Policy lessons from interventions to improve school meal nutrition: A literature review

Background: The National School Lunch Program (NSLP) and School Breakfast Program (SBP) have long been targets of public health interventions to improve childhood nutrition. Some interventions have shown short-term positive impacts on nutritional quality of meals, but long-term, sustainable improvements have not been realized. Purpose: To summarize the impact of interventions on nutritional quality of school meals; identify barriers to implementation; and examine the effect of interventions on policies to improve school food environments. Significance: Lessons learned from successful and sustainable interventions will help researchers identify priorities for policy advocacy. Methodology: Articles were identified using Boolean search terms in PubMed/Medline, PsychINFO, and CINAHL and by searching references. 101 articles were reviewed. 65 met inclusion criteria and were included for final review. Findings/results: Interventions have demonstrated that with focused effort, training for foodservice staff, and marginal increases in costs, schools can improve adherence to federal nutrition guidelines while maintaining NSLP/SBP rates of participation. Barriers to implementation include perceived higher costs, non-compliance of foodservice staff, and regulatory restrictions on schools' culinary autonomy. Restrictions exist on multiple levels, from districts' use of centralized kitchens to federal restrictions on reimbursable items. Interventions were typically not translated into sustained policies at the school, district, or federal levels. Conclusion/recommendations: To sustain positive nutritional changes introduced by interventions, changes must be institutionalized as policy. To this end, researchers must include and engage all relevant policymakers in the dissemination of findings and in conversations about how best to improve school meal nutrition. We will recommend areas for advocacy.