Kids Selected Healthier Foods After Changes to School Lunch Program, Study Finds

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Study finds kids in an urban district picked healthy food after changes to the school lunch program, but it doesn't measure whether they ate it.

With results that will be hotly debated by both sides of the school lunch debate, a long-term study published today by JAMA Pediatrics found that middle and high school students from an urban district made healthier food choices and stuck with their lunch program despite changes brought about by the federal government’s 2010 nutritional overhaul.1

With the 2015 Dietary Guidelines for Americans due at any time, a major change brought about by the 2010 version—the Healthy Hunger-Free Kids Act—remains a point of contention in lunchrooms and with the Congress, which has delayed requirements concerning whole grains and sodium following complaints that cafeteria programs were losing money and many kids wouldn’t eat the food.

Today’s results will be touted by supporters of the Act as evidence that sticking with healthy food works for kids if the grown-ups are willing to stick with it. The authors, led by Donna B. Johnson, PhD, studied data of food selected by students from 3 middle schools and 3 high schools in an urban district from 2011 to 2014.

They found that nutrient density levels increased with the new standards, from a mean adequacy ratio of 58.7 before the new standards took effect in 2012-2013, to a mean adequacy ratio of 75.6 after they took effect.

Meanwhile, the energy density—in other words, the calories—decreased with the new standards from a mean of 1.65 before the new standards to 1.44 after they took effect.


Participation rates did not change, with 47% taking part in the lunch program (range 40.4% to 49.5%) before implementation of the new standards, and 46% afterward (range 39.1% to 48.2%).

An accompanying editorial states that the study “supports other cross-sectional and survey-based studies that demonstrate significant improvements in the nutritional composition of school meals and healthier food consumption among students,” following the changes to the National School Lunch Program, which was part of the Obama Administration’s broader agenda to combat childhood obesity.2

But critics of the 2010 Act will likely take issue with some elements of the study. As previously reported by Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care, the loudest complaints about the school lunch changes came not from urban districts, similar to the one in today’s study, but from suburban districts, where students have more ability to bring lunch from home or buy it off campus in districts where that is permitted.

Also, the school lunch rules require students to place certain healthy items on their trays whether they are eaten or not. Complaints about “plate waste,” which drive up disposal costs for districts, have been equally loud as those about the nutritional standards.

Today’s study notably does not measure consumption, and even states that, “Many of the previous studies sacrificed sample size to measure not only food selection but also consumption.” The authors cite other research that ties portion size to the likelihood of greater consumption to assume this is the case.

The researchers’ findings are based on district data of foods selected, and they do not state whether they attempted to gain access to figures on increases or decreases in cafeteria waste.

In October, a report from the Government Accountability Office (GAO) found that there had been progress in getting school children to accept the new school lunch standards, but that it had not been easy. While there had been a 4.5% overall decline, from just over 62% to 58%, numerous reports suggest the declines have been sharpest in wealthier communities. Because these areas tend to be represented by Republicans in Congress, their representatives have been more willing to roll back some elements of the 2010 legislation that set the nutritional changes in motion.

Some of the harshest criticism of the new standards has come from the School Nutrition Association, which supported the original legislation. But the SNA is not without its own controversy in the matter. As noted in the book, Soda Politics, published in October by nutrition scholar Marion Nestle, PhD, the SNA derives half its income from food industry donations.


1. Johnson DB, Podrabsky M, Rocha A, Otten JJ. Effect of the Healthy Hunger-Free Kids Act on the nutritional quality of meals selected by students and school lunch participation rates [published online January 4, 2016]. JAMA Pediatr. 2016; doi:10.10001/jamapediatrics.2015.3918.

2. Hager ER, Turner L. Successes of the Healthy Hunger-Free Kids Act [published online January 4, 2016]. JAMA Pediatr. 2016;doi:10.10001/jamapediatrics.2015.4268.