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.

     

Impact of Connecticut Legislation Incentivizing Elimination of Unhealthy Competitive Foods on National School Lunch Program Participation

Objectives. We analyzed the impact of Connecticut legislation incentivizing voluntary school district–level elimination of unhealthy competitive foods on National School Lunch Program (NSLP) participation.Methods. We analyzed data on free, reduced, and paid participation in the NSLP from 904 schools within 154 Connecticut school districts from the 2004–2005 to the 2009–2010 school year, resulting in 5064 observations of annual school-level meal participation. We used multilevel regression modeling techniques to estimate the impact of the state competitive food legislation on the count of NSLP lunches served per student in each school.Results. Overall, the state statute was associated with an increase in school lunch participation. We observed increases between 7% and 23% for middle- and high-school meal programs, and a slight decrease of 2.5% for the elementary school free meal eligibility category, leading to an estimated revenue increase of roughly $30 000 for an average school district per school year.Conclusions. This study provides support for national implementation of proposed rigorous competitive food standards that can improve the health of students while supporting local school district finances.Federal meal programs in the United States serve more than 30 million students every day, providing an unparalleled opportunity to improve the diet of the nation’s youths.1 Recent changes to school meal program regulations will substantially improve the nutritional quality of meals that have already succeeded at preventing childhood nutritional deficiencies in the United States.2–4 Public health efforts to reduce childhood obesity rates and improve diet quality in the United States have increasingly focused on improving the food environment in schools.5–7The sale of foods in schools outside the school meal programs, known as competitive foods, has been consistently linked with unhealthy diet and, in some but not all studies,8 with increased risk of obesity.9 Energy-dense, nutrient-poor competitive foods and beverages are widely available in US schools and are regularly consumed by children.10–13 A number of local school district and statewide policy changes reducing or eliminating the sale of unhealthy competitive food and beverages at school have been shown to improve dietary outcomes, including reduced sugar-sweetened beverage consumption and increased consumption of fruits and vegetables.14–16 Sanchez-Vaznaugh et al. reported that removing unhealthy competitive foods may be linked to a lower incidence of overweight in children in California.17 Taber et al. reported findings based on the Early Childhood Longitudinal Study–Kindergarten showing that adolescents in states with strong competitive food standards from 2003 to 2006 gained 0.44 body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) units less than adolescents in states without such standards.18Despite the success of some state and local policies, national policy efforts have so far failed to sufficiently address the negative impact of the sale of unhealthy competitive foods on children’s health. The Child Nutrition and WIC Reauthorization Act of 2004 required all school districts participating in the National School Lunch Program (NSLP) to develop wellness policies that include nutrition guidelines for all foods available at schools by the 2006–2007 school year.19 However, the legislation did not require districts to implement specific competitive food policies.5 A review of a nationally representative sample of wellness policies and related regulations from 2006–2007 up to 2008–2009 found that, although some districts have implemented strong policies, in general, rules governing competitive food sales were weak or nonexistent.20In response to concerns about the role of both the school meal programs and competitive foods in addressing the obesity epidemic, Congress passed The Healthy, Hunger-Free Kids Act of 2010.21 The act required the US Department of Agriculture (USDA) to update the nutrition standards for the NSLP and the School Breakfast Program while providing a performance-based increase in reimbursement rate for lunches. The bill also for the first time gave the USDA authority to set nutrition standards for competitive foods sold throughout the school day.21 Congress instructed the USDA to develop nutrition standards for competitive foods that align with the current Dietary Guidelines for Americans22 while giving consideration to practical application of the standards. The USDA is currently developing competitive food standards with the goal of releasing final regulations in 2013.Reactions to the USDA’s revised nutrition standards for the school meal program suggest that the USDA may face strong opposition to nutritionally rigorous competitive food standards.23,24 In addition to objections raised by food industry associations, the School Nutrition Association, which represents school food service professionals, commented to the USDA that improving the health quality of the school meals may reduce participation in the program if students instead purchase competitive foods or bring food from outside school.25However, creating rigorous new competitive food nutrition standards could support simultaneous implementation of improved meal program standards by removing unhealthy yet attractive alternatives to the meal program from school environments. A number of studies have found that reducing availability of unhealthy competitive foods results in increased meal program participation and limited impact on overall food service revenue.26,27 On the basis of a systematic review that identified 7 studies that assessed the relationship between nutrition standards and school revenue, Wharton et al. concluded that fears of net negative financial impacts of improved nutrition standards are unfounded and that increased participation in NSLP may compensate for lost revenue from lower competitive food sales.27 However, because there is a relatively limited evidence base, additional evidence showing that implementing stronger competitive food standards across a broad range of schools can increase school meal participation would support ongoing USDA efforts to implement rigorous national competitive food and school meal nutrition standards.Since 2006, Connecticut’s Healthy Food Certification (HFC) has offered school districts in the state a monetary incentive to comply with stringent competitive food nutrition standards that are updated annually.28 The standards, which are based on the Dietary Guidelines for Americans, apply to all foods sold at school at all times. Exceptions can be granted by local school boards for food sold during events held outside the regular school day. Districts must annually file compliance forms with the Connecticut State Department of Education (CSDE), which reviews nutrition information for all foods sold in each district and conducts site visits in selected participating districts to ensure compliance. Districts that choose to comply with the voluntary standards are paid an additional 10 cents per lunch by the state, based on the total number of reimbursable lunches (paid, free, and reduced) served in the district in the previous school year. Previous research based on the program’s first year of implementation found that districts participating in HFC substantially reduced the availability of unhealthy competitive food and increased paid school meal participation in middle schools.29This study extends the initial evaluation of the program, and analyzes the impact of district participation in HFC on student participation in free, reduced, and paid lunches by using statewide school meal participation data from the 2004–2005 to 2009–2010 school years. It was hypothesized that district participation in HFC is positively related to student participation in the NSLP.     

Competitive foods sales are associated with a negative effect on school finances

Background

It is widely presumed that competitive foods—foods offered for sale in schools in addition to reimbursable federal meals programs—provide revenue that is essential to maintain school foodservices. However, evidence is lacking to demonstrate whether competitive foods sales truly improve foodservice financial viability.

Objective

The aim of this research was to assess whether or not competitive foods sales have an overall positive financial effect on school foodservice finances.

Design and statistical analyses

This observational study used a multivariate time series analysis of annual foodservice financial data from repeated observations of 344 Minnesota public school districts between 2001 and 2008 (N=2,695). First, revenue from competitive foods was assessed in terms of whether or not such revenue displaced or complemented revenue from reimbursable meals. Second, profit from competitive foods was assessed in terms of whether or not such profit displaced or increased total school foodservice profit.

Results

Fixed effects models indicated small but significant negative relationships between competitive foods sales and reimbursable meals revenue, as well as overall foodservice profit. A 10% increase in competitive foods revenue was associated with a 0.1% decrease in reimbursable meals revenue (P<0.05). A 10% increase in competitive foods profit was associated with a 0.7% decrease in overall foodservice profit among schools with profitable competitive sales (P<0.10).

Conclusions

Study findings suggest that competitive foods can have a negative effect on school foodservice finances. Better understanding of foodservice finances could influence current approaches to improve school nutrition. Improved recordkeeping may be necessary to ensure that public funds are not used to subsidize schools' competitive offerings.     

Peer Reviewed: Changes in Local School Policies and Practices in Washington State After an Unfunded Physical Activity and Nutrition Mandate

Introduction

Policies and practices in schools may create environments that encourage and reinforce healthy behaviors and are thus a means for stemming the rising rates of childhood obesity. We assessed the effect of a 2005 statewide school physical activity and nutrition mandate on policies and practices in middle and high schools in Washington State.

Methods

We used 2002, 2004, and 2006 statewide School Health Profiles survey data from Washington, with Oregon as a comparison group, to create longitudinal linear regression models to describe changes in relevant school policies after the Washington statewide mandate. Policy area composite measures were generated by principal component factor analysis from survey questions about multiple binary measure policy and practice.

Results

Relative to expected trends without the mandate, we found significant percentage-point increases in various policies, including restricted access to competitive foods in middle and high schools (increased by 18.8-20.0 percentage points); school food practices (increased by 10.4 percentage points in middle schools); and eliminating exemptions from physical education (PE) for sports (16.6 percentage-point increase for middle schools), exemptions from PE for community activities (12.8 and 14.4 percentage-point increases for middle and high schools, respectively) and exemptions from PE for academics (18.1 percentage-point increase for middle schools).

Conclusion

Our results suggest that a statewide mandate had a modest effect on increasing physical activity and nutrition policies and practices in schools. Government policy is potentially an effective tool for addressing the childhood obesity epidemic through improvements in school physical activity and nutrition environments.     

Competitive foods and beverages available for purchase in secondary schools--selected sites, United States, 2004

The percentage of overweight youths aged 12-19 years in the United States more than tripled from 5% during 1976-1980 to 16% during 1999-2002. Overweight youths are at increased risk for cardiovascular consequences and other serious physical and psychosocial health problems. Because most youths are enrolled in school, the school nutrition environment is integral to any strategy to improve dietary behavior and reduce overweight among youths. In most schools, the nutrition environment has two components: the U.S. Department of Agriculture (USDA) school meals program and the sale of competitive foods. USDA defines competitive foods as those foods and beverages, regardless of nutritional value, sold at a school separate from the USDA school meals program. To identify the types of competitive foods and beverages available for purchase from school vending machines or at school stores, canteens, or snack bars, CDC analyzed data from the 2004 School Health Profiles for public secondary schools in 27 states and 11 large urban school districts. This report summarizes the results of that analysis, which indicated that, in 2004, the majority of secondary schools (median across states: 89.5%; median across large urban school districts: 81.5%) allowed students to purchase snack foods or beverages from vending machines or at the school store, canteen, or snack bar. In addition, the percentage of schools offering certain types of snack foods and beverages varied across states and large urban school districts. Although the majority of schools offered some nutritious foods and beverages in these settings, the majority of schools also offered less nutritious choices. Educators, families, and school and public health officials should work together to provide school nutrition environments that will help improve dietary behavior and reduce overweight among youths.     

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.     

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.     

Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study

Background

Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children’s school snacks.

Methods

Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n?=?645 children from N?=?99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks.

Results

On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR?=?1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR?=?3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased.

Conclusions

Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

     

Food and Beverage Environment Analysis and Monitoring System: A Reliability Study in the School Food and Beverage Environment

States and school districts around the country are developing policies that set nutrition standards for competitive foods and beverages sold outside of the US Department of Agriculture's reimbursable school lunch program. However, few tools exist for monitoring the implementation of these new policies. The objective of this research was to develop a computerized assessment tool, the Food and Beverage Environment Analysis and Monitoring System (FoodBEAMS),^? to collect data on the competitive school food environment and to test the inter-rater reliability of the tool among research and nonresearch professionals. FoodBEAMS was used to collect data in spring 2007 on the competitive foods and beverages sold in 21 California high schools. Adherence of the foods and beverages to California's competitive food and beverage nutrition policies for schools (Senate Bills 12 and 965) was determined using the data collected by both research and nonresearch professionals. The inter-rater reliability between the data collectors was assessed using the intraclass correlation coefficient. Researcher vs researcher and researcher vs nonresearcher inter-rater reliability was high for both foods and beverages, with intraclass correlation coefficients ranging from .972 to .987. Results of this study provide evidence that FoodBEAMS is a promising tool for assessing and monitoring adherence to nutrition standards for competitive foods sold on school campuses and can be used reliably by both research and nonresearch professionals.     

Competitive Foods in Schools: Availability and Purchasing in Predominately Rural Small and Large High Schools

Objectives

Schools have an important role to play in obesity prevention, but little is known about the food environment in small, predominately rural schools. The primary purpose of this study was to compare the availability and student purchasing of foods sold outside of the reimbursable meals program through à la carte or vending (ie, competitive foods) in small (n=7) and large (n=6) Kansas high schools.

Methods

A cross-sectional observational study design was used to capture the number of à la carte and vending items available and purchased, and the fat and energy content of all available and purchased items on a single school day between January and May 2005.

Results

Small schools had significantly fewer vending machines than large schools (median 3.0 [range 2.0 to 5.0] vs 6.5 [range 4.0 to 8.0], P<0.01]. Vending and à la carte items at small schools contained a median of 2.3 fewer fat grams per item (P≤0.05), whereas vending products contained a median of 25 kcal fewer per item (P≤0.05) than at large schools. Significantly less fat (median −15.4 g/student) and less energy (median −306.8 kcal/student) were purchased per student from all competitive food sources and from à la carte (median −12.9 g fat and −323.3 kcal/student) by students in small schools compared to students in large schools (P≤0.05).

Conclusions

The findings, which highlight less availability and lower energy content from competitive foods at small compared to large schools, have implications for understanding how small schools support their foodservice programs with limited dependence on competitive foods and the influence that food and nutrition professionals can have on school environments by providing more oversight into the nutritional quality of foods available.     

Position of the American Dietetic Association: local support for nutrition integrity in schools

It is the position of the American Dietetic Association that the schools and the community have a shared responsibility to provide all students with access to high-quality foods and school-based nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district wellness policies that create overall school environments that promote access to healthful school meals and physical activity and provide learning experiences that enable students to develop lifelong healthful eating habits. The National School Lunch and School Breakfast Programs are an important source of nutrients for school-age children, and especially for those of low-income status. The American Dietetic Association was actively involved in the 2004 reauthorization of these programs, ensuring access through continued funding, promoting nutrition education and physical activity to combat overweight and prevent chronic disease, and promoting local wellness policies. The standards established for school meal programs result in school meals that provide nutrients that meet dietary guidelines, but standards do not apply to foods and beverages served and sold outside of the school meal. Labeled as competitive foods by the US Department of Agriculture, there is a growing concern that standards should be applied to food in the entire school environment. Legislation has mandated that all school districts that participate in the US Department of Agriculture's Child Nutrition Program develop and implement a local wellness policy by the school year 2006-2007. Resources are available to assist in the development of wellness policies, and dietetics professionals can assist schools in developing policies that meet nutrition integrity standards.     

School‐Level Practices and Perceptions Associated With Salad Bars in Schools

BACKGROUND

Salad bars are placed in schools to promote fruit and vegetable consumption among students. This study assessed differences in school nutrition practices and perceptions in schools with and without salad bars.

METHODS

Cross‐sectional surveys were completed by school nutrition managers (N = 648) in Arizona schools participating in the National School Lunch Program during 2013–2014. Mixed general estimating equation binomial regressions assessed factors related to having a salad bar after mutually adjusting for clustering within districts, school level, free/reduced rate, and respondents' time in current position.

RESULTS

On average, 61% of schools reported having a salad bar. After adjustment, school nutrition managers were significantly more likely to report having a salad bar if they served lunch by grade level (vs mixed grades), had a full‐service kitchen, and their personal perception of salad bars was positive; schools were less likely to have a salad bar if menu and food service decisions were made at the school level.

CONCLUSIONS

Several school‐level nutrition practices and perceptions were associated with having a salad bar in schools. Enhancement of these factors may facilitate having salad bars in schools.

     

Alliance for a Healthier Generation's Competitive Beverage and Food Guidelines: Do Elementary School Administrators Know About Them and Do They Report Implementing Them?

BACKGROUND: The availability of competitive foods in schools is a modifiable factor in efforts to prevent childhood obesity. The Alliance for a Healthier Generation launched the Healthy Schools Program in 2006 to encourage schools to create healthier food environments, including the adoption of nutritional guidelines for competitive beverages and foods. This study examines nationwide awareness and implementation of the guidelines in US public elementary schools. METHODS: Data were collected from a nationally representative sample of elementary schools using mail-back surveys in 2006-2007, 2007-2008, 2008-2009, and 2009-2010. RESULTS: From 2006-2007 to 2009-2010, awareness of the Alliance's beverage guidelines increased from 35.0% to 51.8% among school administrators (p < .01); awareness of the food guidelines increased from 29.4% to 40.2% (p < .01). By 2009-2010, almost one third of the schools that sold competitive beverages and foods reported having implemented or being in the process of implementing the guidelines. Implementation was higher among schools from Southern states. Schools with a majority of Black or Latino students were less likely to implement the guidelines. CONCLUSIONS: Awareness and implementation of the Alliance's beverage and food guidelines has significantly increased since the 2006-2007 school year, indicating successful diffusion of the guidelines. However, many administrators at schools who sold competitive products were not aware of the guidelines, indicating a need for continued efforts. In addition, lower implementation among schools serving minority students suggests that the Alliance's targeted efforts to provide intensive technical assistance to such schools is warranted and necessary.     

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.     

Poverty-related factors associated with obesity prevention policies in Utah secondary schools

To address the childhood obesity epidemic, numerous national agencies have outlined specific school policy recommendations for nutrition and physical activity. The extent to which current policies differ by socioeconomic status and geographic location is yet to be determined. This cross-sectional study examined select school nutrition and physical activity policies by markers for poverty among 209 middle and high schools in Utah (82% response rate). The results show that students' opportunities to establish healthful dietary and physical activity patterns differed by economic circumstances and geographic location. Schools with the highest percentage of free and reduced-price lunch enrollment and schools in rural areas were both less likely to offer a variety of healthful foods outside of the school meal program (ie, competitive foods and drinks) and intramural activities or physical activity clubs. Schools with highest free and reduced-price lunch enrollment were more likely to allow the purchase of unhealthful snacks during lunchtimes than schools with low enrollment (28.4% vs 7.6%, P=0.01). Schools in rural communities were less likely to promote walking and bicycling to school compared with other locations (47.4% rural vs 67.1% urban and 63.6% suburban, P=0.06). Current school policies related to nutrition and physical activity may not be conducive to reducing the childhood overweight problem among children attending schools in areas with increased risk factors due to poverty or rural location in Utah.     

Lessons Learned From Evaluations of California's Statewide School Nutrition Standards

Objectives. We assessed the impact of legislation that established nutrition standards for foods and beverages that compete with reimbursable school meals in California.Methods. We used documentation of available foods and beverages, sales accounts, and surveys of and interviews with students and food service workers to conduct 3 studies measuring pre- and postlegislation food and beverage availability, sales, and student consumption at 99 schools.Results. Availability of nutrition standard–compliant foods and beverages increased. Availability of noncompliant items decreased, with the biggest reductions in sodas and other sweetened beverages, regular chips, and candy. At-school consumption of some noncompliant foods dropped; at-home consumption of selected noncompliant foods did not increase. Food and beverage sales decreased at most venues, and food service à la carte revenue losses were usually offset by increased meal program participation. Increased food service expenditures outpaced revenue increases.Conclusions. Regulation of competitive foods improved school food environments and student nutritional intake. Improvements were modest, partly because many compliant items are fat- and sugar-modified products of low nutritional value. Additional policies and actions are needed to achieve more substantive improvements in school nutrition environments and student nutrition and health.The current obesity epidemic in the United States has been associated with environmental factors such as the proliferation of unhealthy foods in schools and neighborhoods, as well as promotion of unhealthy foods in media environments.^1–4 An effective way to support children in being active and eating healthfully is to change institutional practices within schools by improving physical education and the nutritional value and quality of foods served.^5,6Schools participating in the federally reimbursed National School Lunch Program and School Breakfast Program serve meals that must meet federal nutrition guidelines. However, foods that are not part of the meal programs are only subject to minimal federal regulation, and these “competitive” foods have become increasingly widespread in schools over the last 40 years.⁷ Sold throughout schools in vending machines, school stores, snack bars, and at fundraisers, competitive foods and beverages are of lower nutritional quality and are typically high in added sugars, salt, and fat. Common examples of competitive foods include soft drinks and other sweetened beverages, potato chips, candy, cookies, and pastries.^8–11In an effort to combat childhood obesity, state and local policymakers have recently begun to regulate competitive school food offerings by enacting stricter school nutrition standards.¹² These efforts were reinforced by provisions in the Child Nutrition and WIC Reauthorization Act of 2004, which required school districts receiving federal meal program funding to enact wellness policies—including guidelines for all foods and beverages served—by the 2006–2007 school year.¹³The wellness policies of 92 out of 100 large school districts polled by the School Nutrition Association in 2007 included nutrition standards limiting times or offerings of competitive foods and beverages in school à la carte services, stores, and vending machines.¹⁴ Although the effects of state and local regulations of competitive foods are only beginning to be evaluated,¹⁵ emerging evidence suggests that school policies that decrease access to competitive foods of limited nutritional value are associated with less frequent student consumption of these foods during the school day.^16,17In California, Senate Bill 12 (SB 12), which applied nutrition standards to competitive foods sold in K–12 schools, took effect in July 2007. The law imposed the following limits on foods in secondary schools¹⁸:Individually sold snacks must contain no more than:

• 35% of calories from fat (with some exceptions, such as legumes, nuts, and eggs);
• 10% of calories from saturated fat (excluding eggs and cheese);
• 35% sugar by weight (excluding fruits and vegetables); and
• a total of 250 calories.

Individually sold entrées must contain no more than 36% of calories from fat and 400 calories per entrée.At elementary schools, the only competitive foods allowed are individually sold portions of nuts, nut butters, seeds, eggs, cheese packaged for individual sale, fruit, vegetables that have not been deep-fried, legumes, and dairy or whole-grain foods that meet the nutrient limits described previously and contain no more than 175 calories.A second law, SB 965, limited the competitive beverages that could be offered during the school day.¹⁸ The limits went into full effect in July 2007 for elementary and middle schools; at high schools, 50% of beverages had to comply by July 2007, and 100% of beverages had to comply by July 2009. The law limits competitive beverages to the following:

• fruit-based and vegetable-based drinks that are at least 50% fruit juice without added sweeteners;
• drinking water without added sweeteners;
• milk products and nondairy milks that have no more than 2% fat and 28 g of total sugars per 8 oz; and
• electrolyte replacement beverages with no caffeine and no more than 42 g of added sweetener per 20 oz (not allowed at elementary schools).

Three studies—the Healthy Eating, Active Communities study (HEAC), the High School Study (HSS), and the School Wellness Study (SWS), all conducted by the authors of this article, assessed different aspects of the implementation and impact of California''s school nutrition standards in diverse settings (

Peer Reviewed: Retooling Food Service for Early Elementary School Students in Somerville,Massachusetts: The Shape Up Somerville Experience

Background

Changes in the school food environment are a logical target to prevent childhood overweight. We describe the food service component of a 2-year research intervention to prevent excess weight gain in children.

Context

The goals of the food service component were to improve the presentation and nutrient quality of school meals and to incorporate more fruits and vegetables into students'' diets. The project engaged food service staff, students, parents, teachers, and school leaders to improve school nutrition.

Methods

Modifications addressed needs and barriers identified though dialogue with the food service director, focus groups, key informant interviews, and surveys of school employees, students, and parents and guardians. Attitudes and behavior changes were measured through surveys, direct observation, and sales data.

Consequences

More fruits, vegetables, whole grains, and low-fat dairy products were available during the intervention years; menus and à la carte choices were brought into closer compliance with recommended guidelines for children; attitudes of students, parents and guardians, school faculty, and food service staff improved; and policies related to food service were adopted.

Interpretation

Strategic modification to improve nutrition and increase acceptability of the food served in schools is feasible and sustainable. These results demonstrate that changes to food service can lead to improved nutrient profiles and more favorable attitudes toward food served at school meals. Such changes can help prevent childhood obesity.     

Peer Reviewed: Association Between Food Opportunities During the School Day and Selected Dietary Behaviors of Alternative High School Students,Minneapolis/Saint Paul,Minnesota, 2006

Introduction

Availability of competitive foods in schools has been linked to unhealthful dietary behaviors of students. Little is known about the food environment of alternative high schools, schools that enroll students at risk of academic failure. We examined correlations between food opportunities during the school day and selected dietary behaviors of students attending alternative high schools.

Methods

Baseline data were collected in fall 2006 as part of the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Students (n = 145) attending 6 alternative high schools in Minneapolis/Saint Paul, Minnesota, completed a survey on food opportunities during the school day and selected dietary behaviors. We used mixed-model multivariate cross-sectional analysis and adjusted for demographic characteristics to examine associations of interest.

Results

Food opportunities during the school day were positively associated with overall consumption of sugar-sweetened beverages, high-fat foods, and fast-food restaurant use.

Conclusions

Having many food opportunities during the school day at alternative high schools was linked to the consumption of foods and beverages high in sugar and fat and low in nutrients. School-based interventions should focus on changing the food environment in alternative high schools to decrease less healthful eating opportunities and to increase the availability of healthful foods and beverages.