Year of Publication

2014

College

Public Health

Degree Name

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

Committee Chair

Mark Swanson, Ph.D.

Committee Member

Linda Alexander, Ed.D.

Committee Member

Kate Eddens, Ph.D.

Abstract

While the recent decline in the rate of obesity amongst preschool children in 19 states is encouraging,(1) the overall rate of obese children in the United States remains at 17%.(2) Obese children suffer physical, emotional, and psychological health consequences such as high blood pressure, high cholesterol, impaired glucose tolerance, breathing problems, fatty liver disease, poor selfZesteem, and depression.(3) Furthermore, obese children are more likely to become obese adults with their health problems worsening with age.(3)

The National School Lunch Program (NSLP), which provided meals to over 30 million students in 2013,(4) was recently revised to improve school food environments to help address the childhood obesity epidemic and to improve the dietary quality of schoolZaged children. With the “Healthy, Hungry Free Kids Act of 2012,” the United States Department of Agriculture (USDA) updated standards for the NSLP based on recommendations from the Institute of Medicine (IOM), including more fresh fruits and vegetables, more whole grains, only nonfat and low fat milk, and stricter caloric and fat content limits.(5)

Findings on the effects of the policies that dictate what should be served to schoolchildren have been unequivocal. Compared to nonparticipants, school lunch participants have been found to more likely consume milk, fruit, and vegetables while less likely to consume desserts, snack items, and beverages other than milk or 100% juice.(6) It has also been found that the more stringently a school follows the nutrition standards established by the USDA, the more likely its students are to be an appropriate weight.(7) On the other hand, a study conducted in Louisiana examined food intake and plate waste to conclude that the majority of students exceeded the upper limits of energy and saturated fat recommendations.(8) There is further evidence that few children select and consume the recommended servings of vegetables.(9)

Existing research lacks a comparison between what children select and consume and the specific nutritional guidelines for school lunches using precise student consumption of all foods offered and selected, including beverages. Such a comparison is critical to fully understanding how nutritional guidelines change the diets of individual students. The weakness inherent in most previous studies of school meal programs is that they rely on selfZreport data, even though accuracy of food recalls and food frequency questionnaires by children in grades ranging from one to twelve are questionable.(10) There are a growing number of exceptions using more precise techniques such as digital photography to estimate plate waste but not all food categories, most notably beverages, were evaluated in these studies.(8, 11) If a significant line of defense against childhood obesity is improving the nutritional quality of school lunches, monitoring accurate selection and intake by the target population is a key component.

This study will compare the means of key nutrients selected and consumed by students against both the standards set by the USDA prior to their strengthening by the “Healthy, Hungry Free Kids Act of 2012,” and the more stringent guidelines recommended by the IOM. To address the limitations of previous studies, this study uses the combined method of direct observation of selection and plate waste via digital photography, a method shown to be highly accurate and precise,(12) and before and after carton weights to measure beverage consumption. The research will first determine whether students are selecting the appropriate foods to meet nutritional standards and secondly whether students are consuming enough of the foods to fully benefit from these standards. This will address the effectiveness of nutritional standards for school meals, potentially highlighting needed changes to the school lunch program to ensure children are consuming appropriate nutrients to maintain a healthy weight.

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