Factors related to successful implementation of nutrition guidelines

Federal legislation requires, and most school wellness policies include, nutrition guidelines for foods sold outside the school meal program , i.e. competitive foods. Doubts remain regarding actual implementation of these policies. This study aimed to identify factors which influence adherence to nutrition guidelines for competitive foods and participation in the school meal program. Design: A case study approach examined factors influencing adherence to nutrition guidelines and school meal participation in 16 districts. Data was collected by online survey, interview, on-site observations, and records of school meal participation. Competitive foods were evaluated using California SB-12 nutrition standards for foods and Institute of Medicine nutrition standards for beverages. Results: Extensive cafeteria renovations, increases in points of service points, and improvements to seating, traffic flow, and food options occurred in two districts. One experienced a slight decrease in school meal participation and the other a slight increase where free/reduced (FRP) meal rate also increased. However, the most striking increase in school meal participation (48.6% to 57.7%) occurred when another campus changed from ‘open' to ‘closed' during lunch. ‘Open/closed' campus also appeared to influence competitive food availability. Community and student support were key factors facilitating nutrition policy implementation in two districts. Fruit/vegetable snacks provided to students through the support of grants and donations, led to a 67% decrease in school nurse visits. Student leadership resulted in an increase from 14% to 75% of items meeting nutritional standards. Discussion: Case study results identified unique factors influencing implementation of nutrition guidelines and school meal participation. Environmental change (cafeteria renovation, FRP rates) influence school meal participation; however, open/closed campus policy was more impactful. Community support and student leadership were processes leading to successful initiatives. Ultimately, wellness champions, individual or groups, and strong administrative support were key for successful nutrition guideline implementation.