Pediatric Annals

Feature 

Improved Nutrition through School Food Programs

Karin Testa Ballard, MS, RD, LDN

Abstract

Schools certainly face a difficult task when designing a menu that is not only healthful but also cost-effective and appealing. With many students eating two of three daily meals at school, the type of foods eaten at school can drastically impact a child’s nutritional status, both positively and negatively. Consuming foods that are high in calories but low in nutrients can lead to malnutrition as well as to obesity and its related comorbidities. Choosing balanced meals can help to prevent excess weight gain and nutritional deficiencies and can provide kids with much needed energy to get through the demanding school day.

Many students receive their meals at school as part of the National School Lunch Program (NSLP) or the School Breakfast Program. The NSLP is a federally assisted meal program operating in more than 100,000 schools and residential child care institutions.1 In 2011, the NSLP provided low-cost or free lunches to more than 31 million children each school day. The School Breakfast Program is a similar program operating in more than 89,000 schools and institutions.2 Recent legislation, such as The Healthy, Hunger-Free Kids Act of 2010, updated the meal pattern and nutritional standards for both programs based on the latest Dietary Guidelines for Americans, which increases the availability of fruits, vegetables, and whole grains in the school menu. All meals that are served as part of these government programs must meet federal requirements, although decisions about what foods to serve and how they are prepared are made by local school food authorities. Unfortunately, serving balanced meals does not ensure that students are choosing and consuming healthy meals. In addition, the millions of students who do not receive their food through these federal programs are often able to choose meals that are not required to meet any nutritional standards.

To improve the likelihood that children are receiving and eating healthy foods at school, there should be a joint effort between the school and the parents. The 2005 Dietary Recommendations for Children and Adolescents suggest that parents and guardians should be responsible for teaching their children about food and nutrition both at and away from home.3 The guidelines also recommend that parents and guardians serve as role models and lead by example. The following information aims to help children build healthy meals at school, although it can also be applied to meals at home.

MyPlate from choosemyplate.gov, which has replaced the previous food pyramid model, can serve as a template for how to create a balanced tray when in line at the cafeteria.4 The goal is to fill half of the plate with fruits and vegetables, one-quarter of the plate from protein foods, and one-quarter from grains (preferably whole if available) and to include a serving of fat-free or low-fat dairy at each meal. A tray that is filled with fruits and vegetables is a colorful tray, and the colors found in fruits and vegetables signal that they are packed with nutrients. Children should be encouraged to make their trays colorful with at least one to two colors at each meal.

To help children and adolescents make healthier food choices, many popular foods have been categorized into GO, SLOW, and WHOA foods based on the US National Heart, Lung, and Blood Institute and National Institutes of Health guidelines (see Table).5 This method breaks down food choices into foods that are healthy to consume almost anytime (GO foods), foods that are acceptable sometimes/less often (SLOW foods), and foods that are to be eaten only once in a while (ie, on special occasions) and in small portions (WHOA foods).

Table. Examples of GO, SLOW,…


Schools certainly face a difficult task when designing a menu that is not only healthful but also cost-effective and appealing. With many students eating two of three daily meals at school, the type of foods eaten at school can drastically impact a child’s nutritional status, both positively and negatively. Consuming foods that are high in calories but low in nutrients can lead to malnutrition as well as to obesity and its related comorbidities. Choosing balanced meals can help to prevent excess weight gain and nutritional deficiencies and can provide kids with much needed energy to get through the demanding school day.

Many students receive their meals at school as part of the National School Lunch Program (NSLP) or the School Breakfast Program. The NSLP is a federally assisted meal program operating in more than 100,000 schools and residential child care institutions.1 In 2011, the NSLP provided low-cost or free lunches to more than 31 million children each school day. The School Breakfast Program is a similar program operating in more than 89,000 schools and institutions.2 Recent legislation, such as The Healthy, Hunger-Free Kids Act of 2010, updated the meal pattern and nutritional standards for both programs based on the latest Dietary Guidelines for Americans, which increases the availability of fruits, vegetables, and whole grains in the school menu. All meals that are served as part of these government programs must meet federal requirements, although decisions about what foods to serve and how they are prepared are made by local school food authorities. Unfortunately, serving balanced meals does not ensure that students are choosing and consuming healthy meals. In addition, the millions of students who do not receive their food through these federal programs are often able to choose meals that are not required to meet any nutritional standards.

To improve the likelihood that children are receiving and eating healthy foods at school, there should be a joint effort between the school and the parents. The 2005 Dietary Recommendations for Children and Adolescents suggest that parents and guardians should be responsible for teaching their children about food and nutrition both at and away from home.3 The guidelines also recommend that parents and guardians serve as role models and lead by example. The following information aims to help children build healthy meals at school, although it can also be applied to meals at home.

Meal Planning Tips for the School Cafeteria

Create a Balanced Food Tray

MyPlate from choosemyplate.gov, which has replaced the previous food pyramid model, can serve as a template for how to create a balanced tray when in line at the cafeteria.4 The goal is to fill half of the plate with fruits and vegetables, one-quarter of the plate from protein foods, and one-quarter from grains (preferably whole if available) and to include a serving of fat-free or low-fat dairy at each meal. A tray that is filled with fruits and vegetables is a colorful tray, and the colors found in fruits and vegetables signal that they are packed with nutrients. Children should be encouraged to make their trays colorful with at least one to two colors at each meal.

Choose the Healthiest Options on Most Days

To help children and adolescents make healthier food choices, many popular foods have been categorized into GO, SLOW, and WHOA foods based on the US National Heart, Lung, and Blood Institute and National Institutes of Health guidelines (see Table).5 This method breaks down food choices into foods that are healthy to consume almost anytime (GO foods), foods that are acceptable sometimes/less often (SLOW foods), and foods that are to be eaten only once in a while (ie, on special occasions) and in small portions (WHOA foods).

Examples of GO, SLOW, and WHOA Foods Based on the US National Heart, Lung, and Blood Institute and National Institutes of Health Guidelines

Table. Examples of GO, SLOW, and WHOA Foods Based on the US National Heart, Lung, and Blood Institute and National Institutes of Health Guidelines

GO foods are lowest in fat and sugar, are relatively low in calories, and are nutrient dense. SLOW foods are higher in fat, added sugar, and calories. WHOA foods are highest in fat and added sugar, are calorically dense, and are often low in nutrients. This approach helps to illustrate why choosing doughnuts for breakfast or french fries for lunch (WHOA foods) every day would not be a healthy choice. Instead, children and adolescents should aim to choose foods from the GO column on most days.

Plan Ahead

If daily school cafeteria options are not appealing to students, this can lead to skipping meals. Skipping meals can lead to decreased energy and increased hunger, as well as poor food choices and overeating later in the day. To avoid this scenario, we should encourage families to plan ahead. Reading through the school menu and planning the meal ahead of time can help to avoid impulse food choices and can also identify days that may not have any appealing food options available. Students should be encouraged to bring a school lunch or food items to complement available cafeteria items, such as a sandwich to eat along with a fruit, milk, and vegetable from school. Additionally, if available, children should be encouraged to preorder their lunch choices. A recently published study6 showed that preordering can effectively lead students to pick healthier entrées. Researchers found that students who selected their entrée in the lunch line, where decisions are biased by aromas and sights of tasty, less healthy foods, decreased their selection of healthy entrées by 48% and increased their selection of less healthy entrées by 21%.

Avoid the Vending Machine

Discretionary calories, or calories that can come from foods used purely as a source of energy, should provide less than 150 calories in the diet of most sedentary children.3 This amount is often less than that provided by a typical portion size of the low-nutrient, calorically dense snacks and beverages found in vending machines. In schools where buying “junk food” from vending machines is an option, parents should be encouraged to refrain from providing children with excess money to bring to school. If students are earning their own money through allowance or employment, they should be encouraged to set up a savings plan to put away earnings rather than spending money each day on food and beverages. If possible, students should bring healthier snack options from home to help avoid the temptation of the vending machine.

Cafeteria Meal Makeovers

The Figure shows example meals taken from a list of foods served during the 2012 school year at a large metropolitan public school system (before) and healthier options using the tips mentioned previously (after). The before meals contain high-calorie entrée options, sides that are calorie dense rather than nutrient dense, and juice instead of whole fruit; they also lack vegetable servings.

The serving sizes and food choices are taken from a list of foods served during the 2012 school year at a large metropolitan public school system. Nutritional information is based on foods found in the United States Department of Agriculture database and standardized recipes. Calories, fat, and fiber content have been rounded to an approximate value.Figure courtesy of Karin Testa Ballard, MS, RD, LDN.

Figure. The serving sizes and food choices are taken from a list of foods served during the 2012 school year at a large metropolitan public school system. Nutritional information is based on foods found in the United States Department of Agriculture database and standardized recipes. Calories, fat, and fiber content have been rounded to an approximate value. Figure courtesy of Karin Testa Ballard, MS, RD, LDN.

Conclusion

Fueling kids and adolescents with healthy food during the school day is an important and often daunting task. Legislation has been passed to improve the nutrient content of foods that are served through federally funded meal programs, although there remains much work to be done across our country to improve the meals that are offered, accepted, and consumed by students at all schools. Parents and guardians should take the lead in educating children about making healthy choices at home and at school. Tools such as MyPlate and the GO, SLOW, and WHOA method can be used to demonstrate how to build a healthy tray in the cafeteria. Swapping high-fat and high-calorie entrées for lower-calorie options, choosing fruit instead of juice, and having a serving of vegetables at meals can transform an unhealthy tray into a nutritious meal. These choices can be planned or preordered, if available, ahead of time to avoid impulse food choices and skipping meals.

References

  1. National School Lunch Program. United States Department of Agriculture. 2013. Available at: www.fns.usda.gov/slp. Accessed June 06, 2013.
  2. School Breakfast Program. United States Department of Agriculture. 2013. Available at: www.fns.usda.gov/sbp. Accessed June 06, 2013.
  3. Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics. 2006;117(2);544–559. doi:10.1542/peds.2005-2374 [CrossRef]
  4. United States Department of Agriculture. MyPlate. Available at: www.choosemyplate.gov/food-groups. Accessed Aug. 12, 2013.
  5. National Heart, Lung and Blood Institute. US Department of Health and Human Services National Institutes of Health. 2013. Available at: www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eat-right/choosing-foods.htm. Accessed June 07, 2013.
  6. Hanks AS, Just DR, Wansink B. Preordering school lunch encourages better food choices by children. JAMA Pediatr. 2013;167(7):673–674. doi:10.1001/jamapediatrics.2013.82 [CrossRef]

Examples of GO, SLOW, and WHOA Foods Based on the US National Heart, Lung, and Blood Institute and National Institutes of Health Guidelines

Choose your grain.

GO foods: whole grain breads/ tortillas/pastas, brown rice, and unsweetened whole grain hot and cold cereals

SLOW foods: white bread/pastas, rice, pancakes/waffles/french toast, biscuits, taco shells, cornbread, and granola

WHOA foods: doughnuts, sugar-sweetened cereals, croissants, and muffins

Choose your protein.

GO foods: lean beef/pork, extra lean ground beef, turkey/chicken without skin, fish, tuna canned in water, beans/lentils, egg whites/substitutes, and tofu

SLOW foods: broiled hamburger, lean ground beef, eggs cooked without added fats, ham, Canadian bacon, chicken/turkey with skin, low-fat hot dogs, tuna canned in oil, nuts, and peanut butter

WHOA foods: all fried meats/fish, bacon, pepperoni or sausage, regular ground beef, and whole eggs cooked with fat

Choose your fruit and vegetables.

GO foods: fresh, frozen, or canned fruits and vegetables without sauces, salt, or sugar

SLOW foods: oven-baked fries, avocados, vegetables with added sauces, dried fruits, and fruits in light syrup

WHOA foods: french fries or any fried vegetable and fruits in heavy syrup

Choose your dairy product.

GO foods: skim or 1% white milk, low-fat or fat-free yogurt, and low-fat or fat-free cheese/cottage cheese

SLOW foods: 2% milk and processed cheeses

WHOA foods: whole milk, full-fat yogurts and cheeses, and cream cheese

Choose your healthy drink.

GO foods: skim or 1% milk, water, and sugar-free drinks

SLOW foods: sports beverages and 100% juice

WHOA foods: whole milk, regular sodas, and sugar-sweetened teas/lemonades/juices

Authors

Karin Testa Ballard, MS, RD, LDN, is Senior Clinical Dietitian, Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children’s Hospital of Chicago.

Address correspondence to Karin Testa Ballard, MS, RD, LDN, Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Box 23, Chicago, IL 60611-2605.

Disclosure: The author has no relevant financial relationships to disclose.

10.3928/00904481-20130823-12

Sign up to receive

Journal E-contents