Strategies to Improve School Meal Consumption: A Systematic Review

A scoping review of the existing evidence linking school food procurement contract type with school food provision

OBJECTIVE

School food and catering constitutes the largest area of public sector food spend in the UK, with the potential to influence health on a population scale. This review sought to understand and map the existing evidence linking school meals contracts for food procurement with the quality of food provided and health and academic outcomes for school children.

DESIGN

A scoping review of the peer reviewed and grey literature published between 1988 and 2023 was conducted. The strategy searched in Medline, Web of Science, Scopus, ERIC and Google, using key words related to population, exposure and outcomes.

SETTING

UK and International.

PARTICIPANTS

School meal services.

RESULTS

Thirty documents were included representing 16 papers, 3 books and 11 reports. Documents revealed a complex and fragmented school meal provision system and inconsistent evidence relating to the outcomes of interest. Most studies focused on sustainability or nutrition/ guideline compliance and the main types of food providers discussed were commercial contractors, local authorities and in house catering. However, there was a lack of clarity in contract specifications and definitions of quality and concerns over compliance monitoring and financial viability impacting quality. We found no substantial body of peer reviewed research linking school food procurement contract type with food quality or outcomes of interest.

CONCLUSIONS

The lack of research in this area (and conflicting findings) meant that it was impossible to draw robust conclusions on the benefits of using any particular contract provision type over another. Given the magnitude of public sector spending and the need for urgent improvements to the dietary health of the nation, this presents a significant gap in our knowledge.

School Lunch and Body Size in Japanese Junior High School Students: The Japanese National Health and Nutrition Survey

Objectives: Although the school lunch program is expected to reduce obesity and underweight among children in Japan, there had been no individual-level study examining the impact of school lunch on body size (overweight or underweight). The present study examined the association between school lunch and body size in Japanese junior high school students. Methods: This cross-sectional study was conducted based on data from the Japanese National Health and Nutrition Survey in 2014 and 2018. The present analysis included 323 individuals (12-15 years old). The exposure factor was school lunch usage. The primary outcome measure was body size (normal weight, overweight/obesity (including both overweight and obesity), and underweight). Results: Of 323 individuals, the proportion of school lunch users was 65.6%. School lunch was not statistically significantly associated with normal weight; the multivariate-adjusted odds ratio (95% confidence interval) of normal weight in school lunch users was 1.07 (0.66-1.75) in comparison with non-users. No significant associations were found for overweight/obesity or underweight outcomes. Conclusions: The present findings did not support the expectation for the Japanese school lunch program.

Centering Equity in Evidence-Informed Decision Making: Theoretical and Practical Considerations

Policy Points The population health research field should develop a synthesized approach to evaluate evidence for an intervention's potential impact on equity. When empirical evidence is lacking, theory and frameworks should guide the equity assessments in four areas: 1) understanding historical context, meaning root causes of disparities and inequity; 2) understanding intervention design and intended beneficiaries; 3) understanding differential impact and intersectionality; and 4) understanding community context before implementing or scaling interventions. The synthesized approach of equity assessment better informs practitioners and policymakers in evidence-based decision making to advance equity.

Comparison of Food Selection with the National School Lunch Program Meal Pattern Guidelines and Assessment of Children's Food Intake and Waste Using Digital Photography in a School Cafeteria

Background: School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection. Methods: In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children's food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation. Results: About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades. Conclusions: Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.

Impact of mealtime social experiences on student consumption of meals at school: a qualitative analysis of caregiver perspectives

OBJECTIVE

To understand caregivers' perceptions about their children's mealtime social experiences at school and how they believe these social experiences impact their children's consumption of meals at school (both meals brought from home and school meals).

DESIGN

Qualitative data were originally collected as part of a larger mixed methods study using an embedded-QUAN dominant research design.

SETTING

Semi-structured interviews were conducted with United States (U.S.) caregivers over ZoomTM in English and Spanish during the 2021-2022 school year. The interview guide contained 14 questions on caregivers' perceptions about their children's experiences with school meals.

PARTICIPANTS

Caregivers of students in elementary, middle and high schools in rural, suburban and urban communities in California (n 46) and Maine (n 20) were interviewed. Most (60·6 %) were caregivers of children who were eligible for free or reduced-price meals.

RESULTS

Caregivers reported that an important benefit of eating meals at school is their child's opportunity to socialise with their peers. Caregivers also stated that their child's favourite aspect of school lunch is socialising with friends. However, some caregivers reported the cafeteria environment caused their children to feel anxious and not eat. Other caregivers reported that their children sometimes skipped lunch and chose to socialise with friends rather than wait in long lunch lines.

CONCLUSIONS

Socialising during school meals is important to both caregivers and students. Policies such as increasing lunch period lengths and holding recess before lunch have been found to promote school meal consumption and could reinforce the positive social aspects of mealtime for students.

Dietary Beliefs and Their Association with Overweight and Obesity in the Spanish Child Population

BACKGROUND/OBJECTIVES

Childhood obesity is a multifactorial chronic disease that represents one of the main preventable causes of morbidity and mortality. This study analyzes how nutritional beliefs influence eating habits and the prevalence of overweight and obesity in Spanish children and adolescents.

METHODS

A cross-sectional study was conducted in 35 educational centers in 12 Spanish provinces, with a sample of 1131 children and adolescents aged 6 to 14 years. Anthropometric and sociodemographic data were collected, and dietary habits were assessed by means of questionnaires. Statistical analyses were used to identify associations between dietary beliefs and body mass index.

RESULTS

In total, 29.5% of participants were overweight or obese. Two groups of beliefs were identified: healthier beliefs and less healthy beliefs. Children with less healthy dietary beliefs had a significantly higher BMI (22.16 kg/m2) compared to those with healthier beliefs (17.2 kg/m2). False nutritional beliefs, influenced by advertising and the family environment, contribute to overweight and obesity.

DISCUSSION

Dietary beliefs play a crucial role in determining eating habits and, therefore, the health of children. Nutrition education and public policies that promote healthy eating habits are essential to prevent childhood obesity. It is important to involve the family, the school, and the media in these efforts.

CONCLUSIONS

Despite efforts, many children continue to hold erroneous nutritional beliefs that contribute to the rise in overweight and obesity. This study highlights the importance of addressing dietary beliefs and promoting appropriate nutrition education to prevent childhood obesity. It is recommended to implement educational strategies and public policies that regulate the advertising of unhealthy foods and promote healthy eating habits.

Temporal distribution of schedule-induced behavior depends on the essential value of the reinforcer

The development of schedule-induced drinking depends on different variables affecting the food delivered at the end of the interfood interval. There are mixed results concerning the effects of varying magnitude and/or preference of different reinforcers in the development of schedule-induced drinking, with some studies showing higher levels and other studies showing lower levels of drinking. The purpose of this study was to observe how differences in preference for a flavor of equally nutritious food pellets influence the development and maintenance of schedule-induced drinking. Using the operant demand framework, four flavors of food pellets were compared to form two groups: one in which subjects would receive their most preferred flavor and another in which subjects would receive their least preferred flavor. In general, licking rates were lower and magazine-entering rates were higher when the preferred flavor was delivered regardless of the fixed-time schedule used. It is suggested that the value of the reinforcer has a larger influence on the immediately preceding behaviors, which will determine the distribution of competing responses in the interreinforcement intervals. These results are relevant to developing public policies that manipulate the taste of healthy food to increase its consumption.

School and meal characteristics associated with plate waste in K-12 cafeterias in the United States

Food wasted in primary and secondary education institutions creates nutritional losses, financial inefficiencies, and environmental degradation. While there is some evidence of how particular interventions within schools may influence the amount of waste created, there is little recent information about typical levels of food waste generated in U.S. primary and secondary schools and how waste correlates with school and meal characteristics. We analyze data reported by more than 100 schools from 24 states as part of the World Wildlife Fund's Food Waste Warriors project and identify how plate and beverage waste from school lunches are associated with school and meal service characteristics. We find schools that permit students to choose their own amount of milk report 76% less milk waste than those reliant upon individual milk cartons while schools that implement at least one non-curricular intervention (e.g., a table where students can share unopened food) report significantly less produce waste than other schools. We confirm several patterns observed or hypothesized in the literature, including more waste generated by younger students and during the earliest and shortest lunch periods. We document several novel associations including more plate waste at smaller schools, during winter months and in the Northeast region. We find several nuanced patterns of waste related to the prevalence of free and reduced meal service and whether all meal elements are offered versus served. While this study cannot support rigorous evaluation of intervention effectiveness, it provides insights into school and program characteristics that may pose challenges for schools interested in reducing student plate waste.

Facilitators and barriers to healthful eating among adolescents in high-income countries: A mixed-methods systematic review

Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed-methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10-19 years in high-income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer-reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast-food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions.

National Policies to Limit Nutrients, Ingredients, or Categories of Concern in School Meals: A Global Scoping Review

The school food environment is a key intervention point for influencing children's and adolescents' diets. As more countries establish school meal programs to provide critical nourishment to students, establishing standards for the foods served can increase the consumption of key nutrients and limit the consumption of foods that do not build health. This global scoping review explores the prevalence and basic characteristics of national policies that regulate food served through school meals across 193 countries, particularly by restricting the provision of categories, nutrients, or ingredients of nutritional concern. We gathered evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. We included nationally mandated policies that included restrictions on categories, nutrients, or ingredients of concern served in school meals. Policies that were sub-national, voluntary, and/or did not include restrictive language were excluded from this review. Data was collected in research electronic data capture then extracted into Microsoft Excel and analyzed for policy frequency, prevalence by world region or country income group, and prevalence of certain policy characteristics. Globally, only 15% of countries were found to have a national-level policy restricting foods served through school meals in some capacity, including either nutritional or categorical restrictions. The majority of these policies were found in high-income countries, and no low-income countries had a policy meeting inclusion criteria. Policies in Latin-American and Caribbean countries limited the content of more nutrients of concern than in other regions. Although many policies included explicit guidelines to monitor implementation, few outlined mechanisms for policy enforcement. Future research should evaluate the impact of various school meal regulatory approaches, including implementation of similar policies at sub-national levels, and other elements that affect the impact of school meal programs, such as procurement, infrastructure, costs to school and to students and their families, and acceptability and consumption of foods provided.

Benchmarking the Determinants of Nutritional Status among Community Schools’ Children in Nepal

The government of Nepal initiated the Mid Day Meal Program (MDMP) to reduce hunger and increase educational outcomes, including health status. However, limited studies have been conducted on these issues covering the nutritional status of students at the lower basic level at community schools in Nepal. The main objective of the study is to determine the factors associated with malnutrition among children from community schools in Nepal. A school-based cross-sectional study was conducted in 98 (46 basic and 52 secondary) community schools from 44 municipalities in Nepal. Altogether, 2727 students participated in the questionnaire survey and anthropometric measurement. Data collection was performed on May 10-31, 2023. WHO Anthro plus and LMS (Lambda Mu and Sigma) parameters were used: weight for age for national health and nutrition survey recommended by CDC/National Center for Health Statistics for ages older than ten years to analyze nutritional status, including z scores. Descriptive analysis, including inferential analyses such as the chi-square test and logistic regression, was performed using IBM SPSS Statistics v25. The prevalence of weight-for-age Z-score[WAZ], height-for-age Z-score [HAZ], and body mass index-for-age Z-score [BAZ] were 72%, 75%, and 82%, respectively. Students with z-scores outside the range of ±2 were classified as malnourished. Of them, 27.3%, 23% and 16.6% were assessed as underweight, stunted and thin, respectively. Students' sociodemographic characteristics such as age, asex, family size and type, source of income, wealth status were significantly associated with malnutrition, while age group, gender, wealth status, residence setting, and geographical location were noted as significant predictors of nutritional status. The study found no statistical relationship between school feeding and good nutrition, questioning the quality of the midday meal program. The study concludes that existing school-based nutritional interventions need to be re-evaluated and re-designed since it is less potent to minimize malnutrition among students substantially. Policymakers could consider these findings when planning and implementing nutrition-related policies and programs.

The Quality of Lunches Brought from Home to School: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis, spanning studies published between 1995 and 2021, investigates various aspects of lunches brought from home (LBFH) to school by children. These meals, in contrast to those provided by the National School Lunch Program (NSLP), lack strict nutritional standards. Despite the availability of NSLP lunches, ∼40% of US children opt for LBFH. This review aims to assess the food content and nutritional quality of LBFH, their adherence to NSLP standards in terms of nutrition and cost, effectiveness of intervention programs designed to enhance their nutritional quality and parental and student perceptions of LBFH. The comprehensive literature search yielded 28 eligible papers, with 16 included in meta-analysis. LBFH commonly include fruits (50%), yet vegetables (17%) and dairy (25%) are less prevalent. They frequently contain snacks (50%), sweets (48%), and sugar-sweetened beverages (31%). Compared with school lunches, LBFH exhibit lower levels of calcium, protein, iron, fiber, and vitamin A, and higher levels of carbohydrates and saturated fat. Intervention programs had no effect on quality of LBFH. On average, LBFH ($1.81) cost slightly less than lunches served at school ($1.98), without accounting for free/reduced-price meals in the calculation. The cost of school lunch for pre-k and kindergarten children became $11.32, nearly 4 times higher than that of LBFH ($2.92), after replicating the meal at home and accounting for meal preparation time. Parents preferred LBFH over school lunches because of concerns related to the quality of school meals served. This study concludes that LBFH are generally less nutritious compared with lunches provided by NSLP. Future research needs to further explore ways to improve parent perception of NSLP. Especially with many states making free meals available to all children, identifying effective ways in promoting and increasing NSLP participation can ensure more children have access to nutritionally balanced and affordable lunches.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools

BACKGROUND

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.

METHODS

The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.

CONCLUSIONS

Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Evaluation of School Wellness Policies in Low-Income California Districts After the 2016 USDA Final Rule

BACKGROUND

Districts with federal nutrition programs must have an updated local school wellness policy (LSWP) to promote nutrition, physical activity, and student wellness. This study evaluates factors associated with LSWP quality among low-income districts.

METHODS

In 2018, we collected LSWPs from websites of 200 randomly selected, county-stratified, low-income-serving California public districts. Multivariable linear regression assessed associations between district characteristics, model LSWP use (national, state, none), and adoption date on policy quality.

RESULTS

On the WellSAT 3.0 scale of 0-100, mean (95% CI) comprehensiveness was 65.0 (63.2-66.7) and strength was 37.3 (35.3-39.2). Nearly verbatim adoption of model LSWPs was high (68.5% state model, 13.0% a national model). Half were adopted before mandated updates. District size (≥1000 students) and national model LSWP adoption were associated with higher comprehensive scores. National model LSWP adoption was associated with higher strength scores in updated policies compared with those not updated.

IMPLICATIONS

LSWPs have improved school food and activity environments, but district engagement in LSWP is low. Integration into education frameworks that reduce learning barriers could provide synergy for re-engagement.

CONCLUSIONS

High adoption of model policies and low update compliance indicate little district engagement in LSWP. Mixed methods studies of districts with high-quality LSWP are needed.

Parent Perceptions of School Meals Influence Student Participation in School Meal Programs

OBJECTIVE

To evaluate if parent perceptions of school meals influence student participation.

DESIGN

In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation.

PARTICIPANTS

A total of 1,110 California parents of kindergarten through 12th-grade students.

MAIN OUTCOME MEASURES

Student participation in school lunch and breakfast.

ANALYSIS

Principal component analysis and Poisson regression models.

RESULTS

Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05).

CONCLUSION AND IMPLICATIONS

Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.

Temporal Patterns in Fruit and Vegetable Intake Among Racially and Ethnically Diverse Children and Adolescents in California

Introduction

Childhood dietary behaviors, including fruit and vegetable intake, are associated with adult health. Most children do not meet daily recommended servings of fruits and vegetables. Less is known about temporal patterns in fruit and vegetable consumption or if they vary by race and ethnicity. We investigated temporal patterns in fruit and vegetable intake among California school-age children and adolescents overall and by race and ethnicity.

Methods

We used 2-year cross-sectional datasets from the child and adolescent samples in the California Health Interview Surveys from 2011-2012 through 2019-2020 and modified Poisson regression models to estimate the likelihood of consuming 5 or more servings of fruits and vegetables in 2013-2016 and 2017-2020 compared with 2011-2012. Models controlled for age, race and ethnicity, gender, citizenship status, family income, and adult education and tested for differences by race and ethnicity. The samples included 16,125 children aged 5 to 11 years and 9,672 adolescents aged 12 to 17 years.

Results

Overall, 29.3% of children and 25.9% of adolescents reported intake of 5 or more fruits and vegetables per day. Among children, adjusted prevalence ratios (PR) of fruit and vegetable intake were higher in 2013-2016 (PR,1.25; 95% CI, 1.11-1.42) and 2017-2020 (PR,1.13; 95% CI, 0.99-1.30) compared with 2011-2012. Among adolescents, the adjusted prevalence did not differ significantly over time. We found no evidence of differential associations by race and ethnicity for children and adolescents.

Conclusion

We found favorable temporal changes in fruit and vegetable consumption among children, but not among adolescents. Monitoring temporal patterns in fruit and vegetable intake remains critical for planning population-level interventions to increase consumption.

School food hero and the battle of the food foes: A story of public health policy, power imbalance and potential

This paper explores the impact of school food policy from the perspective of school food workers to offer an alternative account of why school food may not be having the desired impact on child health or food choices. Drawing upon the findings from an institutional ethnography carried out in three UK primary schools, we argue that school food is being asked to perform an unrealistic task of luring children and families away from more unhealthy food options, without being given adequate resources or powers to do this job effectively. We theorise that the narrative depicting school food as a hero, combatting the harms of poor dietary choices and poor health outcomes, is inappropriate as a countermeasure to mitigate the effects of wider food industry forces. We revisit the narrative to consider the power imbalances within society that structure dietary choices, presenting our findings and the wider policy review in the form of a story about the evolution of school food set against a shifting food environment. We conclude with recommendations for policy makers who want to see school food have a greater impact in improving child health.

Policy, Systems, and Environmental Changes in Child Nutrition Programs: A Systematic Literature Review

The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.

Parent perceptions of school meals and how perceptions differ by race and ethnicity

Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.

[Do socioeconomic determinants influence school menus?]

Introduction

Introduction: the components of school menus is an important area in health strategies. Objectives: the aim of this study was to analyse differences in adherence to recommended food frequencies and other characteristics of school meals in educational centres according to the type of school and neighbourhood income. Method: schools in the city of Barcelona with a lunch service were offered a three-year review. In the three academic years, 341 schools participated: 175 were public and 165 were private. To identify any differences, the Pearson Chi-squared test or Fisher exact test were used, as appropriate. Statistical analyses were performed with the STATA SE/15 programme. Results: no statistically significant differences were found by the socioeconomic level of the school neighbourhood. Private and subsidised schools showed lower adherence to recommendations on pasta (11.1 %), red and processed meat (24.7 %), total meat (7.4 %) and fresh fruit (12.1 %), and lower use of the recommended cooking oil (13.1 %). In contrast, public schools showed lower adherence to the recommended type of frying oil (16.9 %). Conclusions: in private and subsidised schools, improvements should be recommended on the frequency of intake of certain foods. Future studies should examine the causes of lower adherence to certain recommendations in these centres.

How to enable healthier and more sustainable food practices in collective meal contexts: A scoping review

Collective meal contexts such as restaurants, cafeterias and canteens can help accelerate transitions to healthier and more sustainable diets. However, evidence from intervention studies on these contexts lacks integration. This scoping review aimed to map determinants of dietary change in collective meal contexts across multiple settings, interventions, target groups, and target behaviors. The review provided two main outcomes: (i) identifying intervention components to promote dietary change in collective meal contexts, based on the existing body of evidence; and (ii) classifying and integrating these intervention components into an overarching framework of behavior change (i.e., COM-B system). The review encompassed twenty-eight databases via two indexing services and extracted information from 232 primary sources (27,458 records selected for title and abstract screening, 574 articles selected for full-text screening). We identified a total of 653 intervention activities, which were classified into intervention components and grouped under three broad themes, namely contextual and environmental changes, social influence, and knowledge and behavioral regulation. Multi-component interventions tended to report overall positive outcomes. The review proposes several directions for future research, including: (i) moving toward more theory-based interventions in collective meal contexts; (ii) providing more detailed information about intervention settings, implementation, target groups, activities, and materials; and (iii) improving the use of open science practices in the field. Furthermore, the review offers a free, original, open-access list and synthesis of 277 intervention studies in collective meal contexts, which can help intervention planners and evaluators optimize their efforts to promote healthier and more sustainable food practices in these contexts.

Adherence to school meals and co-occurrence of the healthy and unhealthy food markers among Brazilian adolescents

The aim of this study was to analyze the association between adherence to school meals and the co-occurrence of the regular consumption of healthy and unhealthy eating markers among Brazilian adolescents. Data from 67,881 adolescents in Brazilian public schools who participated in the 2015 National School Health Survey, were used. From the 7-day FFQ, the dependent variable was constructed, co-occurrence of regular consumption (≥ 5x/week) of healthy and unhealthy food markers, which was categorized as regular consumption of none, one or two, or three eating markers. We performed an ordinal logistic regression with adjustment for sociodemographic, eating habits outside of school, and school characteristics variables. The prevalence of the co-occurrence of the regular consumption of three healthy eating markers was 14.5%, and that of three unhealthy markers was 4.9%. High adherence to school meals (every day) was positively associated with regular consumption of healthy eating markers and inversely associated with regular consumption of unhealthy eating markers. The school meals provided by PNAE contribute to the promotion of healthy eating habits among Brazilian adolescents.

Students' consumption of high and low nutrition foods and reduced plate waste by schools' wellness-related policies and garden program participation

BACKGROUND

Participation in school-based programs that may support children's nutritious dietary behaviours varies across schools. We examined school participation in wellness-related policies, school-based garden programs and students' dietary behaviours.

METHODS

Among matching schools who did and did not participate in school-based garden programs, we analysed the lunches of 80 Pittsburgh Public Schools (PPS) students in 1st, 2nd, 6th and 7th grades during Autumn 2019 using digital food photography. We also acquired school wellness policy data. Using cross-sectional linear regression, we estimated the association between school-based garden programming, wellness-related policies and dietary outcomes, adjusting for grade.

RESULTS

School's implementation of nutrition services policies was negatively associated with energy wasted from lunch (β = - 44.7 , p = 0.01 ${\rm{\beta }}=-44.7,{p}=0.01$ ). The number of semesters the students' school had participated in the garden program was positively associated with students' whole grain consumption (β = 0.07 , p < 0.001 ${\rm{\beta }}=0.07,{p}\lt 0.001$ ).

CONCLUSIONS

Cross-sectional associations suggest that schools that are more engaged in wellness policies and garden programs may provide environments that are more supportive of students' nutrition than in other schools.

Parent Perception of School Meals in the San Joaquin Valley during COVID-19: A Photovoice Project

School-based nutrition programs are crucial to reducing food insecurity. The COVID-19 pandemic adversely impacted students' school meal participation. This study seeks to understand parent views of school meals during COVID-19 to inform efforts to improve participation in school meal programs. Photovoice methodology was used to explore parental perception of school meals in San Joaquin Valley, California, a region of predominately Latino farmworker communities. Parents in seven school districts photographed school meals for a one-week period during the pandemic and then participated in focus group discussions and small group interviews. Focus group discussions and small group interviews were transcribed, and data were analyzed using a team-based, theme-analysis approach. Three primary domains emerged: benefits of school meal distribution, meal quality and appeal, and perceived healthfulness. Parents perceived school meals as beneficial to addressing food insecurity. However, they noted that meals were unappealing, high in added sugar, and unhealthy, which led to discarded meals and decreased participation in the school meal program. The transition to grab-and-go style meals was an effective strategy for providing food to families during pandemic school closures, and school meals remain an important resource for families experiencing food insecurity. However, negative parental perceptions of the appeal and nutritional content of school meals may have decreased school meal participation and increased food waste that could persist beyond the pandemic.

Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers

As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke's Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.

Providing School Meals to All Students Free of Charge during the COVID-19 Pandemic and Beyond: Challenges and Benefits Reported by School Foodservice Professionals in California

Universal school meals (USM) have the potential to increase access to healthy food for millions of U.S. students. This study evaluated school food authorities’ (SFA) perspectives of federal USM in response to COVID-19 (school year (SY) 2021−22) and California’s upcoming USM policy in the SY 2022−23. In February 2022, all SFAs in California (n = 1116) were invited to complete an online survey. Descriptive statistics and logistic regression examining differences by school demographic characteristics were used. Five hundred and eighty-one SFAs completed the survey; 63% of them first implemented USM during the COVID-19 pandemic. Reported benefits included increased student meal participation (79.2%) and reduced stigma (39.7%). Top challenges included staffing (76.9%) and meal packaging/solid waste (67.4%). Nearly all SFAs reported pandemic-related challenges procuring the necessary types (88.9%) and amounts of foods (85.9%), and non-food supplies/equipment (82.6%). Over 40% reported that federal reimbursements were insufficient to cover costs. SFAs with <40% FRPM-eligible students and/or higher student enrollment reported more current challenges and future concerns than those with ≥40% FRPMs and lower student enrollment. The top resources requested to implement CA’s USM included additional facilities/equipment (83.8%), communications/marketing (76.1%), increasing meal participation (71.5%), and financial management (61.5%). Most California SFAs reported that implementing federal USM had the intended effect of feeding more children. This study’s findings may be useful to the several other U.S. states implementing universal school meals in the SY 2022−23, and to other states or countries considering adopting a USM policy in the future.

Impact of a Teacher Intervention to Encourage Students to Eat School Lunch

While school meals are often the healthiest option for students, lunch participation remains relatively low. Few approaches for increasing participation have leveraged teachers' potential social influence. We determined if a teacher intervention about the benefits of school lunch could improve teachers' perceptions of, and participation in, school lunch, and encouragement of students to eat school lunch. This repeated cross-sectional study included teacher/student survey administration in spring of 2016 and 2018 in 19 public secondary schools (9 intervention, 10 comparison) educating students of ages ≈ 11-18. Intervention teachers received monthly newsletters; lunch taste tests; and a promotional video and website. Mixed effects models with a random effect for school showed the proportion of teachers that reported eating with students increased in intervention schools relative to control schools (difference-in-change: 7.6%; 95% CI: 3.578%, 14.861%), as did student agreement that adults at their schools encouraged them to eat school lunch (difference-in-change: 0.15 on a 5-point scale; 95% CI: 0.061, 0.244). There were no between-group differences in teachers' perceptions of school meals or teachers' lunch participation. These findings suggest that teachers' perceptions of school meals do not necessarily need to improve to promote the school lunch program to students. However, to see meaningful change in teacher lunch participation, the taste of school meals likely needs improving.

The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis

The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).

Awareness of and Participation in School Food Programs in Youth from Six Countries

BACKGROUND

School-based meal programs can promote healthy dietary intake in youth. However, limited data exist regarding the impact of income-targeted school meal programs across countries, particularly among food-insecure youth.

OBJECTIVES

We examined self-reported awareness of and participation in free school meal programs, and associations with dietary intake in youth from 6 countries with differing national school meal policies.

METHODS

Data were collected through the 2019 International Food Policy Study Youth Survey, a cross-sectional survey of 10,565 youth aged 10-17 y from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Regression models examined: 1) country differences in awareness of and participation in breakfast and lunch programs; and 2) associations between lunch program participation and intake of fruit and vegetables, and "less healthy" foods during the previous school lunch day.

RESULTS

Awareness of and participation in free breakfast and lunch programs varied across countries. Approximately half of USA and Chilean students participated in school lunch programs-the countries with the most comprehensive national policies-compared with one-fifth of students in the United Kingdom, and ∼5% in Australia, Canada, and Mexico (P < 0.001 for all contrasts). In the United States and Chile, more than two-thirds of youth with the highest level of food insecurity participated in lunch programs, compared with 45% in the United Kingdom, 27% in Canada, and ≤20% in Australia and Mexico. In all countries, youth reporting school lunch program participation were more likely to report fruit and vegetable intake during their previous school lunch (P < 0.001), and higher intake of "less healthy" food in all countries except the United States and Chile.

CONCLUSIONS

More comprehensive national policies were associated with greater participation in school meal programs, particularly among youth at greatest risk of food insecurity, as well as healthier dietary intake from school lunches.

Plate Waste in School Catering in Rezekne, Latvia

This research was conducted within the framework of a research project aimed at detecting patterns of plate waste and developing recommendations for improving catering in seven schools in Rezekne city (Latvia) by a combination of observation, physical weighing, semi-structured interview approaches and statistical analysis of variance (ANOVA). We identified plate waste (including wasted beverages), which remains after the lunch of schoolchildren in grades 1–7, examining a total of 7064 lunch samples. The originality of the research is due to the fact that a unified menu was designed for the field study, which ensured the same field study conditions in all the schools. The results of the research revealed that the average weight of plate waste per schoolchild reached 178 g, and the total weight of plate waste accounted for 28.75% of the total weight of food served. No significant differences in plate waste weight between various age groups and grades of schoolchildren were found, which was also confirmed by a one-way ANOVA test. An analysis of plate waste by food category showed that beverages accounted for the largest share of total plate waste (42.24%), followed by staple food (28.38%) and meat (11.77%). An analysis of plate waste shares of food served (%) by food category revealed a similar situation: the largest share of food served was made up of beverages (37.56%), followed by staple food (36.48%) and meat (28.77%). An analysis of the monetary value of food waste showed that the average cost of plate waste (excluding beverage) per schoolchild was EUR 0.236, which represented 16.6% of the national and municipal funding of EUR 1.42 per portion. Given the research results, the authors have concluded that in order to reduce the amount of plate waste generated by Rezekne city schools, school menus should be based not only on the requirements prescribed by relevant legal acts but also on cooking processes that meet the requirements of modern consumers (learners), e.g., by following trends in cooking practices in society to make the learners interested in consuming school food.

Increased School Breakfast Participation from Policy and Program Innovation: The Community Eligibility Provision and Breakfast after the Bell

School meals provide significant access to food and nutrition for children and adolescents, particularly through universal free meal mechanisms. Alongside added nutritional meal requirements under the Healthy, Hunger-Free Kids Act (2010), schools can utilize meal program and policy mechanisms such as the Community Eligibility Provision (CEP) and Breakfast after the Bell (BATB) to increase participation. This study examines longitudinal statewide school-level CEP and BATB adoption and estimates the impact on increased free and reduced-price (FRP) breakfast participation. We find that FRP breakfast participation increased for schools that utilize both CEP and BATB (14-percentage-point increase) and that CEP-participating schools are more likely to use BATB approaches such as breakfast in the classroom, grab-and-go carts, and second-chance breakfast. Additionally, using a conditional Difference-in-Differences (DiD) approach, we find that BATB adoption accounted for a 1.4-percentage-point increase in FRP school breakfasts served (p < 0.05). Study findings can inform policy and school official decision making around the policy and program mechanisms at their disposal to increase school meal participation and student nutrition.

Breakfast and School-Related Outcomes in Children and Adolescents in the US: A Literature Review and its Implications for School Nutrition Policy

PURPOSE OF REVIEW

To identify and review the latest research on the connections between breakfast and school-related outcomes in children and adolescents in the US, and to explore the implications of this research on US school nutrition policy, particularly as it applies to students experiencing or at risk for food insecurity.

RECENT FINDINGS

Although school personnel, parents, and students have positive attitudes about breakfast and its benefits for learning, recent research finds mixed evidence for the role of breakfast in improving objectively measured grades and test scores. Few recent studies examined behavioral outcomes, limiting the ability to draw clear conclusions about breakfast and school behavior. Several studies observed improved attendance with increased school breakfast access and participation, especially when schools offered breakfast at no cost to all students. There are many challenges to studying the connections between breakfast and learning. The recent research on breakfast and academic outcomes is mixed, but there is a growing body of evidence that eliminating fees for both school breakfast and lunch has promise for improving school-related outcomes.

Teachers' Experiences Implementing a School Wellness Initiative in Anchorage, Alaska: A Qualitative Study

BACKGROUND

Teachers are uniquely poised to support students' healthy eating habits and physical activity. However, research is needed to examine the successes and challenges teachers face when implementing a school wellness initiative.

OBJECTIVE

The purpose of this study was to examine teachers' experiences implementing and managing a pilot school wellness initiative where students had longer lunch and recess, and more physical activity throughout the day.

DESIGN

Focus groups were conducted to understand the challenging and successful experiences of teachers as they implemented and managed a school wellness initiative.

PARTICIPANTS/SETTING

The participants were teachers (n=39) from six purposively selected elementary schools participating in a school wellness initiative. Focus groups were conducted in-person at participating schools.

ANALYSIS

Using a grounded theory approach, transcripts were analyzed qualitatively using principles of content analysis to identify themes and domains. Application of the codes and inter-rater reliability were conducted with a trained research assistant.

RESULTS

Teachers observed calmer students who ate more lunch with longer lunch periods. Additionally, teachers observed improved focus in the classroom and fewer behavioral issues with more physical activity opportunities. Successful strategies included reversing lunch and recess and implementing physical activity into daily lessons. However, some teachers had difficulty managing the extra time in the cafeteria and scheduling physical activity throughout the day, particularly in schools where administrators were not as supportive of the initiative. In the schools with greater administrative buy-in and support, teachers had easier, more positive experiences implementing the wellness initiative.

CONCLUSIONS

School wellness initiatives in which teachers play a large role have the potential to support teachers and students. This study found that teachers value student health and understand students need to be nourished to learn, but teachers' experiences suggest they need support and buy-in from their administrators to be successful.