School meal programs in the United States

Food insecurity has risen in recent years. Between 2007 and 2008, the rate in the U.S. increased from 11.1 percent to 14.6 percent, the largest annual increase since researchers began tracking the rate in the mid-1990s.[1] Among households with children, food insecurity increased from 15.8 percent to 21 percent during that period.

Four million American children "experience prolonged periodic food insufficiency and hunger each year", which amounts to 8 percent of children under the age of 12.[7] An additional 21 percent are at risk.

Food insecurity affects the health and well-being of children in several ways. It is a major threat to "growth, health, cognitive, and behavioral potential",[6] and most behavioral, emotional, and academic problems are more prevalent among hungry children than non-hungry children. Food insecurity is linked to lower math scores, trouble getting along with peers, poor health, and more frequent illness.[8] A study by researchers at the Boston University School of Medicine found that children aged 6–11 who came from food-insecure homes had lower arithmetic scores, were more likely to have repeated a grade or seen a therapist, and had more difficulty getting along with peers than similar children in food-secure homes.[6] Hungry children are much more likely to have clinical levels of psychosocial dysfunction,[7] and they show more anxious, irritable, aggressive, and oppositional behaviors than peers whose families are low-income but food-secure.

In addition to academic and behavioral problems, children with inadequate diets are more prone to illnesses. Researchers have found that malnutrition leads to an array of health problems that can become chronic.[9] Underfed children may have "extreme weight loss, stunted growth, weakened resistance to infection", and even early death. Such ailments reduce the amount of time students can spend learning at school.[9]

These cognitive, behavioral, and physical problems are exacerbated in children who, in addition to being undernourished, are from impoverished backgrounds. Scientists now believe that "malnutrition alters intellectual development by interfering with overall health as well as the child's energy level, rate of motor development and rate of growth." Moreover, "low economic status can exacerbate all [of] these factors, placing impoverished children at particular risk for cognitive impairment later in life".[9]

Education and food both have an effect on the "central capabilities" described by Martha Nussbaum, an American philosopher. These capabilities, which Nussbaum saw as integral to raising people above the poverty threshold, are: life, bodily health, bodily integrity, sense, imagination and thought, emotions, practical reason, affiliation, other species, play, and control over one's environment (both political and material).[10] Nutrition affects bodily health and bodily integrity, and education has broader connections to sense, imagination and thought, practical reason, and control over one's environment. Without these capabilities, according to Nussbaum, people fall into poverty traps and lack the proper opportunities to rise out of them. Government efforts such as meal programs can prevent people from falling into poverty, as well as lift them out of it.

A School Lunch Program recipient in 1936.

Before the official establishment of the large-scale, government-funded food programs that are prevalent today in the United States, small, non-governmental programs existed. As early as the late 19th century, cities such as Boston and Philadelphia operated independent school lunch programs, with the assistance of volunteers or charities.[11]

Until the 1930s, most school lunch programs were volunteer efforts led by teachers and mothers' clubs.[12] These programs drew on the expertise of professional home economics. For the people who began these programs, school lunchrooms were the perfect setting in which to feed poor children and, more importantly, to teach immigrant and middle-class children the principles of nutrition and healthy eating.[12] Thus, the original intent of school meal programs was not primarily to increase the food security of impoverished children and alleviate educational problems, but rather to instill cultural norms.

During the Great Depression, the numbers of hungry children seeking food overwhelmed lunchrooms.[12] Thus, local programs began to look to state governments, and then the national government, for resources. The national government began providing funding for school lunches on a small scale as early as 1932. This funding originated from New Deal agencies such as the Federal Emergency Relief Administration, the Reconstruction Finance Corporation, and the Civil Works Administration.[11] The federal government monitored supplies from commercial farmers and purchased surplus commodities (Levine 6). Schools served as an outlet for federal commodity donations.[12] In 1935, the programs expanded through the Works Progress Administration and the National Youth Administration, both of which provided labor for school cafeterias.[11] During World War II, the War Food Administration (1943–45) helped create school lunch programs.[13][14]

Eventually, the New Deal policies began to dissolve, and farm surpluses decreased. However, there was still a desire to keep school lunch programs in place, so federal cash assistance began to be appropriated on a year-to-year basis, and the National School Lunch Program was developed.

The United States Congress passed the National School Lunch Act in 1946 after an investigation found that the poor health of men rejected for the World War II draft was associated with poor nutrition in their childhood.[15]

By the end of its first year, the National School Lunch Program had helped 7.1 million children.[16] However, from the start, the program linked children's nutrition to the priorities of agricultural and food interests, and to the agenda of the United States Department of Agriculture (USDA).[12] In these early years, the program provided substantial welfare to commercial farmers as an outlet for surplus commodities, but provided few free meals to poor children and fed a relatively small number of schoolchildren.

In the 1960s, a group of mainstream national women's organizations began focusing on the shortcomings of the NSLP. The evidence they presented became crucial to Congressional debates on race and poverty. In 1962, Congress amended the NSLP, changing it from a distributor of state-regulated grant aid to a permanently funded meal reimbursement program. In 1969, President Richard Nixon pushed Congress to provide funding for school lunches beyond the reimbursement program, declaring, "The time has come to end hunger in America."

In between, in 1966, Congress passed the Child Nutrition Act, which stated that educational progress was an objective of school meal programs. The bill, signed by President Lyndon B. Johnson, created the federally subsidized School Breakfast Program (SBP), which supplemented the existing lunch program by providing low-cost or free breakfasts to students at public and nonprofit private schools. It also created the Summer Food Service Program and established National School Lunch Week.

By the end of the 1970s, many advocates saw privatization as the only way to keep school lunch programs going. Fast food from private companies began to be served in cafeterias, rather than more nutritious meals.

In 1994, a number of changes were made to the NSLP, primarily to standardize the nutritional quality of school meals. Dietary guidelines were proposed to take effect in 1996, and the USDA launched the Healthy School Meals Initiative to improve nutritional education for school-age children.

By the end of the 20th century, the NSLP was the nation's second-largest domestic food program, after the Supplemental Nutrition Assistance Program (more commonly known as food stamps).[12]

In 2004, as the childhood obesity crisis came into national focus, the USDA urged school districts to establish wellness policies and initiatives tailored to local needs. The USDA regulations were intended to strengthen nutritional education nationwide while giving schools the autonomy to decide what types of foods could be sold in their cafeterias and vending machines.

In 2007, the USDA hired the Institute of Medicine (IOM; now the National Academy of Medicine) to develop recommendations for "bringing school food up-to-date with current science". Dr. Virginia Stallings, a pediatric gastroenterologist at the Children's Hospital of Philadelphia who led the IOM team, concluded, "Since the school meal programs were last updated, we've gained the greater understanding of children's nutritional needs and the dietary factors that contribute to obesity, heart disease, and other chronic health problems."

In 2010, the Healthy, Hunger-Free Kids Act made the most sweeping changes in the history of the NSLP, putting vending-machine snacks and à la carte menu items under federal regulation for the first time. Championed by First Lady Michelle Obama and directed by the USDA, the law established guidelines requiring more fruits, vegetables, and whole grains in school meals. The guidelines, which took effect in the 2012–13 school year, also limited sodium, fat, and caloric intake based on students' ages.[17]

Historically, the NSLP and other food programs have been used to improve the health of children who are food-insecure or at risk of malnutrition. More recently, however, the NSLP has made a significant shift to fight childhood obesity as well as malnutrition. Unhealthy eating patterns in overweight children—like those in underweight children—are often tied not only to individual choices, but also to social and economic circumstances such as family income and access to fresh foods.[12] School meal programs provide an avenue by which these socioeconomic circumstances can be targeted to improve children's diets.

Most students benefit from the NSLP, even if they do not receive free lunches, because the program also subsidizes full-price meals in the majority of U.S. schools.[8]

The Food and Nutrition Service (FNS), an agency of the USDA, administers the NSLP at the federal level. Within each individual state, the program is administered by a state agency, in most cases the Department of Education. (If state law prevents the state from administering the program, the appropriate FNS regional office may administer it instead.) The state official in charge of the NSLP works with individual school districts to make sure each lunchroom worker receives the necessary information and supplies. Additionally, he or she receives directions from the United States Secretary of Agriculture. School districts that choose to participate in the NSLP follow specific guidelines and receive federal subsidies for each meal they serve.

The NSLP has relationships with several other federal agencies and programs. For example, the Fresh Fruit and Vegetable Program, an initiative of the United States Department of Defense (DoD), allows schools to use USDA entitlement dollars to buy fresh produce. The NSLP also works closely with the Temporary Assistance for Needy Families program and the Supplemental Nutrition Assistance Program (SNAP).

Aside from its impact on public organizations, the NSLP also affects corporate vendors and local businesses. The program is designed to help local farmers by purchasing fresh fruits and vegetables, which make their way to schoolchildren. Additionally, many companies are reformulating their foods to meet federal guidelines so that they can sell their products to the government.

The SBP began as a pilot program in 1966 and became permanent in 1975.[16] It was developed specifically to help impoverished children; the "original legislation stipulated that first consideration for program implementation was to be given to schools located in poor areas or in areas where children had to travel a great distance to school",[18] and in 1971, "Congress directed that priority consideration for the program would include schools in which there was a special need to improve the nutrition and dietary practices of children of working mothers and children from low-income families".[18]

The SBP works in essentially the same way as the NSLP: Participating schools receive cash subsidies from the USDA for every meal they serve.[16] They must meet federal nutrition requirements and offer free or reduced-price breakfasts to children who are eligible. The USDA provides technical training and assistance to help school workers prepare and serve healthy meals, as well as nutrition education to help children understand the links between diet and health.

In 1970, before it was made permanent, the SBP served 500,000 children. In fiscal year 2011, more than 12.1 million children participated each day, 10.1 million of whom received free or reduced-price breakfasts.[16]

Unhealthy school lunches contribute to malnutrition in both the short term and the long term. In many cases, unhealthy adult eating patterns can be traced back to unhealthy school lunches, because children learn eating habits from social settings such as school. A 2010 study of 1,003 middle-school students in Michigan found that those who ate school lunches were significantly more likely to be obese than those who did not.[25]

Promoting healthy eating in schools may reduce adolescent obesity by as much as 25 percent. One such effort is the Berkeley Food System, which uses vegetable gardens to promote education on healthy eating. Janet Brown, who started the project, explained that students were more likely to eat healthy foods such as fruits and vegetables when they were better introduced to them.[26]

In 2008, the Economic Research Service of the USDA issued a report titled "The National School Lunch Program: Backgrounds, Trends, and Issues", which reaffirmed that one of the main goals of the NSLP, as identified by Congress, is to "promote the health and well-being of the Nation’s children".[21] According to the report, new challenges to this goal have emerged with increased scrutiny of high-fat commodities donated by the USDA, such as meat, cheese, and milk. The authors argue that providing high-fat USDA food subsidies contributes to childhood obesity. While NSLP participants have higher intakes of calcium and fiber—nutrients often underconsumed by children—they also have higher fat intakes.[21] However, study results comparing weight gain among NSLP participants and nonparticipants are inconclusive.

A 2011 article in the Journal of Econometrics, "The impact of the National School Lunch Program on child health: A nonparametric bounds analysis", affirmed the nutritional advantages of the Healthy, Hunger-Free Kids Act but found that "children in households reporting the receipt of free or reduced-price school meals through the National School Lunch Program are more likely to have negative health outcomes than observationally similar nonparticipants".[27] The authors asserted that specific groups were not receiving the expected nutritional benefits from the NSLP, and put forth two possible explanations: First, children receiving free or reduced-price meals are likely to differ from their peers in ways that are not reflected in the data. Second, the households of the children most affected by reduced-price lunches may be misreporting participation in the program.

The USDA report in 2008 identified the emergence of "competitive foods" as an obstacle to the NSLP's nutritional goals. Competitive foods—which may include items purchased off campus, à la carte items purchased on campus, products from vending machines, food purchased for school fundraising, food available at school parties, and treats given to students by teachers—are not included in the NSLP reimbursement plan and so are not required to meet USDA standards. Generally speaking, competitive foods are lower in key nutrients and higher in fat than NSLP-reimbursable meals. The availability of such foods in schools often undermines the nutritional goals of the NSLP.

The study recommended that nutritional standards be applied to all food served or sold in schools. In addition, it noted that the Government Accountability Office (GAO) recommended in 2005 that the USDA's authority to regulate "foods of minimal nutritional value" be extended to a wider class of foods.

Research has shown that 36 percent of participants in reduced-price lunch programs are food-insecure and 19 percent are obese.

Studies comparing NSLP participants and nonparticipants have been inconclusive on whether weight gain rates differ between the two groups. The 2008 Economic Research Service study found "similar calorie intakes for participants and nonparticipants but higher fat and sodium intakes for participants".[21] The most obvious challenge to efforts to address such problems is that even if more nutritious foods are provided, there is no guarantee that students will eat them. Additionally, the NSLP does not take into account the physiological differences among participants: Some children are smaller than others, some are more athletic, and some have metabolisms that require more calories than the NSLP allows.

Three ideas have been proposed to address obesity in schools:

• Expose students only to fruits and vegetables as snacks. A 2009 Journal of Nutrition study, "Restricting Snacks in U.S. Elementary Schools Is Associated with Higher Frequency of Fruit and Vegetable Consumption", found that "children in schools with restricted snack availability had significantly higher frequency of fruit and vegetable consumption than children in schools without restricted snack availability", and suggested that a restrictive snack policy should be part of a multifaceted approach to improve children's diets.[28]
• Educate all students about nutrition. A 2007 American Journal of Clinical Nutrition article, "APPLE project: 2-y findings of a community-based obesity prevention program in primary school-age children", stated, "A relatively simple approach, providing activity coordinators and basic nutrition education in schools, significantly reduces the rate of excessive weight gain in children."[29]
• Encourage healthier meal selection without restricting choices. Researchers at Cornell University have suggested techniques based on behavioral economics, such as placing white milk in front of chocolate milk in coolers,[30] moving and highlighting fruit displays,[31] and using appealing names for vegetables to improve palatability.[32]

Studies have shown a positive correlation between school meal programs and increased food security. Among low-income children, the marginal food insecurity rate of those with access to the School Breakfast Program is lower than that of those children without access to the program.[1]

This increase in food security has not been shown to have significant long-term health benefits, but it does have a positive impact on education. Subsidized lunches appear to encourage children to attend school, and to free up food at home for other family members to consume. Public-policy researchers at Georgetown University found in 2010 that "increasing NSLP exposure by ten percentage points results in an average increase in education of .365 years" for girls, and "increases average education by nearly a year" for boys.[11] The researchers found that participation in grades seven through twelve "has a stronger effect on educational attainment than participating in the earlier grades does, whereas there is some evidence suggesting that participation in earlier grades is more important for the health outcomes".[11]

An article in The Wilson Quarterly in 2011 described the impact of the NSLP in the Maplewood–Richmond Heights School District in the St. Louis suburbs, where participation in the program is increasing.[34] Linda Henke, the superintendent of the school district, said: "I was struck by the positive vibe around the revamped program. A teacher said he'd lost seven pounds by eating in the high school cafeteria every school day for the previous three months. A senior girl who had embraced the changes from the beginning observed that even she was surprised when football players started eating salads. The elementary school's cook of 14 years told me her job is now harder, but it’s rewarding." The article continued: "It takes a tough-minded school leader to assert that nutrient-rich food is the right choice for kids—and that it's an appropriate use of government dollars. Kids will complain initially but will come around. And a number of collateral benefits follow when students eat well. Anecdotal reports from schools with healthful and flavorful food indicate that teachers have started eating with students, attendance rates are higher, and fewer students fall asleep in class or commit vandalism and violence at school."[34]

Another article examined the program's effects within the Los Angeles Unified School District. The district's food service director, David Binkle, said: "From what I see and what I hear now that students are getting used to [the new menus] and they have tasted it, they like it. Any time you make a change, and the major change like this, that's an evolution that we have to go through. There's going to be people now saying the meal is too healthy for the kids and it's stuff they don't know. The reality of this is the rest of the country is about to see what we've gone through [when they adopt the new meal pattern regulations]. We did this on purpose so that we could really get out ahead of this and start to work through it and adjust. I think the rest of the country is going to see a lot of the same impact [that we've seen this year]." Binkle added, "What I keep hearing from the principals is that as we keep tweaking and teaching and encouraging the kids, more and more kids are participating."[35]

Research overwhelmingly shows an upward trend in NSLP participation. However, the Wilson Quarterly article described a challenge: "Since 2004, the USDA has administered the HealthierUS School Challenge, awarding distinction but no money, to schools that voluntarily improve the healthfulness of their meals. By last fall, only a paltry 841 of the 101,000 schools in the NSLP (less than one percent) had received awards. That leaves a lot of schools that are still promoting Tater Tot Day and reheating frozen pizzas."[34] The HealthierUS School Challenge (HUSSC) is a voluntary certification initiative recognizing schools that have created healthier environments by promoting nutrition and physical activity. Schools that apply may be awarded HUSSC certification and monetary incentives.[36] As of March 11, 2014, there were 6,706 schools certified, which is 6 percent of the schools participating in the NSLP.