The Gillings Sustainable Agriculture Project: A Gillings Innovative Laboratory


Cafeteria Lunches: Taking it One Tray at a Time

By Megan DeMaria

What are some current issues that can be addressed by improving school lunches?

  • The National School Lunch Program (NSLP) has found there to be a school meal “trilemma” involving the meal’s nutritional quality, program cost, and student participation. All of these are barriers to the health and wellness of students nationwide.9
  • From 1995 to 2004, prevalence of obesity in children aged 11 to 15 has increased from about 14% to 24%. In the 2 to 10-year-old age range, obesity rates jumped from 10% in 1995 to 16% in 2004. 6
  • Short-term consequences of childhood obesity include low self-esteem, lacking energy in the classroom and at recess, high blood pressure, and asthma, to name a few.6
  • Long-term consequences of obesity include diabetes, liver damage, cardiovascular issues, sleep apnea, and preoccupation with weight that could potentially lead to an eating disorder or other psychological illness. 7
  • A study of Michigan sixth graders found that regularly consuming school lunches was a greater risk factor for obesity than spending two or more hours a day watching TV or playing video games. 10

Figure 1. Obesity rates by state, children aged 10 to 17, 2007 (Source: Child Policy Research Center)

Why should efforts be invested into creating healthier school lunches?

  • The $9.8 billion federal school lunch program feeds roughly 32 million American schoolchildren every single day and therefore has the power to positively impact students’ health. 10
  • Improving school lunches is one way to combat the rapidly rising rates of childhood obesity by impacting a large number of children across socioeconomic status, race, and geographic boundaries.5,11
  • In one school-based prevention effort, after two years of serving cafeteria lunches that were lower in fat and included more fruits and vegetables, prevalence of obesity, especially in girls, significantly decreased.1

Barriers to healthy eating in schools and how to overcome them:

  • In order to minimize the risk that students will reject new, healthy choices, conduct a school-wide taste test before implementation.8
  • Modify food items that students already enjoy. For example, keep pizza, but tweak the recipe to include whole-grain crust, low-fat cheese, and vegetable toppings.2
  • Simplify access to free or reduced school meals so that cost does not discourage lower-income families from supporting school lunch improvements.8

There are numerous ways to create healthier cafeterias:

  • Eliminate drinks high in sugar from the lunch line and instead serve low-fat milk and water.3
  • Ensure that portion sizes are not too big for young children and establish calorie maximums.3
  • Stock cafeteria vending machines with healthier choices such as roasted nuts, whole-grain pretzels, and string cheese. Eliminate items such as candy, cookies, and chips.4

Overall goals of a healthier school lunch program:

  • To combat as well as prevent childhood obesity, which is defined as a body mass index that surpasses the 95th percentile of a fixed distribution for a child’s age and gender.11
  • To help students function optimally both in the present and in the future by introducing healthy eating habits that can last throughout their lives.
  • To create and sustain healthy body image and high self-esteem by showing children that they are responsible for their own health and wellness.

Resources

1 Ebbeling, Cara B., Dorota B. Pawlak, and David S. Ludwig “Childhood Obesity: Public-health Crisis, Common Sense Cure.” Lancet 360.9331 (2002): 473-482. Print. 2 United States General Accounting Office: School Lunch Program Report. May 2003. 6 Apr. 2012 <http://www.gao.gov/new.items/d03506.pdf&gt;.

2 United States General Accounting Office: School Lunch Program Report. May 2003. 6 Apr. 2012 <http://www.gao.gov/new.items/d03506.pdf&gt;.

3 Schneider, M. et al “Rationale, Design and Methods for Process Evaluation in the HEALTHY Study.” National Institute of Health 33.4 (2009): 60-67. Print. 4 Stewart, Kimberly L. “School Lunches: Working to Provide Healthier Alternatives.” Better Nutrition Sep. 2009: 1-3. Print. 5 Stewart, Laura. “Childhood Obesity.” Medicine 39.1 (2011): 42-44. Print.

4 Stewart, Kimberly L. “School Lunches: Working to Provide Healthier Alternatives.” Better Nutrition Sep. 2009: 1-3. Print. 5 Stewart, Laura. “Childhood Obesity.” Medicine 39.1 (2011): 42-44. Print.

6 Buttriss, J. L. “Stark Reality – Statistics on Childhood Obesity.” Nutrition Bulletin 25 Aug. 2006: 175-177. Print.

7 Dietz, W. H. “Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease.” Pediatrics (1998): 518-525. Print.

8 “Official Points to Progress on Child Nutrition Act.” Nutrition Week 22 Aug. 2011: 5-7. Print.

9 Ralston, Katherine et al “The National School Lunch Program: Background, Trends, and Issues.” USDA Economic Research Report 61 (2008): 1-40. Print.

10 Hinman, Kristen. “The School Lunch Wars.” Wilson Quarterly 35.2 (2011): 16. Print..

11 Schanzenbach, Diane W. “Do School Lunches Contribute to Childhood Obesity?” Journal of Human Resources 44.3 (2009): 684-709. Print.

Nutrition 245 Annotated Bibliography

Ebbeling, Cara B., Dorota B. Pawlak, and David S. Ludwig “Childhood Obesity: Public-health Crisis, Common Sense Cure.” Lancet 360.9331 (2002): 473-482. Print.

This article details the many complications of obesity and how they relate specifically to children. The authors outline their idea of a common sense approach to combatting the rising childhood obesity rates, and this approach includes facets relating to home, school, media and marketing, politics, and health care. For my fact sheet I was most interested in the school- based approaches, which involved establishing stricter standards for school lunches and offering healthier vending machine items. This article also detailed a two-year study in which the serving of healthier cafeteria lunches (lower in fat and more fruits and vegetables) significantly decreased the prevalence of obesity in the participants. I found this article after searching the PsycINFO database.

United States General Accounting Office: School Lunch Program Report. May 2003. 6 Apr. 2012 <http://www.gao.gov/new.items/d03506.pdf&gt;.

This report was particularly helpful for my research in that it candidly discussed the risks that come with modifying an already existing nationwide school lunch program while also offering helpful suggestions for realistic improvements. It also stated relevant statistics, like the fact that the childhood obesity rate has doubled since 1980 (it is now at 15%). The report’s suggestions for reducing this rate went beyond the cafeteria, imploring parents to get involved and encouraging teachers to incorporate more physical activity during recess. I found this report by searching the EBSCOhost database.

Schneider, M. et al “Rationale, Design and Methods for Process Evaluation in the HEALTHY Study.” National Institute of Health 33.4 (2009): 60-67. Print.

I found this article by searching PubMed Central. It details a study called “HEALTHY” in which researchers wanted to see if a 3-year-school-based nutrition intervention would reduce risk factors for type 2 diabetes in middle school students. It offered some tips that I found to be helpful for my fact sheet, for example, eliminating sugary drinks such as juices and sodas from the lunch line and also establishing calorie maximums for school lunches, which is something I had not previously thought of. This article was a great practical guide to successfully implementing school-based nutrition interventions.

Stewart, Kimberly L. “School Lunches: Working to Provide Healthier Alternatives.” Better Nutrition Sep. 2009: 1-3. Print.

I found this article by searching the EBSCOhost database. Stewart makes some great points when discussing who needs to get involved in school lunch reform, noting that it is not the sole responsibility of one person or organization but rather should involve combined efforts from policy makers, school faculty, students, and parents. She also gave practical tips for getting healthier foods into schools, for example, taking junk food out of school vending machines and replacing it with options such as nuts, pretzels, or even low-fat string cheese. This article really emphasized that school lunch reform will only come as a result of joint efforts, which I think is important to keep in mind so as to avoid placing the responsibility on only one group.

Stewart, Laura. “Childhood Obesity.” Medicine 39.1 (2011): 42-44. Print. This article was found by searching PSYCinfo, and it highlighted the health consequences associated with obesity

along with the many ways in which we can try to lower the prevalence, school lunches included. The article emphasized the importance of taking a multi-component approach, including not only healthier cafeteria lunches but also behavioral changes such as increased physical activity and parent awareness. Many parents do not know that their own child is considered obese, nor are they aware of the associated health issues. Programs that target increased physical activity, improved nutrition (especially in schools), and raising awareness seem to be the most promising in terms of effectiveness.

Buttriss, J. L. “Stark Reality – Statistics on Childhood Obesity.” Nutrition Bulletin 25 Aug. 2006: 175-177. Print. This article was found by searching through UNC Libraries for peer-reviewed articles, and it contained many eye-

opening statistics on obesity that I included in my fact sheet. The article states that from 1995 to 2004, prevalence of obesity in children aged 11 to 15 increased from about 14% to 24%. Also, in the 2 to 10-year-old age range, obesity rates rose from 10% in 1995 to 16% in 2004. These statistics leave little room to argue that obesity is not an increasingly prevalent issue among children. The article also listed several consequences of childhood obesity, including health complications such as high blood pressure, asthma, and cardiovascular issues. It also noted that there are many psychosocial problems that can arise, including low self-esteem, unhealthy body image, or an obsessive preoccupation with body size. All of these are reasons that we need to think of any way possible to lower the prevalence of obesity, especially among children.

Dietz, W. H. “Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease.” Pediatrics (1998): 518- 525. Print.

I found this article by searching the PubMed database. Dietz highlighted some of the long-term consequences of obesity, which I found to be relevant to my fact sheet in that it illustrates the urgency of combatting childhood obesity. Long- term consequences include developing diabetes, having cardiovascular issues, live damage, and sleep apnea along with a host of psychological and social issues. I believe this to be important information when assessing the importance of improving the school lunch program, because school lunches are a major factor in childhood obesity which in turn is a major factor in adult obesity. All of these are linked, thus, preventing obesity in adulthood needs to start with preventing obesity in children.

“Official Points to Progress on Child Nutrition Act.” Nutrition Week 22 Aug. 2011: 5-7. Print. This article pinpointed several barriers that exist on the path to creating healthier cafeterias for our children. It

discussed the Healthy, Hunger-Free Kids Act of 2010 and states that the importance of such legislation should not be underestimated. It also brought up budgeting issues, and noted that Congress may not be inclined to pass similar legislature with the 2012 budget. The author of this article argues that simplify access to free or reduced school meals is critical, so that cost does not discourage lower-income families from supporting school lunch reform. I found the article by searching the UNC Libraries database for information regarding school lunch reform.

Ralston, Katherine et al “The National School Lunch Program: Background, Trends, and Issues.” USDA Economic Research Report 61 (2008): 1-40. Print.

This article discussed the National School Lunch Program (NSLP) which is a huge nutrition assistance program in the United States. It works to provide free or reduced lunches to children, and the article provided several important statistics regarding school lunch trends. It also detailed steps that are currently being taken to improve not only the nutritional quality but also the cost of school lunches nationwide. I found it interesting that they discussed a “trilemma” involving the meal’s nutritional quality, program cost, and student participation. All of these are barriers to the health of students and must be

overcome. This article was found by searching the EBSCOhost database.

Hinman, Kristen. “The School Lunch Wars.” Wilson Quarterly 35.2 (2011): 16. Print. This was a brief yet helpful article, which I found by searching for peer-reviewed articles on the UNC Library website.

It mentioned a study of Michigan sixth-graders that concluded regularly eating school lunches was a greater risk factor for obesity than was playing video games or watching television for two or more hours a day. This was shocking to me, and it stands as evidence that school lunches must be improved nutritionally. Hinman also states the magnitude of the school lunch program- one that feeds around 32 million American children every single day- and discusses how it has the potentially to powerfully impact the health of students.

Schanzenbach, Diane W. “Do School Lunches Contribute to Childhood Obesity?” Journal of Human Resources 44.3 (2009): 684-709. Print.

I found this article by going to UNC Library’s homepage and searching for peer-reviewed articles related to school lunch reform. This article was particularly fascinating in that it brought up the issue of free and reduced lunch, and how that is a major factor to consider when evaluating how to improve the nutritional quality of school lunches. She discusses in detail the policy issues surrounding school lunches, and makes a case for the free and reduced lunch program to be more accessible. However, the author also found that children who buy their lunches have a higher prevalence of obesity than those who bring their own lunch to school, which is her main reason for arguing for healthier lunches.



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