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Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006

The Role of Schools in Obesity Prevention
Mary Story Karen M. Kaphingst Simone French

The School Food Environment

Not only do most U.S. school-aged children attend school, they eat a large share of their daily food while they are there—estimates range from 19 to 50 percent or higher.15  Food is typically available through the U.S. Department of Agriculture's (USDA) school breakfast and lunch programs and through “competitive foods” sold in vending machines, as a la carte offerings in the cafeteria, and at snack bars, school stores, and fundraisers.16

National School Breakfast and Lunch Programs
Ninety-nine percent of all public schools and 83 percent of all public and private schools participate in the National School Lunch Program.17  The School Breakfast Program is offered in 78 percent of the schools that offer the lunch program.18  On an average school day, about 60 percent of children in schools offering the lunch program eat school lunch, and about 37 percent of children in schools in the breakfast program eat school breakfast (see table 1).

Meals in both programs must meet federally defined nutrition standards (see box) for schools to be eligible for federal subsidies, both cash and commodities. Federal school lunches must provide approximately one-third of the recommended dietary allowance (RDA) for key nutrients; school breakfasts offer one-fourth of the RDA. A 1998–99 national study found that federal school lunches generally meet standards for the key nutrients protein, vitamins A and C, calcium, and iron.19  The average calorie content of elementary school lunches was somewhat higher than the RDA while that of secondary school lunches was slightly lower.20  Since 1995, federal school lunches and breakfasts have had to meet the requirements set in the Dietary Guidelines for Americans, which include limits on total and saturated fat (no more than 30 percent of calories from fat, with less than 10 percent from saturated fat). Schools reduced the average share of calories from fat in lunches from 38 percent in 1991–92 to 34 percent in 1998–99, but more than 75 percent of schools have not met the recommended share of 30 percent. Elementary schools are doing better than high schools.21  The nutritional profile of school meals has improved over the past fifteen years but is not yet what it should be.

Impact of school meals on child nutrition. School meal programs significantly improve school-age children's diets.22  Children who eat school lunches and breakfasts have higher mean intakes of micronutrients, both at mealtime and over twenty-four hours, than those who do not.23  For the 59 percent of children eating school meals who come from low-income families, the meals provide a necessary safeguard against hunger.24  Participation in the program declines drastically with age. It also declines as competing options to school meals become available.25

Commodity foods. Schools participating in the lunch program are eligible to receive commodity foods as well as bonus commodities. The commodity foods support American farmers by providing price supports and removing surpluses. Commodity foods must be of domestic origin, and 60 percent of the commodities purchased for schools must be from surplus stocks.26  Commodities make up about 20 percent of the food schools use, with local school districts buying the rest on the open market or through purchasing cooperatives.27  During the 2005–06 school year, schools can receive donated commodity foods from the USDA, valued at 17.5 cents for each lunch served.28  More than 94,000 schools receive commodities. During the 2004 school year, the USDA purchased more than $7.7 million worth of commodities for schools, totaling more than 1.1 billion pounds.29  The states administer the commodities program, with each state selecting from a list of foods purchased by the USDA. Changes are needed in the commodity food program. The USDA should revise specifications to procure commodity foods that are consistent with those outlined in the Dietary Guidelines. The program should also offer more fresh produce and healthful lower-fat foods and make more connections with local farmers.

Financial issues. Budget pressures complicate schools' efforts to provide nutritious meals.30  School food service programs, once regular line items in local school budgets, now must often be completely self-supporting and cover costs of food, labor, and other expenses, such as equipment, utilities, and trash removal.31  Federal reimbursements and revenue from food sales are their principal sources of funds. In the 2005–06 school year, the USDA will reimburse participating schools $2.32 for every free lunch provided, $1.92 for every reduced-price lunch sold, and $0.22 for every other (“paid”) lunch meal sold.32  A recent analysis, however, found that expenses covered by federal reimbursements fell from 54 percent in 1996–97 to 51 percent in 2000–01.33  Schools can enhance revenues in three ways: by increasing the number of students who eat federal meals, by increasing prices for full-price meals, and by expanding a la carte and catering sales.34  The first two options—increasing school meal participation and raising prices of school meals—are difficult because many competing options are available from which students can purchase food at school. To try to break even, many food service directors thus choose the third option: selling popular but nutritionally poor foods a la carte.35  In one analysis in 2000, total revenue from a la carte foods was 43 percent.36  Not surprisingly, sales of a la carte items are inversely related to sales of school lunch meals.37  In states that restrict the sale of competitive foods, such as Mississippi, Louisiana, West Virginia, and Georgia, school meal participation rates exceed the national average.38

To encourage more students to participate in the school meal program, some schools are hiring culinary experts to develop healthful, tasty meals; are making cafeterias more youth friendly; and are enhancing the cafeteria's atmosphere. Indeed, the cafeteria itself can be a barrier to healthy eating. In some schools, lunch is served as early as 10:00 a.m. or as late as 1:30 p.m. Long cafeteria lines send students to vending machines or school stores. Insufficient time for lunch, cramped and unattractive cafeterias, and noise can also discourage participation in school meals. All these issues have financial implications, and structural issues, such as the cafeteria space or time allowed for lunch, are not under the school food service's control.

School food services, facing difficult times, are using a variety of expense-containment and revenue-producing strategies to try to manage school food service finances. Serving reimbursable meals that are more appealing to students and offering more healthful a la carte items would help students eat more healthfully. For this change to happen, however, schools need to curtail foods sold outside the cafeteria that compete with school meals. Limiting competitive foods during school mealtimes could increase meal participation and increase revenues.

Full funding for the school meal programs could also relieve pressure on schools' food services to generate extra funding through competitive food sales. Schools that participate in the federal meal programs receive a fixed reimbursement for each meal served. Federal reimbursement rates are typically nine to ten times higher for free meals than for reduced-price or paid meals.39  Although some states contribute supplemental funds and most schools receive donated USDA commodity foods, federal reimbursements are inadequate to cover the remainder of the meals' costs.

Competitive Foods
Competitive foods are all foods offered for sale at school except federal school meals.40  They include a la carte foods offered in the school cafeteria as well as foods and beverages sold in snack bars, student stores, vending machines, and fund-raisers.41 Current law tightly limits the Agriculture Department's authority to regulate competitive foods, which fall into two categories. The first category, called foods of minimal nutritional value, is defined in federal regulations as foods that provide less than 5 percent of the RDA per serving for each of eight key nutrients. They include soft drinks, water ices, chewing gum, and certain candies made largely from sweeteners, such as hard candy and jelly beans. These foods, which the USDA regulates, cannot be sold in food service areas during meal periods, but they may be sold anywhere else in the school at any time.42  A vending machine with soft drinks and candy, for example, could be placed in the hall outside the cafeteria and be available to students all day. The second category of competitive foods, which is not under USDA authority, consists of all other foods offered for individual sale. This category, which includes candy bars, potato chips, cookies, and doughnuts, may be sold in the cafeteria during meal periods as well as anywhere else in the school. Although reimbursable school meals must meet federal nutrition and dietary guidelines, competitive foods have no such requirements. The federal definition of “foods of minimal nutritional value” is thirty years old and narrow in scope. It should be expanded to include additional foods with limited nutritional value. Further, although the federal school meal programs set appropriate portion sizes, competitive foods follow no size guidelines. Twenty ounces of soda, for example, is the standard size in many school vending machines.

Availability of competitive foods. The availability of high-fat, high-sugar foods and beverages in schools creates a food environment that invites excess energy intake and excess weight gain.43  The national School Health Policies and Programs Study (SHPPS) 2000 found that 43 percent of elementary schools, 74 percent of middle schools, and 98 percent of high schools have vending machines, school snack bars, or other food sources outside of the school meal programs.44  The most common competitive foods are carbonated beverages, fruit drinks that are not 100 percent juice, salty snacks, and high-fat baked goods. Only 18 percent of the foods available through vending machines, school stores, or snack bars are fruits or vegetables. Most schools (58 percent of elementary schools, 84 percent of middle schools, and 94 percent of high schools) sell soft drinks, sports drinks, or fruit drinks.45  In one study, the mean number of soft drink machines available to high school students was 5.3 (ranging from two to eleven).46  Another study found that nearly nine out of ten schools offered competitive foods through a la carte cafeteria lines, vending machines, and school stores during the 2003–04 school year. The sale of competitive foods has increased over the past five years, with schools often selling them in or near the cafeteria and during lunch. High schools and middle schools were more likely to sell such foods than elementary schools.47

In the SHPPS 2000 survey, nearly all (83 percent) schools offered food a la carte.48  And the wide availability of high-fat foods in cafeteria a la carte options has been documented.49   In one study, Simone French and her colleagues found that only a third of foods in high school a la carte areas and in vending machines met the lower-fat guideline of less than 5.5 fat grams per serving.50  The average number of a la carte food items typically available per school was 80 (ranging from 39 to 156), with chips and crackers making up the largest share of items. Fruits and vegetables were available a la carte in 85 percent of the schools, but they made up only 4 percent of total a la carte foods available.51  School districts have also established contracts with fast-food vendors. In the 2003 California High School Fast Food Survey, roughly one-fourth of 173 districts reported selling brand-name products from Taco Bell, Subway, Domino's, and Pizza Hut in high schools.52

School fundraisers often involve the sale of food or beverages. In the SHPPS 2000 survey, 82 percent of the schools reported that school clubs, sports teams, or the parent-teacher association (PTA) sold food at school or in the community to raise money.53 According to the California fast-food survey, 74 percent of school food service directors reported that student clubs sell food during school mealtimes.54 Other groups selling food at mealtimes in high schools are booster clubs (33 percent), the PTA (31 percent), and the physical education (PE) department (28 percent). Food fundraisers directly compete with the food service department and are subject to no nutritional standards. Student groups could instead raise funds by selling nonfood items, such as gift wrap, magazines, and plants, and by hosting walk-a-thons and auctions.

Impact of competitive foods on child nutrition. Competitive foods sold to students are displacing fruits and vegetables and other healthful foods and contributing to excessive fat and saturated fat intake. One study examined the diets of 598 seventh- and eighth-grade students and found that the greater the availability at school of a la carte foods, the lower the daily intake of fruits and vegetables and the higher the intake of daily total fat and saturated fat. The greater the availability of snack vending machines, the lower the intake of fruit.55  Karen Cullen and Issa Zakeri found that when elementary school students entered middle school and gained access to school snack bars, they consumed fewer fruits and non-starchy vegetables, less milk, and more sweetened beverages and high-fat vegetables than they did when they were in elementary school and had no option but the school lunch.56  In a study of 743 sixth-grade students aged eleven to thirteen in three public middle schools in Kentucky, one-third who purchased the regular school lunch also bought competitive food items—mostly chips, fruitades or sport beverages, and cakes and cookies—in the lunchroom.57  These students reduced their school lunch servings, resulting in lower intakes of minerals and vitamins and higher intakes of energy and fat. All these studies highlight the importance of school lunch program meals to fruit, vegetable, and milk consumption among children and adolescents.

School funding issues and competitive foods. As noted, competitive food sales generate an important revenue stream for schools in a climate of funding constraints. Many schools have come to rely on profits from competitive food sales to support food service operations, academic programs, cocurricular activities, and after-school activities.58  Schools that are under financial pressure are more likely to make low-nutrition foods and beverages available to their students, have soft drink contracts, and allow food and beverage advertising to students.59  A 2005 Government Accountability Office (GAO) report found that many schools, particularly high schools and middle schools, generated substantial revenues through competitive food sales— more than $125,000 apiece each year for the top 30 percent of high schools.60  Food services generally spent their revenue on food service operations while school groups put theirs toward student activities.

School districts nationwide have also negotiated contracts for product sales, primarily soft drinks.61 These “pouring rights” contracts typically involve substantial lump-sum payments to school districts and additional payments over five to ten years in return for exclusive sales of one company's products in vending machines and at all school events.62 Companies also advertise on scoreboards, in hallways, on book covers, and elsewhere. Many contracts increase the share of profits schools receive when sales volume increases, further encouraging schools to promote consumption.

These practices contradict the nutrition and health messages students receive in the classroom and contribute to poor dietary habits. They also give soda companies unfettered access to youth and the chance to develop lifetime brand loyalty.63  Despite increased public attention to food in schools and to the eroding quality of diets among youth, many schools hesitate to restrict competitive food for fear of losing income.

In August 2005, in response to growing pressure from parents and public health advocates, the American Beverage Association announced voluntary restrictions on sales of soft drinks in elementary and middle schools. The companies will encourage school districts and bottlers to provide only bottled water and 100 percent juice in elementary schools and to provide lower-calorie beverages in middle schools until after school. But because the new policy will apply only to new contracts, it will take several years to phase high-calorie beverages out of elementary and middle schools.64  And high schools, which have many more vending machines, will be unaffected.

Public discomfort with the school food environment is growing. The question is whether schools can provide more healthful food options without losing sales revenue.65  Evidence about how reducing the sale of unhealthful foods and beverages or offering more healthful options would affect revenue is limited. But some studies have found that school food service staff reported no loss of revenue when they offered students more healthful a la carte choices.66 And schools in Maine, California, Minnesota, and Pennsylvania replaced soft drinks with more healthful beverages without losing revenue.67

Surprisingly few national data are available on schools' income from vending machines.68  A 2003 Texas Department of Agriculture survey found that total annual revenue from vending contracts for all 1,256 state schools was about $54 million.69  It also found that food service departments lose $60 million a year in federal reimbursable meal sales to competitive foods, resulting in a net loss. During the 2001–02 school year, the total deficit for Texas school food service operations was $23.7 million, which had to be subsidized from other district sources.

Because many schools generate substantial revenue through competitive food sales, making changes entails financial risks.70  Some school districts, however, have taken steps to mitigate potential revenue changes, such as substituting healthful foods for less healthful ones instead of removing all competitive foods, getting students involved in promoting healthful foods, using marketing approaches to encourage students to make healthful choices, offering alternate means for fundraising, and implementing changes gradually or at the beginning of the school year. Without support from the groups that use the revenue from competitive food sales, districts can see their policy changes curtailed.71 Also, getting student suggestions about what types of nutritious foods would be offered will promote acceptance.

Policy implications. Federal rules governing the availability, content, and sale of competitive foods and setting schoolwide nutrition standards are inadequate.72  Congress should grant the secretary of agriculture broader authority to regulate the availability, content, and sale of competitive foods during the school day and set nutrition standards for all foods and beverages sold. Such actions would not only enhance children's health and nutrition but also protect the federal investment in child nutrition through the national school meal programs.73  Limiting the sale of competitive foods during school meals would increase participation in school meals and help ensure that children receive a nutritious meal.

Model School Nutrition Programs
Advocates, administrators, parents, educators, and health professionals across the country are promoting grassroots nutrition initiatives. Making It Happen! School Nutrition Success Stories showcases thirty-two schools that are offering and selling more nutritious foods and beverages. The schools carried out their reforms by setting nutrition standards for competitive foods, changing food and beverage contracts, making more healthful foods and beverages available, using marketing techniques to promote healthful choices, limiting access to competitive foods, and using fundraising activities and rewards that support rather than undermine student health.74

The message from Making It Happen! is that, given the opportunity, students will buy and consume healthy foods and beverages and, more important, that schools can maintain a profitable bottom line at the same time. Of the seventeen schools and school districts that reported income data, twelve increased revenue and four reported no change.