School Food and the New AHA Guidelines: How Do We Protect Our Children?

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Consumption of nutrient dense foods is essential to the promotion and maintenance of overall health, especially in young and rapidly growing children. Unfortunately, food at public schools within the United States is notorious for its poor quality, even though millions of children rely on it every day for their nutrition.

Recently, The American Heart Association (AHA), underscored the importance of healthful nutrition during childhood by releasing new guidelines stating that children ages 2 to 18 should eat less than 25 grams (6 teaspoons) of added sugars daily. In addition, this press release further recommends that children and teens limit their intake of sugar-sweetened drinks to 8 ounces per week or less. Consumption of foods high in added sugars throughout childhood has been associated with an increased risk of obesity and hypertension, which can contribute to heart disease in adulthood. Children spend the majority of their days at school; therefore, it is easy to imagine that the food readily available in the school environment has a significant impact on the overall nutritional status of children nationwide. Focusing our attention on the school food environment and exploring possible strategies of cafeteria reform could make a huge impact in the health of America’s youth and improve the long-term health of our country.

Despite efforts by the government to provide meals for children at a reduced cost, there have been several issues with school food that have prevented new school lunch initiatives from being successful. In Free for All: Fixing School Food in America, Janet Poppendieck gives a comprehensive assessment of the food served in public school cafeterias across the country and highlights its main shortcomings: quality, access and stigma. First, although states can establish their own nutritional targets, there are no required federal standards for providing nutritious meals, which increase the variability between regions and lack of accountability for school lunch programs. Second, many public schools struggle to meet the state requirements for calories and nutritional components because of cost constraints, which causes them to compromise on quality. For example, some schools will add bread products to meals to increase the fat or sugar content in order to meet a specific calorie requirement, which highlights a systematic flaw in the way districts implement food production protocols. Recent advances in nutritional and metabolic research have successfully demonstrated that the macronutrient composition of meals is important to ensuring healthful nutrition and that a calorie is not simply a calorie. Creating food menus that focus on hitting pre-defined caloric and macronutrient ratios can lead to unhealthy and problematic food practices in our public schools. Lastly, about 10% of public schools do not even offer a lunch program, which demonstrates a real barrier to access that disproportionately affects food-insecure families.

Using nationwide anecdotal evidence, a large study found that most students judged their school’s food quality as “unappetizing” — vegetables were barely represented, temperature and grease were cited as main complaints, and there was very little variety in the menu. This common perception instills a stigma associated with eating school food that leads to low participation rates in the breakfast and lunch programs. Social pressures are especially problematic for low-income, food insecure children who need the subsidized meals to meet their nutritional requirements. In addition, with the presence of competitive food sources in schools, such as vending machines, soda machines and fast food restaurants, many students are opting for purchasing food from other sources. This is problematic as most of these foods are highly processed, energy dense, and nutrient poor. According to Poppendieck, 9 out of 10 schools sell competitive foods; therefore, a la carte items and vending machines may become a major food source among children, further highlighting the need for the new AHA guidelines.

There are several solutions that are currently being explored to improve the efficacy of the existing school lunch programs. Reform needs to focus on improving food quality and ensure, as Poppendeick writes, that “meals are truly accessible, socially and emotionally as well as physically and financially to the children who need them.” In an effort to improve the quality of food items, some school districts have aimed to reduce fat, salt, and sugar and increase fruits, vegetables and whole grains through healthier substitutions and salad bar options. With the inclusion of fresh, local produce, establishing food preparation on site, and creating seasonal menus, several school districts have seen increased program participation rates. In addition, eliminating vending machines and establishing nutrient standards for competitive foods sold in schools through state legislature has been instrumental in helping children choose healthier options. Nutrition education and hands-on experience growing vegetables in classroom gardens has also been shown to promote awareness among children and encourage them to make healthy decisions in the cafeteria. Furthermore, creating a stable “farm-to-school” partnership between local farmers and school districts stimulates the local economy and provides a sustainable supply of fresh produce for the cafeteria lunches.

Ultimately, the most effective strategy to reform school food would be to improve its quality by increasing the allocated federal budget and establishing nationwide nutrition standards that hold institutions accountable. By increasing the availability of nutritious, tasty meals, the stigma of eating school lunches will inevitably dissipate. Importantly, reform efforts should mainly target large school systems in low-income neighborhoods because of the rising rates of diabetes and other diet-related illnesses within this demographic, conditions that added sugars and sugar sweetened beverages undoubtedly contribute to. School lunch programs have the potential to make a significant impact on the majority of American youths by promoting a healthy lifestyle and improving public nutrition. As physicians, we can work to improve the health of children by advocating for increased school-lunch funding, curricula that connect our children with their local food system, and encouraging the elimination of fast foods and vending machines from our schools.

Atalah Juliana
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