The Impact of Nutrition Standards on Competitive Food Offerings and Purchasing Behaviors of High School Students

BACKGROUND: With adolescent obesity rates on the rise, the school food environment is receiving closer scrutiny. This study looks at the effects of nutrient standards as part of a wellness policy that was implemented in 3 public high schools in 1 county, by analyzing the nutritional value of competitive food offerings and purchases before and after the development of the standards.
METHODS: All food offerings and purchases were labeled based on their nutritional density using a stoplight approach of green, yellow, and red colors for the pre- and post- period. The stoplight approach to ranking foods is on a continuum of nutrient density, with green foods being the healthiest choices and red foods offering minimal nutrient density.
RESULTS: Results showed that after the implementation of the standards, red foods made up 30% of offerings, down from 48% of offerings prior to the existence of the guidelines. The proportion of red food purchases also decreased, from 83% to 47%. Additionally, yellow food offerings increased from 18% to 48% and purchases increased from 6% to 34%.
CONCLUSION: Results indicate that the nutrient standards as part of the wellness policy contributed to a positive shift in the nutritional value of competitive food purchases and offerings.     

Children's eating behavior: the importance of nutrition standards for foods in schools

BACKGROUND: To enhance the impact of school nutrition programs on children's health, more information is needed on the associations between healthy and unhealthy food offerings during school lunch periods and children's eating behavior. The purpose of this study is to evaluate the contributions of food offerings and participation in school lunch programs on children's overall (both in‐ and out‐of‐school) eating behavior. METHODS: A cross‐sectional observational study was conducted in which 2039 students in 12 elementary and 10 middle schools reported their eating behavior and the frequencies with which they purchased meals and à la carte items in the school cafeteria. Food service managers from each school provided information on the availability of foods and beverages during school lunch periods. Multilevel regression analyses were conducted to identify school‐ and student‐level predictors of children's eating behavior. RESULTS: The availability of nutritious foods during school lunch periods was associated with healthier eating behavior among students. However, this effect was observed only among children who infrequently purchased à la carte food items, and not among those who were frequent purchasers. CONCLUSION: Increased availability of fruits, vegetables, whole grains, and low‐fat dairy products as components of school meals may be an effective strategy to promote healthy eating behaviors among children. Improving the nutrition standards for foods offered in competition with federally reimbursable school meals may enhance the positive effects of school meal programs on student eating behavior.     

The national school lunch and competitive food offerings and purchasing behaviors of high school students

BACKGROUND: Across the nation, schools have become actively involved in developing obesity prevention strategies both in classrooms and in cafeterias. We sought to determine the type of foods being offered during lunch in the cafeteria of 3 public high schools in 1 county and if this reflects the purchasing patterns of students. By labeling foods based on nutrient density using a stoplight approach of green, yellow, and red colors, we were able to categorize all foods including the National School Lunch Program (NSLP) and competitive foods available in the cafeteria. METHODS: Over a 4-week cycle, daily food purchases were gathered and the proportions of green, yellow, and red foods offered and purchased was compared. RESULTS: Findings from this study suggest that students in these 3 high schools purchased foods in relative proportion to what was available in the school cafeteria for the NSLP. Green and yellow foods included in the NSLP comprised 77% of the offerings and 73% of the purchases. In contrast, 61% of the competitive foods were classified as red foods, and the purchasing of red foods made up 83% of competitive food sales. These results indicate that students purchase foods of minimal nutritional value at greater proportions in the school cafeteria. CONCLUSIONS: These results suggest that the nutritional policy for the NSLP promotes the offerings of a wide array of foods. Schools should consider a nutrition policy that regulates the sale of competitive foods.     

Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position to promote healthy dietary behaviors and help ensure appropriate nutrient intake. This article describes the characteristics of both school nutrition services and the foods and beverages sold outside of the school meals program in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=944). RESULTS: Few states required schools to restrict the availability of deep-fried foods, to prohibit the sale of foods that have low nutrient density in certain venues, or to make healthful beverages available when beverages were offered. While many schools sold healthful foods and beverages outside of the school nutrition services program, many also sold items high in fat, sodium, and added sugars. CONCLUSIONS: Nutrition services program practices in many schools continue to need improvement. Districts and schools should implement more food preparation practices that reduce the total fat, saturated fat, sodium, and added sugar content of school meals. In addition, opportunities to eat and drink at school should be used to encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products.     

Are school vending machines loaded with calories and fat: an assessment of 106 middle and high schools

BACKGROUND: The purpose of this study was to describe the extent to which vending offerings in 106 schools in the St. Paul‐Minneapolis, Minnesota metropolitan area, met criteria for types of beverages, fat, and calories based on selected criteria offered by the Institute of Medicine. METHODS: Schools where youth participants were attending for the 2006–2007 school year were identified and invited to participate in the study (n = 143); 81% of schools (n = 116) agreed to participate. RESULTS: Of the 116 schools, 106 had vending machines. Across schools with vending machines (n = 106), 5085 food and 8442 beverage items were offered. Overall, only 18% of beverage items met criteria for calories and type of beverage; significantly more items in public schools met the criteria as compared to private schools (19% vs 12%; p < .01). This difference was also significant for high schools as compared to middle schools (18% vs 22%; p < .01). For food items, 41% met calorie criteria, 45% met fat criteria, and 22% met both fat and calorie criteria. Significantly more food items met both criteria in public than private schools (22% vs 18%; p = .01), while high schools (22%) and middle schools (21%) were similar. A very small proportion of foods (<5%) would have met the full criteria suggested by the Institute of Medicine for competitive foods. CONCLUSION: Overall, foods and beverages offered in vending machines continue to be high in fat and calories. Public schools are doing a slightly better job of providing healthy foods as compared to private schools.     

Impact of portion-size control for school a la carte items: changes in kilocalories and macronutrients purchased by middle school students

We assessed the impact of a pilot middle school a la carte intervention on food and beverage purchases, kilocalories, fat, carbohydrate, and protein sold per student, and nutrient density of the foods sold. A la carte sales were obtained from six middle schools in three states for 1 baseline week and daily during the 6-week intervention. Intervention goals included reducing sizes of sweetened beverages and chips, and increasing the availability of water and reduced-fat/baked chips. Nutrients sold per day were computed and weekly nutrient means per student and per number of items sold were calculated and compared between baseline and week 6. Five schools achieved all goals at 6 weeks. Four schools showed increases in the percentage of kilocalories from protein and decreases in the amount of sweetened beverages sold; five showed substantial increases in water sales. Changes in regular chips varied by school. There were significant changes in energy density of foods sold. School foodservice changes in middle school snack bar/a la carte lines can be implemented and can lead to a reduction in the caloric density of foods purchased.     

What do middle school children bring in their bag lunches?

BACKGROUND: Limited documentation exists on nutritional characteristics of bag lunches, although about 30% of adolescents take them. This study describes: (a) the prevalence of different types of foods in bag lunches, (b) the number of kilocalories, percentage of kilocalories from fat, amount of total fat, saturated fat, cholesterol, and sugar, and (c) the differences related to gender and grade. METHODS: In 24 middle schools, observations were made on 1,381 bag lunches (about 58 per school) during one semester. RESULTS: The most common bag lunch components were beverages and sandwiches. Fruits were more common than vegetables; non-chip snacks and chips were more common than cookies, candy, and cakes/pies. Bag lunches averaged 596.2 kcal (29.7% from fat), 20.8 g of total fat, 6.2 g of saturated fat, 32.6 mg of cholesterol, and 21.3 g of sugar. Boys' bag lunches had significantly more kilocalories, total fat, saturated fat, cholesterol, and percentage of energy from fat than girls' lunches. Significant grade differences were found only for total fat and cholesterol, with seventh graders bringing more than sixth graders. CONCLUSION: More research on the nutritional quality of foods brought to school in bag lunches is important for gaining a better understanding about how to improve students' nutrition.     

Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school‐based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced‐price lunch. Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low‐nutrient, energy‐dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.     

Competitive foods and beverages available for purchase in secondary schools--selected sites, United States, 2006

Schools are in a unique position to help improve youth dietary behaviors and prevent and reduce obesity. In most schools, foods and beverages are made available to students through the U.S. Department of Agriculture (USDA) school meal programs and the sale of competitive foods, which are any foods and beverages sold at a school separately from the USDA school meal programs. Foods and beverages sold through the USDA school meal programs must meet federal nutrition requirements. Competitive foods are not subject to any federal nutrition standards unless they are sold inside the food service area during mealtimes. A 2007 Institute of Medicine (IOM) report concluded that schools should limit the availability of less nutritious competitive foods or include more nutritious foods and beverages if they make competitive foods available. To identify the types of competitive foods and beverages available for purchase from vending machines or at school stores, canteens, or snack bars, CDC analyzed data from the 2006 School Health Profiles for public secondary schools in 36 states and 12 large urban school districts. CDC also compared 2004 and 2006 data among 24 states and nine large urban school districts. This report summarizes the results of these analyses, which indicated that, from 2004 to 2006, the median percentage of secondary schools across states allowing students to purchase chocolate candy and salty snacks that are not low in fat decreased; however, in 2006, secondary schools still offered less nutritious foods and beverages that compete with school meals. School and public health officials should work together with families to provide foods and beverages at school that follow the IOM recommendations.     

Association between Nutrition Policies and Student Body Mass Index

In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: −0.06, 95% CI: −0.12, −0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.     

District Wellness Policy Nutrition Standards Are Associated with Healthier District Food Procurement Practices in the United States

Food procurement policies often exist to require that schools purchase foods with specific nutrient standards. Such policies are increasingly being used with the hope of improving access to healthier foods and beverages. Local wellness policies, required in any school district that participates in Federal Child Nutrition Programs, often contain specific nutrition standards that detail what can be sold to students during the school day. This study investigated the extent to which nutrition standards in wellness policies may be associated with healthier nutrition standards in district-level purchasing specifications. Cross-sectional data from the 2014–2015 school year for 490 school food authorities from 46 states and the District of Columbia were collected as part of the School Nutrition and Meal Cost Study and the National Wellness Policy Study. Survey-adjusted multivariable logistic regression models were computed to examine the association between district wellness policy nutrition standards and corresponding district food purchasing specifications. Results show that having a district wellness policy with corresponding nutrition standards and being in a rural area were associated with district food purchasing specifications for specific nutrients. These findings contribute to the literature to suggest that having a wellness policy with detailed nutrition standards may help to increase access to healthier foods and beverages.     

Evaluating the Impact of a Connecticut Program to Reduce Availability of Unhealthy Competitive Food in Schools

BACKGROUND: This article seeks to inform state and local school food policies by evaluating the impact of Connecticut's Healthy Food Certification (HFC), a program which provides monetary incentives to school districts that choose to implement state nutrition standards for all foods sold to students outside reimbursable school meals. METHODS: Food service directors from all school districts participating in the National School Lunch Program (NSLP) (N = 151) in Connecticut were surveyed about the availability of competitive foods before and after the 2006-2007 implementation of HFC. Food categories were coded as healthy or unhealthy based on whether they met the Connecticut Nutrition Standards. Data on NSLP participation were provided by the State Department of Education. Changes in NSLP participation and availability of unhealthy competitive foods in elementary, middle, and high schools were compared pre- and post-HFC across districts participating (n = 74) versus not participating (n = 77) in HFC. RESULTS: On average, all districts in Connecticut reduced the availability of unhealthy competitive foods, with a significantly greater reduction among HFC districts. Average NSLP participation also increased across the state. Participating in HFC was associated with significantly greater NSLP participation for paid meals in middle school; however, implementing HFC did not increase overall NSLP participation beyond the statewide upward trend. CONCLUSION: The 2006–2007 school year was marked by a significant decrease in unhealthy competitive foods and an increase in NSLP participation across the state. Participation in Connecticut's voluntary HFC further reduced the availability of unhealthy competitive foods in local school districts, and had either a positive or neutral effect on NSLP participation.     

A Cross-Sectional Study of the Nutritional Quality of New South Wales High School Student Food and Drink Purchases Made via an Online Canteen Ordering System

Unhealthy dietary patterns in adolescence are associated with an increased risk of future chronic disease. This study aimed to assess online canteen lunch purchases made by high school students to identify: (1) the nutrient composition of purchases (energy, saturated fat, sugar, sodium, percent energy from saturated fat and total sugar); (2) the proportion of items classified as healthier (‘Everyday’) and less healthy (‘Occasional’ or ‘Should not be sold’) according to the New South Wales Healthy Canteen Strategy; (3) the frequency of purchases by product type (e.g., salty snacks), their classification and nutrient composition; and (4) associations between student characteristics and the nutrient composition and classification of purchases. The average order contained 2075 kJ of energy, 6.4 g of saturated fat, 18.4 g of sugar and 795 mg of sodium. Less healthy (‘Occasional’ and ‘Should not be sold’) items combined accounted for 56% of purchases. The most frequently purchased products were burgers and crumbed/coated foods. Students in higher grades purchased a significantly higher mean percent of ‘Everyday’ items, compared to students in grades 7 or 8. The majority of high school student purchases were less healthy (‘Occasional’ or ‘Should not be sold’) items, warranting further investigation of factors influencing online canteen purchasing behaviour in this setting.     

Nutrient intake of children consuming breakfast at school clubs in London

Introduction: Research into the effectiveness of breakfast clubs has most commonly focused on social benefits to the child and school, such as improved attendance at school, punctuality and improved concentration levels in the classroom ( UEA, 2002 ). Limited research has been undertaken to investigate the nutritional value of the breakfast foods on offer, or the nutritional content of foods consumed by the child. The aim of this study was to find out what children eat and drink at school breakfast clubs in London. Method: The sample population consisted of 98 children (39 boys and 59 girls) aged 5–11 years attending four primary schools in London. Data were collected about the food on offer and the pricing of different food items, demographic data about the children attending the school club, qualitative data on food preferences and a weighed food intake on two different occasions for each child. Statistical tests (anova and chi‐squared tests) and nutrient analysis using Comp‐Eat were carried out. Results: The average nutrient content of the breakfast meal consumed was 330 kcal, 12 g protein, 11 g fat and 49 g carbohydrate. Variation was seen between schools. Generally intakes of vitamin C, calcium and sodium were high and intakes of iron were average. anova between schools showed statistically significant results for a number of nutrients – protein, fat, saturated fat, carbohydrate, sugar, calcium and sodium. Boys were consuming statistically significantly more fat, saturated fat and calcium than girls. One in five children did not have a drink at breakfast. Menu options and pricing of food items varied between the schools and it was noted to influence children's food choice and consumption. Mean energy intakes equated to 18% of the estimated average requirement for boys and 20% for girls, with girls consuming more carbohydrate and sugar, and boys consumed more fat and protein. Discussion: The findings suggest that careful planning of menus should be undertaken with cereal‐based options being offered daily and cooked options only occasionally, and that healthier eating messages can be incorporated effectively into school clubs when supported by the whole school approach to healthy eating. Conclusion: Food offered at school breakfast clubs can contribute substantial nutrients to a child's daily intake and therefore a varied menu, and guided food choices, should be developed incorporating healthier nutrient rich options. This work was supported by Brooke Bond working in partnership with the BDA Community Nutrition Group.     

Results of evaluability assessments of local wellness policies in 6 US school districts

BACKGROUND: A US federal mandate that school districts devise and implement local wellness policies (LWPs) has potential widespread impact on the nutritional content of foods and beverages available in schools and on the amount of physical activity that students engage in; however, evidence concerning the mandate's effectiveness is limited. This study describes the content of LWPs of 6 US school districts and steps taken toward their implementation and evaluation. METHODS: During visits to 6 school districts, we interviewed 88 school and community representatives about the content of their district's LWPs and how the LWPs were being implemented and evaluated. RESULTS: The 6 LWPs were consistent with the federal mandate, although they varied in content and degree of specificity, and none had been fully implemented. All 6 districts were pursuing strategies to ensure that foods and beverages available at school met nutrition standards but did not offer nutrition education to all K‐12 students. All 6 districts offered students only limited opportunities for physical activity, and all 6 collected data to monitor process and outcomes of their LWPs. CONCLUSIONS: Partial implementation of LWPs in the districts we visited resulted in significant improvement in the nutritional quality of foods available at district schools, but only slight improvement in students' opportunities for school‐based physical activity. We provide recommendations for school districts on implementation and evaluation. Future research is needed to determine the impact of these LWPs on students' health.     

Changes in School Competitive Food Environments after a Health Promotion Campaign

BACKGROUND

Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K‐8 schools participating in the Philadelphia Campaign for Healthier Schools.

METHODS

Interviews with school staff were used to elicit information about policies, practices, and guidelines to restrict/limit competitive foods in schools, before and 1 year into the campaign. To increase the validity of responses, respondents provided documentation for reported policies and guidelines. Baseline interviews were conducted between April and June 2011 and follow‐up interviews were conducted between April and June 2012.

RESULTS

At follow‐up, significantly more schools reported having policies and/or guidelines in place to regulate food as a reward in the classroom, food served at parties and celebrations, outside foods allowed in school, and the availability of sodas and sugar‐sweetened beverages. There were no measurable effects on food available in school stores, fundraisers, or afterschool programs. Availability of concrete documentation of policies was limited, but when provided, it corroborated the interview responses.

CONCLUSIONS

In the context of a comprehensive school wellness policy, school wellness councils were associated with increases in school‐level policies and practices that improved the competitive nutrition environment.