Online Program

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

Monday, November 4, 2013

Elizabeth Duthie, PhD, Department of Medicine/Center for Patient Care & Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
Annie Nguyen, PhD, MPH, Department of Family Medicine, University of California, Irvine School of Medicine, Orange, CA
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.

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe the effect of interventions on the nutritional quality of National School Lunch Program and School Breakfast Program meals. Identify avenues to advocate for policy changes related to school food environments.

Keyword(s): Food and Nutrition, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD-prepared public and community health researcher with a masters in sociology. I am a postdoctoral research fellow at the Medical College of Wisconsin. I have experience conducting research on nutrition and physical activity, body image, and maternal and child health. I have taught in a school where >90% of children qualify for free-or-reduced-price lunch, and have conducted ethnography in a lunchroom where the majority of children qualify for free-or-reduced-price lunch.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.