Healthy school lunch initiatives

Healthy school lunch initiatives modify the food environment during school lunch periods, prominently displaying, marketing, and increasing the convenience of healthy foods and providing many healthy options, especially fresh, whole foods and foods cooked from scratch. Healthy school lunch initiatives can focus on food served through the National School Lunch Program (NSLP) as well as competitive or à la carte offerings. Under the Healthy, Hunger-Free Kids Act (HHFKA) of 2010’s strengthened nutrition standards, NSLP meals include more whole grains, fruits and vegetables, low-fat milk and dairy products, and less sodium and fat than previous years (USDA-HHFKA). Regulations for the availability and nutritional content of competitive foods vary by state and community. 

Expected Beneficial Outcomes (Rated)

  • Increased healthy food consumption

  • Increased healthy food purchases

  • Improved dietary choices

Other Potential Beneficial Outcomes

  • Improved nutrition

  • Improved weight status

  • Increased academic achievement

  • Increased food security

Evidence of Effectiveness

There is some evidence that healthy school lunch initiatives increase healthy food selection and consumption, and improve students’ eating behaviors (Driessen 2014*, Williamson 2013*, Cohen 2013*, Hanks 2013*). Such initiatives can also improve childhood nutrition (Williamson 2013*). Additional evidence is needed to confirm effects (Driessen 2014*).

Small modifications to the school lunch environment that are appropriate to the age of the students, such as pre-slicing fruit in middle schools and giving vegetables appealing names (e.g., X-Ray Vision Carrots) in elementary schools can increase students’ selection and consumption of healthy food, and decrease plate waste (Wansink 2013*, Wansink 2012*). Verbal prompts alone can also increase fruit consumption (Schwartz 2007). Students participating in Chef Initiative healthy school lunch programs have been shown to consume more fiber, vitamin C, and vitamin A and waste fewer vegetables than peers in schools with traditional school lunches (Cohen 2013*). Reducing availability of sugar-sweetened beverages and french fries as part of a healthy school lunch initiative is also associated with improved dietary intake (Briefel 2009*). Healthy school lunch initiatives that combine cafeteria environment improvements with classroom nutrition education improve fruit and vegetable consumption and dietary choices more than cafeteria improvements alone (Song 2016*).

Healthier school lunches can improve academic outcomes and reduce authorized absences related to illness (Belot 2011*). Healthy school lunch initiatives have been associated with increased free National School Lunch Program (NSLP) participation (Wojcicki 2006*). Many school districts report increased participation following implementation of the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) (USDA-HHFKA implementation 2014, Pew-School food 2012).

Schools with a majority of students (two-thirds or more) eligible for free and reduced-price lunch (FRPL) report more participation in healthy school lunch programs and less plate waste than schools with fewer FRPL eligible students (BTG-Terry-McElrath 2014). Offering healthy, culturally relevant foods can increase participation in such programs (Wojcicki 2006*); a culturally sensitive approach is suggested to increase effectiveness of obesity prevention efforts such as healthy school lunch initiatives (CDC-Health equity resources, NRC NPAA-Cultural diversity).

Early examinations of HHFKA suggest that strengthened school lunch standards increase fruit consumption, reduce plate waste (especially vegetables and entrees), and do not change milk consumption (Schwartz 2015). Surveys suggest that changes in plate waste may vary, with the least waste reported at urban and suburban elementary and middle schools with a large proportion of students from lower income families (BTG-Terry-McElrath 2014). Careful implementation of HHFKA and healthy school lunch initiatives is necessary to maintain gains in food security realized through the NSLP (Gundersen 2015).

Many aspects of healthy school lunch initiatives are low cost, easy to implement, and scalable, such as appealing names, attractive displays, verbal prompts, and pre-slicing (Wansink 2012*, Wansink 2013*, Schwartz 2007). Cooking from scratch can also be cost-effective; lower food costs and higher labor costs often lead to small changes in total costs (Woodward-Lopez 2014*). Inadequate equipment, kitchen infrastructure, and staff training to support new cooking, food safety, equipment operation, and healthy food promotion responsibilities along with revisions to menu development and food purchasing processes can be challenges for healthy school lunch initiatives (Pew-Urahn 2013).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2013, 28 states and Washington DC have authorized funding for school nutrition grants to improve the school food environment or passed school nutrition legislation. These state actions complement the new nutrition standards outlined by the 2010 federal Healthy, Hunger-Free Kids Act (HHFKA) (NCSL Winterfeld 2014a). According to the USDA, over 90% of schools already meet the new HHFKA standards, and only 0.15% of schools have opted out of the NSLP following implementation (USDA-HHFKA implementation 2014).

More public elementary schools offered school lunches with healthy foods in the 2013-14 school year than the 2006-07 school year. The portion of schools serving whole grains, for example, increased from 76% to 97%, those serving vegetables (other than potatoes) increased from 74% to 83%, fresh fruit from 61% to 80%, and the portion of schools with salad bars increased from 17% to 31%. Unhealthy foods also decreased during this time period. Just over half (53%) of elementary schools always offered fried potatoes (73% in 2008-09); 37% of schools always offered higher-fat pizza (down from 70% in 2010-11), and 35% of schools always offered higher-fat milk (down from 79% in 2006-07) (BTG-Turner 2015).

Many non-profit organizations support healthy school lunch initiatives. The Alliance for a Healthier Generation, for example, supports efforts in over 28,000 schools, touching every state (AFHG-Lunch). Santa Barbara’s School Food Initiative features a Culinary Boot Camp and kitchen staff training to bring cooked from scratch lunches into Santa Barbara public schools (Orfalea-School food). In Massachusetts, Project Bread’s Chefs in Schools program helps school kitchen staff learn to prepare healthy meals and supports farm to school efforts (Project Bread-Schools). Let’s Move Salad Bars to Schools has donated over 4,000 salad bars to schools across the country (SB2S-Salad bar). In Colorado, The Lunch Box’s Rainbow Day program encourages students to eat from the salad bars in their school lunchrooms (The Lunch Box-Rainbow days). 

Implementation Resources

USDA-NSLP - US Department of Agriculture (USDA). National School Lunch Program (NSLP).

USDA-HMRS - US Department of Agriculture (USDA). Team Nutrition: Healthy meals resource system (HMRS).

SLI-Resources - School Lunch Initiative (SLI), Center for Ecoliteracy, The Edible Schoolyard Project. Resources.

AFHK-Smarter lunchrooms - Action for Healthy Kids (AFHK). Smarter lunchrooms.

The Lunch Box-Tools - The Lunch Box. Tools for school food change.

Pew-KSHFP - The Pew Charitable Trusts (Pew), Robert Wood Johnson Foundation. Kids' safe and healthful foods project (KSHFP).

CDC-School nutrition environment - Centers for Disease Control and Prevention (CDC). CDC healthy schools: School nutrition environment.

RWJF-Healthy schools - Robert Wood Johnson Foundation (RWJF). Healthy school environments: Building a culture of health in US schools.

ChangeLab-Healthy food at schools - ChangeLab Solutions. Healthy food at schools: A webinar on how to provide healthier school food options.

YES!-Toolkits - Youth Empowered Solutions (YES!). Toolkits and resources.

CSPI-School meals - Center for Science in the Public Interest (CSPI). Model school wellness policies: School meals.

USDA-Cafeteria toolkit - US Department of Agriculture (USDA), Maryland State Department of Education, University of Maryland-Extenstion. Project ReFresh: Cafeteria toolkit. Team Nutrition; 2010.

Citations - Evidence

* Journal subscription may be required for access.

Driessen 2014* - Driessen CE, Cameron AJ, Thornton LE, Lai SK, Barnett LM. Effect of changes to the school food environment on eating behaviours and/or body weight in children: A systematic review. Obesity Reviews. 2014;15(12):968-982.

Williamson 2013* - Williamson DA, Han H, Johnson WD, Martin CK, Newton RL. Modification of the school cafeteria environment can impact childhood nutrition. Results from the Wise Mind and LA Health studies. Appetite. 2013;61(1):77–84

Cohen 2013* - Cohen JFW, Richardson S, Austin SB, Economos CD, Rimm EB. School lunch waste among middle school students: Nutrients consumed and costs. American Journal of Preventive Medicine. 2013;44(2):114-121.

Hanks 2013* - Hanks AS, Just DR, Wansink B. Smarter lunchrooms can address new school lunchroom guidelines and childhood obesity. Journal of Pediatrics. 2013;162(4):867-869.

Wansink 2013* - Wansink B, Just DR, Hanks AS, Smith LE. Pre-sliced fruit in school cafeterias: Children's selection and intake. American Journal of Preventive Medicine. 2013;44(5):477-480.

Wansink 2012* - Wansink B, Just DR, Payne CR, Klinger MZ. Attractive names sustain increased vegetable intake in schools. Preventive Medicine. 2012;55(4):330-332.

Schwartz 2007 - Schwartz MB. The influence of a verbal prompt on school lunch fruit consumption: A pilot study. International Journal of Behavioral Nutrition and Physical Activity. 2007;4(1):6.

Briefel 2009* - Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of US public school children. Journal of the American Dietetic Association. 2009;109(2 Suppl):S91-107.

Song 2016* - Song HJ, Grutzmacher S, Munger AL. Project ReFresh: Testing the efficacy of a school-based classroom and cafeteria intervention in elementary school children. Journal of School Health. 2016;86(7):543-551.

Belot 2011* - Belot M, James J. Healthy school meals and educational outcomes. Journal of Health Economics. 2011;30(3):489-504.

Wojcicki 2006* - Wojcicki JM, Heyman MB. Healthier choices and increased participation in a middle school lunch program: Effects of nutrition policy changes in San Francisco. American Journal of Public Health. 2006;96(9):1542-1547.

USDA-HHFKA implementation 2014 - US Department of Agriculture (USDA). Fact sheet: Healthy, Hunger-Free Kids Act school meals implementation. Release No. 0098.14;2014.

Pew-School food 2012 - The Pew Charitable Trusts (Pew). School food success stories. 2012.

BTG-Terry-McElrath 2014 - Terry-McElrath YM, Turner L, Colabianchi N, et al. Student reactions during the first year of updated school lunch nutrition standards: A Bridging The Gap research brief. Ann Arbor, MI: Bridging the Gap Program (BTG), Institute for Social Research, University of Michigan. 2014.

CDC-Health equity resources - Centers for Disease Control and Prevention (CDC). Health equity resource toolkit for state practitioners addressing obesity disparities.

NRC NPAA-Cultural diversity - National Resource Center on Nutrition, Physical Activity & Aging (NRC NPAA). Creative solutions: Cultural diversity as part of nutrition education and counseling.

Schwartz 2015 - Schwartz MB, Henderson KE, Read M, Danna N, Ickovics JR. New school meal regulations increase fruit consumption and do not increase total plate waste. Childhood Obesity. 2015;20(10):1-6.

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.

Woodward-Lopez 2014* - Woodward-Lopez G, Kao J, Kiesel K, et al. Is scratch-cooking a cost-effective way to prepare healthy school meals with US Department of Agriculture foods? Journal of the Academy of Nutrition and Dietetics. 2014;114(9):1349-1358.

Pew-Urahn 2013 - Urahn S, Olson E, Thomas K, et al. Serving healthy school meals despite challenges: Schools meet USDA meal requirements. The Pew Charitable Trusts (Pew), Robert Wood Johnson Foundation, Kids' Safe and Healthful Foods Project Report. 2013.

Citations - Implementation Examples

* Journal subscription may be required for access.

NCSL Winterfeld 2014a - Winterfeld A. State actions to reduce and prevent childhood obesity in schools and communities: Summary and analysis of trends in legislation. National Conference of State Legislators (NCSL); 2014.

USDA-HHFKA implementation 2014 - US Department of Agriculture (USDA). Fact sheet: Healthy, Hunger-Free Kids Act school meals implementation. Release No. 0098.14;2014.

BTG-Turner 2015 - Turner L, Chaloupka F. Improvements in school lunches result in healthier options for millions of U.S. children: Results from public elementary schools between 2006-07 and 2013-14. Chicago: Bridging the Gap Program (BTG), Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2015.

AFHG-Lunch - Alliance for a Healthier Generation (AFHG). Breakfast and lunch.

Orfalea-School food - Orfalea Foundation. School food initiative.

Project Bread-Schools - Project Bread. Children and schools: Our initiatives.

SB2S-Salad bar - Salad Bars to Schools (SB2S). Get a salad bar in your school.

The Lunch Box-Rainbow days - The Lunch Box. Lunchroom education: Rainbow days.

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