Creating nutrition policy change: What's on the plates in school cafeterias?

Background: Attention is focused on the quality of school meals. Initiatives at national, state, and local levels seek to encourage schools to modify meal contents to provide more fresh fruits, vegetables, and whole grains and reduce fat and sugar, while maintaining federal requirement compliance. Purpose: As part of the evaluation of Arkansas Act 1220 of 2003, on-site observations of school meals throughout Arkansas were completed to understand school nutrition environments. Methods: Observations were completed in a purposeful sample of 151 school cafeterias (14% of Arkansas' public schools) during the period December 2008 to May 2011. Items offered at lunch in both plate and a-la-carte lines were assessed using the School Cafeteria Nutrition Assessment instrument, a meal assessment tool. Scoring algorithms based on IOM's dietary recommendations evaluated offerings of fruits, vegetables, whole grains, desserts, entrees, side dishes, and beverages. Findings/Results: Of the 151 cafeterias observed, 82.3% offered at least 1 fruit serving, and 58.9% offered at least 2 vegetable servings. However, 17.2% offered no fruit, and 2.0% offered no visible vegetable serving. Further, the majority (79.5%) of cafeterias offered no whole grains. Fat was added to many entrees and side dishes, often in the form of butter or cheese. Virtually all schools included low-fat or skim milk among options available to students, but few meals offered water. Conclusions: Schools strive to provide healthy meals within severe budgetary constraints and stringent federal requirements. These findings suggest that improvements to school food environments are needed for meeting national standards.