School breakfast programs
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Health factors shape the health of individuals and communities. Everything from our education to our environments impacts our health. Modifying these clinical, behavioral, social, economic, and environmental factors can influence how long and how well people live, now and in the future.
Community in Action
School breakfast programs (SBP) offer students a nutritious breakfast, often incorporating a variety of healthy and culturally relevant choices. Breakfast can be served in the cafeteria before school starts, from grab and go carts in hallways, or in classrooms as the school day begins. Some schools offer breakfast during a morning break, called second chance breakfast or school brunch1. Schools that participate in the federal School Breakfast Program receive subsidies for each breakfast served. Students from families with incomes at or below 130 percent of the federal poverty level (FPL) are eligible for free breakfast and children from families with incomes between 130 and 185 percent FPL qualify for reduced-cost breakfast; schools are reimbursed at higher rates for free and reduced-cost breakfasts2. School participation in the federal program varies by state and region3. Some participating schools offer free breakfast to all students, often called universal free breakfast, others only to qualifying students4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased academic achievement
Increased healthy food consumption
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved nutrition
Increased food security
Improved weight status
Improved student attendance
What does the research say about effectiveness?
There is strong evidence that having access to school breakfast programs (SBP) increases academic engagement and achievement, especially among nutritionally deficient or malnourished children5, 6, 7, 8. SBP effects can vary by participant characteristics and program type (e.g., universal, breakfast in the classroom, grab and go, etc.)9. Access to school breakfast programs also increases healthy food consumption and can improve breakfast nutrition5, 10, 11, 12, 13.
SBP participation improves academic achievement among elementary school students, especially math achievement6, 8. Overall, SBPs have positive effects on long-term academic achievement, which may be due to increased attendance6. Academic effects are strongest with universal free breakfast programs6 and among nutritionally vulnerable children6, 8. SBPs may improve school attendance5, 6, 7, 9, 14; universal free breakfast programs appear to improve test scores and attendance more than other breakfast programs9. One study suggests breakfast in the classroom (BIC) may modestly increase reading and math achievement, as well as test scores more than traditional cafeteria-based programs15. Other studies suggest that access to school breakfast is important, but that universal and BIC programs may not improve academic outcomes more than traditional breakfast programs14, 16. Studies of habitual breakfast quality show regular access and exposure to higher quality, nutritious SBPs can improve academic performance more than less nutritious breakfasts5, 6, 8.
School breakfast availability can reduce short-term hunger17, marginal food insecurity, and food-related concerns in low income households18, 19, 20. State policies requiring schools to offer breakfast can reduce food insecurity for elementary school age children21. Students regularly eating school breakfast, even those eating double breakfasts, appear more likely to have a healthy weight trajectory than students frequently skipping breakfast22. Following implementation of nutrition standards through the Healthy, Hunger-Free Kids Act (HHFKA), eating school breakfast and lunch daily is associated with modestly healthier dietary intake, including more fruits and vegetables, dietary fiber, whole grains, dairy, and calcium23. Prior to implementing HHFKA standards, school breakfast and lunch participation was associated with increases in the likelihood of childhood overweight and obesity24, especially for children from low income families25, which supports the importance of offering high quality, nutritious school breakfasts. SBP participation may reduce students’ body mass indexes (BMIs), especially among non-Hispanic white students26, and may reduce weight gain12, 27. However, school breakfast may not significantly alter nutritional intake over the course of a day28, 29.
Universal free breakfast programs have been shown to dramatically increase school breakfast participation, especially when breakfast is served in classrooms3, 14, 30, 31, 32. Universal programs also appear to slightly, but significantly, increase servings of fruit and dairy products at breakfast, and reduce cholesterol intake13, 29. BIC effects on weight outcomes vary; in some studies BIC is associated with improved diet, and is not associated with excess calorie consumption33, BMI increases31, or childhood obesity even among students eating BIC as a second breakfast33. However, in a Philadelphia-based study, BIC may be associated with increased incidence and prevalence of childhood obesity, which may be related to nutrition standards, participant or location characteristics, or food consumed during the rest of the day30.
To increase student participation in SBPs, experts recommend longer breakfast periods and adequate breakfast time between bus arrival and the start of class3, universal programs to reduce stigma, promotion of the health benefits of breakfast, marketing SBPs to older students, and education for families about the low cost and variety of foods available34. Experts suggest that efforts to improve the nutritional quality of food available through school meals avoid strict calorie restrictions, particularly for food insecure children who consume significant portions of their daily calories in school meals35.
Overall, skipping breakfast can diminish cognitive performance36. Breakfast consumption improves short-term memory, attention, and cognitive performance6, 37, and has positive effects on academic achievement, quality of life, and well-being37. Breakfast consumption is also associated with a reduced risk of becoming overweight or obese and with a reduced BMI among children and adolescents38.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
In the 2018-2019 school year, the federal School Breakfast Program (SBP) served over 2.4 billion school breakfasts to children across the nation39. Low income children participate in the SBP much more than higher income children, and schools that serve mostly low income students are more likely to offer breakfast3. Just over half of the low income children who participated in the National School Lunch Program also participated in the SBP in 2013-20144. In 2017-2018, on an average school day, nearly 12.5 million students from families with low incomes participated in the SBP2.
States across the country have enacted legislation to increase access to school breakfast, for example Delaware, Colorado, and New Mexico40. Other states require all schools to serve breakfast, including Florida, West Virginia, and Maine. Some states require schools to offer breakfast if a set percentage of their students are eligible for free or reduced price school meals, as in Illinois, Texas, and Washington41. Several states have established school breakfast challenges to increase school breakfast participation, using alternative programs such as grab and go breakfast, breakfast in the classroom, or second chance breakfast, as in Maryland, Michigan, Nebraska, New Hampshire, and North Carolina1.
In the 2018-2019 school year, for schools in the contiguous states, reimbursement rates were $1.79 for each free breakfast served, $1.49 for each reduced-cost breakfast, and 31 cents for each full price breakfast. Severe needs schools qualified for an additional 35 cents per free or reduced-cost breakfast served42.
The Whole School, Whole Community, Whole Child (WSCC) model creates environments that support healthy choices for students, which includes efforts to improve the school food environment, often incorporating healthy school breakfast programs43.
Implementation Resources
FRAC-SBP - Food Research and Action Center (FRAC). School breakfast program.
USDA-SBP - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). School Breakfast Program (SBP).
CDC-Health and academics - Centers for Disease Control and Prevention (CDC). Health and academic achievement. 2014.
CDC-School nutrition 2019 - Centers for Disease Control and Prevention (CDC). Comprehensive framework for addressing the school nutrition environment and services. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.
USDA-SN training - U.S. Department of Agriculture (USDA). Professional standards for school nutrition professionals: Training and resources.
NKH CBP-School breakfast - No Kid Hungry, Center for Best Practices (NKH CBP). School breakfast: How to launch a successful school breakfast challenge.
Footnotes
* Journal subscription may be required for access.
1 NKH CBP-School breakfast - No Kid Hungry, Center for Best Practices (NKH CBP). School breakfast: How to launch a successful school breakfast challenge.
2 FRAC-SBP - Food Research and Action Center (FRAC). School breakfast program.
3 Bartfeld 2010 - Bartfeld J, Kim M. Participation in the School Breakfast Program: New evidence from the ECLS-K. Social Service Review. 2010;84(4):541–62.
4 FRAC-Woo 2015 - Woo N, Hewins J, Burke M, et al. School breakfast scorecard: School year 2013-2014. Washington, D.C.: Food Research and Action Center (FRAC); 2015.
5 Frisvold 2015 - Frisvold DE. Nutrition and cognitive achievement: An evaluation of the School Breakfast Program. Journal of Public Economics. 2015:124:91-104.
6 Hoyland 2009 - Hoyland A, Dye L, Lawton CL. A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutrition Research Reviews. 2009;22(2):220–43.
7 Meyers 1989 - Meyers AF, Sampson AE, Weitzman M, et al. School Breakfast Program and school performance. The American Journal of Diseases of Children. 1989;143:1234-1239.
8 Adolphus 2013 - Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Frontiers in Human Neuroscience. 2013;7:425.
9 Bartfeld 2019 - Bartfeld JS, Berger L, Men F, et al. Access to the school breakfast program is associated with higher attendance and test scores among elementary school students. Journal of Nutrition. 2019;149(2):336-343.
10 Bhattacharya 2006 - Bhattacharya J, Currie J, Haider SJ. Breakfast of champions? The School Breakfast Program and the nutrition of children and families. Journal of Human Resources. 2006;41(3):445–66.
11 Murphy 2011 - Murphy S, Moore GF, Tapper K, et al. Free healthy breakfasts in primary schools: A cluster randomised controlled trial of a policy intervention in Wales, UK. Public Health Nutrition. 2011;14(2):219-226.
12 Ask 2006 - Ask AS, Hernes S, Aarek I, Johannessen G, Haugen M. Changes in dietary pattern in 15 year old adolescents following a 4 month dietary intervention with school breakfast: A pilot study. Nutrition Journal. 2006;5:33.
13 ERS-Fox 2004 - Fox M, Hamilton W, Lin B. Effects of food assistance and nutrition programs on nutrition and health: Volume 4, Executive summary of the literature review. Economic Research Service (ERS), Food Assistance and Nutrition Research Reports. 2004;19(4):1-10.
14 Anzman-Frasca 2015 - Anzman-Frasca S, Djang HC, Halmo MM, Dolan PR, Economos CD. Estimating impacts of a breakfast in the classroom program on school outcomes. JAMA Pediatrics. 2015;169(1):71-77.
15 Imberman 2014 - Imberman SA, Kugler AD. The effect of providing breakfast in class on student performance. Journal of Policy Analysis and Management. 2014;33(3):669-699.
16 Leos-Urbel 2013 - Leos-Urbel J, Schwartz AE, Weinstein M, et al. Not just for poor kids: The impact of universal free school breakfast on meal participation and student outcomes. Economics of Education Review. 2013;36:88-107.
17 Mhurchu 2012 - Mhurchu NC, Gorton D, Turley M, et al. Effects of a free school breakfast programme on children's attendance, academic achievement and short-term hunger: Results from a stepped-wedge, cluster randomised controlled trial. Journal of Epidemiology & Community Health. 2012:6-13.
18 USDA-Bartfeld 2009 - Bartfeld J, Kim M, Ryu JH, Ahn H-M. The School Breakfast Program: Participation and impacts. Washington, D.C.: U.S. Department of Agriculture (USDA), Economic Research Service (ERS); 2009.
19 Bartfeld 2011 - Bartfeld JS, Ahn H-M. The School Breakfast Program strengthens household food security among low-income households with elementary school children. Journal of Nutrition. 2011;141(3):470–5.
20 Gundersen 2015 - Gundersen C. Food assistance programs and child health. The Future of Children: Policies to Promote Child Health. The Woodrow Wilson School of Public and International Affairs at Princeton University, The Brookings Institution. 2015:25(1):91-109.
21 Fletcher 2017 - Fletcher JM, Frisvold DE. The relationship between the school breakfast program and food insecurity. The Journal of Consumer Affairs. 2017;51(3):481-500.
22 Wang 2017 - Wang S, Schwartz MB, Shebl FM, et al. School breakfast and body mass index: A longitudinal observational study of middle school students. Pediatric Obesity. 2017;12(3):213-220.
23 Au 2018 - Au LE, Gurzo K, Gosliner W, et al. Eating school meals daily is associated with healthier dietary intakes: The healthy communities study. Journal of the Academy of Nutrition and Dietetics. 2018;118(8):1474-1481.e1.
24 Capogrossi 2017 - Capogrossi K, You W. The influence of school nutrition programs on the weight of low-income children: A treatment effect analysis. Health Economics. 2017;26(8):980-1000.
25 Sudharsanan 2016 - Sudharsanan N, Romano S, Cunningham SA. School breakfast receipt and obesity among American fifth- and eighth-graders. Journal of the Academy of Nutrition and Dietetics. 2016;116(4):599-607.e3.
26 Gleason 2009 - Gleason PM, Hedley-Dodd A. School breakfast program but not school lunch program participation is associated with lower body mass index. Journal of the American Dietetic Association. 2009;109(2 Suppl):S118–28.
27 Millimet 2010 - Millimet DL, Tchernis R, Husain M. School nutrition programs and the incidence of childhood obesity. The Journal of Human Resources. 2010;45(3):640-654.
28 NBER-Schazenbach 2014 - Schanzenbach DW, Zaki M. Expanding the school breakfast program: Impacts on children's consumption, nutrition and health. National Bureau of Economic Research (NBER). 2014: Working Paper 20308.
29 Crepinsek 2006 - Crepinsek MK, Singh A, Bernstein LS, McLaughlin JE. Dietary effects of universal-free school breakfast: Findings from the evaluation of the school breakfast program pilot project. Journal of the American Dietetic Association. 2006;106(11):1796-1803.
30 Polonsky 2019 - Polonsky HM, Bauer KW, Fisher JO, et al. Effect of a breakfast in the classroom initiative on obesity in urban school-aged children: A cluster randomized clinical trial. Journal of American Medical Association (JAMA) Pediatrics. 2019;173(4):326-333.
31 Corcoran 2016 - Corcoran SP, Elbel B, Schwartz AE. The effect of breakfast in the classroom on obesity and academic performance: Evidence from New York City. Journal of Policy Analysis and Management. 2016;35(3):509-532.
32 USDA-Bernstein 2004 - Bernstein LS, McLaughlin JE, Crepinsek MK, et al. Evaluation of the School Breakfast Program pilot project: Final report. Alexandria: Office of Analysis, Nutrition, and Evaluation, Food and Nutrition Service, U.S. Department of Agriculture (USDA); 2004.
33 Ritchie 2016 - Ritchie LD, Rosen NJ, Fenton K, et al. School breakfast policy is associated with dietary intake of fourth- and fifth-grade students. Journal of the Academy of Nutrition and Dietetics. 2016;116(3):449-457.
34 Lopez-Neyman 2016 - Lopez-Neyman SM, Warren CA. Barriers and advantages to student participation in the school breakfast program based on the social ecological model: A review of the literature. The Journal of Child Nutrition and Management. 2016;40(2):1-13.
35 Brookings-Bauer 2016 - Bauer L, Schanzenbach DW. Are nutrition policies making teenagers hungry? Washington, D.C.: Brookings Institution; 2016.
36 Basch 2011 - Basch CE. Breakfast and the achievement gap among urban minority group. Journal of School Health. 2011;81(10):635-40.
37 Lundqvist 2018 - Lundqvist M, Vogel NE, Levin LA. Effects of eating breakfast and school breakfast programmes on children and adolescents: A systematic review. Center for Medical Technology Assessment. 2018:47.
38 Rampersaud 2005 - Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. Journal of the American Dietetic Association. 2005;105(5):743-760.
39 USDA-SBP - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). School Breakfast Program (SBP).
40 NCSL Winterfeld 2014b - Winterfeld A. State legislators: Champions of breakfast at school. Healthy Communities Legislative Action Bulletin 6: School Breakfast. National Conference of State Legislatures (NCSL). 2014;1(6).
41 NCSL-SBP guide - National Conference of State Legislatures (NCSL). A guide to the School Breakfast Program.
42 USDA-Meal reimbursement - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). National School Lunch Program and School Breakfast Program rates of reimbursement.
43 CDC-School nutrition 2019 - Centers for Disease Control and Prevention (CDC). Comprehensive framework for addressing the school nutrition environment and services. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.
Related What Works for Health Strategies
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