Did school lunch changes improve nutrition?

When school lunches were changed in 2012 to make them more nutritious, there were fears that students wouldn’t accept the changes and school lunch participation rates would fall.

That isn’t the case, according to a new study that found participation rates have remained basically unchanged while the nutritional quality of the meals have improved.

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“Practically all American children don’t consume enough fruits and vegetables,” says Mary Podrabsky, MPH, RD, director of school and community initiatives at the Center for Public Health Nutrition at the University of Washington in Seattle and co-author of the study. “Eating school lunch is an easy way for most patients to increase the variety and quantity of fruits and vegetables in their diets.”

The 2012 school lunch program changes made under the Healthy Hunger-Free Kids Act (HHFKA) represented the first change for school meals in 15 years. The changes aligned school lunches with the Dietary Guidelines of 2010, taking into consideration portion sizes and calorie counts; increasing the amounts of fruits and vegetables; increasing whole grains; and reducing sodium.

Simply put, the changes resulted in meals with calorie caps that included at least 1 fruit or vegetable, and increased the number of vital nutrients including calcium, vitamin A, vitamin C, iron, fiber, and protein.

Now, Podrabsky and others are reviewing the impact of these changes and found that the lunches after the HHFKA offered students more nutrition with less calories, and participation in school lunch programs was unchanged during the study period despite concerns that the changes resulted in a drop in lunch purchases.

Researchers reviewed the lunch program at 3 urban middle schools and 3 urban high schools in the 16 months before the lunch changes and the 15 months after the changes. In the first year after HHFKA implementation, there were complaints about the changes as schools adjusted to the new requirements, but actual participation rates were relatively unchanged and complaints diminished. Participation rates didn’t even change for high school students with the option of leaving the school to get food elsewhere, according to the study.

From 2013 to 2015, the US Department of Agriculture (USDA) actually indicated an increase in school lunch participation from 30.4 million to 30.5 million, but this study indicates a decline in participation from 47% before the lunch changes to 46% following the changes.

The study also notes, however, that participation rates began to decline even before the nutrition changes were implemented, and the changes are believed to stem from other factors, such as the economy.

NEXT: The cost of the program

Some groups were initially concerned about the cost of the program, and how schools would cope and continue to meet growing demands for student nutrition.

More children depend on school breakfast and lunch programs than ever before, and many even continue nutrition programs in the summer months. According to the USDA, 163.5 million summer meals were provided to children compared to just 2.2 million in 1969.

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The cost of many school meals are supplemented today, and children from families with incomes at or below 130% of the federal poverty level are eligible for free meals. Students from families with incomes between 130% and 185% (between $31,525 and $44,863 in 2015) of the poverty level are eligible for reduced price meals. According to the USDA, 15% of children received free or reduced-price lunches in 1969 compared to 72.6% in 2015.

According to the School Nutrition Association (SNA), the revised nutrition standards came at a cost, increasing the cost to prepare school lunches by 10 cents each, and 27 cents per breakfast-but federal funding increases to cover the changes equaled just 6 cents for lunch and nothing for breakfast. As a result, SNA says schools have had to find ways to make up these costs, with most opting to cut staffing in cafeterias. The SNA recently penned a letter to Congress about the cost burden, and advocates revising portions of the new standards, such as the heavy whole grain requirement.

While participation rates have remained steady, Podrabsky’s study did not review how much of the lunches students were actually eating. However, previous studies indicate the food waste rates in school cafeterias did not change after the new lunch standards were implemented.

In terms of the quality of school lunches, the study found that the mean adequacy ratio of nutrient density increased from 58.7 before HHFKA implementation to 75.6. Energy density decreased, from a mean density of 1.65 before the changes to 1.44 after, according to the study.

NEXT: Why good nutrition in schools is important

Offering good nutrition in schools is critical because so many children depend on schools for their most complete meal of the day, and the American Academy of Pediatrics (AAP) estimates that children consume up to half of their daily calories during the school day. At least 2 out of 5 children also consumer at least one snack food or beverage at school, accounting for about 400 billion snack food calories in school annually, according to AAP. Requiring schools to offer healthy choices to students-even at a higher cost-is crucial to combatting growing childhood obesity rates, since the school food environment plays a key role is what students know about nutrition, says AAP.

A 2013 study revealed that children who ate school lunches were more than 12% less likely to develop obesity than their counterparts, and low-income children who receive free or discounted lunches are typically most at risk of developing obesity.

Next: Why low-income kids are at greater risk of obesity

Podrabsky says her study reaffirms that the school lunch changes, despite continued concerns raised by groups like the SNA, are right on track. The nutritional benefit is there, and Podrabsky says wider participation in school lunch programs would have an even greater impact.

“Encouraging all children to participate in school lunch is a good thing for health equity because it becomes more socially acceptable for everyone,” she says. “One reason that low-income children don’t participate is that there is often a stigma associated with free and reduced meals.”

Pediatricians can play a role in ensuring children receive proper nutrition in school by working with local school districts and parent-teacher associations to advocate for school meal participation and support school wellness programs.

Additionally, as school lunch and snack programs have improved, there is a new focus for pediatricians to advocate for healthier options sent from home. The AAP released a new policy statement just last year, urging parents to continue the work schools have started by limiting the amount of high-calorie, nutrient-poor snacks sent to school. Snacking guidelines from AAP and other groups can help pediatricians guide parents to make better decision about the lunches and snacks they send to school with their children.