Is The School Lunch Program Making Students Less Healthy?

Valerie Becker

HLTH 640 Nutrition Program Design

Key Words: Nutrition Education, Lunch, Obesity, NSLP, High School

Introduction

According to the USDA’s Food and Nutrition Service, the National School Lunch Program (NSLP) provides lunches to over 31 million children each school day (National School Lunch Program, n.d.). The school lunch program is a reliable, dependable and important program to keep students fed and guarantee that ⅓ of the DRI for macronutrients is met daily. While NSLP continues to benefit the community from a hunger and financial standpoint, it must be noted that obesity rates in adolescents continue to rise. Is it possible that the standards set by the NSLP could be contributing to the obesity epidemic? Perhaps students aged 13-19 years old are more susceptible to poor eating behaviors because of their newfound independence, lack of nutrition knowledge/education and their food choices available to them in school. The goal moving forward would be to increase awareness of healthy eating to ultimately decrease the risk of obesity later in life through a nutrition education program mandated by schools in New Jersey. Students will understand the importance of healthy eating and develop simple strategies towards maintaining a healthier lifestyle.

Obesity is on the Rise

In 2016, by definition, 13% of the world’s population was considered obese. According to the CDC, 21% of 13-19 year olds are overweight/obese (Overweight & Obesity Statistics, 2017). This graph to the right represents overwight and obese children based by region (Overweight & Obesity Statistics, 2017). In New Jersey, approximately 1 out of every 4 adults are obese with 23% of NJ highschool students being classified as overweight or obese (Physical Activity, Nutrition, and Obesity, 2018). In 2008, $2.2 billion was spent on obesity health care costs while that cost quadrupled in 2018 to $9.3 billion. (Physical Activity, Nutrition, and Obesity, 2018). Inventions must be in place for the health of adolescents to minimize their risk of obesity.
This chart shows the obesity percentage in NJ high school students. In 2019 it was reported that 11.9% of students are obese which represents a 3.2% increase since 2013. Since 2000, the percentage of obesity in NJ high schools has continued to steadily increase. This blog is posing the question, is the school lunch program healthy?

What is the National School Lunch Program?

First, we must better understand what NSLP is. The NSLP is regulated by federal law and provides low-cost or free lunches to 29.7 million children daily at a cost of $13.8 billion. Free lunches are available to children in households with incomes at or below 130 percent of poverty and reduced-price lunches are available to children in households with incomes between 130 and 185 percent of poverty. More information on NSLP can be found at https://www.nj.gov/agriculture/divisions/fn/childadult/school_lunch.html. Lunches must meet ⅓ of the DRI, however are not nutritionally adequate. The chart below shows the minimum requirements for calories, protein, fat, calcium, iron vitamin A and C (Institute of Medicine, nd.). Saturated fat is not required. It is important to note that these requirements are for the complete meal, however students have the flexibility to pick and choose the components they would like. Therefore, it can not be implied that all students are receiving adequate nutrition. If these students are going to
have the independence to make their own food choices, then it is incumbent upon the school to provide the tools for children to make smart choices. Without that, school meals will promote a false sense of healthy eating and poor eating habits will prevail.
Adolescents participating in NSLP are provided with a meal that meets the DRI requirements, and as such, qualifies as a complete meal in the eyes of the government. Kids are probably psyched to eat french fries (vegetable), chicken nuggets (protein) and sugary fruit juice (fruit). Tasty? Maybe. Healthy? Definitely not. While this meal may meet the standards of a DRI prepared meal, it is high in fat, starch, and sugar. As a registered dietitian, I have worked in a high school and have seen this firsthand. Schools must comply with NSLP guidelines, and this meal dynamic works. While following the strict interpretation of a nutrition label, micronutrients may be met in the acceptable quantities. However from a registered dietitians perspective, this is proving an unhealthy lifestyle and instilling the belief to the children that fries, juice and chicken nuggets represent a complete and healthy meal. Why do school lunches fail to meet the gold standard of nutrition?

What Can be Done?

While I understand that this issue must be addressed at a policy level and there is a lot of work to be done there, implementing a nutrition program will educate students about a healthy diet and foods to support a healthy lifestyle. Educating children on the food groups, how to read a nutrition facts label, and following easy recipes will make small, yet impactful changes to these students’ well being. A great example curriculum of basic nutrition knowledge can be found at https://4-h.org. Students will better understand the relationship food has on their health and the associated risk factors with a diet rich in saturated fats and sugar. Nutrition implementation in highschool schools would be a start towards promoting a healthier lifestyle. For example, bringing kids together, perhaps with an assembly, would provide a crash course explaining the basics like the five food groups and how to identify items that are classified as low fat and high salt. They would discuss effects of added sugars, fried foods, processed foods, etc. No one, but the students, can determine what food they eat. At the cafeteria, they must become vigilant and aware that not all foods are created equal. Instead of an option for the burger and fries, you can always choose a salad loaded with veggies and protein, or even vegetable soup, a piece of bread and maybe a deli sandwich. All things can fit into their diet, but the importance of this nutrition education program will be to get the students more involved with the foods, their choices and understanding the benefits of maintaining a healthy diet.

References:
Booker, C. (2020, February 13). All Info – S.3293 – 116th Congress (2019-2020): Food and Nutrition Education in Schools Act of 2020. Retrieved September 18, 2020, from https://www.congress.gov/bill/116th-congress/senate-bill/3293/all-info
Childhood Obesity Facts. (2019, June 24). Retrieved November 11, 2020, from https://www.cdc.gov/obesity/data/childhood.html
FACT SHEET: Healthy, Hunger-Free Kids Act School Meals Implementation. (n.d.). Retrieved September 25, 2020, from https://www.usda.gov/media/press-releases/2014/05/20/fact-sheet-healthy-hunger-free-kids-act-school-meals-implementation
Federal Nutrition Standards for School Meals. (n.d.). Retrieved September 25, 2020, from https://meals4kids.org/federal-nutrition-standards-school-meals
FoodCorps. (2020, February 13). What is the Food and Nutrition Education In Schools Act of 2020? Retrieved October 12, 2020, from https://foodcorps.org/food-and-nutrition-education-in-schools-act-of-2020/
Healthy-Food-Choices-In-Schools. (2019, June 13). Tray Waste Part III: Effectively Present Your Data. Retrieved October 16, 2020, from https://healthy-food-choices-in-schools.extension.org/tray-waste-part-iii-effectively-present-your-data/
Hunger, J. M., Major, B., Blodorn, A., & Miller, C. T. (2015). Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health. Social and Personality Psychology Compass, 9(6), 255-268. doi:10.1111/spc3.12172
Institute of Medicine (US) Committee on Nutrition Standards for National School Lunch and Breakfast Programs. ( January 01). Introduction. Retrieved December 02, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK214991/?report=reader
National School Lunch Program. (n.d.). Retrieved September 09, 2020, from https://www.ers.usda.gov/topics/food-nutrition-assistance/child-nutrition-programs/national-school-lunch-program
Overweight & Obesity Statistics. (2017, August 01). Retrieved December 02, 2020, from https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
Physical Activity, Nutrition, and Obesity New Jersey Fact Sheet. (2018). Retrieved November 18, 2020, from https://www.nj.gov/health/nutrition/services-support/breastfeeding/Obesity%20Data%20Fact%20Sheet_Dec2016_FINAL.PDF

Process Evaluation

The program,Be Sweet Without the Sugar, aims to prevent both the development of adolescent obesity and type 2 diabetes through social media in order to reduce sugar sweetened beverage consumption among teens. Nutrition education is not mandatory in the state of NJ, and through this program high school students will learn the importance of nutrition by understanding the risks associated with SSB consumption. The ideally implemented Be Sweet Without the Sugar program will consist of three essential components: social marketing for nutrition education, incentives to promote engagement in the program, and environmental support by swapping out SSB for water or other low-sugar options in vending machines on the school grounds. Research shows that school-based interventions that provide adolescents education on health consequences combined with improving the environment, such as removing vending machines or providing healthy alternatives, are effective in reducing the consumption of SSB among adolescents.

Sample Schedule of Topics:

Each topic will be presented through social media posts, videos and photos. Students will attend an assembly in the first and last week of the program to complete a nutrition education survey for research purposes. Throughout the weeks, students will see social media posts addressing varying topics. These short videos will capture the importance of the topic while only lasting a minute at most. This will keep the students engaged and provide nutrition education through a series of short video posts. Students will be encouraged to follow the accounts and engage in the activities throughout the weeks to enter a biweekly raffle with varying prizes.

Month-Topic-Important Takeaways-Activity/Incentive

January 1-15

Understanding the 5 food groups. General nutrition education. Promote water. Students will be provided with the social media sites to follow and engage in for the duration of the program. Social media will provide daily videos and photos providing education, activities and ways to enter the raffle biweekly.

How all foods can fit into a healthy lifestyle. Distinguish between the different food groups.
MyPlate activities.

Incentive to join the program, all students participating will receive a reusable water bottle to promote water drinking throughout the day, instead of SSB beverages from the vending machine. Late partipments after this week are welcome, but no incentive. Nutrition knowledge survey to determine baseline – for research purposes.

January 16-31

How to read a nutrition facts label. Where is the added sugar on the label? How much total added sugar should be consumed a day? Promote water.

Understand how to read a nutrition label. Can quickly find where calories, fat, fiber, added sugar and protein are on the label. Able to define low and high amounts of nutrients per serving.

Activity of bingo where a student must complete their bingo board during the week for a chance to win the raffle prize ($10 amazon gift card).

February 1-15

Effects of added sugar and disease. Understand the role SSB has on health and lasting negative long term effects. Promote water.

Understand how much added sugar is in sweetened beverages. How too much sugar can contribute to chronic diseases. Risk of SSB. Ways to decrease consumption.

Guess the beverage activity. Vials filled with sugar – students must guess which beverage contains that much sugar. Those who get all questions correct will be entered to win raffle (6 case of unsweetened beverages)

February 16-28

Hydration and the importance of water in the body.

Water is vital to our functioning. How much of our bodies are made up of water.

Hydration challenge. Must refill their water bottles (received in week 1) at least 3 times throughout the day. Take a picture each time for a chance to win a raffle. Incentive activity – winner receives a swell water bottle.

March 1-15

Program wrap up. Review of all concepts learned.

Students are able to vocalize the importance of water in the body, how much added sugar they should aim for a day and the negative effects of SSB on the body.

Students complete the nutrition education survey – same as completed in week 1 of program. Incentive to complete in the survey is a raffle ticket to win a $50 amazon gift card.

Social Component:
Social media will be an important way to portray nutrition education material to high school students. This program will encourage students to participate in the social media contests and understand the benefits of water in the body. Social media platforms such as Facebook, Instagram and TikTok will show students that drinking water can be both fun while promoting positive behavior change. Students will follow these social media accounts and be provided with daily tips and tricks to a healthy lifestyle. These posts will include general nutrition information such as how to read a nutrition facts label and MyPlate information. Posts will also include specific information on the effects of sugary beverages and the lasting negative health implications. Students will recognize the importance of water on the body and ways to decrease their risk of chronic disease through the incorporation of a healy lifestyle.
Incentive Component: Certain challenges will be displayed through the social media sites, such as a hydration challenge, to encourage students to participate with the incentive of winning a raffle at the end of each week. Students must engage on the social media sites to show involvement in the program for a chance to win. Prizes will include reusable water bottles, monetary gift cards, apparel, and cookbooks. Through the incentive component of this program, more student participation is expected.

Financial / Environmental Component:
The facility will earn approximately $90 (per 400) by swapping soda for a mix of water and unsweetened tea. Schools that implement our program will be asked to submit data on sales of water and SSB in vending machines and the cafeteria. We will also monitor usage of water stations in schools. Data will be reviewed 4 months before the program, 4 months during the program, and 4 months after the program. This data will be used to determine if our program is increasing the consumption/sale of water in the school and decreasing consumption/sales of SBB.

Target of Question
Process- Evaluation Question
Method of Assessment for Question
Resources Required

Target of Question:
Recruitment
Process- Evaluation Questions:
What procedures were followed to recruit students to engage with the social media platform?
Did all employees successfully complete the nutrition education training program?
Method of Assessment for Question:
Morning meetings will address the program and encourage students to participate.
Resources Required:
Morning meeting announcements will need appropriate technology and wifi. Space for staff to
complete training programs.

Target of Question:
Reach
Process- Evaluation Questions:
Was the social media engagement delivered to at least 85% of the high school students?
To what extent did the engagement in social media posts have reduced SSB consumption while
simultaneously increasing water consumption?
Method of Assessment for Question:
How many students have smartphones where they are able to access the social media accounts
during the day? Make sure students are respectful to teachers and only on social media when
appropriate.
Resources Required:
Social media outlets. Availability to skilled staff.

Target of Question:
Fidelity
Process- Evaluation Questions:
To what extent was each of the program elements implemented as planned as described in the
‘complete and acceptable delivery’?
Did the social media accounts gain the students’ attention and encourage them to participate
in the incentive programs?
Method of Assessment for Question:
How many active followers the account has.
Amount of likes and shares increases over the weeks.
Students have the available time during the day to participate in the incentives provided.
Resources Required:
Social media accounts. Wifi throughout the school building. Activity tables are placed in common areas of the school.

Target of Question:
Context
Process- Evaluation Questions:
Did the school allow for free time throughout the day for students to participate in
incentive programs?
Was there enough available space at the school for students to congregate and complete the
tasks set forth by the program?
Method of Assessment for Question:
Did students increase their nutrition knowledge by scoring at least 25% better on the post
survey than the pre survey which will be provided at the start and conclusion of the
program?
Resources Required:
Amount of likes, follows and shares on social media accounts. Post survey to compare to pre
survey of baseline knowledge. Admin account access to all sites. Pre survey. Space in a
common area for students to gather to participate in incentive activities.

Target of Question:
Dose Delivered
Process- Evaluation Questions:
Did the vending machines swap out the SSB for unsweetened beverages and water?
Did all the students engage in the daily social media activities?
Were all employees given the opportunity to complete the training program?
Method of Assessment for Question:
Pre-survey to determine baseline knowledge. Weekly checks of vending machines to ensure
correct fill.
Resources Required:
Pre survey. Computer, pencils, paper. Classroom space for employee training.

Target of Question:
Dose Received
Process- Evaluation Questions:
To what extent did the students participate on the social media platforms and engage with
other students?
To what extent did the school administration work towards healthier and unsweetened
beverages in the vending machines?
Did the students enjoy the way nutrition education was taught via social media and the
incentives provided through the social media accounts?
Did at least 75% of the students engage in the program?
Method of Assessment for Question:
Self-reported checklist and observation with checklist.
Resources Required:
Post survey.Computer, pencils, paper.

The questions that are most relevant for this evaluation plan include dose delivered, dose received, reach, and fidelity. Dose delivered is the total number of intended units of each intervention provided by the program (Saunders, Evans & Joshi, 2015). A question that will be used to determine the effectiveness of the dose delivered will be: Did the vending machines swap out the SSB for unsweetened beverages and water? This is the most relevant dose delivered question as this is the backbone for this program. Without the substitution of SSB with unsweetened beverages, students will not be provided with healthier, less sugary, alternatives. The program supervisor will monitor and adjust the program implementation to ensure that this intervention is met. Dose received is essential to quantify how the intervention was received. By referring to the question: To what extent did the students participate on the social media platforms and engage with other students? This question is addressing the extent to which participants are actively engaged with, interact with, and are receptive to the program (Saunders, Evans & Joshi, 2015). Reach is the extent to which participants’ activity engage in the program and are receptive to the material provided. The question: “Was the social media engagement delivered to at least 85% of the high school students?” will show how engaged the target audience was in the program and to ensure that the program is making an impact in the community by reaching a certain percentage of the students. Lastly, fidelity shows the extent to which the intervention was implemented as planned. The question, “Did the social media accounts gain the students’ attention and encourage them to participate in the incentive programs?” will ensure that the program is running as intended. Evlution will be essential in regards to the implementation of the program and monitoring for success.

Saunders, R.P., Evans, M. H., & Joshi, P. (2005). Developing a Process-Evaluation Plan for Assessing Health Promotion Program Implementation: A How-To Guide. Health Promotion Practice, 6(2), 134-147.