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 years1. Regulations for the availability and nutritional content of competitive foods vary by state and community.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased healthy food consumption
Increased healthy food purchases
Improved dietary choices
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved nutrition
Improved weight status
Increased academic achievement
Increased food security
Reduced emissions
What does the research say about effectiveness? This strategy is rated some evidence.
There is some evidence that healthy school lunch initiatives increase healthy food selection and consumption, and improve students’ eating behaviors2, 3, 4, 5. Such initiatives can also improve childhood nutrition3. Additional evidence is needed to confirm effects2.
Small modifications to the school lunch environment such as pre-slicing fruit in middle schools can increase students’ selection and consumption of healthy food, and decrease plate waste6. Verbal prompts alone can also increase fruit consumption7. 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 lunches4. Reducing availability of sugar-sweetened beverages and french fries as part of a healthy school lunch initiative is also associated with improved dietary intake8. 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 alone9.
Healthier school lunches can improve academic outcomes and reduce authorized absences related to illness10. Healthy school lunch initiatives have been associated with increased free National School Lunch Program (NSLP) participation11. Many school districts report increased participation following implementation of the Healthy, Hunger-Free Kids Act of 2010 (HHFKA)12, 13.
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 students14. Offering healthy, culturally relevant foods can increase participation in such programs11; a culturally sensitive approach is suggested to increase effectiveness of obesity prevention efforts such as healthy school lunch initiatives15, 16.
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 consumption17. 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 families with lower incomes14. Careful implementation of HHFKA and healthy school lunch initiatives is necessary to maintain gains in food security realized through the NSLP18.
Healthy school lunch initiatives may reduce food waste and increase cooking from scratch with fresh, seasonal produce, which may reduce emissions from fossil fuels used to produce, process, and transport food19, 20, 21, 22, 23. Such initiatives may also reduce the energy intensity of an individual’s diet if more plant-based foods are consumed in place of animal products19, 24.
Many aspects of healthy school lunch initiatives are low cost, easy to implement, and scalable, such as attractive displays, verbal prompts, and pre-slicing6, 7. Cooking from scratch can also be cost-effective; lower food costs and higher labor costs often lead to small changes in total costs25. 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 initiatives26.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
In 2019, 40 states and Washington DC proposed legislation and 16 states passed legislation to support school nutrition and healthy school lunches, including proposals to enhance farm to school programs, local procurement incentives, organic food purchasing, vegetarian lunch options, and school garden programs. Many proposed bills also intend to reduce single use plastic straws and containers in food service establishments including school food service operations27. As of 2013, 28 states and Washington DC authorized funding for school nutrition grants to improve the school food environment or passed school nutrition legislation. These state actions complement the nutrition standards outlined by the 2010 federal Healthy, Hunger-Free Kids Act (HHFKA)28. According to the USDA, over 90% of schools meet the HHFKA standards, and only 0.15% of schools have opted out of the National School Lunch Program following implementation12.
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)29.
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 state30. 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 schools31. In Massachusetts, Project Bread’s Chefs in Schools program helps school kitchen staff learn to prepare healthy meals and supports farm to school efforts32. Let’s Move Salad Bars to Schools has donated almost 6,000 salad bars to schools across the country33. In Colorado, The Lunch Box’s Rainbow Day program encourages students to eat from the salad bars in their school lunchrooms34.
Implementation Resources
USDA-NSLP - US Department of Agriculture (USDA). National School Lunch Program (NSLP).
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-Resources - University of Michigan, School of Public Health. Youth Empowered Solutions (YES). Resources.
CSPI-School meals - Center for Science in the Public Interest (CSPI). Model school wellness policies: School meals.
MD DOE-Cafeteria toolkit - Maryland State Department of Education (MD DOE), University of Maryland-Extension. Project ReFresh: Cafeteria toolkit. Team Nutrition; 2010.
ISU-Food and sustainability resources - Iowa State University (ISU), Sustainable Food Processing Alliance. Online resources for food and sustainability.
Footnotes
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1 USDA-HHFKA - US Department of Agriculture (USDA). School meals: Healthy, Hunger-Free Kids Act (HHFKA).
2 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.
3 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
4 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.
5 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.
6 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.
7 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.
8 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.
9 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.
10 Belot 2011 - Belot M, James J. Healthy school meals and educational outcomes. Journal of Health Economics. 2011;30(3):489-504.
11 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.
12 USDA-HHFKA implementation 2014 - US Department of Agriculture (USDA). Fact sheet: Healthy, Hunger-Free Kids Act school meals implementation. Release No. 0098.14;2014.
13 Pew-School food 2012 - The Pew Charitable Trusts (Pew). School food success stories. 2012.
14 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.
15 CDC-Health equity resources - Centers for Disease Control and Prevention (CDC). Health equity resource toolkit for state practitioners addressing obesity disparities.
16 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.
17 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.
18 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.
19 Ringling 2020 - Ringling KM, Marquart LF. Intersection of diet, health, and environment: Land grant universities’ role in creating platforms for sustainable food systems. Frontiers in Sustainable Food Systems. 2020;4(70).
20 FAO-Food waste - Food and Agriculture Organization of the United Nations (FAO). Food wastage footprint & climate change.
21 Hic 2016 - Hic C, Pradhan P, Rybski D, Kropp JP. Food surplus and its climate burdens. Environmental Science and Technology. 2016;50(8):4269-4277.
22 SSSA-McIvor 2017 - McIvor K. Soils in the city: Community gardens. Soil Science Society of America (SSSA). 2017.
23 CCAFS-Campbell 2012 - Campbell B. Is eating local good for the climate? Thinking beyond food miles. Research Program on Climate Change, Agriculture and Food Security (CCAFS), CGIAR Research Programs. 2012.
24 Hamerschlag 2017 - Hamerschlag K, Kraus-Polk J. Shrinking the carbon and water footprint of school food: A recipe for combating climate change. A pilot analysis of Oakland Unified School District's food programs. Friends of the Earth; February 2017.
25 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.
26 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.
27 SNA-2019 legislation - School Nutrition Association (SNA). 2019 state legislative summary: Year-end report.
28 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.
29 BTG-Turner 2015 - Turner L, Chaloupka F. Improvements in school lunches result in healthier options for millions of US 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.
30 AFHG-Lunch - Alliance for a Healthier Generation (AFHG). Breakfast and lunch.
31 Orfalea-School food - Orfalea Foundation. School food initiative.
32 Project Bread-Chefs in schools - Project Bread. Chefs in schools: Improving the quality of food for kids. East Boston, MA.
33 SB2S-Salad bar - Salad Bars to Schools (SB2S). Get a salad bar in your school.
34 The Lunch Box-Rainbow days - The Lunch Box. Lunchroom education: Rainbow days.
Related What Works for Health Strategies
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