Healthy school lunch initiatives

There is strong evidence that certain types of healthy school lunch initiatives increase healthy food consumption (Cohen 2021a, Graziose 2018, Driessen 2014, Williamson 2013). These initiatives include offering more menu choices, adapting recipes to improve palatability or cultural appropriateness, providing pre-sliced fruits, rewarding students who try fruits and vegetables, limiting access to competitive foods, providing longer lunch periods, and having recess before lunch (Cohen 2021a).

Healthy school lunch initiatives consisting of multiple interventions are more effective than single interventions, such as offering more fruit and vegetable choices in addition to providing pre-sliced fruits (Cohen 2021a). Students consume more of their lunches if they have longer lunch periods (Cohen 2021a, Graziose 2018, Burg 2021). Research suggests that 30-minute lunch periods can help ensure students have enough time to eat after waiting in the lunch line and could be combined with scheduling recess before lunch to create a calmer lunchroom environment (Cohen 2021a). Removing competitive foods can increase participation in healthier school meals (Boehm 2020).

Nutrition education, taste tests, and Smarter Lunchroom techniques have inconsistent impacts on student meal consumption; however, decision-makers may still consider implementing these initiatives alongside strategies with stronger evidence (Cohen 2021a). Healthy school lunch initiatives that combine cafeteria environment improvements with classroom nutrition education can improve fruit and vegetable consumption and dietary choices more than nutrition education or cafeteria improvements alone (Cohen 2021a, Song 2016). One study showed that Smarter Lunchroom marketing and nudging techniques resulted in increased school meal participation but did not decrease competitive food purchases by students (Boehm 2020). Other nudging techniques may increase healthy meal choices initially but do not show persistent effects (Ozturk 2020).

Healthier school lunches can improve academic outcomes (NBER-Anderson 2017) and appear to reduce absences related to illness (Belot 2011). Healthy school lunch initiatives have been associated with increased free National School Lunch Program (NSLP) participation (Wojcicki 2006). Many school districts report increased NSLP participation following implementation of the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) (USDA-HHFKA implementation 2014, Pew-School food 2012). Careful implementation of HHFKA and healthy school lunch initiatives is necessary to maintain gains in food security realized through the NSLP (Gundersen 2015).

Healthy school lunch initiatives can be combined with nutrition standards or physical activity programs to reduce or maintain rates of obesity or overweight status in students (CG-Healthy school foods 2016). One program that combines scratch-cooked, less processed meals with physical activity coaching found that students consumed more fruits and vegetables (Koch 2021). Another study found that menu changes, new kitchen equipment, and food staff training is associated with increased fresh fruit and vegetable offerings (Behrens 2018).

Experts suggest that students’ perceptions of barriers and facilitators of school lunches play a key role in healthy eating (Payan 2017). Long cafeteria lines, time constraints, lack of variety, and limited quantities of preferred foods can be challenges for students, while access to fresh foods can facilitate healthy eating (Payan 2017). Inadequate equipment, kitchen infrastructure, and staff training to support new cooking, food safety, equipment operation, and healthy food promotion responsibilities along with revisions to menu development and food purchasing processes can be challenges for healthy school lunch initiatives (Pew-Urahn 2013).

Healthy school lunch initiatives may reduce food waste and increase cooking from scratch with fresh, seasonal produce, which may reduce emissions from fossil fuels used to produce, process, and transport food (Ringling 2020, FAO-Food waste, Hic 2016, Stone 2021, CCAFS-Campbell 2012). Such initiatives may also reduce the energy intensity of an individual’s diet if more plant-based foods are consumed in place of animal products (Ringling 2020, Hamerschlag 2017).

Many aspects of healthy school lunch initiatives are low cost, easy to implement, and scalable, such as recess before lunch and pre-slicing (Cohen 2021a, Wansink 2013). Cooking from scratch can also be cost-effective; lower food costs and higher labor costs often lead to small changes in total costs (Woodward-Lopez 2014).

Healthy school lunch initiatives are a suggested strategy to reduce disparities in healthy food consumption between children from families with low incomes and those from families with higher incomes (Cohen 2021a). Families with lower incomes often lack access to affordable healthy food and are more likely to experience food insecurity (USDA-ERS Coleman-Jensen 2021). Children who experience food insecurity consume more of their daily energy from school meals than children who do not experience food insecurity (Forrestal 2021). Schools with two-thirds or more of students eligible for free and reduced-price lunch (FRPL) report more participation in healthy school lunch programs and less plate waste than schools with fewer students eligible for FRPL (BTG-Terry-McElrath 2014). Overall, school foods are higher quality and more nutritious than non-school foods (Forrestal 2021), particularly after the Healthy, Hunger-Free Kids Act (HHFKA) updated nutrition standards in 2010 and improved child diet quality (Liu 2021a).

Offering healthy, culturally relevant foods can increase participation in healthy school lunch programs (Wojcicki 2006). A culturally sensitive approach is suggested to increase effectiveness of obesity prevention efforts such as healthy school lunch initiatives (CDC-Health equity resources). Universal school meals are a suggested strategy to increase healthy food consumption and remove economic, administrative, and language barriers for students and families (CG-Healthy school meals for all 2022).

In the U.S., the first school meal programs were provided by private societies and child welfare associations in the 1800s and early 1900s (USDA-Gunderson 1971). Congress established the National School Lunch Program (NSLP) in 1946 to both reduce undernutrition in children and increase demand for domestic agriculture commodities (USDA-ERS Ralston 2008). In 1966 during the Civil Rights movement, the Child Nutrition Act created the first NSLP subsidies for children from low-income families (Thompson 2020a). The Reagan Administration made significant cuts to the NSLP budget in 1981. In response the U.S. Department of Agriculture (USDA) broadened NSLP food categories to cut costs, such as reclassifying corn chips, doughnuts, and pies as “bread” (Gaddis 2019). At the same time, the USDA’s commodity distribution program for school lunch began shifting towards ready-to-heat-and-eat foods which are more heavily processed but are easier for schools to serve (Gaddis 2019). Participation in the NSLP declined slightly in the 1980s and 1990s (USDA-Child nutrition data). Implementation of healthier school meals after the passage of the Healthy, Hunger-Free Kids Act (HHFKA) has been associated with reductions in obesity-related disparities among children in poverty (Cohen 2021a, Kenney 2020). In 2018, the Trump Administration introduced school nutrition standard flexibilities that weakened the phased implementation of lower sodium limits and reduced requirements for whole grains (Kogan 2019). The USDA announced updated standards in 2024 that will limit added sugars and sodium in school meals starting in the 2025-2026 school year (USDA-School nutrition updates).

School nutrition standards are often influenced by the commercial interests of corporations who sell school food (Gaddis 2019). Large companies or organizations in the food industry, such as the National Potato Council and the School Nutrition Association, have lobbied against healthier school food (Schwartz 2019). In the current U.S. policy context, food that is cheap for corporations to produce tends to be less nutritious, more calorie dense, and contains more chemical additives and preservatives than food that is more expensive. Food procurement policies that dictate schools must choose the lowest bid, rather than the healthiest one, may entrench cheaply made and less healthy food options (Gaddis 2019).

• Who decides whether to start or sustain healthy school lunch initiatives? Who should have a voice in ongoing school lunch decisions?
• What barriers or challenges to healthy eating do students experience in your lunchroom?
• What are the strengths of your school and community? How can you build on those strengths in the lunchroom?
• What funds are available for healthy school lunch initiatives? If healthy school lunch initiatives are low or no-cost, what other resources might they need to be successful?

School meal programs face higher food costs and staffing challenges as they return to regular meal service after the COVID-19 pandemic. During the pandemic, the U.S. Department of Agriculture (USDA) offered waivers that provided flexibility and additional funding (NCSL-Katz 2023). As of 2023, many state legislatures are considering healthy school meals for all and 8 states have passed state-wide free school meal policies (SNA-2023 legislation, FRAC-Healthy school meals). More broadly in 2019, 40 states and Washington, D.C. proposed legislation and 16 states passed legislation to support school nutrition and healthy school lunches, including proposals to enhance farm to school programs, local procurement incentives, organic food purchasing, vegetarian lunch options, and school garden programs (SNA-2019 legislation). These state actions complement the nutrition standards outlined by the 2010 federal Healthy, Hunger-Free Kids Act (HHFKA). According to the USDA, over 90% of schools meet the HHFKA standards, and only 0.15% of schools have opted out of the National School Lunch Program following implementation (USDA-HHFKA implementation 2014).

Many non-profit organizations support healthy school lunch initiatives. The Alliance for a Healthier Generation, for example, supports efforts in over 28,000 schools, touching every state (AFHG-Lunch). Santa Barbara’s School Food Initiative features a Culinary Boot Camp and kitchen staff training to bring cooked from scratch lunches into Santa Barbara public schools (Orfalea-School food). In Massachusetts, Project Bread’s Chefs in Schools program helps school kitchen staff learn to prepare healthy meals and supports farm to school efforts (Project Bread-Chefs in schools). Let’s Move Salad Bars to Schools has donated almost 6,000 salad bars to schools across the country (SB2S-Salad bar). In Colorado, The Lunch Box’s Rainbow Day program encourages students to eat from the salad bars in their school lunchrooms (The Lunch Box-Rainbow days).

‡ Resources with a focus on equity.

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ChangeLab-Healthy food at schools - ChangeLab Solutions. Healthy food at schools: A webinar on how to provide healthier school food options.

CSPI-School meals - Center for Science in the Public Interest (CSPI). Model school wellness policies: School meals.

ISU-Food and sustainability resources - Iowa State University (ISU), Sustainable Food Processing Alliance. Online resources for food and sustainability.

MD DOE-Cafeteria toolkit - Maryland State Department of Education (MD DOE), University of Maryland-Extension. Project ReFresh: Cafeteria toolkit. Team Nutrition; 2010.

Pew-KSHFP - The Pew Charitable Trusts (Pew), Robert Wood Johnson Foundation. Kids' safe and healthful foods project (KSHFP).

SLI-Resources - School Lunch Initiative (SLI), Center for Ecoliteracy, The Edible Schoolyard Project. Resources.

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UM-YES-Resources - University of Michigan (UM), School of Public Health. Youth Empowered Solutions (YES). Resources.

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USDA-NSLP - U.S. Department of Agriculture (USDA). National School Lunch Program (NSLP).

* Journal subscription may be required for access.

AFHG-Lunch - Alliance for a Healthier Generation (AFHG). Breakfast and lunch.

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CG-Healthy school meals for all 2022 - The Guide to Community Preventive Services (The Community Guide). Healthy school meals for all. 2022.

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FAO-Food waste - Food and Agriculture Organization of the United Nations (FAO). Food wastage footprint & climate change.

Forrestal 2021 - Forrestal S, Potamites E, Guthrie J, Paxton N. Associations among food security, school meal participation, and students’ diet quality in the first school nutrition and meal cost study. Nutrients. 2021;13(2):307.

FRAC-Healthy school meals - Food Research and Action Center (FRAC). Healthy school meals for all.

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Kenney 2020 - Kenney EL, Barrett JL, Bleich SN, et al. Impact of the Healthy, Hunger-Free Kids Act on obesity trends. Health Affairs. 2020;39(7):1122-1129.

Koch 2021 - Koch PA, Wolf RL, Trent RJ, et al. Wellness in the schools: A lunch intervention increases fruit and vegetable consumption. Nutrients. 2021;13(9):1-11.

Kogan 2019 - Kogan R. Rollback of nutrition standards not supported by evidence. Health Affairs Forefront. 2019.

Liu 2021a - Liu J, Micha R, Li Y, Mozaffarian D. Trends in food sources and diet quality among U.S. children and adults, 2003-2018. JAMA Network Open. 2021;4(4):e215262.

NBER-Anderson 2017 - Anderson ML, Gallagher J, Ritchie ER. School lunch quality and academic performance. National Bureau of Economic Research (NBER). 2017: Working Paper 23218.

NCSL-Katz 2023 - Katz E, Rockenback H. New state and federal policies expand access to free school meals. National Conference of State Legislatures (NCSL). 2023.

Orfalea-School food - Orfalea Foundation. School food initiative.

Ozturk 2020* - Ozturk OD, Frongillo EA, Blake CE, McInnes MM, Turner-McGrievy G. Before the lunch line: Effectiveness of behavioral economic interventions for pre-commitment on elementary school children’s food choices. Journal of Economic Behavior and Organization. 2020;176:597-618.

Payan 2017* - Payán DD, Sloane DC, Illum J, Farris T, Lewis LB. Perceived barriers and facilitators to healthy eating and school lunch meals among adolescents: A qualitative study. American Journal of Health Behavior. 2017;41(5):661-669.

Pew-School food 2012 - The Pew Charitable Trusts (Pew). School food success stories. 2012.

Pew-Urahn 2013 - Urahn S, Olson E, Thomas K, et al. Serving healthy school meals despite challenges: Schools meet USDA meal requirements. The Pew Charitable Trusts (Pew), Robert Wood Johnson Foundation, Kids' Safe and Healthful Foods Project Report. 2013.

Project Bread-Chefs in schools - Project Bread. Chefs in schools: Improving the quality of food for kids. East Boston, MA.

Ringling 2020 - Ringling KM, Marquart LF. Intersection of diet, health, and environment: Land grant universities’ role in creating platforms for sustainable food systems. Frontiers in Sustainable Food Systems. 2020;4(70).

SB2S-Salad bar - Salad Bars to Schools (SB2S). Get a salad bar in your school.

Schwartz 2019* - Schwartz MB, Brownell KD, Miller DL. Primer on U.S. food and nutrition policy and public health: Protect school nutrition standards. American Journal of Public Health. 2019;109(7):990-991.

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SNA-2023 legislation - School Nutrition Association (SNA). 2023 third-quarter state legislative report (January-August). 2023.

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The Lunch Box-Rainbow days - The Lunch Box. Lunchroom education: Rainbow days.

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USDA-HHFKA implementation 2014 - U.S. Department of Agriculture (USDA). Fact sheet: Healthy, Hunger-Free Kids Act school meals implementation. Release No. 0098.14;2014.

USDA-School nutrition updates - U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS). School nutrition standard updates.

Wansink 2013* - Wansink B, Just DR, Hanks AS, Smith LE. Pre-sliced fruit in school cafeterias: Children's selection and intake. American Journal of Preventive Medicine. 2013;44(5):477-480.

WI DPI-Team nutrition - Wisconsin Department of Public Instruction (WI DPI). Team nutrition.

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Wojcicki 2006* - Wojcicki JM, Heyman MB. Healthier choices and increased participation in a middle school lunch program: Effects of nutrition policy changes in San Francisco. American Journal of Public Health. 2006;96(9):1542-1547.

Woodward-Lopez 2014* - Woodward-Lopez G, Kao J, Kiesel K, et al. Is scratch-cooking a cost-effective way to prepare healthy school meals with U.S. Department of Agriculture foods? Journal of the Academy of Nutrition and Dietetics. 2014;114(9):1349-1358.