Did the Healthy, Hunger-Free Kids Act of 2010 improve school nutrition?

Much ink has been spilled over former First Lady Michelle Obama’s pet project the Healthy, Hunger-Free Kids Act of 2010 and many have wondered whether the act prompted an improvement in the dietary quality of lunch served to children who participated in the National School Lunch Program. An investigation in JAMA may be able to provide an answer.¹

Investigators created a serial cross-sectional study design that used data from the National Health and Nutrition Examination Survey from 2007-2008, 2009-2010, 2013-2014, and 2015-2016. They used data from participants who participated in the National School Lunch Program. The participants included in the study were aged 5 to 18 years, enrolled in kindergarten to 12th grade, attending a school that provided a school lunch, and were able to reliably recall weekday dietary consumption. Dietary quality was assessed by the Healthy Eating Index (HEI), where a score of 0 means there was no adherence to the 2010 Dietary Guidelines for Americans and a score of 100 means complete adherence.

A total of 6389 were included in the study of which 56% were middle-high-income students; 12% were low-middle-income students; and 32% were low-income students. Among low-income students, the adjusted average prepolicy HEI among students who participated in the National School Lunch Program was 42.7 and postpolicy was 54.6. For low-income students who didn’t participate in the program, the average adjusted prepolicy score was 34.8 and postpolicy, it was 34.1. For low-middle-income students, students in the program had an average prepolicy score of 40.4 and postpolicy score of 54.8. For children not in the program, the average adjusted score was 34.2 and the postpolicy score was 36.1. The trend continued in the middle-high-income students, in the program the adjusted average prepolicy score was 42.7 and postpolicy was 55.5. Among nonparticipants, the adjusted prepolicy score was 38.9 and postpolicy was 43.6.

The investigators concluded that Healthy, Hunger-Free Kids Act of 2010 was linked to improved dietary quality for lunch for children who were part of National School Lunch Program. Unfortunately, as the study notes, the act has been watered down over the years. It now allows less whole grains, more flavored milk, and more sodium. Additionally, the US Department of Agriculture is currently considering changing the policy to allow participating schools to serve fewer servings of vegetables.

Reference

1. Kinderknecht K, Harris C, Jones-Smith J. Association of the Healthy, Hunger-Free Kids Act with dietary quality among children in the US national school lunch program. JAMA. 2020:324(4):359. doi:10.1001/jama.2020.9517