportunities for physical activity. The federal school wellness policy is discussed later.

State-Level School Physical Education and Activity Standards

States may set general or minimum requirements or directions, but many delegate responsibility for educational decisions to the local school districts ( NASPE and AHA 2006 ).

In 2007, twenty-five states sponsored policies promoting activity in schools across physical education/activity curricula, opportunities, instructors' expertise, and fitness testing and performance.

Although the majority of states do have physical education mandates for schools, they vary by level of school. Thirty-six states mandate physical education in elementary school, thirty-three states for middle or junior high school, and forty-two states for high school. But the translation of these mandates into schools' daily physical activities is significantly lower. Only 4 percent of elementary schools, 8 percent of middle and junior high schools, and 2 percent of high schools provide daily physical education ( Lee et al. 2007 ).

Despite the national goals and recommended standards for school time spent on physical education and activity, few states have enacted legislation increasing this time or the opportunities offered in school. Currently, only eleven states require a set number of minutes spent in physical education classes for elementary schools, and even fewer do so for secondary schools. Only seven states set requirements for the amount of time that students must participate in physical education classes for middle or junior high schools, and ten states for high schools.

A few states do meet the national recommendations for weekly time spent in physical education class for elementary schools (Louisiana, New Jersey), middle schools (Montana), and high schools (Indiana, Montana, South Carolina, District of Columbia) ( NASPE and AHA 2006 ).

The states also are beginning to address the quality of time spent in physical education classes. Legislation enacted in 2007 by Arizona, Florida, Oregon, and Texas stated that a specified amount of physical education class time must be dedicated to moderate and vigorous activities ( Robert Wood Johnson Foundation 2008 ). Arizona (AZ HB 2140) calls for 50 percent of physical education time to be devoted to moderate to vigorous exercise and can include recess. Texas Senate Bill 530 requires students in the sixth through eighth grades to participate in moderate to vigorous daily activity for a minimum of thirty minutes during at least four semesters. Connecticut Senate Bill 2004 promotes creative ways to reach these goals by requiring schools and municipal parks to coordinate their services. Other ways that state goals have been implemented in classrooms include the North Carolina Energizers. Energizers are ten-minute bouts of activity that integrate physical activity with academic concepts ( Mahar et al. 2006 ).

Thirty-five of all states mandate the number of high school physical education credits that are required for a student to graduate. Of those, New Jersey requires the most, 3.75 credits. Twenty-two states require that physical education grades be included in a student's grade point average.

Recess and Walking or Biking to School

Despite the evidence-based position of the National Association for Sport and Physical Education that recess should be an integral part of elementary education—separate and distinct from physical education—only 12 percent of states require (six states require and thirteen states recommend) elementary schools to give students regularly scheduled recesses ( National Association for Sport and Physical Education 2001 ). This percentage has risen by only 7 percent since 2000 ( Centers for Disease Control and Prevention 2007a ). This state-level policy means that 57 percent of districts required recess in 2006. In addition, only five states have adopted policies that prohibit denying recess as a punishment for poor behavior in the classroom. Twenty-five states have even adopted a more lenient language discouraging districts from doing so ( Centers for Disease Control and Prevention 2007b ). Similarly, districts are providing the policy leadership for encouraging walking and biking to school; 14 percent of all states (seven) and 18 percent of districts have adopted policies supporting or promoting walking or biking to and from school.

Instructors' Qualifications

Nationwide, the majority of states have adopted policies stating that newly hired staff who teach physical education must have undergraduate or graduate training in physical education. There are more state policy requirements for high school instructors (48 states) than for those in middle (43 states) or elementary schools (28 states) ( Lee et al. 2007 ). All states offer at least one type of certification, licensure, or endorsement to teach physical education, and about half offer a combination of these. Thirty states support the certification of physical education teachers by the National Board Certification, and fourteen states pay certified teachers more ( NASPE and AHA 2006 ).

Fitness Testing and Performance Standards

Fewer than half the states require or recommend that schools perform any of three forms of physical education assessment: written knowledge, skills performance, or fitness levels. Student fitness testing is required by states most often for high schools (8 states) and less often for middle (7 states) and elementary schools (6 states). States generally recommend (18 to 21 states) rather than require (1 to 2 states) that written knowledge and skills performance tests be performed ( Lee et al. 2007 ).

In 2007, eleven states enacted policies to assess students' physical fitness. Most of these assessments involve body mass index measurements, described elsewhere. Delaware calls for fitness testing of students at least once in elementary, middle, and high school.

School Body Mass Index Measurements

Measuring school-based body mass index (BMI) (i.e., taking students' heights and weights and calculating BMI) and reporting the results to parents has been recommended as a way to prevent obesity ( IOM 2005 ). The two types of school BMI measurement strategies are surveillance alone or a combination of surveillance and screening ( Nihiser et al. 2007 ).

BMI surveillance data often are collected anonymously and are much less controversial than BMI screening programs. BMI surveillance programs gather population-level prevalence data on weight status and thereby can identify the number of students with weight problems. Surveillance data can be used to monitor and track trends in growth patterns and obesity over time to aid in the planning and delivery of services and to determine whether programs and policies are having a desirable effect. BMI screening programs, similar to other school health screenings (e.g., hearing, vision), identify those students most at risk and give parents confidential information about their child's weight status. BMI screening and reporting programs can help increase public and professional understanding of children's weight issues and can be a useful vehicle for engaging with children and families about healthy lifestyles and weight problems ( Nihiser et al. 2007 ). Although reporting hearing and vision results to parents has been a standard practice, sharing height and weight data has not been a routine practice and has been criticized. The concerns pertain to potential safety issues and unintended negative consequences, such as parents putting children on restrictive diets and stigmatizing them, even though no empirical data support these concerns.

In 2003, Arkansas was the first state to pass legislation mandating statewide public school–based BMI assessments, and since then, eleven states—California, Delaware, Florida, Illinois, Kansas, Maine, Missouri, New York, Pennsylvania, Tennessee, and West Virginia—have passed legislation enabling schools to measure students' BMI levels as part of either health examinations or physical education activities ( Trust for America's Health 2007 ). The 2006 SHPPS study found that of these eleven states requiring schools or school districts to measure students' height and weight, eight mandate notifying parents of the results ( Nihiser et al. 2007 ).

Few studies have examined the effectiveness or impact of school-based BMI measurement programs. Arkansas has the United States' most extensive school BMI initiative, which until recently required all public school students to have their BMI measured and reported annually to parents. School participation rates have been high, ranging from 94 to 99 percent of public school participation, and student assent forms range from 90 to 95 percent. Only 5 to 6 percent of students could not be measured because they or their parents refused ( Justus et al. 2007 ). In 2008, in response to constituents' concerns about annual assessments, such as time away from class and the personnel needed, the Arkansas legislature amended the periodicity of the BMI assessments so that only students in even-numbered grades from kindergarten through tenth grade will be assessed annually. Parents must give the school a written refusal if they do not want their child to participate. The statewide BMI student monitoring data have shown that in Arkansas, schoolchildren's obesity rates have not increased since 2003 ( Justus et al. 2007 ).

Kubik, Story, and Rieland (2007) conducted focus groups with parents to find out their opinions about BMI screening programs and message content. The parents were generally supportive of school-based BMI screening but wanted assurance that the students' privacy and respect would be maintained during the measurement and that the BMI results would be provided to parents in a neutral manner that avoided weight labeling. Kubik and colleagues (2006) also surveyed 790 parents of elementary school students after they received an individualized BMI report letter. Almost all the parents (95 percent) stated that they had read all or most of the letter. Most parents (80 percent) and children (83 percent) reported comfort with the information in the letter; parents of overweight children were more likely to report discomfort with the content. If a BMI surveillance or screening program is implemented, important concerns that must be considered are financial support for the schools and costs involved, training of staff, use of the data, privacy laws and issues, and safeguards to minimize risks to students by supplying a private, safe, and supportive environment.

School Wellness Policies

Section 204 of the 2004 Child Nutrition and WIC Reauthorization Act requires all local education agencies (LEA) participating in federally funded school meal programs (e.g., the National School Lunch and Breakfast Programs) to create a school wellness policy (SWP) by the start of the 2006/2007 school year. This law is the first successful federal effort to address the school food and activity environment ( Smith 2006 ).

According to the federal law, school wellness policies must have five features to promote student wellness: (1) goals for nutrition education, physical activity, and other school-based activities; (2) nutrition guidelines for all foods available on each school campus during the school day; (3) assurance that guidelines for reimbursable school meals will not be less restrictive than federal regulations and guidance; (4) a plan for measuring implementation of the local wellness policy, including the designation of one or more responsible persons; and (5) the involvement of parents, students, and representatives of the school food authority, the school board, school administrators, and the public in developing the school wellness policy.

An important feature of these guidelines is that the details were left up to the local school districts; no specific national requirements were set for any of the policy components. The strategy of placing the responsibility on school districts to establish their own policies has both benefits and risks. On the positive side, giving the committee full power to write the policy and requiring the inclusion of parents, students, the public, school administrators, the board of education, and the food service sets the stage for each district to hear the views of several relevant parties and ideally to achieve a high level of buy-in and cooperation. This inclusive strategy was designed to increase compliance with the policy's implementation. On the negative side, there are no minimum national standards for policy components, such as the nutritional value of competitive foods or the amount of time devoted to physical activity, which in turn has led to the creation of some extremely weak policies and has created a national landscape with considerable variability among districts.

State-Level Influences on School Wellness Policies

In addition to the federal requirements, several states have regulations and policies that influenced the development of SWPs. These regulations contain requirements like setting state-level nutrition standards for à la carte and vending, submitting all policies for review by the Department of Education, and posting all SWPs on a central website. A complete catalog of all state requirements can be found in the National Association of State Boards of Education report State Strategies to Support Local Wellness Policies ( Pekruhn and Bogden 2007 ) and the annual Robert Wood Johnson Foundation Balance reports (2008).

Another important factor influencing the SWPs' language was the large number of model policies that were created and distributed. At the national level, some of the most frequently discussed model policies were those from the National Alliance for Nutrition and Activity (NANA), the Center for Ecoliteracy, Action for Healthy Kids, and USDA Team Nutrition. Some individual states developed model and sample policies, and many also created tool kits to aid school districts. State-level model policies were likely to have been used the most often because they helped districts ensure compliance with both the federal and their own state regulations. The sources of state-level guidance were most often the state department of education, the state board of education, the state Action for Healthy Kids team, and universities in the state with departments interested in school nutrition ( Pekruhn and Bogden 2007 ). Note that one risk of creating state model policies is that districts may simply download the language and avoid self-assessment through stakeholder input. This process of working together as a community, however, has been identified as an important way of promoting lasting change ( Wechsler et al. 2004 ).

Evaluating School Wellness Policies

The scientific literature evaluating school wellness policies is just beginning to be written. The national School Nutrition Association (SNA) has taken the lead in evaluating policies and their implementation across the country ( SNA 2006a , 2006b , 2008 ; SNA and School Nutrition Foundation 2007 ). In 2006, the national SNA released a report examining the policies of the one hundred largest school districts, which was followed by another study of a random sample of 140 districts in seven regions of the country. The findings of these two studies were similar. The majority of written policies (87 percent to 99 percent) addressed the requirements outlined in the law (i.e., setting nutrition standards for school meals, à la carte, and vending, as well as requiring physical activity, nutrition education, and a plan for their implementation and evaluation). Approximately two-thirds of the districts also created nutrition standards for fund-raisers, classroom celebrations and parties, and teachers' use of food as a reward. The SNA studies reported the frequency of breakdown between policies that “mandated” and those that “encouraged” different components. Guidelines for meals, à la carte, and vending were much more likely to be mandated than encouraged, while nutrition standards for fund-raisers, parties, and food as a reward were equally likely to be encouraged as mandated.

In their most recent report, the SNA and the School Nutrition Foundation surveyed food service directors about how many wellness policy components had been implemented to date ( SNA 2008 ; SNA and School Nutrition Foundation 2007 ). Surveys are a cost-effective method of collecting data, although they carry a risk of inflated estimates of compliance when using self-reported data. The SNA obtained a 28 percent response rate and was able to compare districts based on size, percentage of free and reduced-price lunches requested, and geographic region. Overall, the SNA found a high level of implementation (92 percent) for reimbursable meal program nutrition standards and a fairly high level (72 percent) for à la carte items. The authors state that their successful implementation may be that they typically are controlled by one person and that the food service is accustomed to following regulations. In contrast, policies regarding other food at school, such as that for fund-raising, class parties, school stores, and food as a reward were much less successful, with only approximately one-third of districts reporting their implementation. This may be due to the challenges in obtaining buy-in from all teachers, parents, and students to follow the standards as well as, perhaps, the difficulty of monitoring these activities. Some interesting trends also emerged regarding the relationship between district size and the percentage of free and reduced-price lunches requested. Specifically, larger districts with more requests for free and reduced-price lunches also appeared to have stronger policies and more successful implementation of their policies. Research using an objective assessment of implementation (e.g., observation) would be useful to validate these findings.

The only published peer-reviewed study to date examines the strength of school wellness policies in thirty districts in Utah ( Metos and Nanney 2007 ). This study found that the majority of districts (78 percent) complied with the federal guidelines regarding policy content, although the strength of the language used in the policies varied widely. Those policy components most likely to be mandated tended to be those already mandated by other laws, suggesting the limited incremental value of the school wellness policy. As the SNA study pointed out, the districts with the strongest language regarding mandatory policy components were those with the most free and reduced-price meal programs. The authors speculate that this may be due to characteristics of the district, such as past attention to the issue or the administrator's experience, and suggest that future research examine such possible predictive factors as the superintendent's experience, previous wellness initiatives, and the school board's or wellness committee's composition and size.

A similar study in Connecticut coded all the state's district policies and looked at a range of potential predictive variables ( Schwartz and Henderson 2007 ). This study also found that districts with low socioeconomic status (SES) had significantly stronger policies than did high-SES districts ( Connecticut State Department of Education 2008 ). When examining predictors of overall policy strength, the district's political climate was also an independent significant predictor, beyond the effect of SES. Specifically, the greater was the proportion of Democrats to Republicans in the district, the stronger the district policy would be. This finding suggests that local control of policy content may result in policies that are consistent with local political beliefs ( Schwartz and Henderson 2007 ).

One of the challenges in studying SWPs is the lack of a standard measure to assess a policy's strength and comprehensiveness. To address this, a group of researchers funded by the Robert Wood Johnson Foundation's Healthy Eating Research program created a ninety-six-item measure to code the policies on a large number of items under each of the major domains: nutrition education, nutrition standards for school lunch, nutrition standards for competitive foods, physical education, physical activity, and communication and promotion ( Schwartz et al. in press ). This measure is conceptually similar to those used by the SNA (2006a , 2006b) and by Metos and Nanney (2007) , in that it distinguishes between weak and strong language but builds on these measures by including a large number of items to cover as many components of key policy domains as possible.

Conclusions: What Is Needed to Accelerate Change

Research consistently shows that the majority of American children do not consume diets that meet the Dietary Guidelines for Americans, nor do they achieve the recommended levels of daily physical activity. As a result, more children in the United States are overweight today than at any other time in its history. Obesity prevention efforts need to begin early, focusing on children and families and the environments in which they live, such as home, schools, and communities. Schools can help in the fight against obesity by creating environments conducive to healthful eating and physical activity. The CDC has identified what it believes to be the ten most promising school policies and practices to address childhood obesity ( Wechsler et al. 2004 ):

• Address physical activity and nutrition through a coordinated school health program.
• Designate a school health coordinator, and maintain an active school health council.
• Assess the school's health policies and programs, and develop a plan for improvement.
• Strengthen the school's nutrition and physical activity policies.
• Offer a high-quality health promotion program for the school's staff.
• Offer a high-quality course of study in health education.
• Offer a high-quality course of study in physical education.
• Increase opportunities for students to engage in physical activity.
• Offer a quality school meals program.
• Ensure that students have appealing, healthy choices in foods and beverages offered outside the school meals program.

If schools can work together with policymakers, advocates, parents, and communities to create an environment where children eat healthfully, become physically fit, and develop lifelong habits that contribute to wellness, the nation could be well on its way to preventing obesity ( Story, Kaphingst, and French 2006 ).

Policy decisions that influence school environments are made at many levels, including state law, state board of education policy, local school board policy, and other state regulatory and licensing requirements ( Rosenthal and Chang 2004 ). Policy and legislative initiatives at the national, state, and local levels are needed to develop and support healthful food and physical activity behaviors that will promote energy balance and a healthy body weight. The states should establish policies that increase the amount of time children spend in physical education and improve the quality of this physical education. Strong policies are needed for nutrition standards for all foods available during the school day. The school lunch and breakfast programs should be the main source of nutrition at school, and opportunities for competitive foods should be limited. But if they are available, they should consist of only nutritious foods. Statewide school BMI surveillance and monitoring systems are needed in order to establish baseline rates and track population trends of obesity and to determine whether policies, programs, and services are in fact reducing childhood obesity.

In addition to state and local initiatives, we need stronger federal policies. Congress should authorize the USDA to establish and enforce regulations for all foods and beverages sold or served in schools that participate in the National School Lunch Program. Unhealthy foods have no place in schools. Haskins, Paxson, and Donahue (2006) observed that because local education agencies receive substantial amounts of federal aid each year—$10 billion in FY 2007—to run their food programs, there is little doubt that Congress could rule that schools that do not comply with limiting high-calorie, low-nutrition competitive foods would be ineligible to receive federal dollars for school lunch and breakfast programs. If Congress enacted such a rule, the presence of competitive foods and beverages in the nation's schools would instantly disappear ( Haskins, Paxson, and Donahue 2006 ).

More efforts and resources should be devoted to policy and implementation efforts at the federal, state, and local levels. Finally, we need research funding to create and evaluate innovative obesity prevention pilot interventions in schools, using behavioral, environmental, and policy change strategies. In the past five years, schools have been making progress and moving in the right direction. Both children and the nation will benefit if schools push even more aggressively in the direction in which they are already moving ( Haskins, Paxson, and Donahue 2006 ). To do this, we need a coordinated and systematic plan and the political will to place a priority on children's health and well-being.

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Home — Essay Samples — Nursing & Health — Nursing — Importance Of School Lunches

Importance of School Lunches

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Published: Mar 13, 2024

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In conclusion, the significance of school lunches extends far beyond simply providing sustenance. These meals are essential for promoting student health, academic performance, and overall well-being. By acknowledging their importance and prioritizing their quality, we can create a positive and nurturing environment for students to thrive. As such, school lunches should be regarded as a fundamental aspect of the educational experience, deserving of our attention and investment.

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School Lunches and Obesity Essay

Problem Statement

There has been recently a significant rise in childhood obesity. There are various factors that have influenced the occurrence of this trend. The ineffectiveness of the counter measures that have been implemented thus far has fashioned an environment that is conducive for the perpetuation of child obesity. According to Grossman & Mocan (2011), the ineffectiveness of the programs and initiatives that have been proposed by various regulatory bodies may be blamed on insufficient research.School Lunches and Obesity Essay.  Pearce & Witten (2010) argues that the need for greater research stems from the need to better inform the implemented strategies. Too much focus has been directed towards corporate advertisements and inactivity, much to the detriment of a focus on school lunch programs (Barbour, 2011). Addressing the perpetuation of obesity will require a wholesome approach that covers all the potential instigators of child obesity. Undertaking a research on the effect of school lunch program will enable various regulators to better advice on the dietary plan that is employed. After conducting the current research, the findings will assist in the development of a meal plan that would be best suited for school feeding programs.

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Addressing the problem of child obesity will aid in reducing its rise in the nation. According to Murphy (2012), the rate of child obesity has been on the rise. The core rationale for this may be attributed to flawed marketing undertakings and the lack of requirements for physical activities in education curriculum. The flawed marketing undertakings that have been referenced herein are in reference to the targeted product promotion initiatives by the food chains (Haerens, 2012). So, one of the factors that has led to an increase in child obesity is the lack of physical education in the contemporary education curriculum (Bouchard & Katzmarzyk, 2010). With this being said, some measures have been implemented to counter the effects of these two features. However, the rate of child obesity in the contemporary setting can attest to the need for additional measures to counter the perpetuation of child obesity. Addressing this problem will certainly create better understanding of the dynamics associated with child obesity. School Lunches and Obesity Essay.

The purpose of the current study is to understand the current status of school lunches, and their contribution to the reduction of obesity among children. It is an important research topic, due to the increased rate of child mortality throughout the world. In order to address the research topic, a qualitative research will be conducted, and it will provide ample information that will enable one to make a proper conclusion on the best approach to be applied in the development of a school feeding program. It will be a program, the main motive of which will be the reduction of obesity among children.

Significance

The above described study will add the current information regarding the status of the school feeding programs, and obesity among children to the already available literature. In the past, studies have focused on various issues of obesity among children, as well as, school feeding programs, but little has been done in regard to how the feeding programs can be used in order to reduce obesity among children. It is ostensible that thoughtfulness is required regarding prevalence of obesity among children. Prevention strategies have to be implemented in order to safeguard the future generations. School Lunches and Obesity Essay. However, this can only be done through conducting research on the already existing relationships between children and their eating habits. School lunches and other school feeding programs have been in existence for a long time now. Nonetheless, the continued increase in the number of obese children indicates that these programs are not working effectively enough to reduce the obesity among children. In addition to the common health problems associated with obesity, such as, high blood pressure, cardiovascular diseases, and diabetes, obese children also face social and emotional problems (Seth & Sharma, 2013). There is stigma associated with obesity, and such children become victims of discrimination, stereotyping, bullying, and teasing (Seth & Sharma, 2013). The study carries a big significance not only in regard to the contribution to literature, but also in regard to the improvement of children’s lives.

A number of articles that provide information regarding childhood obesity and school feeding or lunches, as well as, other issues, related to child obesity are described below:

• Briefel, Wilson & Gleason (2009), Hastert, Just & Babey (2009), and Taylor, Holben, Shirk, & Wang (2009) provided information on the consumption of food among individuals who consume school lunches, and make comparisons to children who eat lunches at home. They also compare the dietary behavior of adolescents, and the rates of obesity and central adiposity among adolescents who take school breakfast and lunch programs. School Lunches and Obesity Essay.
• Magryta (2009), Peters (2010), and Woo & Taveras (2014) offered information on the strategies being applied to combat obesity among children through school the improvement of lunch and feeding programs. They focus on the protection of children against obesity by making sure that the lunches offered through the school feeding programs contain the required nutrients, and do not have ingredients that cause obesity.
• Kuhle, Kirk, Ohinmaa, Urschitz, & Veugelers (2012) provided information on the relationship that child obesity has to different ailments, including otitis media, which is the second common ailment among children, and it is the infection of the middle ear.
• Liou, Yang, Wang, & Huang (2015) offered results from a two-year national wide prospective study that focused on school lunch, policy, and environment as determinants of obesity prevention among children. They agree that besides school lunches, other factors should also be taken into consideration to prevent obesity.
• Hanks, Just & Wansink (2013) offered details on how smarter lunchrooms could be used to address the guidelines provided for the school lunchrooms, in relation to child obesity. The aim of the article was to offer practical solutions on how school lunches would be transformed to offer healthy food for children and reduce obesity.
• Hurley, Cross, & Hughes (2011) conducted a systematic review of receptive model of feeding and child obesity in developed or high income nations. It is a model that would promote the reduction of obesity among children. School Lunches and Obesity Essay.

The current study’s theoretical framework is based on the energy imbalance theory (EIT), which was developed by Hill, Wyatt, & Peters (2012), describing the relationship among the intake of energy in the body, its utilization, and storage of the energy. It indicates that in order to control and prevent obesity, it is required that modification is done on both energy intake and utilization, and the focus should never be on only one of the two factors. As such, the required energy should be input into the body, and this should be enough for the body to utilize. As such, a balance in the amount of energy that children receive through food, and its utilization by their bodies should be a feasible approach in obesity prevention. In a situation where there is more energy intake through eating fat, carbohydrates and protein, and less expenditure of energy through exercising and other physical activities, the body will store up the energy as body fat, which will lead to obesity. The current study aims at understanding the effectiveness of school lunches in the reduction of obesity among children.School Lunches and Obesity Essay.

The conceptual framework of the study revolves around a number of issues raised by Adair, Ng & Popkin (2012), who attribute the increase in the obesity levels to a number of factors. These factors include the changes that have occurred in the production of edible oils that have resulted in cheap vegetable oils, which are, consequently, used in the fast food industry, resulting in accessibility of the fast foods due to their low cost. Additionally, technological advancement has led to reduced physical activities, as children, and adults mainly engage in in-doors activities that lead to reduced consumption of energy. As a result, there is reduced consumption of energy, whereas the intake is high. Consequently, an imbalance develops, leading to obesity (Adair, Popkin & Ng, 2012). School Lunches and Obesity Essay.

School Lunch Program on Reducing Obesity Among Children Proposal

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Topic Context

Research aims, research questions, research design, discussions, reference list.

Childhood obesity is a severe problem in the modern world. Children are considered obese if they are above the average weight for their height and age. According to Powel (2019, p. 3), the number of children of 6-10 years old who have the body-mass index (BMI) of 30 and higher has doubled in the US over the past years. This health condition can be caused by various phenomena, including appropriate eating habits, the lack of physical activity, multiple diseases and others.

Furthermore, paediatric obesity implies numerous consequences, and they include hypertension, diabetes, asthma, ischemic heart disease, and many others (Powel, 2019, p. 4). That is why it is reasonable to develop interventions to address the given issue, and school lunch programs are among them. School lunch refers to the food that is provided to children on behalf of educational establishments. Since the problem is of a global scale, such programmes are present in numerous world countries, and multiple pieces of research try to identify the effectiveness of this intervention.

According to the information above, it is not a surprise that paediatric obesity is the topic of the given appraisal. Here, one should mention that the proposal is based on two significant aims. The first objective is to identify whether there are some steps that can reduce childhood obesity rates. In other words, it is essential to determine whether the given problem is a feasible one. The second aim is to find out if there is any correlation between childhood obesity and school lunches. If there is some connection, it will be possible to address the issue and improve public health.

In addition to the aims above, the given proposal evokes essential questions and answers them. The PICO (people, intervention, comparison and outcomes) model is useful to define the issues. The first question is: what is the target population of the appraisal? It refers to 6-12-year-old school students with obesity, who have access to school lunches. The second question: what is possible to do to address the problem? It relates to providing more students with school lunches to improve their health. The third question: do school lunches contribute to better results in comparison with lunches from homes? Here, it is necessary to compare whether students who eat school lunches are less obese compared to those individuals who eat packed lunches. The fourth question is simple: are school lunches a useful tool to reduce childhood obesity rates? This question focuses on the effectiveness of the proposed intervention.

Since the topic under consideration is of crucial concern, it is not a surprise that there are many scholarly articles devoted to it. Thus, the challenge is to find a few sources that are suitable for the given appraisal. In this case, Google Scholar was utilized to identify the articles using keywords, such as nurse, school, lunch, childhood and obesity. This search engine offered approximately 32,700 articles on the topic, but the necessity to use new sources only left more than 18,500 articles that were published in 2016 and later.

Among this number, 17 sources have been selected because they contain relevant data on the topic. The relevance was identified with the help of abstracts that were read and analysed. In addition to that, the CASP quality appraisal tool was used to choose the sources. This tool helped find the articles that had the most suitable designs and samples, which contributed to achieving valid results.

As has been mentioned above, childhood overweight is a central topic of many scholarly articles, and numerous researchers consider the problem from different sides. However, it does not mean that some sources are more significant than others. That is why it is reasonable to present the table that will consider the main findings of the articles used in this appraisal. It will also include the country of the studies to show how the issue is addressed worldwide. The table will be useful to compare and contrast the results, which is necessary to determine how helpful the articles are for the given appraisal.

According to the table above, the sources are suitable for the appraisal because they address its aims and research questions. On the one hand, one should draw attention to the objectives. Thus, it has been indicated that childhood obesity is a severe problem that, however, can be solved. For example, the study by Miyawaki, Lee and Kobayashi (2019, p. 362) proves that overweight can be addressed with the help of a healthy diet. Furthermore, a few sources support the idea that there is a close connection between reducing childhood obesity and school lunches. It is so because these meals provide students with the necessary nutrients. Thus, Vernarelli and O’Brien (2017, p. 1) stipulate that school lunches are healthier because they contain less sugar and fat.

On the other hand, multiple articles provide data that are necessary to answer the research questions. Firstly, Morshed et al . (2016, p. 3378) indicate that the target population is children of 3-13 years old. Secondly, Evans et al . (2016, p. 36) show that it is necessary to provide more children with school lunches because these meals provide the students with essential nutrients. Thirdly, some researchers try to identify the effectiveness of the given proposal by comparing the results of the children who eat school lunches and those who eat lunches from their homes.

Minaya and Rainville (2016, p. 6) have demonstrated the effectiveness of school lunches because they do not have ingredients that can contribute to childhood obesity. Finally, numerous articles show that school lunches are useful, but their effectiveness depends on external factors. Thus, Harrell (2017, p. 198) indicates that children need sufficient time to benefit from school lunches, while Hildebrand, Betts and Gates (2019) focus on the fact that parents’ participation is required to address childhood obesity. Consequently, the studies under consideration are useful for the given appraisal.

Asirvatham, J. et al . (2019) ‘Do fast food restaurants surrounding schools affect childhood obesity?’ Economics & Human Biology, 33, pp. 124-133.

Bramante, C.T. et al . (2019) ‘Systematic review of natural experiments for childhood obesity prevention and control’, American Journal of Preventive Medicine, 56(1), pp. 147-158.

Evans, C.E. et al . (2016) ‘Impact of school lunch time on nutritional quality of English children’s diets’, Public Health Nutrition, 19(1), pp. 36-45.

Greece, J.A. et al . (2017) ‘Effects of a school-based intervention on middle school children’s daily food and beverage intake’, Health Behaviour and Policy Review, 4(1), pp. 24-36.

Harrell, H. (2017) ‘Children need sufficient time to eat school lunch’, American Journal of Public Health, 107(2), p. 198.

Hildebrand, D.A., Betts, N.M. and Gates, G.E. (2019) ‘Parents’ perceptions of childhood obesity and support of the school wellness policy’, Journal of Nutrition Education and Behaviour, 51(4), pp. 498-504.

Kenney, E.L. et al . (2019) ‘Cost-effectiveness of water promotion strategies in schools for preventing childhood obesity and increasing water intake’, Obesity Society, 27(12), pp. 2037-2045.

McLoughlin, G. et al . (2017) ‘School lunch and physical activity during recess: interactive effects of health behaviours in the school setting’, The FASEB Journal, 31(1), p. 4866.

Minaya, S. and Rainville, A.J. (2016) ‘How nutritious are children’s packed school lunches? A comparison of lunches brought from home and school lunches’, The Journal of Child Nutrition & Management, 40(2), pp. 1-7.

Miyawaki, A., Lee, J.S. and Kobayashi, Y. (2019) ‘Impact of the school lunch programme on overweight and obesity among junior high school students: a nationwide study in Japan’, Journal of Public Health, 41(2), pp. 362-370.

Morshed, A.B. et al . (2016) ‘Early nutrition transition in Haiti: linking food purchasing and availability to overweight status in school-aged children’, Public Health Nutrition, 19(18), pp. 3378-3385.

Olarte, D.A. et al . (2019) ‘P129 How ‘teachers’ childhood school lunch experiences impact their views and actions related to school lunch with their students’, Journal of Nutrition Education and Behaviour, 51(7), pp. S90-S91.

Powel, F. (2019) ‘Childhood obesity: getting back to the basics’, DNP Qualifying Manuscripts, pp. 1-15.

Vernarelli, J.A. (2017) ‘The case for school lunch: comparison of diet quality among National Lunch Programme participants vs. income-eligible non-participants’, The FASEB Journal, 31(1). Web.

Vernarelli, J.A. and O’Brien, B. (2017) ‘A vote for school lunches: school lunches provide superior nutrient quality than lunches obtained from other sources in a nationally representative sample of US children’, Nutrients, 9(9), pp. 1-10.

Wang, Y. et al . (2017) ‘Child and parental perspectives on diet and physical activity decisions: implications for childhood obesity prevention in China’, Asia Pacific Journal of Clinical Nutrition, 26(5), pp. 888-898.

Welker, E., Lott, M. and Story, M. (2016) ‘The school food environment and obesity prevention: progress over the last decade’, Current Obesity Reports, 5, pp. 145-155.

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Why School Lunches in America Are Unhealthy and 10 Ways You Can Take Action to Improve Them

We all have a stake in making school lunches healthier. Learn what you can do…

Debates about school lunch have been going on for more than a century. Learn why school lunches in America have a terrible reputation and how you can help make a difference.

School lunch matters — for better learning and academic performance, for improved behavior and performance at school, for the overall health of kids, and much more.

In fact, school meals can have tremendous impacts on the next generation, the future of a country, and maybe even the future of our world .

The State of School Lunches In America

In the U.S., school lunches have a terrible reputation.

A 2009 investigation by USA Today found that meat served in U.S. schools wouldn’t meet the quality or safety standards of fast-food restaurants. And according to the book Lunch Lessons , almost half the vegetables eaten by most children aged 2 to 19 in the U.S. were French fries.

Although America’s school lunches have improved since Congress strengthened the standards for the national school lunch program in 2010, they have a long way to go.

Most menus now include more whole grains and more fruit and vegetable options and less salt. But they also offer an abundance of factory-farmed animal products and heavily processed foods, like corn dogs, tater tots, and cheese pizza.

But School Lunches Can Improve

Programs exist to help improve food at schools, and some schools are taking bold, inspiring steps. Parents, educators, students, and everyone can take action to help students have access to healthier foods.

As Ocean Robbins says in his upcoming book 31-Day Food Revolution , “ As long as tens of millions of families depend on school meals for a fundamental part of daily nutrition, we all have a stake in making them healthier. ”

As long as tens of millions of families depend on school meals for a fundamental part of daily nutrition, we all have a stake in making them healthier. Ocean Robbins

Why Are School Lunches in America Unhealthy?

Many countries around the world serve school lunch for students. In America, midday meals have been a fixture in education for more than 70 years.

A variety of factors contribute to the school lunches in the U.S. today. Here are some of them:

The National School Lunch Program provides low-cost or free school lunches to 31 million students at more than 100,000 public and private schools per day. Meals must meet nutritional standards based on the Dietary Guidelines for Americans.

Participating schools receive approximately $1.30 to spend for each child. This amount must cover the food, as well as any labor, equipment, electricity, and other costs. School food programs also depend on income from students who often pay for the food they eat.

Tight budgets make serving healthier foods challenging .

The USDA Foods Program

The United States Department of Agriculture purchases hundreds of millions of dollars worth of agricultural products and gives them to schools for free. (The government does this to stabilize food prices and to ensure demand for the country’s agricultural goods.)

Free food may sound good, especially when funding is so limited. But in 2015 , 64% of the program’s spending went to meat , dairy , and egg products . Virtually all these products came from factory farms.

The School Milk Program

Why does almost every school lunch include milk? Because milk in schools has been federally subsidized since 1940 .

In the 2013-14 school year, more than $20 million taxpayer dollars were spent directly by the USDA on dairy product subsidies that went into child nutrition programs, including school lunch.

Even though most schools now ban sodas and other sugary beverages, chocolate milk still gets a pass . A single serving of chocolate milk contains between four and six teaspoons of sugar.

And there are many reasons why all this milk might not be the healthiest option for our kids.

Unhealthy School Vendors

Some schools have given contracts to food management companies to manage the food offered to students. In these cases, the companies have the purchasing power — not the schools.

The contracting most often goes to one of three main corporations: Aramark, Compass Group, and Sodexo. These companies are in business to make money, and it seems that children’s health isn’t always their top priority.

Why the Quality of School Lunches Matters for Students

Children consume up to 50% of their daily calories at school. And for low-income children, lunch may be the only real meal of the day.

Here are seven reasons to feed kids healthy, well-balanced meals:

1) Better Learning and Memory

As studies show, children who are hungry or undernourished are unable to focus and have a hard time learning .

According to a 2008 study published in Nature Reviews Neuroscience , diets with high levels of saturated fats may impair learning and memory . Many foods commonly served during school lunch, such as French fries, cheeseburgers, and chicken nuggets, are loaded with saturated fat.

When kids get adequate nutrition, they are sick fewer days and don’t need to miss school, which can lead to improved performance.

A 2011 study published in the Journal of Health Economics showed that when Greenwich switched from low-budget processed meals towards healthier options, educational outcomes improved and authorized absences fell by 14% .

2) Improved Concentration

Deficiencies in vitamins and minerals are shown to diminish cognitive abilities and mental concentration . Many school lunches are low in the fruits, vegetables, and whole foods that provide an abundance of vitamins and minerals.

3) Better Overall Health

A 2008 study published in the Journal of School Health found that effective school nutrition programs “have the potential to improve student’s diet quality, academic performance, and, over the long term, their health .”

4) Better Behavior and Fewer Problems

A series of studies in the 1980s removed chemical additives and processed food, and reduced levels of sugar, in the diets of more than 8,000 juvenile delinquents in 12 correctional facilities.

What was the result? Problem behaviors fell 47% .

Similarly, in Virginia, 300 particularly hardened juvenile delinquents were put on a diet with no chemical additives and little sugar for two years. During that time, incidences of theft fell 77%, insubordination dropped 55%, and hyperactivity went down by 65% .

Also, in 2008, a comprehensive analysis from the Harvard School of Public Health concluded that students with access to nutritious meals had lower rates of aggression and disciplinary problems .

5) Better Academic Performance

According to a study conducted at the University of California at Berkeley, students who eat healthier school lunches achieve higher standardized test scores .

And a 2008 study published in the Journal of School Health found an association between higher quality diets and better performance on exams .

6) Reducing Obesity

Obesity rates among children nearly tripled from 1970 to 2000. And according to a 2017 projection published in The New England Journal of Medicine , most 2-year-olds in America today will develop obesity by the time they turn 35 . But could school lunches help reduce obesity?

A 2013 study published in JAMA Pediatrics showed that children residing in states with stringent nutritional standards for school meals had lower rates of obesity than those states with more lax regulations.

And a 2018 nationwide study conducted in Japan and published in the Journal of Public Health concluded that “Appropriate nutritional intake through school lunch may be effective to reduce childhood obesity.” (Japan has a relatively low childhood obesity rate and one of the world’s most successful nationwide school lunch programs.)

7) Better Habits for the Future

Researchers say that the eating patterns kids develop early in life typically follow them into adulthood.

A group of Canadian researchers said: “ If children are to learn to prefer and select healthy foods, they need early, positive, repeated experiences with those foods. ”

Federal Changes to Make American School Lunches Healthier

In 2010, Congress adopted the Healthy, Hunger-Free Kids Act — the first significant change to school meal nutrition in more than 15 years .

If children are to learn to prefer and select healthy foods, they need early, positive, repeated experiences with those foods.

The standards went into effect in 2012, with schools that met the new criteria receiving additional funding. And federal funding for school lunches increased — by about six cents per meal — for the first time in more than three decades.

Schools are now required to:

• Offer fruit daily at breakfast and lunch
• Offer vegetables daily at lunch
• Increase the amount of whole grains
• Require students to select either a fruit or vegetable with each meal
• Reduce the sodium content of meals
• Only offer fat-free or low-fat milk varieties
• Create grade-specific limits on total calories
• Remove trans fats

Researchers who examined 1.7 million meals in an urban Washington State school district found that the overall nutritional quality of meals increased by 29% after the standards took effect .

Problems Faced by School Lunch Programs

But despite these improvements, many nutritional experts still find school lunches to be inadequate. Most meals aren’t prepared from scratch and don’t use fresh fruits and vegetables . Instead, foods are frozen or made elsewhere and then heated before serving. This food preparation creates meals that are far from fresh and, sadly, unappealing.

And the new federal administration is scaling back the updated school meal nutrition requirements, which could lead to less nutritious foods in many schools.

10 Ways You Can Help Improve School Food

Even though it can feel daunting to get involved, simple steps can have meaningful impacts on improving food in schools .

You may want to start by educating yourself about your school’s food-service program by checking the district’s or school’s website.

And here are some ideas for taking action to improve school meals:

Show your support for healthy school lunches in your community .

You can set up a meeting with your local school district’s Food Service Director (or your school superintendent) to find out what changes are already in progress and to see how you can help.

Be an advocate for healthier food in your school district .

The Chef Ann Foundation has a parent advocacy toolkit . Physicians Committee for Responsible Medicine has a healthy school lunch campaign . They offer resources for schools, parents, and schools.

Start a farm-to-school program .

You can find some suggestions from Kids Health here .

Get a school garden in a school .

You can find helpful guides and resources from The Lunch Box here .

Start Meatless Mondays in a school.

Foodservice workers can use this guide from Meatless Monday. Students, parents, and staff can use this ambassador guide from Meatless Monday.

Advocate for more plant-based options .

You can try encouraging a school to offer one plant-based entree per day by sharing recipes and testing them with staff. Amie Hamlin, the executive director of the New York Coalition for Healthy School Food, which offers 13 plant-based, kid-approved recipes , suggests this idea to make an impact

Help increase nutrition education in a school .

You can help implement the Coalition for Healthy School Food’s Wellness Wakeup Call , which provides schools and classrooms with daily, healthy eating tips that can be read in classrooms and over PA systems. This program is free for schools in New York, but out-of-state schools can use it for a small fee.

Advocate for lunchtimes that are long enough for students to get to eat.

You can advocate for lunches that are at least 30 minutes long and for scheduling recess before lunch. Research backs up these changes for getting kids to eat more fruits and veggies. The Peaceful Playgrounds Foundation has resources to help lengthen lunches.

Contact elected officials.

You can support legislation and funding that promote healthier school lunches. Contact your elected officials and let them know why healthy school lunches matter. Call to schedule a meeting with your member of Congress to speak out for federal change, with local school board members, or with a school board superintendent to take action locally. You can sign up for action alerts from the School Nutrition Associate Action Network to stay informed and engaged about school nutrition policy issues.

Students can take action, too .

The School Nutrition Association has 10 tips for students who want to make a difference in the school cafeteria.

What If School Lunches Around the World Encouraged Healthy Eating Behaviors?

Children’s bodies and brains are still developing — and the habits and attitudes they’ll carry with them throughout life are being formed.

Healthy, balanced school lunches could lead to better health and better academic performance for students. They could lead to reduced aggression, hyperactivity, and other problems. And they could help break the cycles that trap low-income children in poor health.

Healthy school lunches could also help reverse childhood obesity trends, which lead to type 2 diabetes and other chronic illness. And they could contribute to a healthier and more productive future for the next generation.

As former President Harry S. Truman said when signing the National School Lunch Act: “ No nation is any healthier than its children or more prosperous than its farmers. ”

Tell us in the comments:

What are your experiences with school lunch, how will you take action.

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10 revolutionary ways school lunch is improving (plus, healthy school lunch ideas) 

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Why School Meals Matter

According to the Centers for Disease Control and Prevention (CDC), childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. Weight statistics for children are approaching that of adults: 1 in 3 children is now overweight or obese. Studies have also shown a rising prevalence of type 1 and 2 diabetes in adolescents ages 10 through 19 years, with increasing obesity cited as a key contributor. [1]

On a positive note, the CDC showed a significant 40% decline in obesity rates from 2003 to 2012 in younger children ages 2 to 5 years. [2] Another CDC report revealed a decline in obesity rates among low-income children ages 2 to 4 years participating in federal nutrition programs. [3] Authors from both studies discussed the likely impact of early education programs focusing on improved nutrition and exercise standards, as guided by the HHFKA.

Despite some anecdotal reports in the media that fruits and vegetables from these new updated school meals were ending up in the trash, two studies discovered the opposite. In 2014, Cohen at al. found that children were eating more of their entrees and selecting and eating more fruit. [4] In 2015, Schwartz et al. followed more than 500 children in urban schools in grades 5 through 7, comparing before and after pictures and weights of their school lunches. [5] They found that after two years there was a 19% increase in vegetable intake. Though the amount of fruit eaten did not change, 12% more children were selecting fruits as part of their lunch tray. The authors noted that a greater variety of fruits had been made available, which may have encouraged the children to choose fruit.

Healthier choices throughout the school day

According to standards that went into effect in 2016, a Smart Snack must be one of the following:

• A grain product that contains 50 percent or more whole grains by weight (i.e., lists a whole grain as the first ingredient)
• Have as the first ingredient a fruit, a vegetable, a dairy product, or a protein food
• A combination food that contains at least ¼ cup of fruit and/or vegetable

The snack must also meet specific  nutrient standards for calories, sodium, sugar, and fats per serving.

When it comes to drinks, allowed beverages include the following:

• Plain water (with or without carbonation)
• Unflavored low fat milk
• Unflavored or flavored fat-free milk and milk alternatives
• 100% fruit or vegetable juice
• Calorie-free, flavored water (with or without carbonation)
• Flavored and/or carbonated beverages that contain less than 5 calories per 8 fluid ounces or ≤10 calories per 20 fluid ounces.

Further modifications beyond these school food standards might include eliminating flavored, sweetened milks and offering only plain milk; limiting fruit juice; providing entrees of poultry, fish, and beans more often than red meat and processed meats; and replacing solid fats with healthful oils such as canola, sunflower, and olive oil when preparing food, salad dressings and sauces.

Parent Tip: How do I know my child is eating their school lunch?

• An important step is to involve your child with meal decisions and maintain an encouraging and non-judgmental attitude to foster open dialogue.
• Most schools provide monthly calendars of their school lunch offerings that include the main meal and alternatives. Discuss each of the choices with your child and highlight the specific foods in the meal they like, dislike, or aren’t sure of. After school, ask what foods they ate and didn’t eat and why. This can help to plan their future meals and snacks.
• Pack nutritious snacks of string cheese, sunflower or pumpkin seeds, whole or chopped fruit, and cut up vegetables that your child enjoys in case they don’t finish the school lunch offering one day. As children respond positively to variety [5], periodically change up the types of fruits and vegetables in their snack bag.

• If your child does not consume foods offered at school, here are some tips and inspiration for preparing healthy lunchboxes and snack ideas.
• Dabelea, D., et al. Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. JAMA , 2014. 311(17): p. 1778-86.
• Ogden, C.L., et al. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA, 2014;311(8):806-14.
• Vital Signs: Obesity Among Low-Income, Preschool-Aged Children—United States, 2008–2011. MMWR, 2013;62(31);629-34.
• Cohen, J., et al. Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste.  Am J Prev Med, 2014;46(4):388-94.
• Schwartz Marlene B., et al. New School Meal Regulations Increase Fruit Consumption and Do Not Increase Total Plate Waste. Childhood Obesity, 2015;11(3): 242-7.