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Progress Against Childhood Obesity Could Be Threatened By Rolling Back School Lunch Standards, Experts Say

school lunch 5

Efforts to roll back current nutritional standards for the National School Lunch Program could jeopardize gains made in the fight against childhood obesity, write the authors of a new article in the New England Journal of Medicine. The article, co-authored by two pediatricians from Massachusetts General Hospital for Children (MGHfC), addresses the claims raised by opponents of the current standards and stresses the standards’ importance for maintaining the progress that has been made to improve the quality of school meals.

“The School Lunch Program provides meals to more than 30 million students a day, and few other programs that can protect against obesity and chronic diseases have such a broad reach,” says Dr. Elsie Taveras, MD, MPH, chief of General Pediatrics at MGHfC and a co-author of the NEJM article. “The recent politicization of the program and attempts to roll back the improvements that have been made represent to us – as pediatricians and public health practitioners – a threat to children’s health, development and academic success.”

Established in 1946, the National School Lunch Program provides free or reduced-cost meals in more than 100,000 public and non-profit private schools and other child-care institutions nationwide. A 2008 Institute of Medicine report found that children participating in the program were eating few fruits and vegetables – with potatoes accounting for one-third of their vegetables – and consuming high levels of saturated fats and sodium. The 2010 Healthy, Hunger-Free Kids Act specified updated nutritional standards for the program, increasing servings of fruits, vegetables and whole grains, and limiting calories, trans fats and sodium.

Industry-backed efforts to undermine nutrition standards

Under the old standards, this qualified as "lunch" for schoolchildren in America.

Under the old standards, this qualified as “lunch” for schoolchildren in America.

Gradual implementation of the new standards began in 2012, but in recent months some school officials, food industry representatives and the School Nutrition Association – a professional organization that includes food manufacturers – have claimed that students were unwilling to accept meals prepared under the new standards, leading to increased waste of uneaten food and reduced participation in the program overall. They also have claimed that meeting the standards is difficult and has increased operating costs. In response to these claims, the 2015 Republican-led House of Representatives budget resolution – currently on hold but needing to be resolved by December 2014 – includes a waiver that would allow schools with a 6-month net loss in school lunch revenues to return to the old standards.

Those who support reverting back to unhealthier lunch standards claim that the waivers will provide schools with greater flexibility and allow them to cut down on waste. However, opponents, such as Mark Bishop, Vice President of Policy at Healthy Schools Campaign, contend, “what some people call greater flexibility other people call gutting the nutrition standards.” Indeed, the GOP-led House that proposed the waivers is the same one which, in 2011, decided that pizza was a vegetable.

The influence of industry lobbyists cannot be overlooked: the biggest funder behind the bill has been the potato lobby, which spent $120,000 in support of the bill last year alone. The potato lobby fought proposals for tighter USDA regulations on white potatoes in 2011 and continues to spend huge amounts to oppose health regulations that target fatty foods like french fries. It’s also worth noting that the School Nutrition Association — once a supporter of the new school food law, but now its most vocal critic on Capitol Hill — has strong ties to industry, as well: the processed food industry funds at least half of the association’s operating budget.

Claims not substantiated by evidence

Importantly, recent studies show that many of the arguments made against the new lunch standards are groundless, and in many cases, easily disproven. In the NEJM article, Dr. Taveras and lead author Dr. Jennifer Woo Baidal, MD, MPH – a fellow in pediatric health services research at MGHfC and a pediatric gastroenterologist at Boston Children’s Hospital – note the following:

  • Most of those raising objections to the current standards have an interest in keeping program costs as low as possible and have not documented their claims.
  • Waste of fruits and vegetables served in school lunches has been a problem for many years, and a recently published study found not only that waste had decreased under the new standards but also that students were eating greater proportions of the served entrees and vegetables and more fruit.
  • The decline in participation in the school lunch program goes back to the 2007-08 school year, and a recent Government Accounting Office report found that the reasons for the decline were unclear and supported maintaining the new nutrition standards.
  • It is well known that children’s food preferences are changeable and that their willingness to accept new foods increases with greater exposure to new options.

They also write that more than 200 organizations – including the American Academy of Pediatrics, the American Heart Association, and the Academy of Nutrition and Dietetics – along with Secretary of Agriculture Tom Vilsack and first lady Michelle Obama have opposed challenges to the new standards. And while current leaders of the School Nutrition Association are among those calling for changes, a group of 19 of the organization’s past presidents has opposed the waiver. The authors suggest that schools could improve both the quality and acceptability of the meals they serve by collaborating with local chefs, dietitians, parents and students.

“Allowing schools to opt out of the new school lunch standards would deny many children access to healthy meals and represent a large step backwards in the efforts to prevent childhood obesity,” Dr. Woo Baidal says. “Matters of children’s health should not be driven by political considerations.”

 New standards are feasible, accepted by schools and children

Ironically, just as Congress is debating rolling back nutrition standards, the healthier school meals seem to be gaining wider acceptance among students. A study published earlier this year in the journal Childhood Obesity, for example, found that while kids initially complained about the new school meals, 70 percent of principals observed that their students now actually like the lunches, with many students even indicating a preference for the new lunches over the old ones. This finding was particularly true at poorer schools where the school lunch program is of obvious importance.

And despite claims that the stronger nutrition guidelines are too burdensome, experts say most schools have adopted the standards without significant difficulty. The Department of Agriculture reports that nearly 90 percent of schools nationwide have implemented meal plans that meet the new standards, and ongoing reports by the Healthy Schools Campaign document the many innovative approaches schools are using to effectively meet — and even exceed — the new nutrition guidelines. Furthermore, the Department of Agriculture has already responded to needs for greater flexibility by eliminating weekly maximums for grains and protein foods and making adjustments to school lunch pricing requirements.

As you can see in the figure below, the new requirements are not excessive:

school lunch 10Strong nutrition standards can prevent childhood obesity

With more than 32 million children participating in the National School Lunch Program, experts say relaxing nutrition standards could lead to a rise in already staggering rates of childhood obesity, which has more than quadrupled in children and adolescents over the past 30 years. These effects are likely to be concentrated among poor children and and students of color, who are the primary recipients of school lunches and already face a significantly higher risk of childhood obesity.

According to a 2013 study from the Robert Wood Johnson Foundation, students who receive free or reduced-price lunches–almost all of whom are from lower-income families—had higher obesity rates than those who did not participate in the lunch program, but the gap was much smaller in states with strong meal standards. For example, in states with weaker standards, 26 percent of students who received free or reduced-price lunches were obese, compared with 14 percent of students who did not participate in the lunch program. But in states with stronger standards, the difference was much smaller—21 percent of students who received free or reduced-price lunches were obese compared with 17 percent of students who did not participate. The same findings have also been reported after the implementation state laws on school snacks and drinks—students consume fewer calories and gain less weight when policymakers actively support stronger nutrition standards for such products.

Today, one-third of American adolescents are overweight or obese, putting them at risk for a wide range of diseases, including cardiovascular disease, type 2 diabetes and certain cancers. Research has shown that childhood obesity results in $19,000 on average in medical costs throughout an individual’s lifetime, meaning increased childhood obesity could put an even greater strain on the nation’s already overburdened healthcare system. And, due in large part to the obesity epidemic, the U.S. is facing a sustained drop in life expectancy for the first time in history. As Dr. William H. Dietz, a director at the Center for Disease Control and Prevention has warned in the past, “this may be the first generation of children that has a lower life span than their parents.”

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