School Lunch Program
Efforts Needed to Improve Nutrition and Encourage Healthy Eating
Gao ID: GAO-03-506 May 9, 2003
Recent trends in children's health and eating habits are alarming. Over 15 percent of children are overweight--double the rate in 1980. Children's diets are high in fat but low in fruits, vegetables, and other nutritious foods. The National School Lunch Program has had a continuing role in providing students with nutritious meals. However, serving the meals is only the first step. Students must choose to eat the nutritious food and limit the less healthful choices. GAO was asked to report on the extent to which school lunches, nationwide, were meeting nutrition standards, and schools were encouraging healthy eating, what barriers selected schools faced in accomplishing this, and what innovative steps they had taken to overcome the barriers.
Schools are moving toward meeting school lunch nutrition requirements, but more improvements are needed. According to national studies, lunches meet requirements for nutrients such as protein, vitamins, calcium, and iron, but do not meet the required 30 percent limit for calories from fat. Also, efforts to encourage healthy eating could be increased. Students may need more exposure to nutrition education to effect positive changes in their behavior, and most students have access to foods of little nutritional value, such as soft drinks and candy, at school. In schools we visited, barriers to providing nutritious meals and encouraging healthy eating included budget pressures and competing time demands. Regarding providing nutritious food, officials said when they introduce healthier foods, they take the risk that students will buy fewer school lunches resulting in loss of needed revenue. Regarding encouraging healthy eating, officials said the focus on meeting state academic standards limited time to teach nutrition. Also, schools paid for special activities or other items not covered in the school's budget with profits from vending machines and snack bar sales. Schools had taken a variety of innovative steps to overcome barriers. With respect to providing nutritious food, while minimizing the risk students might reject healthier choices, schools modified recipes to lower the fat content of popular foods such as pizza and conducted taste tests before adding healthier choices. To encourage healthy eating, schools found time to teach nutrition by integrating nutrition lessons into reading and math classes, and some established school food policies to restrict unhealthy choices. Some schools enlisted help from parents, community organizations, and businesses. Officials noted that overcoming barriers required strong and persevering leadership.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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GAO-03-506, School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating
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Report to Congressional Requesters:
United States General Accounting Office:
GAO:
May 2003:
SCHOOL LUNCH PROGRAM:
Efforts Needed to Improve Nutrition and Encourage Healthy Eating:
GAO-03-506:
GAO Highlights:
Highlights of GAO-03-506, a report to Congressional Requesters
Why GAO Did This Study:
Recent trends in children‘s health and eating habits are alarming.
Over 15 percent of children are overweight”double the rate in 1980.
Children‘s diets are high in fat but low in fruits, vegetables, and
other nutritious foods. The National School Lunch Program has had a
continuing role in providing students with nutritious meals. However,
serving the meals is only the first step. Students must choose to eat
the nutritious food and limit the less healthful choices. GAO was
asked to report on the extent to which school lunches, nationwide,
were meeting nutrition standards, and schools were encouraging healthy
eating, what barriers selected schools faced in accomplishing this,
and what innovative steps they had taken to overcome the barriers.
What GAO Found:
Schools are moving toward meeting school lunch nutrition requirements,
but more improvements are needed. According to national studies,
lunches meet requirements for nutrients such as protein, vitamins,
calcium, and iron, but do not meet the required 30 percent limit for
calories from fat. Also, efforts to encourage healthy eating could be
increased. Students may need more exposure to nutrition education to
effect positive changes in their behavior, and most students have
access to foods of little nutritional value, such as soft drinks and
candy, at school.
In schools we visited, barriers to providing nutritious meals and
encouraging healthy eating included budget pressures and competing
time demands. Regarding providing nutritious food, officials said when
they introduce healthier foods, they take the risk that students will
buy fewer school lunches resulting in loss of needed revenue.
Regarding encouraging healthy eating, officials said the focus on
meeting state academic standards limited time to teach nutrition.
Also, schools paid for special activities or other items not covered
in the school‘s budget with profits from vending machines and snack
bar sales.
Schools had taken a variety of innovative steps to overcome barriers.
With respect to providing nutritious food, while minimizing the risk
students might reject healthier choices, schools modified recipes to
lower the fat content of popular foods such as pizza and conducted
taste tests before adding healthier choices. To encourage healthy
eating, schools found time to teach nutrition by integrating nutrition
lessons into reading and math classes, and some established school
food policies to restrict unhealthy choices. Some schools enlisted
help from parents, community organizations, and businesses. Officials
noted that overcoming barriers required strong and persevering
leadership.
What GAO Recommends:
GAO recommends that the Secretaries of Agriculture, Health and Human
Services, and Education work together to identify specific strategies
to help schools promote nutrition education while meeting the demands
of state academic standards and to encourage each state to identify a
focal point to promote collaborative efforts that would further
develop nutrition education activities for schools.
www.gao.gov/cgi-bin/getrpt?GAO-03-506.
To view the full report, including the scope
and methodology, click on the link above.
For more information, contact David D. Bellis at (415) 904-2272.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Schools Moving Toward Meeting Nutrition Requirements, but Improvements
Needed:
Barriers Exist to Providing Nutritious Food and Encouraging Healthy
Eating Choices:
Schools Have Implemented Approaches to Overcome Barriers:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendix I: Comments from the Department of Health and
Human Services:
Appendix II: Comments from the Department of Education:
Appendix III: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Staff Acknowledgments:
Tables:
Table 1: Mean Nutrient and Caloric Content of School Lunches Offered in
School Year 1998-99 and School Year 1991-92 Compared with NSLP
Standards:
Table 2: Percentage of Schools Offering Selected Foods in Competition
with School Lunches:
Abbreviations:
CDC: Centers for Disease Control and Prevention
MOU: Memorandum of Understanding
NSLP: National School Lunch Program
SFA: School Food Authority
SNDA: School Nutrition Dietary Assessment Study
SHPPS: School Health Policies and Programs Study
USDA: United States Department of Agriculture:
United States General Accounting Office:
Washington, DC 20548:
May 9, 2003:
The Honorable Tom Harkin
Ranking Minority Member
Committee on Agriculture, Nutrition, and Forestry
United States Senate:
The Honorable Richard G. Lugar
United States Senate:
The nation faces a complex challenge in addressing recent trends in
children's health and eating habits. The percentage of children ages 6
to
19 who are overweight has more than doubled to over 15 percent since
1980, and the incidence of Type II diabetes--closely associated with
obesity--has also increased in the past decade. Children's diets are
too high in fat but low in fruits, vegetables, and other foods that
provide needed nutrients, according to the U.S. Department of
Agriculture (USDA). At the same time, a recent study reported that, in
2001, nearly one-half million children lived in households in which one
or more children were hungry at some time during the year because the
household lacked money enough for food.[Footnote 1] Healthy eating
patterns in childhood are important to promote optimal intellectual
development and prevent health problems.
The National School Lunch Program has played a continuing role in
school-based efforts to provide students with nutritionally balanced
meals at low or no cost. In fiscal year 2002, about 28 million children
each day at about 99,000 public and nonprofit schools and residential
child care institutions received meals through this program. USDA's
Food and Nutrition Service administers the program at the federal
level, and state education agencies typically administer and monitor
the program through agreements with local school food authorities--
offices responsible for managing the school meals program in one or
more schools. School food authorities that choose to participate are
federally subsidized for each meal they serve. To be reimbursable,
meals must meet certain nutritional requirements. However, serving
nutritious lunches and other meals is only the first step in promoting
a healthy school food environment. Students must choose to eat the
nutritious meals as well as limit the other less healthful food they
may eat during the day.
Because of your concern about the serious diet-related health problems
faced by the nation's children and the role of school lunches in
addressing the problems, you asked us to answer the following
questions: (1) What is known nationally about the extent to which
schools and school food authorities are meeting USDA nutrition
requirements and promoting healthy eating among students? (2) What
barriers do schools and school food authorities face in serving
nutritious food and encouraging students to make healthy eating
choices? (3) What steps have schools and school food authorities taken
to overcome the barriers to serving nutritious food and encouraging
students to make healthy eating choices? We are also issuing two other
related reports--one concerns keeping school meals safe from food borne
illness and the other addresses the cost of school meals.[Footnote 2]
To report on the extent to which schools are meeting USDA nutrition
requirements and promoting healthy eating among students, we relied
primarily on the findings of three national studies[Footnote 3]
considered to be authoritative by researchers and other experts in the
field. A statistician and a social scientist examined each study to
assess the adequacy of the samples and measures employed, the
reasonableness and rigor of the statistical techniques used to analyze
them, and the validity of the results and conclusions that were drawn
from the analyses. To report on the barriers schools face and the
efforts schools and districts have made to overcome the barriers to
serving nutritious food and encouraging healthy eating choices, we
reviewed the literature and consulted with experts in the school lunch
program and child nutrition area. On the basis of recommendations from
these sources, we identified and selected states for site visits that
were recognized leaders in the area, schools that had approaches
already in place, and schools that had not yet fully implemented such
efforts. We selected schools for site visits that represented a range
of the following characteristics: school district size, locale (rural,
urban, or suburban), type of school (elementary and secondary), and
percent of students eligible for free or reduced price meals. We
conducted on-site reviews of school lunch activities at
22 schools in California, Kentucky, Michigan, Rhode Island, and
Texas.[Footnote 4] We discussed state operations and activities with
officials in each state. In each school district, we discussed efforts
and barriers to providing nutritious food and encouraging healthy
eating choices with school food authority officials, food service site
managers, school principals, and teachers. At some locations, we also
discussed efforts with students and parents. We conducted our study
from August 2002 to March 2003 in accordance with generally accepted
government auditing standards.
Results in Brief:
Schools have made significant progress in meeting USDA nutrition
requirements since the mid-1990s but need to make improvements both in
meeting the nutrition requirements and in promoting students' healthy
eating choices, according to national studies of school lunches.
Regarding nutrition requirements, the studies found that in 1991-92 and
1998-99, the average school lunch exceeded the required amount of
nutrients, such as protein, vitamins A and C, and calcium.
Additionally, schools have reduced the average proportion of calories
from fat in lunches from 38 to
34 percent, nationwide, during this period. However, more than three-
quarters of schools have not yet achieved the required rate of no more
than 30 percent. Regarding encouraging healthy eating, a national study
of nutrition education in kindergarten through fifth grade found that
nutrition is taught by most teachers. However, studies suggest, not
enough to show an impact on children's behavior. Moreover, national
studies also noted that even when at school, students had access to
food from a number of sources other than the meals that are regulated
by USDA's programs. For example, students at most secondary schools and
many elementary schools can purchase foods and beverages of limited
nutritional value from vending machines and school stores.
Some school and school food authority officials in the 22 schools we
visited cited barriers they faced in improving the nutritional quality
of their lunches; however, many we spoke with expressed greater concern
over the barriers to promoting healthy eating among students. In regard
to improving the nutritional quality of lunches, many officials cited a
barrier that was financial rather than dietary. They said that when
school food authorities introduce healthier foods with lower fat
content they take the risk that students will not like the menu changes
and will buy fewer school lunches. Because school food authorities
operate their programs on a break-even financial basis, and student
meal payments make up a large part of their revenue, a decrease in
meals purchased can throw their budget out of balance, officials said.
With respect to encouraging healthy student eating habits, many
teachers and school officials told us that their ability to place more
emphasis on teaching nutrition and good dietary habits was limited by
the increased focus on devoting class time to the subject matter needed
to meet state academic standards. Officials also said that they face
barriers to restricting student in-school access to foods of limited
nutritional value. For example, many school principals and
organizations told us they receive money from vending machines and
sales of other food and beverages that may be of limited nutritional
value. They said it is difficult to limit these sales because the funds
are often used to pay for special activities or items not covered in
the school's budget. Similarly, school food authority officials told us
that to help manage their budgets, they have chosen to sell less
healthful items in the cafeteria, in competition with the USDA
reimbursable meals.
Many of the schools and districts we visited had taken steps to
overcome such barriers. To improve nutritional quality while minimizing
the risk that students would reject healthier choices, some schools
developed recipes and techniques that lowered the fat and sodium
content of popular foods such as pizza and enchiladas without
sacrificing the appeal of these items. Some schools conducted student
taste tests before they added new and healthier choices such as yogurt
and salads. To encourage healthy eating, some schools changed their
cafeteria layout and offered more healthy choices--for example,
offering lunch stations or lines with different themes, such as soup
and salad or deli sandwich selections. To expand students'
opportunities to learn about healthy eating despite limited class time,
some schools integrated nutrition education into the existing reading
and math curricula and displayed nutrition bulletin boards. To restrict
other, less healthy food choices, a few schools had established a
school food policy that, for example, limited certain vending machine
items or improved the nutritional quality of foods on school grounds.
Finally, some schools had devised a broader approach that reached
beyond the school to enlist help from parents, community organizations,
and businesses. Together, they sponsored health fairs and organized
health-related family activities to raise nutrition awareness.
Officials told us that their efforts to overcome barriers and make any
change--particularly involving collaboration on a school or community
wide level--required strong and persevering local leadership with a
focus on nutrition and healthy eating. Leadership at the state level
was also viewed as valuable.
In support of such efforts, USDA and the Departments of Health and
Human Services and Education have recently signed a memorandum of
understanding--an important step in establishing a partnership to
address student nutrition and other health-related issues. We recommend
that the agencies, using the partnership as a foundation, identify
specific strategies and develop materials to help schools promote
nutrition education while also meeting the requirements of state
academic standards. We further recommend that the agencies, working
together through the memorandum of understanding, encourage states to
identify a focal point in each state to promote collaborative efforts
that would further develop nutrition education activities for the
schools.
We received oral comments on this report from USDA and written comments
from the Departments of Health and Human Services and Education. The
agencies generally agreed with the report and recommendations. However,
the Department of Education expressed concern that the information we
present appears to imply that accountability provisions in the No Child
Left Behind Act may contribute to compromising a healthy eating
environment in schools. We believe that nutrition education and other
components of a healthy eating environment can and should be compatible
with schools' efforts to meet the requirements of state academic
standards. It is for this reason that we recommended that federal
agencies work together to help schools promote nutrition education and
healthy eating among students. See appendixes I and II for the written
comments.
Background:
The National School Lunch Program (NSLP), established in 1946 and
amended many times, provides nutritionally balanced, low-cost or free
meals to children throughout the United States. Over 180 billion
lunches have been served since the program's inception. USDA's Food and
Nutrition Service, state agencies--usually departments of education--
and school food authorities (SFAs) all play a role in managing the
program. SFAs that choose to take part in the program are reimbursed
with cash subsidies and receive donated commodities from USDA. In
return, they must serve lunches that meet federal requirements and
offer free or reduced price lunches to eligible children. The federal
government reimburses the states, which in turn reimburse SFAs for each
meal served.[Footnote 5] In fiscal year 2001, the federal government
spent over $6 billion in cash reimbursements and commodities for school
lunches. To ensure nutritional quality, regulations developed under the
National School Lunch Act initially required schools to include
specific serving sizes of food such as fruits, vegetables, and whole
milk in school lunches. In 1994, Congress amended NSLP requirements
with the Healthy Meals for Healthy Americans Act[Footnote 6] to require
schools to serve meals that adhere to Dietary Guidelines for Americans,
which include limits on total fat and saturated fat. Additionally,
school meals must meet one-third the recommended daily allowance for
calories and for nutrients such as protein, calcium, iron, and vitamins
A and C. Compliance with the standards is determined by averaging the
nutritional content of the lunches offered over a school week.
SFAs have flexibility in operating their school meal programs. They may
operate the programs themselves or contract with food service
management companies to perform functions such as planning and
preparing menus and selecting and buying food. All or some food
preparation may occur at on-site school kitchens or at central
kitchens, which distribute food to satellite schools. In addition, SFAs
select one of five menu-planning approaches they use to comply with
nutritional requirements: two food-based, two nutrient-based--as well
as a fifth option for "any reasonable approach." In a food-based
approach, SFAs plan meals to include minimum quantities of five meal
pattern items (i.e., milk, meat or meat alternative, two different
servings of vegetables and/or fruits, and bread or grain products). In
a nutrient-based approach, SFAs prepare a computerized nutritional
analysis of the week's menu to ensure that the meals meet nutritional
requirements. Schools that use a nutrient-based approach are required
to serve milk and to offer at least one entrée and one side dish.
To increase student participation and reduce waste, an "offer vs.
serve" provision in NSLP was introduced. Previously, for reimbursable
lunches, the entire meal package was served to students. Under the new
provision, schools offer foods that meet nutrient requirements and
encourage students to take them. Students are not required to take all
menu items, but must select specific menu items for a meal to be
reimbursed. For example, in SFAs that use a food-based menu planning
system, students must take a full portion of a least three of five
meal-pattern items offered for a lunch to be reimbursable. In SFAs that
use a nutrient-based system and offer the minimum of three menu items,
students must select at least two of the USDA meal-pattern items
offered, one of which must be an entrée. If more than three menu items
are offered, students may decline a maximum of two menu items, however,
the entrée may not be declined. SFAs are required to use the offer vs.
serve provision for senior high school students, and they have the
discretion to use the provision for elementary and middle school
students.
NSLP requires state agencies to conduct periodic evaluations of SFA
compliance with nutritional and other requirements. State agencies
often review SFA compliance with the School Meals Initiative in
conjunction with the broader-based administrative reviews called
Coordinated Review Efforts that are conducted every 5 years. The
procedures followed in conducting School Meals Initiative reviews
depend upon the menu planning system used by the SFA. For SFAs using
food-based menu planning systems, the state agency must conduct its own
nutrient analysis of the menu served during the review period. For SFAs
using nutrient-based systems, the state agency reviews the menus and
production records and assesses the SFA's nutrient analysis for a 1-
week period, which can be any week of the current school year prior to
the period of review.
SFAs and schools may allow the sale of food in addition to meals served
through NSLP. Under USDA regulations, these foods are considered
"competitive foods" if they are sold in competition with lunches served
under the program in food service areas during the lunch periods.
Competitive foods may also include foods and beverages purchased from
vending machines, school stores, and snack bars. The regulations
provide the states and SFAs with discretion as to whether to impose
restrictions on the sale of all foods, such as by limiting the time or
locations of the sales. However, under the regulations, the schools
must prohibit the sale of "foods of minimal nutritional value" in the
school cafeteria during meal periods. The federal regulations do not,
however, prohibit the sale of foods of minimal nutritional value
outside the cafeteria any time during the school day.[Footnote 7] Foods
of minimal nutritional value are defined in federal regulations and
include, for example, carbonated soft drinks, chewing gum, and
marshmallow candies.
In addition to providing assistance in meeting nutrition requirements,
USDA's Food and Nutrition Service established the Team Nutrition
initiative in 1995 to develop and disseminate a package of materials
that encourage healthy eating and physical activity among students.
These materials focus on the benefits of good nutrition and motivating
students to change their behavior. Additionally, Team Nutrition
provides grants to states and technical assistance materials for school
food service personnel and classroom nutrition education materials as
well as guidance and materials on how to build school and community
support for healthy eating, physical activity, and a healthy school
nutrition environment. The initiative has its own Web site and recently
began an electronic newsletter to food service personnel as another
channel to share ideas for implementing activities and concepts at
state and local levels. Changing the Scene and Eat Smart-Play Hard, two
additional USDA initiatives that provide resources to promote healthy
eating and physical activity are also available to schools.
Additionally, the Department of Health and Human Services' Centers for
Disease Control and Prevention (CDC) has developed and disseminated a
variety of materials and information to help schools implement efforts
to address health issues, including nutrition and physical activity.
CDC has also provided funding to promote healthy eating and physical
activity. For example, in 2000, CDC initiated a grant program to
support state health departments in developing and implementing
nutrition and physical activity interventions. In 2003, CDC provided
support for coordinated school health programs in 22 states that
focused on promoting healthy eating behaviors, physical activity, and
tobacco use prevention among students. Finally, the role of schools and
the community in addressing the national problem of child obesity is
underscored in "The Surgeon General's Call to Action to Prevent and
Decrease Overweight and Obesity." This document--published in December
2001--emphasizes the seriousness of the health problems associated with
being overweight or obese and outlines strategies that communities can
use to address overweight and obesity by focusing on both improved
nutrition and increased physical activity. The document also recommends
providing more healthful food options on school campuses as well as
requiring physical education in all school grades. USDA officials
reported that Team Nutrition and CDC collaborate on an ongoing basis
and are currently developing implementation materials for schools to
use to improve their school nutrition environment. The materials
address issues such as offering and promoting nutritious food and
beverage options in vending machines, school stores, and a la carte.
The officials said they will also report on case studies of schools
that have made successful changes.
Schools Moving Toward Meeting Nutrition Requirements, but Improvements
Needed:
Schools have made measurable progress, nationwide, in meeting USDA
nutrition requirements and other guidelines over the past decade.
Additional improvement, however, is needed not only in meeting the
nutrition requirements, but also in encouraging students to eat more
healthfully. With respect to nutritional quality, on average, schools
are exceeding the requirements for a variety of nutrients. However,
while most schools have reduced the average percent of calories from
fat in school lunches, few have met the required goal for fat content.
Regarding promoting healthy eating, nutrition education is taught at
most schools, but studies suggest it may not be enough to show an
impact on student behavior. Moreover, students at most secondary
schools and many elementary schools nationwide have access to a variety
of food and beverages from vending machines, school stores, and other
sources that is of little nutritional value--for example, high in fat,
sodium, and/or added sugars, but low in nutrients such as vitamins or
minerals.
School Lunch Nutrition Improving but Still Not Meeting Requirements:
In school year 1991-92, a USDA national study to determine the
nutritional quality of school meals found that schools were generally
meeting standards for nutrients, including protein, vitamins A and C,
calcium, and iron.[Footnote 8] The average calorie content of
elementary school lunches was somewhat higher than the standard, and
the calorie content of secondary school lunches was slightly lower than
the standard. However, the study also found that levels of fat,
saturated fat, and sodium[Footnote 9] in school lunches were not
consistent with the standards set out in the "Dietary Guidelines for
Americans."[Footnote 10] As a result of those findings, USDA developed
the School Meals Initiative to improve the nutritional quality of
school meals through, for example, changes in meal menu planning
requirements and enhanced training and technical assistance for school
food service personnel.[Footnote 11]
In school year 1998-99, a USDA follow-up study provided an updated
national picture of the nutrient profile of school meals.[Footnote 12]
According to this study, schools across the nation have, on average,
continued to meet or exceed required nutrient standards for protein,
vitamins A and C, calcium, and iron. The average calorie content of
elementary school lunches continued to be somewhat higher than the
standard and that of secondary school lunches, slightly lower. The
study also reported a significant trend toward lower total fat levels
in school lunches from nearly 38 percent of total lunch calories in
1991-92 down to about 34 percent in 1998-99, however, still above the
required 30-percent standard. Additionally, according to the study,
while the number of schools meeting the
30-percent standard had increased substantially, more than three-
quarters of elementary and secondary schools still had not yet achieved
that goal. Sodium levels had also declined significantly in both
elementary and secondary schools but were still considerably higher
than the 800-mg. standard. Table 1 compares the nutritional content
standards with findings from these two studies.
Table 1: Mean Nutrient and Caloric Content of School Lunches Offered in
School Year 1998-99 and School Year 1991-92 Compared with NSLP
Standards:
Elementary schools:
Protein (gm); NSLP standard: 10; SY 1991-92[A,B]: 30; SY 1998-99[A,B]:
30; Percent change (SY 1991-92 vs. SY 1998-99): 0.
Vitamin A (mcg RE); NSLP standard: 224; SY 1991-92[A,B]: 397; SY 1998-
99[A,B]: 491; Percent change (SY 1991-92 vs. SY 1998-99): +24[D].
Vitamin C (mg); NSLP standard: 15; SY 1991-92[A,B]: 28; SY 1998-
99[A,B]: 37; Percent change (SY 1991-92 vs. SY 1998-99): +32[D].
Calcium (mg); NSLP standard: 286; SY 1991-92[A,B]: 483; SY 1998-
99[A,B]: 505; Percent change (SY 1991-92 vs. SY 1998-99): +5[D].
Iron (mg); NSLP standard: 3.5; SY 1991-92[A,B]: 4.1; SY 1998-99[A,B]:
4.6; Percent change (SY 1991-92 vs. SY 1998-99): +12[D].
Sodium (mg); NSLP standard: 800; SY 1991-92[A,B]: 1,399; SY 1998-
99[A,B]: 1,285; Percent change (SY 1991-92 vs. SY 1998-99): -8[D].
Cholesterol (mg); NSLP standard: 100; SY 1991-92[A,B]: 84; SY 1998-
99[A,B]: 68; Percent change (SY 1991-92 vs. SY 1998-99): -19[D].
Total calories; NSLP standard: 664; SY 1991-92[A,B]: 715; SY 1998-
99[A,B]: 738; Percent change (SY 1991-92 vs. SY 1998-99): +3.
% Calories from fat; NSLP standard: 30%; SY 1991-92[A,B]: 37.5%; SY
1998-99[A,B]: 33.5%; Percent change (SY 1991-92 vs. SY 1998-99): -11.
% Calories from saturated fat; NSLP standard: 10%; SY 1991-92[A,B]:
15.2%; SY 1998-99[A,B]: 11.9%; Percent change (SY 1991-92 vs. SY 1998-
99): -22[D].
Secondary schools:
Protein (gm); NSLP standard: 16; SY 1991-92[A,B]: 33; SY 1998-99[A,B]:
33; Percent change (SY 1991-92 vs. SY 1998-99): 0.
Vitamin A (mcg RE); NSLP standard: 300; SY 1991-92[A,B]: 418; SY 1998-
99[A,B]: 519; Percent change (SY 1991-92 vs. SY 1998-99): +24[D].
Vitamin C (mg); NSLP standard: 18; SY 1991-92[A,B]: 34; SY 1998-
99[A,B]: 42; Percent change (SY 1991-92 vs. SY 1998-99): +24[D].
Calcium (mg); NSLP standard: 400; SY 1991-92[A,B]: 518; SY 1998-
99[A,B]: 542; Percent change (SY 1991-92 vs. SY 1998-99): +5[D].
Iron (mg); NSLP standard: 4.5; SY 1991-92[A,B]: 4.8; SY 1998-99[A,B]:
5.0; Percent change (SY 1991-92 vs. SY 1998-99): +4[C].
Sodium (mg); NSLP standard: 800; SY 1991-92[A,B]: 1,641; SY 1998-
99[A,B]: 1,502; Percent change (SY 1991-92 vs. SY 1998-99): -8[D].
Cholesterol (mg); NSLP standard: 100; SY 1991-92[A,B]: 95; SY 1998-
99[A,B]: 75; Percent change (SY 1991-92 vs. SY 1998-99): -21[D].
Total calories; NSLP standard: 825; SY 1991-92[A,B]: 820; SY 1998-
99[A,B]: 798; Percent change (SY 1991-92 vs. SY 1998-99): -3.
% Calories from fat; NSLP standard: 30%; SY 1991-92[A,B]: 37.5%; SY
1998-99[A,B]: 33.7%; Percent change (SY 1991-92 vs. SY 1998-99): -
10[D].
% Calories from saturated fat; NSLP standard: 10%; SY 1991-92[A,B]:
14.6%; SY 1998-99[A,B]: 11.8%; Percent change (SY 1991-92 vs. SY 1998-
99): -19[D].
Source: SNDA-II pp. 148-155.
Note: NSLP Standards reflect minimums defined in current program
regulations for grades K-6 (elementary schools) and grades 7-12
(secondary schools). NSLP standards for the percentage of calories from
fat and saturated fat were not in effect during SY 1991-92. NSLP
standards reflect minimum content requirements for total calories,
protein, vitamins A and C, calcium, and iron and maximum content
limitations for sodium, cholesterol, calories from fat, and calories
from saturated fat.
[A] Data for all public schools in the first School Nutrition Dietary
Assessment Study (SNDA-I).
[B] Data from the second School Nutrition Dietary Assessment Study
(SNDA-II).
[C] Difference between SY 1991-92 and SY 1998-99 is statistically
significant at the 0.01 level.
[D] Difference between SY 1991-92 and SY 1998-99 is statistically
significant at the 0.001 level.
[End of table]:
The 1998-99 study also points out that schools may also offer low fat
menu options that allow students to choose menu items that provide a
lunch that meets the standard, even when the average lunch offered
exceeds the
30-percent standard for calories from fat. The percentage of elementary
schools that provided such low-fat options increased from 34 percent to
82 percent and for secondary schools, from 71 percent to 91 percent
between school years 1991-92 and 1998-99. The study further reported
that 99 percent of elementary schools and 96 percent of secondary
schools were meeting the cholesterol standard of 100 mg. or less.
However, only
1 percent of elementary schools and less than 1 percent of secondary
schools were meeting the sodium content standard of 800 mg. or less.
Efforts to Encourage Healthy Eating Could be Increased at Many Schools:
In addition to making progress in serving nutritious meals, schools
have made a variety of efforts to encourage healthy eating among
students. However, such efforts remain limited in many locations,
according to national studies. Nutrition education is one way to
promote good dietary habits among youth, and a Department of Education
study found that in school year 1996-97, 88 percent of kindergarten
through fifth-grade teachers presented lessons about
nutrition.[Footnote 13] According to that study, the average total
amount of time teachers devoted to nutrition education was 13 hours per
school year. Further, a CDC study found that most schools, at all grade
levels, require some nutrition to be taught, however, the median amount
of time spent on nutrition education as part of schools' health
education classes was 5 hours during the elementary years, 5 hours
during the high school years, and 4 hours during the middle school
years.[Footnote 14] A 1995 report summarizing the research on nutrition
education for school age children concluded that time and intensity of
the instruction offered do matter. Programs with longer durations, more
contact hours, and more components, such as parent involvement and
changes in school meals, result in more positive outcomes.[Footnote 15]
Additionally, the study emphasizes the importance of focusing on
student behavior--an approach also supported by the Department of
Education report. The study concludes that, given the limited amount of
time available, those interventions that focus on specific student
behaviors, such as reduced fat intake or use of salt, result in more
behavioral change than do general nutrition education programs.
Finally, the study underscores the importance of providing a healthy
school environment to reinforce and encourage students to make healthy
eating choices.
The school environment--both inside and outside the cafeteria--is
important in encouraging healthy eating by providing students with
access to healthful food choices and models of healthful food
practices. The
2000 CDC study highlights the need to address those aspects of the
school nutrition environment that are not regulated by USDA, such as a
la carte cafeteria items and food and beverages in vending machines,
school stores, and snack bars.[Footnote 16] The study reports that
while many schools offered low fat foods and fruits and vegetables,
many also offered foods and beverages of limited nutritional value that
competed with the healthful food for student selection. For example,
while 36 percent of elementary school SFAs served low-fat baked goods a
la carte in the cafeteria, nearly 49 percent served baked goods that
were not low in fat. Additionally, about 43 percent of elementary
schools, 74 percent of middle schools, and 98 percent of high schools
have vending machines, school stores, canteens, or snack bars,
according to the study, which often offered foods high in fat, sodium,
or added sugars. Table 2 shows the percentage of schools that offer
various foods for sale to students in competition with school lunches
both within the cafeteria as a la carte selections and outside the
cafeteria.
Table 2: Percentage of Schools Offering Selected Foods in Competition
with School Lunches:
Numbers in percent.
Type of food or beverage.
Low in fat:
100% fruit or vegetable juice; Schools offering food or beverage a la
carte: Elementary schools: 57.8; Schools offering food or beverage a la
carte: Middle/Junior high schools: 63.9; Schools offering food or
beverage a la carte: Senior high schools: 77.4; [Empty]; Schools where
students can purchase food or beverage in vending machines, school
store, canteen, or snack bar: Elementary schools[A]: 49.4; Schools
where students can purchase food or beverage in vending machines,
school store, canteen, or snack bar: Middle/Junior high schools[B]:
53.1; Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Senior high schools[C]:
65.0.
Fruits or vegetables; Schools offering food or beverage a la carte:
Elementary schools: 68.1; Schools offering food or beverage a la carte:
Middle/Junior high schools: 74.0; Schools offering food or beverage a
la carte: Senior high schools: 90.4; [Empty]; Schools where students
can purchase food or beverage in vending machines, school store,
canteen, or snack bar: Elementary schools[A]: 20.0; Schools where
students can purchase food or beverage in vending machines, school
store, canteen, or snack bar: Middle/Junior high schools[B]: 11.8;
Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Senior high schools[C]:
22.0.
Low-fat cookies, crackers, pastries; Schools offering food or beverage
a la carte: Elementary schools: 36.1; Schools offering food or beverage
a la carte: Middle/Junior high schools: 40.8; Schools offering food or
beverage a la carte: Senior high schools: 48.0; [Empty]; Schools where
students can purchase food or beverage in vending machines, school
store, canteen, or snack bar: Elementary schools[A]: 26.4; Schools
where students can purchase food or beverage in vending machines,
school store, canteen, or snack bar: Middle/Junior high schools[B]:
37.7; Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Senior high schools[C]:
49.6.
Low-fat salty snacks; Schools offering food or beverage a la carte:
Elementary schools: 29.5; Schools offering food or beverage a la carte:
Middle/Junior high schools: 42.6; Schools offering food or beverage a
la carte: Senior high schools: 58.3; [Empty]; Schools where students
can purchase food or beverage in vending machines, school store,
canteen, or snack bar: Elementary schools[A]: 44.5; Schools where
students can purchase food or beverage in vending machines, school
store, canteen, or snack bar: Middle/Junior high schools[B]: 54.5;
Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Senior high schools[C]:
65.0.
High in fat, sodium, or added sugars:
Soft or sports drinks or fruit drinks not 100% juice; Schools offering
food or beverage a la carte: Elementary schools: 19.0; Schools offering
food or beverage a la carte: Middle/Junior high schools: 40.3; Schools
offering food or beverage a la carte: Senior high schools: 57.2;
Schools offering food or beverage a la carte: Senior high schools:
77.4: 90.4: 48.0: 58.3: High in fat, sodium, or added sugars: [Empty];
High in fat, sodium, or added sugars: 58.1; Schools where students can
purchase food or beverage in vending machines, school store, canteen,
or snack bar: Middle/Junior high schools[B]: 83.5; Schools where
students can purchase food or beverage in vending machines, school
store, canteen, or snack bar: Senior high schools[C]: 93.6.
Chocolate candy; Schools offering food or beverage a la carte:
Elementary schools: 2.4; Schools offering food or beverage a la carte:
Middle/Junior high schools: 8.9; Schools offering food or beverage a la
carte: Senior high schools: 23.7; Schools offering food or beverage a
la carte: Senior high schools: 77.4: 90.4: 48.0: 58.3: High in fat,
sodium, or added sugars: [Empty]; High in fat, sodium, or added sugars:
29.2; Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Middle/Junior high
schools[B]: 46.6; Schools where students can purchase food or beverage
in vending machines, school store, canteen, or snack bar: Senior high
schools[C]: 72.2.
Cookies, crackers, pastries not low-fat; Schools offering food or
beverage a la carte: Elementary schools: 48.8; Schools offering food or
beverage a la carte: Middle/Junior high schools: 66.8; Schools offering
food or beverage a la carte: Senior high schools: 79.9; Schools
offering food or beverage a la carte: Senior high schools: 77.4: 90.4:
48.0: 58.3: High in fat, sodium, or added sugars: [Empty]; High in fat,
sodium, or added sugars: 52.6; Schools where students can purchase food
or beverage in vending machines, school store, canteen, or snack bar:
Middle/Junior high schools[B]: 61.2; Schools where students can
purchase food or beverage in vending machines, school store, canteen,
or snack bar: Senior high schools[C]: 80.7.
Salty snacks not low-fat; Schools offering food or beverage a la carte:
Elementary schools: 25.8; Schools offering food or beverage a la carte:
Middle/Junior high schools: 40.6; Schools offering food or beverage a
la carte: Senior high schools: 57.8; Schools offering food or beverage
a la carte: Senior high schools: 77.4: 90.4: 48.0: 58.3: High in fat,
sodium, or added sugars: [Empty]; High in fat, sodium, or added sugars:
51.0; Schools where students can purchase food or beverage in vending
machines, school store, canteen, or snack bar: Middle/Junior high
schools[B]: 62.4; Schools where students can purchase food or beverage
in vending machines, school store, canteen, or snack bar: Senior high
schools[C]: 83.0.
Source: School Health Policies and Programs Study, 2000.
[A] Among the 43.0 percent of elementary schools with a vending
machine, school store, canteen, or snack bar.
[B] Among the 73.9 percent of middle/junior high schools with a vending
machine, school store, canteen, or snack bar.
[C] Among the 98.2 percent of high schools with a vending machine,
school store, canteen, or snack bar.
[End of table]:
According to the study, a relatively small percentage of school
districts have policies in place that require the sale of healthy
choices or that restrict the sale of foods with little nutritional
value. For example, only about 19 percent of districts require schools
to offer fruit and vegetables as a la carte items, and 23 percent of
districts require schools to prohibit the sale of foods that have
little nutritional value as a la carte items. Furthermore, about half
of school districts have a contract that gives a company rights to sell
soft drinks at schools in the district. Most of those districts receive
a percentage of sales receipts or other incentives.[Footnote 17]
Finally, in most schools, organizations such as student clubs, sports
teams, and parent-teacher associations sell food to raise money, and
the food sold is typically high in fat and added sugars, according to
the study.
Barriers Exist to Providing Nutritious Food and Encouraging Healthy
Eating Choices:
School and SFA officials in the 22 schools in 13 school districts that
we visited cited a number of barriers to meeting nutrition requirements
and improving school lunch nutritional quality. However, many officials
we spoke with were more concerned with the barriers they faced in
encouraging healthy eating among students and establishing a broader
community approach. Regarding improving nutritional quality and meeting
USDA requirements, SFA officials said that the pressure to balance
their budgets could affect the food served in the school.[Footnote 18]
Also, according to state officials we spoke with, they have limited
ability to enforce the nutrition requirements. Regarding encouraging
healthy eating, school officials said that they have limited time and
resources available to teach nutrition education. Additionally, school
principals and organizations are reluctant to limit the sale of food
and beverages of limited nutritional value at the schools that we
visited because they use the money to support student activities not
covered in the school budget.
Budget Pressures Can Affect Nutritional Quality of Food:
SFA officials we talked with cited financial barriers to providing
nutritious meals. Many officials said that they are under pressure to
balance their budgets, while at the same time provide meals that meet
USDA nutrition guidelines and appeal to students. Some officials said
that providing a lunch that meets USDA's guidelines for nutrition and
comes in under budget is achievable, but the challenge is in preparing
healthful foods that are also appealing to the students and that
students will select and eat. Many SFA officials said that when they
make changes in the menu items offered, such as lowering the fat
content or introducing new items, they run the risk that students will
not like the changes and will decline to participate. They noted that
because food service programs are typically required to operate on a
break-even basis, and student meal payments make up a large part of
their revenue, a decline in participation could have a negative effect
on the budget. For example, in Rhode Island, an official told us that
several years ago SFA officials decided to no longer offer deep-fried
French fries to the students. Disappointed by this decision, the
students boycotted the entire school lunch program. Within a week the
school restored them to the menu--but as an a la carte item. Some SFA
officials mentioned that the school food service staff has sometimes
been reluctant to adopt standardized recipes that did not include bacon
fat, butter, cream, or other ingredients that made their recipes
popular with the students.
When schools serve meals that do not comply with federal nutrition
requirements, enforcement options are limited, according to state and
federal officials. If the state School Meals Initiative review reveals
noncompliance, the state agency works with district officials to
develop a plan to correct deficiencies and follows up to monitor the
progress of the plan. Although regulations allow for withholding of
federal meal reimbursements if the SFA has not been acting in good
faith to meet the terms of the corrective action plan, state and USDA
officials questioned whether this offers a practical or realistic
solution because of the possibility of program cutbacks or closure and
the effect on the students, especially those receiving free or reduced
price lunches.
Efforts to meet various school and district financial pressures have
led SFAs to serve less healthful a la carte items in the cafeteria in
competition with school lunches. While a la carte items can include
such things as fruit and milk, they may also include cookies, candy,
ice cream, and deep-fried French fries. One SFA director said that a la
carte sales help her balance the budget. She said the SFA probably
sells about $600 a day in a la carte items, such as pudding, toaster
pastry, beef jerky, and cheese sticks. Less healthful a la carte items
may be sending a mixed nutrition message to students, according to
officials. SFA officials said that they recognize that some of the a la
carte items offered are less nutritious or healthful, but said they
need the revenue the items generated to help balance their budgets.
Competing Time and Budget Pressures May Compromise Healthy Eating
Environment in Schools:
School and SFA officials we spoke with said that time constraints and
financial needs within the school sometimes compromise efforts to
encourage healthy eating choices among students. Principals, teachers,
and other officials said that classroom time is focused almost entirely
on making sure that students meet state academic standards, and little
time is left to include subjects or information not included on the
state academic standards test.[Footnote 19] One SFA director said that
state testing is leading the curriculum--social skills, nutrition
education, and other subjects are being left out. As another official
said, "If you want it taught, get it on the test." Three states we
visited required students to take nutrition education as part of a
health class at the secondary level, but only one state included it
when preparing for a required statewide health test. Several schools we
visited taught some nutrition education--often as part of a consumer
and family sciences course, health, or physical education at the
secondary level (middle, junior, and senior high schools). These
classes were usually elective and taken by only a few students. Some
districts we visited included nutrition as part of their health
curriculum at various grade levels, but typically limited it to a few
hours class time. Finally, while a variety of materials and information
is available to assist teachers in presenting nutrition information to
both elementary and secondary students, some teachers said they were
not aware of, or did not have time to locate and utilize these
resources.
Students at the schools we visited also had access to soft drinks,
candy, and other foods of limited nutritional value elsewhere in the
school because, according to officials, the school relies on the
revenue. For example, at several schools we visited the profits from
soda vending machines generated several thousand dollars over a year's
time to be used at the discretion of the principal. Some principals
said that it was their only funding source for expenditures such as
awards for students' academic and athletic achievements, for school or
class fieldtrips, and for other educational opportunities. One
principal bought a bassoon for the school orchestra because a
particularly promising low-income student musician needed it. Officials
said that finding another source of funding to replace that generated
by these machines would be difficult, and as one principal said, "It
would be World War III if the machines were removed.":
Many schools that we visited also sold food and beverages as part of
Parent Teacher Association or athletic team fundraisers or other school
club sales. They acknowledged that often these items sold outside of
the cafeteria--such as candy and cookies--are of limited nutritional
value. However, officials said that the profits made from these sales
provide funds for school activities or projects that would otherwise
not be funded, so officials say they are reluctant to restrict or
prohibit them. Additionally, in some schools that we visited, a healthy
nutrition environment was compromised by teachers and others using
foods of limited nutritional value, such as candy and cookies, as a
reward for good classroom or hallway behavior, scoring well on a test
or project, or from even bus drivers for good conduct on the bus. Some
school or PTA activities also included refreshments that were of
limited nutritional value. Officials said that foods of limited
nutritional value were often less expensive and more convenient.
Schools Have Implemented Approaches to Overcome Barriers:
The schools and SFAs that we visited had established a variety of
approaches to overcome the barriers they face in providing nutritious
food and encouraging students to make healthy eating choices. Nearly
all the visited schools had taken actions to improve the nutritional
quality of the food served to students and at the same time help ensure
that the food would be appealing to the students. To promote healthy
eating habits among their students, some schools offered nutrition
education both in and outside the classroom. Some had taken steps to
limit students' access to foods of limited nutritional value at school.
A number of schools had enlisted community organizations and businesses
for assistance and resources to help sponsor activities outside the
classroom such as health fairs, family events, and nutrition awareness
campaigns. Additionally, state and federal agencies had a number of
efforts in place to support local initiatives and community-wide
collaborations.
A Variety of Efforts Are in Place to Improve Nutritional Quality of
School Meals:
In most of the SFAs that we visited, officials had taken a number of
steps to improve the nutritional quality of the food. For example, some
food service officials had modified the recipes of several foods that
are popular with students, such as enchiladas and macaroni and cheese,
to make them more nutritious yet still appealing to student palates.
Their techniques included baking rather than frying, reducing salt
usage, and substituting low-fat ingredients wherever possible, such as
in gravies, cheese sauces, and salad dressings. At one high school in
Kentucky, the food service replaced the nacho cheese sauce with a low-
fat substitute, and students told us they were not aware of the change.
Several SFA directors said that they worked with vendors of prepared
food to provide items that had healthier nutritional specifications and
lower fat content. For example, an SFA in Washington State negotiated
with a vendor to supply French fries with less fat and sodium. In
Kentucky, an SFA worked with venders to provide low-fat pizza and
chicken nuggets.
School food service managers and school officials found that expanding
the number and variety of healthy food choices increased the likelihood
that students would select them. Two of the schools that we visited
were part of a six-school research project that focused on increasing
the number of healthy lunch options available to students. Researchers
reported that when the number of healthy entrees was increased, the
percent of students purchasing them increased and has stayed higher
than pre-intervention levels. Also, several SFAs periodically provided
free taste testing or samples of proposed new additions to the school
lunch. SFA directors considered the student preferences and made
changes in the menu as long as their food service operation broke even
financially as required. We visited an elementary school in northern
Virginia when students were participating in a taste test. The students
said that they enjoyed the opportunity to taste the new items. Students
filled out an evaluation form, after they ate each sample, providing
comments and indicating how much they liked or disliked the item. The
SFA director said that the tastings increased student awareness of
healthier food items and induced them to taste items that they may not
have normally chosen on their own.
Schools Have Implemented Activities to Promote Healthy Eating Choices:
The schools and SFAs we visited had efforts in place to overcome the
barriers to encouraging healthy eating. They initiated changes in the
cafeteria and education activities in the classroom and beyond. Some
actions extended throughout the school and to the local community.
Efforts to support school activities are also taking place at the state
and federal levels.
Efforts in the Cafeteria:
SFAs in the districts that we visited had introduced a variety of
approaches in their cafeterias to make healthier school food more
appealing to students. One approach was to package the food in a manner
similar to what students find in fast-food restaurants. For example, a
high school in Washington State modeled its salads on those found in a
leading chain restaurant. A Kentucky high school served its reduced-fat
pizzas in small boxes imprinted with a brand name logo; and a Rhode
Island high school used colorful wrappers for its sandwiches. In
another approach, a California SFA found that vegetable consumption
increased when kitchen staff let the students serve themselves from the
garden bar rather than take vegetables served in individual
bowls.[Footnote 20] In addition, one district we contacted increased
the appeal of healthier food by reducing the selling price of items
such as string cheese, fresh fruit, and sunflower seeds.
Some schools and SFAs we visited had taken actions to make their
cafeterias more attractive to students. In several districts, schools
tried to recreate, to some degree, the experience students find in
popular restaurants and food courts. They configured school cafeterias
with multiple serving lines, each with a different theme. For example,
at a high school in Kentucky, one line served the standard school lunch
entrees, while other lines were for salads and submarine sandwiches. A
high school in Michigan added an area that sold just soup, salad, and
deli-sandwiches. Several schools made cafeterias more inviting places
to eat by incorporating colorful décor. For example, the cafeteria
manager at a Texas high school installed red and white awnings above
the doorways into the food area to make it look more like a café. One
SFA in Rhode Island had decorated school cafeterias with specific
themes. For example one junior high school cafeteria had a nautical
décor, and a high school cafeteria had murals of maps and flags
representing each of the countries of origin represented in the student
body.
In several districts, SFAs used the monthly school menu to reach out
beyond the cafeteria and focus attention on nutrition. Some menus
contained items of nutritional interest or facts such as the calories
and fat content in the various school foods. School food service
managers said that since the students often took the menus home, it
helped them reach parents and guardians with their message of healthy
eating choices. In a related example, a Texas school district reported
putting a new nutrition article on their website every month.
Educational Efforts:
Many schools had identified opportunities to instruct students about
nutrition both in the classroom and in other school activities. One SFA
in California had a nutritionist visit fourth grade classrooms to
explain the food pyramid and the importance of fruits and vegetables in
their diet. As part of her presentation, she gave the students samples
of different fruits. At a Rhode Island middle school, we watched a
family and consumer science class prepare a raspberry ice yogurt as a
healthful alternative to the traditional milk shake. The teacher said
she used USDA nutrition education materials as well as those from food
industry associations. She also had class visits to farms, a farmers'
market, and restaurant kitchens. An SFA in California reported a
noticeable change in what students chose and ate after providing
students with more information about fruits and vegetables. Its schools
placed nutrition-themed posters in hallways and the cafeterias and
started teaching nutrition in the classroom. With the help of a Team
Nutrition grant, a Michigan elementary school integrated nutrition
education into existing reading and math curriculum. The project helped
the school overcome the difficulty of finding time to teach nutrition,
a subject with less priority to teachers because it is not included in
state academic standards assessments. The school was also using the
School Health Index for Physical Activity and Healthy Eating, a self-
assessment and planning guide developed by CDC, to assess its nutrition
and physical activity policies and create a healthy school environment.
School Policies, Practices, and Community Activities:
Some schools and districts had adopted new policies or practices to
restrict or replace food of limited nutritional value sold in schools.
These policies and practices varied widely in their scope from those
limited to a single classroom to school and districtwide efforts. For
example, at the classroom level, in several elementary schools we
visited, teachers said that they no longer used candy as a reward in
the classroom as a means of supporting the healthy eating message.
Instead, they substituted healthful snacks, stickers, or extra minutes
for recess as incentives. One teacher in a Rhode Island elementary
school rewarded her students with pennies for demonstrating good health
habits. Students could later exchange the pennies for healthful snacks.
At the school level, some schools that sold competitive foods through
vending machines or in a cafeteria a la carte line, regulated the type
of items that could be sold. For example, at one Rhode Island
elementary school, at the principal's request, the food service manager
replaced school snack bar items, such as candy bars and potato chips,
with healthier choices, such as rice cereal cookies and raisins.
According to the food service manager, students accepted the new
selections with minimal controversy, sales rebounded, and other
elementary schools in the district adopted the same changes. A Texas
school district had a similar experience when it revised its vending
machine policy to include only healthier items. An elementary school
principal in California said her school made more money selling
healthier snacks than the limited nutritional value items previously
sold in the school. One district that we visited in Michigan allows
middle school students to make snack purchases only after they have
eaten their regular lunch.
At the district level, one large urban SFA that we visited was
beginning to implement a broad districtwide food policy that set
multiple goals focusing on improving the nutritional quality of school
food, serving enjoyable foods from diverse cultures, and improving the
quality of food service jobs. The policy also established a Nutrition
Advisory Board that includes teachers, principals, students, parents,
and community representatives in addition to district administration
and SFA staff. Several districts that we visited had established
policies that prohibited candy and soft drink machines at elementary
schools and some regulated a la carte sales in their secondary schools.
A number of districts focused on increasing the offerings of healthier
items such as milk, water, and juices.
In addition to efforts in the cafeteria, educational efforts, and
changes in policies and practices to encourage healthy eating, several
schools that we visited had taken steps to establish a broader more
systematic healthy school environment that includes both healthy eating
and physical activity. Two elementary schools in Texas--as part of a
university and state health department study funded by CDC--were
working closely with their SFAs to increase low-fat choices in the
cafeteria, were providing more nutrition education to students, and
were increasing students' physical activity through physical education
and other activities. These schools had established a school committee
of faculty, staff, students, and parents to plan many of the school
activities. Also, one elementary school that we visited in Rhode Island
had established a comprehensive school health initiative that included
both nutrition and physical activity efforts. The school nurse taught
health and was working on integrating nutrition education into
classroom lessons. She recently taught a lesson on comparing the
nutritional information on cereal boxes. The school had established a
healthy schools committee which meets twice a month and was using a
$1,000 grant to set up a walking program. Last year, the school held a
heart health fair for students and parents that included healthful
snacks and group exercise.
Several school districts had expanded their nutrition education efforts
beyond the school by collaborating not only with families, but also
with community organizations and businesses to raise healthy nutrition
and lifestyle awareness. Several districts held health fairs for
families of students in which nutrition was a central theme. For
example, a fair at one Rhode Island school had restaurant chefs speak
to parents, demonstrate healthful food preparation, and provide samples
of healthful snacks. Three schools in another Rhode Island district
also had a health fair that had the sponsorship of organizations such
as the local police department. A health insurance company sponsored a
pilot project at two middle schools in Grand Rapids, Michigan, in the
spring of 2001. The "Trek Around the World" encouraged students to
increase their physical activity and eat more fresh fruits and
vegetables.
Many SFA officials, principals, and other officials that we contacted
said leadership makes a difference in the success of nutrition and
healthy eating efforts. They emphasized the importance of local
leadership in implementing and sustaining a successful child nutrition
and health program in the school and community. For example, one
elementary school principal made a point of frequently eating fresh
fruit in front of her students. A middle school administrator roamed
the cafeteria at lunchtime encouraging students to eat healthful foods.
In some schools we visited, other people such as a teacher, a physical
education teacher, the school nurse, or the local parent-teacher
association president had taken a leadership role in implementing and
sustaining efforts to encourage good nutrition and create a healthy
school environment.
State Efforts to Support School Activities:
State efforts to support local leaders in improving school meal
nutrition and encouraging healthy eating among students in the states
we visited included a variety of approaches. For example, in Rhode
Island, a private nonprofit organization facilitated Team Nutrition
efforts, providing a focal point for assistance and outreach to schools
and districts. In Michigan, the Michigan State University Extension and
the Michigan Department of Education worked as a team to promote Team
Nutrition. The extension service provided materials, information, and
assistance to schools and SFAs. The state department of education and
the extension service have a history of collaboration to address a
variety of state issues, according to state officials. In Kentucky,
Rhode Island, and Texas, state departments of education and health have
also established ways to collaborate to address student health issues,
including nutrition. In California, the state passed legislation that
will take effect in 2004 that establishes restrictions on beverages
sold in elementary and middle schools and places nutritional standards
on the type of foods that can be sold--including in vending machines.
State education department officials in California report that they are
working with school districts to promote districtwide healthful food
policies. School and SFA officials acknowledged that state assistance
and leadership was valuable in implementing local activities. However,
USDA officials report that not all states have established a state
focal point for leadership or have begun collaboration among state
agencies to address nutrition education.
Federal Efforts to Support School Activities:
A growing support structure for these local efforts is in place at the
federal level. According to USDA officials, the agency will continue
and expand its nutrition and healthy eating efforts through the Team
Nutrition initiative. According to officials from USDA and CDC, they
collaborate on a number of health efforts to avoid duplication and
ensure a single message is communicated. Additionally, USDA, CDC, and
the Department of Education partnered with a number of national
organizations to sponsor a Healthy Schools Summit in October 2002. The
conference emphasized collaboration to foster change at the state,
district, and local levels and launched the establishment of Action for
Healthy Kids teams in 50 states and the District of Columbia. Further,
in June 2002, the Secretaries of the Departments of Agriculture, Health
and Human Services, and Education signed a memorandum of understanding
to strengthen and promote the education and health of school-age
children. The memorandum specifies the types of activities the
departments will conduct over 5 years. For example, USDA will develop
and distribute grade-specific materials to schools to use in the
classroom, and Health and Human Services will provide technical
assistance to help state education agencies support schools in
selecting or developing effective physical education and nutrition
education curricula. Additionally, the Department of Education will
encourage schools to participate in Team Nutrition and encourage state
boards of education to develop policies that will provide healthy
school environments. However, the memorandum does not identify specific
strategies to address how schools will find time to use the materials
and technical assistance provided by federal agencies given the time
requirements for meeting state academic standards--for example, by
facilitating the integration of nutrition education into the existing
curricula and activities and by focusing on student behavior.
Furthermore, the memorandum does not specifically address the
importance of leadership and agency collaborations at the state level
in addressing nutrition and healthy eating in schools.
Conclusions:
With an urgent health problem threatening the well being of the
country's youth, it is important that actions be taken to reverse
current trends toward obesity and related physical problems. While
schools and the school lunch program cannot be expected to solve these
problems alone, they are well positioned to positively influence what
children eat and what they know about the importance of good nutrition.
However, many schools are sending a mixed message when they provide
nutritious meals and encourage healthy choices, but at the same time
rely on the sales of foods of limited nutritious value to fund school
and student activities. Despite the difficulties of making significant
changes in the foods sold at schools, a number of schools and districts
have shown that healthful food policies and practices can be put in
place. These policies not only help ensure that the food children eat
at school is healthful; they also provide a positive model within the
school and an opportunity to learn about healthy eating outside the
classroom. Many schools, however, continue to face challenges to
providing nutrition education in the classroom, in part, because of the
need to focus on subject matter covered to meet state academic
standards.
Federal efforts to promote and support local initiatives, including
increasing collaboration among agencies, show promise. The recent
memorandum of understanding signed by USDA, the Department of Health
and Human Services, and the Department of Education underscores the
importance of agencies working together and contributing what they do
best. This federal partnership could be fruitful in increasing the
emphasis on, and resources available for, encouraging healthy eating
and the integration of nutrition education into schools' existing
curriculum in ways that would meet state academic standards
requirements while advancing students' awareness of the importance of
healthy eating.
The state role in promoting nutrition education--both in the classroom
and beyond--is also seen as an important part of the nutrition and
healthy eating equation. Efforts in some states are promising. However,
not all states appear to have established the focused and coordinated
effort among appropriate state agencies that could facilitate active
partnering with the federal agencies that provide resources and
assistance.
Providing healthful food and encouraging healthy eating among students
is a complex undertaking and schools differ in their needs and
capabilities so that no single program can be appropriate for all.
Moreover, healthy eating is only one of the changes needed to address
the growing overweight and health problems among our nation's youth.
Ultimately, a more comprehensive program that addresses students'
entire environment, and one that provides multiple exposures to
nutritious food and information on healthy eating--as well as promoting
appropriate physical activity--appears to offer the most hope of
success. The Surgeon General's office has emphasized the importance of
individuals and groups, across all settings, working in concert to
educate people about health issues related to overweight and obesity
and to promote balancing healthy eating with regular physical activity.
A number of models have already been developed for schools to use in
that endeavor, including USDA's Changing the Scene and East Smart-Play
Hard and CDC's School Health Index. However, nationwide progress could
be facilitated by enhanced and continuing collaboration among officials
and organizations at the federal, state, and local level to inform,
promote, and help sustain efforts.
Recommendations for Executive Action:
We recommend that the Secretaries of Agriculture, Health and Human
Services, and Education use their recently signed memorandum of
understanding as a vehicle to:
* identify specific strategies and develop materials to help schools
promote nutrition education while still meeting the requirements of
state academic standards and:
* encourage states to identify a focal point in each state to promote
collaborative efforts that would further develop nutrition education
activities for the schools.
Agency Comments:
We requested comments on a draft of this report from the Secretary of
Agriculture or her designee. On April 11, 2003, officials from USDA's
Food and Nutrition Service, Child Nutrition Division, provided us with
the following oral comments on the draft. The officials said that they
were in general agreement with the findings and recommendations as
presented in the report. However, they said that targeted nutrition
education training funds, which were provided to states in the past,
are no longer available, and they believe that, without additional
funding, states are unlikely to implement our recommendation that each
state identify a focal point to promote collaborative efforts to
develop nutrition education activities for schools. We recognize that
states are currently facing budget shortfalls and may find it difficult
to create new staff positions at this time. However, we believe that
states, at a minimum, can identify a focal point from among existing
positions to promote a focused and coordinated effort among appropriate
state agencies.
The officials also noted that they believe their major school nutrition
initiatives--which are Team Nutrition, Changing the Scene, and Eat
Smart-Play Hard--all play an important role in encouraging schools to
serve nutritious food and in encouraging children to eat well. We agree
that such initiatives can play an important role in improving the
school nutrition environment in schools where they are implemented;
however, not all schools participate in the initiatives. Our
recommendations focus on the need for various federal and state
agencies to work together as a next step to help focus resources and
activities on nutrition education and other efforts to encourage
children to eat healthy foods. Regarding this need for collaboration,
Food and Nutrition Service officials said that they would like to be
more active in their support for, and collaboration with, CDC. However,
they believe USDA is not always in a position to support CDC as much as
they would like and would need additional resources to do so. In our
review, we did not analyze funding levels of the different agencies.
Finally, in addition to these observations, USDA provided technical
comments that we have incorporated as appropriate.
The Department of Health and Human Services provided written comments
on a draft of this report. (See app. I.) Health and Human Services
generally agreed with our findings and recommendations and provided
information on the Steps to a Healthier US initiative. It also provided
technical comments that we have incorporated as appropriate. Along with
the technical comments, the department provided a table summarizing the
strategies for improving school nutrition that were presented in the
report. We have included the table in appendix I.
The Department of Education also provided written comments on a draft
of this report. (See app. II.) Education said that the report provides
a review of the many issues facing schools in their efforts to meet
USDA nutrition requirements and promote healthy eating among students
and they also provided additional information on department initiatives
that support student health and nutrition. However, Education expressed
concern that the information we present appears to imply that
accountability provisions in the No Child Left Behind Act may
contribute to compromising a healthy eating environment in schools, and
it raised questions about the support for our finding that school
officials have difficulty finding the time to incorporate nutrition
education into every day lessons because of pressures to meet state
academic standards. Our findings are based on the views expressed by
school and SFA officials we interviewed, and we believe we have fairly
reflected the views of those officials. We believe that nutrition
education and other components of a healthy eating environment can and
should be compatible with, and complementary to, schools' efforts to
meet the requirements of state academic standards. It is for this
reason that we have recommended that federal agencies partner and work
with states to help schools find ways to promote nutrition education
and healthy eating among students.
Education suggested that we acknowledge other provisions of the No
Child Left Behind Act that can support nutrition and also suggested
that we include more examples of physical activity programs in our
report. It specifically noted the Carol M. White program, which
includes elements that address both physical activity and healthy
eating. We recognize that there may be a number of programs that have
the potential to contribute to nutrition and healthy eating efforts,
and we agree that physical activity programs could be an important
component of a healthy school environment. However, the scope of our
study did not include a comprehensive review of initiatives that
support nutrition or physical activity. Also, the department
recommended that we include the Action For Healthy Kids Initiative with
our examples of community collaborations to promote children's
nutrition as well as physical activity. We have done so.
Education also provided us with technical comments, which we have
incorporated as appropriate.
We will send copies of this report to the Secretaries of Agriculture,
Health and Human Services, and Education, appropriate congressional
committees, and other interested parties. In addition, the report will
be available at no charge on GAO's Web site at http://www.gao.gov.
If you or your staff have any questions or wish to discuss this
material, please call me at (415) 904-2272 or Kay E. Brown at (202)
512-3674.
David D. Bellis
Director, Education, Workforce, and Income Security Issues:
Signed by David D. Bellis:
[End of section]
Appendix I: Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General:
APR 15 2003:
Washington, D.C. 20201:
Mr. David D. Bellis:
Acting Director, Education, Workforce and Income Security Issues:
United States General Accounting Office Washington, D.C. 20548:
Dear Mr. Bellis:
Enclosed are the department's comments on your draft report entitled,
"School Lunch Program: Efforts Needed to Improve Nutrition and
Encourage Healthy Eating." The comments represent the tentative
position of the department and are subject to reevaluation when the
final version of this report is received.
The department provided several technical comments directly to your
staff.
The department appreciates the opportunity to comment on this draft
report before its publication.
Dennis J. Duquette:
Signed by Dennis J. Duquette:
Acting Principal Deputy Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the department's
response to this draft report in our capacity as the department's
designated focal point and coordinator for General Accounting Office
reports. The OIG has not conducted an independent assessment of these
comments and therefore expresses no opinion on them.
Comments of the Department of Health and Human Services on the General
Accounting Office's Draft Report, "School Lunch Program: Efforts Needed
to Improve Nutrition and Encourage Healthy Eating" (GAO-03-506):
General Comments:
The Department of Health and Human Services (department) appreciates
the opportunity to review and comment on the draft report of the
General Accounting Office (GAO) entitled School Lunch Program: Efforts
Needed to Improve Nutrition and Encourage Healthy Eating. The
department commends GAO for this report which focuses on concerns
regarding recent trends in children's health and eating habits.
Obesity, physical activity, and diabetes are among the department's
priorities.
In fact, the department has many programs underway to help foster a
healthful school nutrition environment. The recent memorandum of
understanding between the department and the U.S. Departments of
Agriculture and Education, "Healthier Children and Youths," will afford
many opportunities to coordinate efforts to promote healthy eating and
physical activity behaviors among the nation's school-aged children and
youths. Together, the departments are actively promoting awareness
among school officials of the importance of a school environment which
supports physical activity and eating a nutritious diet so that
children and youth may stay healthy and be ready to learn.
In addition, Health and Human Services Secretary Tommy Thompson's Steps
to a HealthierUS (Steps) initiative will advance President George W.
Bush's HealthierUS goal of helping Americans of all ages to live
longer, better, and healthier lives. This initiative specifically
targets diabetes, obesity, asthma, cancer, cardiovascular disease as
well as risk factors such as poor nutrition and physical inactivity,
tobacco use, and youth risk behaviors. Building on a growing body of
prevention research which shows that small, simple steps can often
prevent or control these health burdens, Steps will promote programs to
motivate and support responsible health choices, support community
initiatives to promote and enable healthy choices, encourage healthcare
and insurance systems which target reduction of risk factors and
complications of chronic disease, and encourage cooperation among
policy makers to invest in health promotion.
Also included in our technical comments is a draft table which provides
a clear summary of ideas that can be used to improve school nutrition.
This draft table would serve as a complement to the narrative.
Recommendations for Executive Action:
"We recommend that the Secretaries of Agriculture, Health and Human
Services, and Education use their recently signed memorandum of
understanding as a vehicle to
identify specific strategies and develop materials to help schools
promote nutrition education while still meeting the demands of state
standards based assessments, and:
* direct states to identify a focal point in each state to promote
collaborative efforts that would further develop nutrition education
activities for the schools.":
Department Response:
In the second bullet, the department would like the word "direct"
changed to the word "encourage." To "direct states to identify a focal
point in each state..." may be perceived by some as an unfunded federal
mandate. Under the terms of the current memorandum of understanding, as
stated in the report, the department will provide technical assistance
to state education agencies to help schools select or develop effective
physical education and nutrition education curricula.
Strategies for Improving School Nutrition:
[See PDF for image]
[End of table]
[End of section]
Appendix II: Comments from the Department of Education:
UNITED STATES DEPARTMENT OF EDUCATION:
THE UNDER SECRETARY:
April 15, 2003:
Mr. David D. Bellis Acting Director Education, Workforce, and Income
Security Issues General Accounting Office:
Washington, DC 20548:
Dear Mr. Bellis:
Thank you for the opportunity to review and comment on the draft
report, "School Lunch Program: Efforts Needed to Improve Nutrition and
Encourage Healthy Eating." The report provides a review of the many
issues facing schools in their efforts to meet USDA nutrition
requirements and promote healthy eating among students. We were
particularly pleased to see the auditors' review of some of the
challenges that schools face trying to serve nutritious foods and teach
students to eat healthy foods, as well as the creative methods some
schools are using to overcome those challenges. We have a number of
comments and suggestions below for improving the report and making it
more accurate and complete. We also have enclosed some more specific
and technical comments.
We strongly recommend the deletion of the unsupported statement on
pages 15 and 16 (and especially footnote 17) that appears to imply that
the accountability provisions in the No Child Left Behind Act (NCLB)
may contribute to "compromising" a healthy eating environment in the
schools. On the contrary, as noted below, NCLB has many provisions that
promote a safe and healthy environment for students, conducive to
learning. Furthermore, the accountability provisions are designed to
support learning and parental choice and should in no way compromise a
healthy eating environment in the schools. While we have no problems
with the recommendation on helping school districts identify strategies
and develop materials to help schools promote nutrition education while
still meeting the demands of state academic standards, we also have
some concerns about related statements on pages 5, 23, 24, and 25 on
related issues. In the enclosure, we suggest some revisions that make
these statements more appropriate.
On pages 21 and 22, the auditors include examples of nutrition and
physical activity collaborations with community organizations. The
Action for Healthy Kids (AFHK) Initiative, which came out of the
Healthy Schools Summit held last fall in Washington, D.C., has state
nutrition and physical activity teams that are examples of the state
collaborations the report recommends. Some of these state teams are
working directly with schools in their areas on nutrition and physical
activity issues. Alicia Moag-Stahlberg, M.S., R.D., L.D., is the
Executive Director, and the organization's Internet address is
www.ActionForHealthyKids.org. All five of the states your auditors
visited
for this report have AFHK state teams. We recommend that you expand
your examples of community organization collaborations to include the
AFHK state teams.
On page 23 of the report, the auditors discuss Federal efforts to
support school activities in health and nutrition. It would be helpful
if the report also acknowledged the provisions in NCLB that can be used
to support nutrition, physical education, and health-related services.
For example, provisions in Title I (section 1115(e)(2)) and the Carol
M. White Physical Education program under Title V (Part D, Subpart 10)
of the Elementary and Secondary Education Act (ESEA), as amended by
NCLB (a competition for new awards was announced on April 1, 2003)
should be mentioned as supportive of improved nutrition and health.
Additionally, Title V of ESEA could support nutrition education and
other related program activities, and some funds from after-school
programs under the 21st Century Community Learning Centers can be used
for nutrition activities (including after-school snacks to provide
nourishment so that students can participate well in learning
activities).
Additionally, the President has requested $10 million in fiscal year
2004 for a new physical education initiative that would help build
capacity nationally for long-term improvements in physical education.
Grants to school districts would support the demonstration of high-
quality, research-based approaches for incorporating regular physical
activity into students' everyday lives and promoting lifelong personal
fitness activities and healthy habits tied to state standards in
physical education. Each grant would include a rigorous evaluation
component designed to assess outcomes, including student success in
increasing knowledge of, and forming positive attitudes about, physical
fitness, as well as attaining increased levels of fitness. Results of
this demonstration activity would be widely disseminated to state and
local educational agencies and community-based organizations that work
with youth. We hope that this initiative will be included in your
revised discussion of physical activity programs.
Although the report does include some examples of physical activity
programs, we hope this discussion will be expanded as noted above. In
addition to the health and wellness benefits of physical activity,
preliminary research indicates a direct link between physical activity
and improved academic performance. Studies have found that
participation in physical activity increases adolescents' self-esteem,
as well as physical and mental health. Physically active students are
also less likely to be regular or heavy smokers and to use drugs or
alcohol; they are more likely to stay in school and have good conduct
and high academic achievement.
In addition to our interest in the link between nutrition and physical
activity programs, we are also interested in the research done with
students in each of the states that GAO visited. The draft report
includes very few examples of student comments or feedback, especially
about the success stories from individual states. Therefore, we
recommend that you revise your discussion to incorporate more of this
valuable student information.
We appreciate the mention of the memorandum of understanding (MOU)
among the Departments of Agriculture, Health and Human Services, and
Education. Since the
creation of this MOU, we have worked aggressively to fulfill our
responsibilities to promote healthy eating and physical activity. We
have coordinated with USDA and HHS to develop a better understanding of
the health-related programs of each department.
Again, thank you for providing a copy of this draft report for our
review. The Department of Education has an important interest in
ensuring that children are healthy and ready to learn. We appreciate
the opportunity to comment and would be glad to assist in the
redrafting or reviewing of a revised draft response. Please let me know
if you have any questions about our comments.
Sincerely,
Eugene W. Hickok:
Signed by Eugene W. Hickok:
Enclosure:
[End of section]
Appendix III: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Kay E. Brown (202) 512-3674 (brownke@gao.gov)
Susan J. Lawless (206) 287-4792 (lawlesss@gao.gov):
Staff Acknowledgments:
In addition to the individuals named above, Robert B. Miller,
Dianne L. Whitman-Miner, Shana B. Wallace, Tamara L. Fucile,
Daniel A. Schwimer, Karyn I. Angulo, and Stanley G. Stenersen made key
contributions to this report.
FOOTNOTES
[1] Mark Nord, Margaret Andrews, and Steven Carlson, Household Food
Security in the United States, 2001 Washington, D.C.: U.S. Department
of Agriculture, Economic Research Service, 2002.
[2] U.S. General Accounting Office, School Meal Programs: Few Instances
of Food Borne Outbreaks Reported, but Opportunities Exist to Enhance
Outbreak Data and Food Safety Practices, GAO-03-530 (Washington, D.C.:
May 9, 2003) and School Meal Programs: Revenue and Expense Information
from Selected States, GAO-03-569 (Washington, D.C.: May 9, 2003).
[3] U.S. Department of Agriculture, Food and Nutrition Service, Office
of Analysis, Nutrition and Evaluation, School Nutrition Dietary
Assessment Study II, Final Report (SNDA-II), July 2001. For subsequent
references to the same work: SNDA-II; (2) Centers for Disease Control
and Prevention, School Health Policies and Programs Study 2000: A
Summary Report, (SHPPS 2000) Journal of School Health, Volume 71,
Number 7, September 2001. For subsequent references to the same work:
SHPPS 2000; and (3) U.S. Department of Agriculture, Food and Nutrition
Service, Office of Analysis, Nutrition and Evaluation, The School Meals
Initiative Implementation Study, Third Year Report, June 2002.
[4] In addition, we visited one school and talked with a school food
official in both Virginia and Washington State.
[5] In school year 2002-03, USDA reimbursed participating schools $2.14
for every free lunch meal provided, $1.74 for every reduced price lunch
meal sold, and $0.20 for every other lunch meal sold. The rates are the
minimum cash amounts reimbursed. USDA also provides higher amounts for
districts with 60 percent or more children approved for free and
reduced-price meals, districts in Hawaii and Alaska, and districts
identified by states as having critical needs in order to ensure
equitable distribution.
[6] P.L. No. 103-448, sec. 106 (1994).
[7] In National Soft Drink Ass'n. v. Block, 721 F.2d 1348 (D.C. Cir.
1983), the Court of Appeals for the District of Columbia overturned the
federal regulation in effect at the time prohibiting the sale of foods
of minimal nutritional value anywhere in the school from the beginning
of the school day until the last meal period. The court construed a
1977 amendment to the Child Nutrition Act as allowing USDA to regulate
the sale of competitive foods only in food service areas during meal
periods. Following this decision, USDA amended its regulation to limit
the prohibition of these foods to food service areas during meal
periods.
[8] Mathematica Policy Research, Inc., The School Nutrition Dietary
Assessment Study, School Food Service, Meals Offered, and Dietary
Intakes, (SNDA-1), Oct. 1993. For subsequent references to the same
work: (SNDA-I).
[9] According to USDA officials, the standard for sodium level used in
SNDA-II is based on National Research Council recommendations.
[10] U.S. Department of Agriculture and U. S. Department of Health and
Human Services, Nutrition and Your Health: Dietary Guidelines for
Americans, 3rd edition, Washington, D.C. (1990).
[11] At the time SNDA-I was conducted, schools were not required to
offer meals that were consistent with the Dietary Guidelines for
Americans.
[12] SNDA-II.
[13] U.S. Department of Education, Office of Educational Research and
Improvement, National Center for Education Statistics, Nutrition
Education in Public Elementary School Classrooms, K-5, (Feb. 2000).
[14] SHPPS 2000.
[15] Leslie A. Lytle, Nutrition Education for School-aged Children,
Journal of Nutrition Education, Vol. 27, No. 6, (Dec. 1995).
[16] SHPPS 2000.
[17] For more information on commercial activities in schools, see U.S.
General Accounting Office, Public Education: Commercial Activities in
Schools, GAO/HEHS-00-156 (Washington, D.C.: Sept. 8, 2000).
[18] For more information on school meal revenues compared to expenses
in school years 1996-97 through 2000-01, see U.S. General Accounting
Office, School Meal Programs: Revenue and Expense Information from
Selected States, GAO-03-569 (Washington, D.C.: May 9, 2003).
[19] In 1994, Congress mandated major changes to Title I of the
Elementary and Secondary Education Act in response to concerns that
Title I funding was not significantly improving the educational
achievement of at-risk students. Under the 1994 reauthorization, states
were required to adopt or develop challenging curriculum content and
performance standards, assessments aligned with content standards, and
accountability systems to assess schools' and districts' progress in
raising student achievement. The No Child Left Behind Act of 2001
augmented the assessment and accountability requirements that states
must implement and increased the stakes for schools that fail to make
adequate progress. For more information on state implementation of
these requirements see U.S. General Accounting Office, Title I:
Education Needs to Monitor States' Scoring of Assessments, GAO-02-393,
(Washington, D.C.: April 1, 2002).
[20] USDA cautions that schools must take other issues into account
when considering adding a salad bar including food safety practices
associated with preparing and storing the salad bar items as well as
proper student use.
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