Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Mark Swanson, Ph.D.

Committee Member

Corrine Williams, ScD

Committee Member

Christina Studts, Ph.D.


According to the National Health and Nutrition Examination Survey (NHANES) nearly 17% of children nineteen years of age and younger are obese.1 Obese children face many health ailments similar to those of obese adults including sleep apnea, asthma, hypertension, and early onset of type 2-diabetes.2 These problems continue into adulthood when additional risks such as cancer and cardiomyopathy begin to develop.2 Furthermore, obese children are at increased risk of adult obesity.3 Addressing the childhood obesity challenge has become a national priority, with significant initiatives from the White House, USDA, CDC, and other national health organizations as well as numerous intervention research studies. 4-8 The national initiatives include Let’s Move, National Farm-To-School, and My Plate. 9-11 After the home environment, the elementary school is arguably one of the most influential on a child’s lifelong habits, and it is an ideal place to begin obesity prevention.12,13 Kids spend more than half the year in school, and consume up to two meals and a snack a day at school.14 Examples of successful school interventions are the CATCH study, Chef Initiative, and the implementation of salad bars.15-17 All three of these initiatives made simple changes to the school day such as having a chef present or a salad bar available during lunchtime in order to improve the health of their students. One such easy change that could be made is the removal of flavored milk from school meals. Milk is an important and significant source of nutrients and calories in school meals. It provides nutrients such as calcium, vitamin A, vitamin D, and potassium. However, There is increasing concern about the dietary implications of the widespread use of flavored milks to meet the national school lunch program (NSLP) requirement. Flavored Milk and the NSLP 3 This is because the flavored milk that is offered is full of sugar.18 In 2009 the American Heart Association released a report stating that school aged children should only consume about 12g of added sugar per day. The NSLP strives to offer at least ⅓ of each day’s recommended daily allowances.19 Following this rule, students should only consume about 4g of added sugar per school lunch. Flavored milk alone has at least 6g of added sugar. This leads to an unnecessary increase in consumption of calories and sugar, and it may affect the consumption of other important low calorie, nutrient dense foods offered in the meal.18,20 Students filling up on unnecessary sugars from flavored milk may not choose to eat nutrient dense items, and thus may not eat a balanced school meal. One argument against the removal of flavored milk from school meals is the lack of calcium that students will consume, but as seen in a study by the Yale Rudd Center for Policy and Obesity involving schools that removed flavored milk, consumption rates are similar in when looking at flavored versus white. Furthermore this study points out that calcium and added sugar can be received from other sources in the meal.18 Moreover, the data on how flavored milk affects the school lunch is of limited quality, relying mostly on self-reported twenty-four hour dietary recall. 21,22 Twenty-four hour recall is not particularly useful when dealing with young children or when needing actual serving sizes consumed.23 This study provides needed information about how flavored milk consumption shapes the dietary habits of students during the school lunch hour. This study uses objective, rather than self-reported, data to test the association between consumption of flavored milk and overall nutritional intake of school lunches. It is a cross-sectional study building upon previous research by looking at the school lunch Flavored Milk and the NSLP 4 food and milk consumption through the examination of photos taken before and after school lunch and the weighing of milk cartons after lunch to measure consumption. The amount of nutrients from food eaten is expected to be lower when flavored milk is chosen over white milk because it is believed that students will fill up on milk and not eat the food. Additionally there is expected to be a difference in the amount of total nutrients consumed (food and milk) between students that consumed flavored milk versus students that consumed white milk. We aim to determine whether there is an association between type of milk chosen and the amount of food consumed, and the amount of total nutrients consumed between the types of milk chosen in order to better guide the discussion on the removal of flavored milk from school meals.

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