Good Nutrition News in Our Schools –Why Not a Press Release?

Washington Post: Why is the USDA downplaying good news

An excerpt:

The best news was that the Healthy Eating Index (HEI-2010), a multicomponent measure of diet quality, shot up dramatically for both school-provided breakfasts and lunches.

For the 2009-2010 school year, the score for breakfast was an abysmal 49.6 out of 100 (even lower than the overall American average of 59), rising to 71.3 by the 2014-2015 school year. In that same time frame, the lunch score went from 57.9 to 81.5. The score for whole grains in school meals went from 25 to 95 percent of the maximum score, and the score for greens and beans rose from 21 to 72 percent.

In addition, there was greater participation in school meal programs at schools with the highest healthy food standards. And the study found food waste, a troubling national problem in the lunchroom, remained relatively unchanged.

The 52-page summary of study findings is chockablock with other good news, so why isn’t Agriculture Secretary Sonny Perdue crowing about it?…

In December, Perdue announced the USDA was weakening school nutrition standards for whole grain, nonfat milk and sodium, all of which had been tightened during the Obama administration. He cited food waste and nonparticipation as key rationales for the shift

 

Rolling Back School Lunch Standards

NY Times: Trump Administration Rolls Back Obama-Era Rules for School Lunches

An excerpt for 12/8/18:

This week, the United States Department of Agriculture announced its final plans to lower nutrition standards for grains, flavored milks and sodium in school cafeterias that were part of the Healthy, Hunger-Free Kids Act of 2010 …

The Obama-era rules required that schools must serve entirely “whole grain-rich” foods, meaning that the product — whether it is pizza, pasta or hamburger buns — must contain at least 50 percent whole grains…Under the new rules, only half of the grain products on the cafeteria’s weekly menu must be whole grain-rich….

It was unclear why the Trump administration would backtrack when schools were in good standing with the nutritional goals… more than 99 percent of schools in the country reported that they were meeting the Obama-era standards…

“It seems like a small thing,” she said. “But the behavioral research shows you have to offer nutritious food to kids over and over and be consistent.”

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How to Improve Food Selection at Schools

A recent study (Cohen JFW et al. JAMA Pediatr 2015; 169: 431-7; thanks to Ben Gold for this reference) showed both the short-term and long-term effects of targeted interventions to improve food selection at schools.

The Modifying Eating and Lifestyles at School Study (MEALS study) was a randomized trial in 2 urban, low-income school districts in Massachusetts.  After a one month baseline, there was an initial 3 month randomization period in which there were 4 “chef” schools and 10 control schools.  As you may have guessed, the “chef” schools were assigned a chef to improve food palatability and to teach the cafeteria staff.

The recipes are available at the following link: www. projectbread.org/reusable-components/accordions/download-files/school-food-cookbook.pdf.  The recipes in this cookbook are great if you need to put together meals serving 100.  Recipes include Cachupa, Quinoa, Squash, and Kale.

During the next study period of 4 months, both groups were further divided into schools with “smart cafe” design or control design.  The smart cafes encouraged both vegetable and fruit selection/healthy food selection:

  • Veggies offered at beginning of lunch line
  • Fruits placed in attractive containers
  • Fruit options placed by cashier
  • Improved signage and images promoting fruits and veggies
  • White milk placed in front of sugar-sweetened milk (eg. chocolate milk)

Did these interventions work?  Yes, pretty much.

  • After 3 months, vegetable selection increased in chef schools with odds ratio (OR) of 1.75
  • At conclusion of study, vegetable selection increased in the chef (OR 2.54), smart cafe (OR 1.91) and chef plus smart cafe (OR 7.38)
  • At conclusion of study, fruit selection increase in the chef (OR 3.08), smart cafe (OR 1.45) and chef plus smart cafe (OR 3.10)
  • Actual consumption (not just selection) increase in chef and chef plus smart cafe schools but there was no lasting effect of smart cafe by itself.  The amount of vegetable intake approximately doubled in the chef or chef plus smart cafe, consuming an additional 0.75 cups of vegetables per week.

Conclusions (from the authors): “While using choice architecture [i.e. smart cafe design] “may be a good short-term strategy to increase healthier food consumption, it does not appear to be a successful long-term strategy…This study also reaffirms that a chef intervention focusing on school food quality, palatability, and variety is an effective method …over time…This study also confirms the importance of repeated exposures to new school foods.”

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Kori Bustard, Zoo Atlanta

Kori Bustard, Zoo Atlanta

Lunchroom Makeover

A recent pilot study indicates that $50 and three hours can increase the chances that teens will eat their fruits and vegetables (J Pediatr 2013; 162: 867-9).  While the US Department of Agriculture has mandated alterations in what foods that schools offer for lunch, schools cannot force students to eat specific foods.  As such, the authors tried changing the convenience, attractiveness, and ‘normative nature of healthy foods’ in the lunchroom. These changes are part of a behavioral science called “libertarian paternalism.”

These field studies took place at two schools in western New York with students at 7-12 grade levels.  After implementing changes in the lunchrooms, researchers recorded tray waste on multiple dates.

Specific changes included the following:

Improved convenience:

  • “Healthy convenience line” with only submarine sandwiches and healthier sides (fruits/vegetables)
  • Salad served in see-through to-go containers

Improved attractiveness:

  • Lunch menu posted with nice color photos of fruits and vegetables
  • Fruit displayed in nice bowls or tiered stands

Normative behavior:

  • Verbal prompts by staff: “Would you like to try…”, “No veggie? How about…” “You can get another side with your meal. How about grabbing a piece of fruit?”
  • “Last chance for Fruit” sign displayed next to fruit basket at the cash register

The impact of the “smarter lunchroom:” actual fruit consumption increased by 18% and vegetable consumption increased by 23%.  The limitations of this study: no control school, did not track individual consumption, and small number of measured days.

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