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Importance of School Lunches

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Published: Mar 13, 2024

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In conclusion, the significance of school lunches extends far beyond simply providing sustenance. These meals are essential for promoting student health, academic performance, and overall well-being. By acknowledging their importance and prioritizing their quality, we can create a positive and nurturing environment for students to thrive. As such, school lunches should be regarded as a fundamental aspect of the educational experience, deserving of our attention and investment.

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Personal Health

Feeding Young Minds: The Importance of School Lunches

By Jane E. Brody

June 5, 2017

Harding Senior High, a public school in St. Paul, Minn., has long been known as a 90-90-90 school: 90 percent of students are minorities, nearly 90 percent come from poor or struggling families and, until recently, 90 percent graduate (now about 80 percent) to go on to college or a career.

Impressive statistics, to be sure. But perhaps most amazing about this school is that it recognizes and acts on the critical contribution that adequate food and good nutrition make to academic success. Accordingly, it provides three balanced meals a day to all its students, some of whom might otherwise have little else to eat on school days.

For those who can’t get to school in time for early breakfast, a substitute meal is offered after first period, to be eaten during the second period. Every student can pick up dinner at the end of the school day, and those who play sports after school can take the dinner with them to practices and games.

To Jennifer Funkhauser, a French teacher at Harding and a hands-on participant in the meal program, making sure the students are well fed is paramount to their ability to succeed academically. Ms. Funkhauser and the staff at Harding are well aware of the many studies showing that children who are hungry or malnourished have a hard time learning.

After she noticed that some youngsters were uncomfortable eating with hundreds of others in a large, noisy lunchroom, Ms. Funkhauser created a more private, quieter “lunch bunch” option for them.

The attitude and atmosphere at Harding are in stark contrast to the humiliating lunchroom experiences suffered by students at some schools, where youngsters are sometimes shamed in front of their classmates and their meals confiscated and dumped in the garbage when parents have an unpaid lunch bill.

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Why School Meals Matter

Lunch tray with apple, whole grain sandwich, almonds carrot sticks, celery sticks and milk

According to the Centers for Disease Control and Prevention (CDC), childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. Weight statistics for children are approaching that of adults: 1 in 3 children is now overweight or obese. Studies have also shown a rising prevalence of type 1 and 2 diabetes in adolescents ages 10 through 19 years, with increasing obesity cited as a key contributor. [1]

On a positive note, the CDC showed a significant 40% decline in obesity rates from 2003 to 2012 in younger children ages 2 to 5 years. [2] Another CDC report revealed a decline in obesity rates among low-income children ages 2 to 4 years participating in federal nutrition programs. [3] Authors from both studies discussed the likely impact of early education programs focusing on improved nutrition and exercise standards, as guided by the HHFKA.

Despite some anecdotal reports in the media that fruits and vegetables from these new updated school meals were ending up in the trash, two studies discovered the opposite. In 2014, Cohen at al. found that children were eating more of their entrees and selecting and eating more fruit. [4] In 2015, Schwartz et al. followed more than 500 children in urban schools in grades 5 through 7, comparing before and after pictures and weights of their school lunches. [5] They found that after two years there was a 19% increase in vegetable intake. Though the amount of fruit eaten did not change, 12% more children were selecting fruits as part of their lunch tray. The authors noted that a greater variety of fruits had been made available, which may have encouraged the children to choose fruit.

Healthier choices throughout the school day

According to standards that went into effect in 2016, a Smart Snack must be one of the following:

A grain product that contains 50 percent or more whole grains by weight (i.e., lists a whole grain as the first ingredient)
Have as the first ingredient a fruit, a vegetable, a dairy product, or a protein food
A combination food that contains at least ¼ cup of fruit and/or vegetable

The snack must also meet specific nutrient standards for calories, sodium, sugar, and fats per serving.

When it comes to drinks, allowed beverages include the following:

Plain water (with or without carbonation)
Unflavored low fat milk
Unflavored or flavored fat-free milk and milk alternatives
100% fruit or vegetable juice
Calorie-free, flavored water (with or without carbonation)
Flavored and/or carbonated beverages that contain less than 5 calories per 8 fluid ounces or ≤10 calories per 20 fluid ounces.

Further modifications beyond these school food standards might include eliminating flavored, sweetened milks and offering only plain milk; limiting fruit juice; providing entrees of poultry, fish, and beans more often than red meat and processed meats; and replacing solid fats with healthful oils such as canola, sunflower, and olive oil when preparing food, salad dressings and sauces.

Parent Tip: How do I know my child is eating their school lunch?

An important step is to involve your child with meal decisions and maintain an encouraging and non-judgmental attitude to foster open dialogue.
Most schools provide monthly calendars of their school lunch offerings that include the main meal and alternatives. Discuss each of the choices with your child and highlight the specific foods in the meal they like, dislike, or aren’t sure of. After school, ask what foods they ate and didn’t eat and why. This can help to plan their future meals and snacks.
Pack nutritious snacks of string cheese, sunflower or pumpkin seeds, whole or chopped fruit, and cut up vegetables that your child enjoys in case they don’t finish the school lunch offering one day. As children respond positively to variety [5], periodically change up the types of fruits and vegetables in their snack bag.

Lunchbox graphic with the Kid's Healthy Eating Plate

If your child does not consume foods offered at school, here are some tips and inspiration for preparing healthy lunchboxes and snack ideas.
Dabelea, D., et al. Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. JAMA , 2014. 311(17): p. 1778-86.
Ogden, C.L., et al. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA, 2014;311(8):806-14.
Vital Signs: Obesity Among Low-Income, Preschool-Aged Children—United States, 2008–2011. MMWR, 2013;62(31);629-34.
Cohen, J., et al. Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste. Am J Prev Med, 2014;46(4):388-94.
Schwartz Marlene B., et al. New School Meal Regulations Increase Fruit Consumption and Do Not Increase Total Plate Waste. Childhood Obesity, 2015;11(3): 242-7.

How the quality of school lunch affects students’ academic performance

Subscribe to the brown center on education policy newsletter, michael l. anderson , mla michael l. anderson associate professor of agricultural and resource economics - university of california, berkeley justin gallagher , and jg justin gallagher assistant professor of economics - case western reserve university elizabeth ramirez ritchie err elizabeth ramirez ritchie ph.d. graduate student - university of california-berkeley, department of agricultural and resource economics.

May 3, 2017

In 2010, President Barack Obama signed the Healthy, Hunger-Free Kids Act. The main goal of the law was to raise the minimum nutritional standards for public school lunches served as part of the National School Lunch Program. The policy discussion surrounding the new law centered on the underlying health reasons for offering more nutritious school lunches, in particular, concern over the number of children who are overweight. The Centers for Disease Control estimates that one in five children in the United States is obese.

Surprisingly, the debate over the new law involved very little discussion as to whether providing a more nutritious school lunch could improve student learning. A lengthy medical literature examines the link between diet and cognitive development, and diet and cognitive function. The medical literature focuses on the biological and chemical mechanisms regarding how specific nutrients and compounds are thought to affect physical development (e.g., sight), cognition (e.g., concentration, memory), and behavior (e.g., hyperactivity). Nevertheless, what is lacking in the medical literature is direct evidence on how nutrition impacts educational achievement.

We attempt to fill this gap in a new study that measures the effect of offering healthier public school lunches on end of year academic test scores for public school students in California. The study period covers five academic years (2008-2009 to 2012-2013) and includes all public schools in the state that report test scores (about 9,700 schools, mostly elementary and middle schools). Rather than focus on changes in national nutrition standards, we instead focus on school-specific differences in lunch quality over time. Specifically, we take advantage of the fact that schools can choose to contract with private companies of varying nutritional quality to prepare the school lunches. About 12 percent of California public schools contract with a private lunch company during our study period. School employees completely prepare the meals in-house for 88 percent of the schools.

To determine the quality of different private companies, nutritionists at the Nutrition Policy Institute analyzed the school lunch menus offered by each company. The nutritional quality of the menus was scored using the Healthy Eating Index (HEI). The HEI is a continuous score ranging from zero to 100 that uses a well-established food component analysis to determine how well food offerings (or diets) match the Dietary Guidelines for Americans. The HEI is the Department of Agriculture’s preferred measure of diet quality, and the agency uses it to “examine relationships between diet and health-related outcomes, and to assess the quality of food assistance packages, menus, and the US food supply.” The average HEI score for the U.S. population is 63.8, while the median HEI score in our study is 59.9. In other words, the typical private company providing public school lunch in CA is a bit less healthy than the average American diet.

We measure the relationship between having a lunch prepared by a standard (below median HEI) or healthy (above median HEI) company relative to in-house preparation by school staff. Our model estimates the effect of lunch quality on student achievement using year-to-year changes between in-house preparation of school meals and outside vendors of varying menu quality, within a given school . We control for grade, school, and year factors, as well as specific student and school characteristics including race, English learner, low family income, school budget, and student-to-teacher ratios.

We find that in years when a school contracts with a healthy lunch company, students at the school score better on end-of-year academic tests. On average, student test scores are 0.03 to 0.04 standard deviations higher (about 4 percentile points). Not only that, the test score increases are about 40 percent larger for students who qualify for reduced-price or free school lunches. These students are also the ones who are most likely to eat the school lunches.

Moreover, we find no evidence that contracting with a private company to provide healthier meals changes the number of school lunches sold. This is important for two reasons. First, it reinforces our conclusion that the test score improvements we measure are being driven by differences in food quality, and not food quantity. A number of recent studies have shown that providing (potentially) hungry kids with greater access to food through the National School Lunch Program can lead to improved test scores. We are among the very few studies to focus on quality, rather than food quantity (i.e., calories). Second, some critics of the Healthy, Hunger-Free Kids Act worried that by raising the nutritional standards of school lunches that fewer children would eat the food, thereby unintentionally harming the students that the law was designed to help. Our results provide some reassurance that this is not likely to be the case.

Finally, we also examine whether healthier school lunches lead to a reduction in the number of overweight students. We follow previous literature and use whether a student’s body composition (i.e. body fat) is measured to be outside the healthy zone on the Presidential Fitness Test . We find no evidence that having a healthier school lunch reduces the number of overweight students. There are a few possible interpretations of this finding, including that a longer time period may be necessary to observe improvements in health, the measure of overweight is too imprecise, or that students are eating the same amount of calories due to National School Lunch Program calorie meal targets.

Education researchers have emphasized the need and opportunity for cost-effective education policies . While the test score improvements are modest in size, providing healthier school lunches is potentially a very cost-effective way for a school to improve student learning. Using actual meal contract bid information we estimate that it costs approximately an additional $80 per student per year to contract with one of the healthy school lunch providers relative to preparing the meals completely in-house.

While this may seem expensive at first, compare the cost-effectiveness of our estimated test score changes with other policies. A common benchmark is the Tennessee Star experiment , which found a large reduction in the class size of grades K-3 by one-third correlated with a 0.22 standard deviation test score increase. This reduction cost over $2,000 when the study was published in 1999, and would be even more today. It is (rightfully) expensive to hire more teachers, but scaling this benefit-cost ratio to achieve a bump in student learning gains equal to our estimates, we find class-size increases would be at least five times more expensive than healthier lunches.

Thus, increasing the nutritional quality of school meals appears to be a promising, cost-effective way to improve student learning. The value of providing healthier public school lunches is true even without accounting for the potential short- and long-term health benefits, such as a reduction in childhood obesity and the development of healthier lifelong eating habits. Our results cast doubt on the wisdom of the recently announced proposal by Agriculture Secretary Sonny Perdue to roll back some of the school lunch health requirements implemented as part of the Healthy, Hunger-Free Kids Act.

Follow YES! For Teachers

Six brilliant student essays on the power of food to spark social change.

Read winning essays from our fall 2018 “Feeding Ourselves, Feeding Our Revolutions,” student writing contest.

For the Fall 2018 student writing competition, “Feeding Ourselves, Feeding Our Revolutions,” we invited students to read the YES! Magazine article, “Cooking Stirs the Pot for Social Change,” by Korsha Wilson and respond to this writing prompt: If you were to host a potluck or dinner to discuss a challenge facing your community or country, what food would you cook? Whom would you invite? On what issue would you deliberate?

The Winners

From the hundreds of essays written, these six—on anti-Semitism, cultural identity, death row prisoners, coming out as transgender, climate change, and addiction—were chosen as essay winners. Be sure to read the literary gems and catchy titles that caught our eye.

Middle School Winner: India Brown High School Winner: Grace Williams University Winner: Lillia Borodkin Powerful Voice Winner: Paisley Regester Powerful Voice Winner: Emma Lingo Powerful Voice Winner: Hayden Wilson

Literary Gems Clever Titles

Middle School Winner: India Brown

A Feast for the Future

Close your eyes and imagine the not too distant future: The Statue of Liberty is up to her knees in water, the streets of lower Manhattan resemble the canals of Venice, and hurricanes arrive in the fall and stay until summer. Now, open your eyes and see the beautiful planet that we will destroy if we do not do something. Now is the time for change. Our future is in our control if we take actions, ranging from small steps, such as not using plastic straws, to large ones, such as reducing fossil fuel consumption and electing leaders who take the problem seriously.

Hosting a dinner party is an extraordinary way to publicize what is at stake. At my potluck, I would serve linguini with clams. The clams would be sautéed in white wine sauce. The pasta tossed with a light coat of butter and topped with freshly shredded parmesan. I choose this meal because it cannot be made if global warming’s patterns persist. Soon enough, the ocean will be too warm to cultivate clams, vineyards will be too sweltering to grow grapes, and wheat fields will dry out, leaving us without pasta.

I think that giving my guests a delicious meal and then breaking the news to them that its ingredients would be unattainable if Earth continues to get hotter is a creative strategy to initiate action. Plus, on the off chance the conversation gets drastically tense, pasta is a relatively difficult food to throw.

In YES! Magazine’s article, “Cooking Stirs the Pot for Social Change,” Korsha Wilson says “…beyond the narrow definition of what cooking is, you can see that cooking is and has always been an act of resistance.” I hope that my dish inspires people to be aware of what’s at stake with increasing greenhouse gas emissions and work toward creating a clean energy future.

My guest list for the potluck would include two groups of people: local farmers, who are directly and personally affected by rising temperatures, increased carbon dioxide, drought, and flooding, and people who either do not believe in human-caused climate change or don’t think it affects anyone. I would invite the farmers or farm owners because their jobs and crops are dependent on the weather. I hope that after hearing a farmer’s perspective, climate-deniers would be awakened by the truth and more receptive to the effort to reverse these catastrophic trends.

Earth is a beautiful planet that provides everything we’ll ever need, but because of our pattern of living—wasteful consumption, fossil fuel burning, and greenhouse gas emissions— our habitat is rapidly deteriorating. Whether you are a farmer, a long-shower-taking teenager, a worker in a pollution-producing factory, or a climate-denier, the future of humankind is in our hands. The choices we make and the actions we take will forever affect planet Earth.

India Brown is an eighth grader who lives in New York City with her parents and older brother. She enjoys spending time with her friends, walking her dog, Morty, playing volleyball and lacrosse, and swimming.

High School Winner: Grace Williams

Apple Pie Embrace

It’s 1:47 a.m. Thanksgiving smells fill the kitchen. The sweet aroma of sugar-covered apples and buttery dough swirls into my nostrils. Fragrant orange and rosemary permeate the room and every corner smells like a stroll past the open door of a French bakery. My eleven-year-old eyes water, red with drowsiness, and refocus on the oven timer counting down. Behind me, my mom and aunt chat to no end, fueled by the seemingly self-replenishable coffee pot stashed in the corner. Their hands work fast, mashing potatoes, crumbling cornbread, and covering finished dishes in a thin layer of plastic wrap. The most my tired body can do is sit slouched on the backless wooden footstool. I bask in the heat escaping under the oven door.

As a child, I enjoyed Thanksgiving and the preparations that came with it, but it seemed like more of a bridge between my birthday and Christmas than an actual holiday. Now, it’s a time of year I look forward to, dedicated to family, memories, and, most importantly, food. What I realized as I grew older was that my homemade Thanksgiving apple pie was more than its flaky crust and soft-fruit center. This American food symbolized a rite of passage, my Iraqi family’s ticket to assimilation.

Some argue that by adopting American customs like the apple pie, we lose our culture. I would argue that while American culture influences what my family eats and celebrates, it doesn’t define our character. In my family, we eat Iraqi dishes like mesta and tahini, but we also eat Cinnamon Toast Crunch for breakfast. This doesn’t mean we favor one culture over the other; instead, we create a beautiful blend of the two, adapting traditions to make them our own.

That said, my family has always been more than the “mashed potatoes and turkey” type.

My mom’s family immigrated to the United States in 1976. Upon their arrival, they encountered a deeply divided America. Racism thrived, even after the significant freedoms gained from the Civil Rights Movement a few years before. Here, my family was thrust into a completely unknown world: they didn’t speak the language, they didn’t dress normally, and dinners like riza maraka seemed strange in comparison to the Pop Tarts and Oreos lining grocery store shelves.

If I were to host a dinner party, it would be like Thanksgiving with my Chaldean family. The guests, my extended family, are a diverse people, distinct ingredients in a sweet potato casserole, coming together to create a delicious dish.

In her article “Cooking Stirs the Pot for Social Change,” Korsha Wilson writes, “each ingredient that we use, every technique, every spice tells a story about our access, our privilege, our heritage, and our culture.” Voices around the room will echo off the walls into the late hours of the night while the hot apple pie steams at the table’s center.

We will play concan on the blanketed floor and I’ll try to understand my Toto, who, after forty years, still speaks broken English. I’ll listen to my elders as they tell stories about growing up in Unionville, Michigan, a predominately white town where they always felt like outsiders, stories of racism that I have the privilege not to experience. While snacking on sunflower seeds and salted pistachios, we’ll talk about the news- how thousands of people across the country are protesting for justice among immigrants. No one protested to give my family a voice.

Our Thanksgiving food is more than just sustenance, it is a physical representation of my family ’s blended and ever-changing culture, even after 40 years in the United States. No matter how the food on our plates changes, it will always symbolize our sense of family—immediate and extended—and our unbreakable bond.

Grace Williams, a student at Kirkwood High School in Kirkwood, Missouri, enjoys playing tennis, baking, and spending time with her family. Grace also enjoys her time as a writing editor for her school’s yearbook, the Pioneer. In the future, Grace hopes to continue her travels abroad, as well as live near extended family along the sunny beaches of La Jolla, California.

University Winner: Lillia Borodkin

Nourishing Change After Tragedy Strikes

In the Jewish community, food is paramount. We often spend our holidays gathered around a table, sharing a meal and reveling in our people’s story. On other sacred days, we fast, focusing instead on reflection, atonement, and forgiveness.

As a child, I delighted in the comfort of matzo ball soup, the sweetness of hamantaschen, and the beauty of braided challah. But as I grew older and more knowledgeable about my faith, I learned that the origins of these foods are not rooted in joy, but in sacrifice.

The matzo of matzo balls was a necessity as the Jewish people did not have time for their bread to rise as they fled slavery in Egypt. The hamantaschen was an homage to the hat of Haman, the villain of the Purim story who plotted the Jewish people’s destruction. The unbaked portion of braided challah was tithed by commandment to the kohen or priests. Our food is an expression of our history, commemorating both our struggles and our triumphs.

As I write this, only days have passed since eleven Jews were killed at the Tree of Life Synagogue in Pittsburgh. These people, intending only to pray and celebrate the Sabbath with their community, were murdered simply for being Jewish. This brutal event, in a temple and city much like my own, is a reminder that anti-Semitism still exists in this country. A reminder that hatred of Jews, of me, my family, and my community, is alive and flourishing in America today. The thought that a difference in religion would make some believe that others do not have the right to exist is frightening and sickening.

This is why, if given the chance, I would sit down the entire Jewish American community at one giant Shabbat table. I’d serve matzo ball soup, pass around loaves of challah, and do my best to offer comfort. We would take time to remember the beautiful souls lost to anti-Semitism this October and the countless others who have been victims of such hatred in the past. I would then ask that we channel all we are feeling—all the fear, confusion, and anger —into the fight.

As suggested in Korsha Wilson’s “Cooking Stirs the Pot for Social Change,” I would urge my guests to direct our passion for justice and the comfort and care provided by the food we are eating into resisting anti-Semitism and hatred of all kinds.

We must use the courage this sustenance provides to create change and honor our people’s suffering and strength. We must remind our neighbors, both Jewish and non-Jewish, that anti-Semitism is alive and well today. We must shout and scream and vote until our elected leaders take this threat to our community seriously. And, we must stand with, support, and listen to other communities that are subjected to vengeful hate today in the same way that many of these groups have supported us in the wake of this tragedy.

This terrible shooting is not the first of its kind, and if conflict and loathing are permitted to grow, I fear it will not be the last. While political change may help, the best way to target this hate is through smaller-scale actions in our own communities.

It is critical that we as a Jewish people take time to congregate and heal together, but it is equally necessary to include those outside the Jewish community to build a powerful crusade against hatred and bigotry. While convening with these individuals, we will work to end the dangerous “otherizing” that plagues our society and seek to understand that we share far more in common than we thought. As disagreements arise during our discussions, we will learn to respect and treat each other with the fairness we each desire. Together, we shall share the comfort, strength, and courage that traditional Jewish foods provide and use them to fuel our revolution.

We are not alone in the fight despite what extremists and anti-semites might like us to believe. So, like any Jew would do, I invite you to join me at the Shabbat table. First, we will eat. Then, we will get to work.

Lillia Borodkin is a senior at Kent State University majoring in Psychology with a concentration in Child Psychology. She plans to attend graduate school and become a school psychologist while continuing to pursue her passion for reading and writing. Outside of class, Lillia is involved in research in the psychology department and volunteers at the Women’s Center on campus.

Powerful Voice Winner: Paisley Regester

As a kid, I remember asking my friends jokingly, ”If you were stuck on a deserted island, what single item of food would you bring?” Some of my friends answered practically and said they’d bring water. Others answered comically and said they’d bring snacks like Flamin’ Hot Cheetos or a banana. However, most of my friends answered sentimentally and listed the foods that made them happy. This seems like fun and games, but what happens if the hypothetical changes? Imagine being asked, on the eve of your death, to choose the final meal you will ever eat. What food would you pick? Something practical? Comical? Sentimental?

This situation is the reality for the 2,747 American prisoners who are currently awaiting execution on death row. The grim ritual of “last meals,” when prisoners choose their final meal before execution, can reveal a lot about these individuals and what they valued throughout their lives.

It is difficult for us to imagine someone eating steak, lobster tail, apple pie, and vanilla ice cream one moment and being killed by state-approved lethal injection the next. The prisoner can only hope that the apple pie he requested tastes as good as his mom’s. Surprisingly, many people in prison decline the option to request a special last meal. We often think of food as something that keeps us alive, so is there really any point to eating if someone knows they are going to die?

“Controlling food is a means of controlling power,” said chef Sean Sherman in the YES! Magazine article “Cooking Stirs the Pot for Social Change,” by Korsha Wilson. There are deeper stories that lie behind the final meals of individuals on death row.

I want to bring awareness to the complex and often controversial conditions of this country’s criminal justice system and change the common perception of prisoners as inhuman. To accomplish this, I would host a potluck where I would recreate the last meals of prisoners sentenced to death.

In front of each plate, there would be a place card with the prisoner’s full name, the date of execution, and the method of execution. These meals could range from a plate of fried chicken, peas with butter, apple pie, and a Dr. Pepper, reminiscent of a Sunday dinner at Grandma’s, to a single olive.

Seeing these meals up close, meals that many may eat at their own table or feed to their own kids, would force attendees to face the reality of the death penalty. It will urge my guests to look at these individuals not just as prisoners, assigned a number and a death date, but as people, capable of love and rehabilitation.

This potluck is not only about realizing a prisoner’s humanity, but it is also about recognizing a flawed criminal justice system. Over the years, I have become skeptical of the American judicial system, especially when only seven states have judges who ethnically represent the people they serve. I was shocked when I found out that the officers who killed Michael Brown and Anthony Lamar Smith were exonerated for their actions. How could that be possible when so many teens and adults of color have spent years in prison, some even executed, for crimes they never committed?

Lawmakers, police officers, city officials, and young constituents, along with former prisoners and their families, would be invited to my potluck to start an honest conversation about the role and application of inequality, dehumanization, and racism in the death penalty. Food served at the potluck would represent the humanity of prisoners and push people to acknowledge that many inmates are victims of a racist and corrupt judicial system.

Recognizing these injustices is only the first step towards a more equitable society. The second step would be acting on these injustices to ensure that every voice is heard, even ones separated from us by prison walls. Let’s leave that for the next potluck, where I plan to serve humble pie.

Paisley Regester is a high school senior and devotes her life to activism, the arts, and adventure. Inspired by her experiences traveling abroad to Nicaragua, Mexico, and Scotland, Paisley hopes to someday write about the diverse people and places she has encountered and share her stories with the rest of the world.

Powerful Voice Winner: Emma Lingo

The Empty Seat

“If you aren’t sober, then I don’t want to see you on Christmas.”

Harsh words for my father to hear from his daughter but words he needed to hear. Words I needed him to understand and words he seemed to consider as he fiddled with his wine glass at the head of the table. Our guests, my grandma, and her neighbors remained resolutely silent. They were not about to defend my drunken father–or Charles as I call him–from my anger or my ultimatum.

This was the first dinner we had had together in a year. The last meal we shared ended with Charles slopping his drink all over my birthday presents and my mother explaining heroin addiction to me. So, I wasn’t surprised when Charles threw down some liquid valor before dinner in anticipation of my anger. If he wanted to be welcomed on Christmas, he needed to be sober—or he needed to be gone.

Countless dinners, holidays, and birthdays taught me that my demands for sobriety would fall on deaf ears. But not this time. Charles gave me a gift—a one of a kind, limited edition, absolutely awkward treat. One that I didn’t know how to deal with at all. Charles went home that night, smacked a bright red bow on my father, and hand-delivered him to me on Christmas morning.

He arrived for breakfast freshly showered and looking flustered. He would remember this day for once only because his daughter had scolded him into sobriety. Dad teetered between happiness and shame. Grandma distracted us from Dad’s presence by bringing the piping hot bacon and biscuits from the kitchen to the table, theatrically announcing their arrival. Although these foods were the alleged focus of the meal, the real spotlight shined on the unopened liquor cabinet in my grandma’s kitchen—the cabinet I know Charles was begging Dad to open.

I’ve isolated myself from Charles. My family has too. It means we don’t see Dad, but it’s the best way to avoid confrontation and heartache. Sometimes I find myself wondering what it would be like if we talked with him more or if he still lived nearby. Would he be less inclined to use? If all families with an addict tried to hang on to a relationship with the user, would there be fewer addicts in the world? Christmas breakfast with Dad was followed by Charles whisking him away to Colorado where pot had just been legalized. I haven’t talked to Dad since that Christmas.

As Korsha Wilson stated in her YES! Magazine article, “Cooking Stirs the Pot for Social Change,” “Sometimes what we don’t cook says more than what we do cook.” When it comes to addiction, what isn’t served is more important than what is. In quiet moments, I like to imagine a meal with my family–including Dad. He’d have a spot at the table in my little fantasy. No alcohol would push him out of his chair, the cigarettes would remain seated in his back pocket, and the stench of weed wouldn’t invade the dining room. Fruit salad and gumbo would fill the table—foods that Dad likes. We’d talk about trivial matters in life, like how school is going and what we watched last night on TV.

Dad would feel loved. We would connect. He would feel less alone. At the end of the night, he’d walk me to the door and promise to see me again soon. And I would believe him.

Emma Lingo spends her time working as an editor for her school paper, reading, and being vocal about social justice issues. Emma is active with many clubs such as Youth and Government, KHS Cares, and Peer Helpers. She hopes to be a journalist one day and to be able to continue helping out people by volunteering at local nonprofits.

Powerful Voice Winner: Hayden Wilson

Bittersweet Reunion

I close my eyes and envision a dinner of my wildest dreams. I would invite all of my relatives. Not just my sister who doesn’t ask how I am anymore. Not just my nephews who I’m told are too young to understand me. No, I would gather all of my aunts, uncles, and cousins to introduce them to the me they haven’t met.

For almost two years, I’ve gone by a different name that most of my family refuses to acknowledge. My aunt, a nun of 40 years, told me at a recent birthday dinner that she’d heard of my “nickname.” I didn’t want to start a fight, so I decided not to correct her. Even the ones who’ve adjusted to my name have yet to recognize the bigger issue.

Last year on Facebook, I announced to my friends and family that I am transgender. No one in my family has talked to me about it, but they have plenty to say to my parents. I feel as if this is about my parents more than me—that they’ve made some big parenting mistake. Maybe if I invited everyone to dinner and opened up a discussion, they would voice their concerns to me instead of my parents.

I would serve two different meals of comfort food to remind my family of our good times. For my dad’s family, I would cook heavily salted breakfast food, the kind my grandpa used to enjoy. He took all of his kids to IHOP every Sunday and ordered the least healthy option he could find, usually some combination of an overcooked omelet and a loaded Classic Burger. For my mom’s family, I would buy shakes and burgers from Hardee’s. In my grandma’s final weeks, she let aluminum tins of sympathy meals pile up on her dining table while she made my uncle take her to Hardee’s every day.

In her article on cooking and activism, food writer Korsha Wilson writes, “Everyone puts down their guard over a good meal, and in that space, change is possible.” Hopefully the same will apply to my guests.

When I first thought of this idea, my mind rushed to the endless negative possibilities. My nun-aunt and my two non-nun aunts who live like nuns would whip out their Bibles before I even finished my first sentence. My very liberal, state representative cousin would say how proud she is of the guy I’m becoming, but this would trigger my aunts to accuse her of corrupting my mind. My sister, who has never spoken to me about my genderidentity, would cover her children’s ears and rush them out of the house. My Great-Depression-raised grandparents would roll over in their graves, mumbling about how kids have it easy nowadays.

After mentally mapping out every imaginable terrible outcome this dinner could have, I realized a conversation is unavoidable if I want my family to accept who I am. I long to restore the deep connection I used to have with them. Though I often think these former relationships are out of reach, I won’t know until I try to repair them. For a year and a half, I’ve relied on Facebook and my parents to relay messages about my identity, but I need to tell my own story.

At first, I thought Korsha Wilson’s idea of a cooked meal leading the way to social change was too optimistic, but now I understand that I need to think more like her. Maybe, just maybe, my family could all gather around a table, enjoy some overpriced shakes, and be as close as we were when I was a little girl.

Hayden Wilson is a 17-year-old high school junior from Missouri. He loves writing, making music, and painting. He’s a part of his school’s writing club, as well as the GSA and a few service clubs.

Literary Gems

We received many outstanding essays for the Fall 2018 Writing Competition. Though not every participant can win the contest, we’d like to share some excerpts that caught our eye.

Thinking of the main staple of the dish—potatoes, the starchy vegetable that provides sustenance for people around the globe. The onion, the layers of sorrow and joy—a base for this dish served during the holidays. The oil, symbolic of hope and perseverance. All of these elements come together to form this delicious oval pancake permeating with possibilities. I wonder about future possibilities as I flip the latkes.

—Nikki Markman, University of San Francisco, San Francisco, California

The egg is a treasure. It is a fragile heart of gold that once broken, flows over the blemishless surface of the egg white in dandelion colored streams, like ribbon unraveling from its spool.

—Kaylin Ku, West Windsor-Plainsboro High School South, Princeton Junction, New Jersey

If I were to bring one food to a potluck to create social change by addressing anti-Semitism, I would bring gefilte fish because it is different from other fish, just like the Jews are different from other people. It looks more like a matzo ball than fish, smells extraordinarily fishy, and tastes like sweet brine with the consistency of a crab cake.

—Noah Glassman, Ethical Culture Fieldston School, Bronx, New York

I would not only be serving them something to digest, I would serve them a one-of-a-kind taste of the past, a taste of fear that is felt in the souls of those whose home and land were taken away, a taste of ancestral power that still lives upon us, and a taste of the voices that want to be heard and that want the suffering of the Natives to end.

—Citlalic Anima Guevara, Wichita North High School, Wichita, Kansas

It’s the one thing that your parents make sure you have because they didn’t. Food is what your mother gives you as she lies, telling you she already ate. It’s something not everybody is fortunate to have and it’s also what we throw away without hesitation. Food is a blessing to me, but what is it to you?

—Mohamed Omar, Kirkwood High School, Kirkwood, Missouri

Filleted and fried humphead wrasse, mangrove crab with coconut milk, pounded taro, a whole roast pig, and caramelized nuts—cuisines that will not be simplified to just “food.” Because what we eat is the diligence and pride of our people—a culture that has survived and continues to thrive.

—Mayumi Remengesau, University of San Francisco, San Francisco, California

Some people automatically think I’m kosher or ask me to say prayers in Hebrew. However, guess what? I don’t know many prayers and I eat bacon.

—Hannah Reing, Ethical Culture Fieldston School, The Bronx, New York

Everything was placed before me. Rolling up my sleeves I started cracking eggs, mixing flour, and sampling some chocolate chips, because you can never be too sure. Three separate bowls. All different sizes. Carefully, I tipped the smallest, and the medium-sized bowls into the biggest. Next, I plugged in my hand-held mixer and flicked on the switch. The beaters whirl to life. I lowered it into the bowl and witnessed the creation of something magnificent. Cookie dough.

—Cassandra Amaya, Owen Goodnight Middle School, San Marcos, Texas

Biscuits and bisexuality are both things that are in my life…My grandmother’s biscuits are the best: the good old classic Southern biscuits, crunchy on the outside, fluffy on the inside. Except it is mostly Southern people who don’t accept me.

—Jaden Huckaby, Arbor Montessori, Decatur, Georgia

We zest the bright yellow lemons and the peels of flavor fall lightly into the batter. To make frosting, we keep adding more and more powdered sugar until it looks like fluffy clouds with raspberry seed rain.

—Jane Minus, Ethical Culture Fieldston School, Bronx, New York

Tamales for my grandma, I can still remember her skillfully spreading the perfect layer of masa on every corn husk, looking at me pitifully as my young hands fumbled with the corn wrapper, always too thick or too thin.

—Brenna Eliaz, San Marcos High School, San Marcos, Texas

Just like fry bread, MRE’s (Meals Ready to Eat) remind New Orleanians and others affected by disasters of the devastation throughout our city and the little amount of help we got afterward.

—Madeline Johnson, Spring Hill College, Mobile, Alabama

I would bring cream corn and buckeyes and have a big debate on whether marijuana should be illegal or not.

—Lillian Martinez, Miller Middle School, San Marcos, Texas

We would finish the meal off with a delicious apple strudel, topped with schlag, schlag, schlag, more schlag, and a cherry, and finally…more schlag (in case you were wondering, schlag is like whipped cream, but 10 times better because it is heavier and sweeter).

—Morgan Sheehan, Ethical Culture Fieldston School, Bronx, New York

Clever Titles

This year we decided to do something different. We were so impressed by the number of catchy titles that we decided to feature some of our favorites.

“Eat Like a Baby: Why Shame Has No Place at a Baby’s Dinner Plate”

—Tate Miller, Wichita North High School, Wichita, Kansas

“The Cheese in Between”

—Jedd Horowitz, Ethical Culture Fieldston School, Bronx, New York

“Harvey, Michael, Florence or Katrina? Invite Them All Because Now We Are Prepared”

—Molly Mendoza, Spring Hill College, Mobile, Alabama

“Neglecting Our Children: From Broccoli to Bullets”

—Kylie Rollings, Kirkwood High School, Kirkwood, Missouri

“The Lasagna of Life”

—Max Williams, Wichita North High School, Wichita, Kansas

“Yum, Yum, Carbon Dioxide In Our Lungs”

—Melanie Eickmeyer, Kirkwood High School, Kirkwood, Missouri

“My Potluck, My Choice”

—Francesca Grossberg, Ethical Culture Fieldston School, Bronx, New York

“Trumping with Tacos”

—Maya Goncalves, Lincoln Middle School, Ypsilanti, Michigan

“Quiche and Climate Change”

—Bernie Waldman, Ethical Culture Fieldston School, Bronx, New York

“Biscuits and Bisexuality”

“W(health)”

—Miles Oshan, San Marcos High School, San Marcos, Texas

“Bubula, Come Eat!”

—Jordan Fienberg, Ethical Culture Fieldston School, Bronx, New York

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Why School Lunches in America Are Unhealthy and 10 Ways You Can Take Action to Improve Them

We all have a stake in making school lunches healthier. Learn what you can do…

Debates about school lunch have been going on for more than a century. Learn why school lunches in America have a terrible reputation and how you can help make a difference.

School lunch matters — for better learning and academic performance, for improved behavior and performance at school, for the overall health of kids, and much more.

In fact, school meals can have tremendous impacts on the next generation, the future of a country, and maybe even the future of our world .

The State of School Lunches In America

In the U.S., school lunches have a terrible reputation.

A 2009 investigation by USA Today found that meat served in U.S. schools wouldn’t meet the quality or safety standards of fast-food restaurants. And according to the book Lunch Lessons , almost half the vegetables eaten by most children aged 2 to 19 in the U.S. were French fries.

Although America’s school lunches have improved since Congress strengthened the standards for the national school lunch program in 2010, they have a long way to go.

Most menus now include more whole grains and more fruit and vegetable options and less salt. But they also offer an abundance of factory-farmed animal products and heavily processed foods, like corn dogs, tater tots, and cheese pizza.

But School Lunches Can Improve

Programs exist to help improve food at schools, and some schools are taking bold, inspiring steps. Parents, educators, students, and everyone can take action to help students have access to healthier foods.

As Ocean Robbins says in his upcoming book 31-Day Food Revolution , “ As long as tens of millions of families depend on school meals for a fundamental part of daily nutrition, we all have a stake in making them healthier. ”

As long as tens of millions of families depend on school meals for a fundamental part of daily nutrition, we all have a stake in making them healthier. Ocean Robbins

Why Are School Lunches in America Unhealthy?

Many countries around the world serve school lunch for students. In America, midday meals have been a fixture in education for more than 70 years.

A variety of factors contribute to the school lunches in the U.S. today. Here are some of them:

The National School Lunch Program provides low-cost or free school lunches to 31 million students at more than 100,000 public and private schools per day. Meals must meet nutritional standards based on the Dietary Guidelines for Americans.

Participating schools receive approximately $1.30 to spend for each child. This amount must cover the food, as well as any labor, equipment, electricity, and other costs. School food programs also depend on income from students who often pay for the food they eat.

Tight budgets make serving healthier foods challenging .

The USDA Foods Program

The United States Department of Agriculture purchases hundreds of millions of dollars worth of agricultural products and gives them to schools for free. (The government does this to stabilize food prices and to ensure demand for the country’s agricultural goods.)

Free food may sound good, especially when funding is so limited. But in 2015 , 64% of the program’s spending went to meat , dairy , and egg products . Virtually all these products came from factory farms.

The School Milk Program

Why does almost every school lunch include milk? Because milk in schools has been federally subsidized since 1940 .

In the 2013-14 school year, more than $20 million taxpayer dollars were spent directly by the USDA on dairy product subsidies that went into child nutrition programs, including school lunch.

Even though most schools now ban sodas and other sugary beverages, chocolate milk still gets a pass . A single serving of chocolate milk contains between four and six teaspoons of sugar.

And there are many reasons why all this milk might not be the healthiest option for our kids.

Unhealthy School Vendors

Some schools have given contracts to food management companies to manage the food offered to students. In these cases, the companies have the purchasing power — not the schools.

The contracting most often goes to one of three main corporations: Aramark, Compass Group, and Sodexo. These companies are in business to make money, and it seems that children’s health isn’t always their top priority.

Why the Quality of School Lunches Matters for Students

Children consume up to 50% of their daily calories at school. And for low-income children, lunch may be the only real meal of the day.

Here are seven reasons to feed kids healthy, well-balanced meals:

1) Better Learning and Memory

As studies show, children who are hungry or undernourished are unable to focus and have a hard time learning .

According to a 2008 study published in Nature Reviews Neuroscience , diets with high levels of saturated fats may impair learning and memory . Many foods commonly served during school lunch, such as French fries, cheeseburgers, and chicken nuggets, are loaded with saturated fat.

When kids get adequate nutrition, they are sick fewer days and don’t need to miss school, which can lead to improved performance.

A 2011 study published in the Journal of Health Economics showed that when Greenwich switched from low-budget processed meals towards healthier options, educational outcomes improved and authorized absences fell by 14% .

2) Improved Concentration

Deficiencies in vitamins and minerals are shown to diminish cognitive abilities and mental concentration . Many school lunches are low in the fruits, vegetables, and whole foods that provide an abundance of vitamins and minerals.

3) Better Overall Health

A 2008 study published in the Journal of School Health found that effective school nutrition programs “have the potential to improve student’s diet quality, academic performance, and, over the long term, their health .”

4) Better Behavior and Fewer Problems

A series of studies in the 1980s removed chemical additives and processed food, and reduced levels of sugar, in the diets of more than 8,000 juvenile delinquents in 12 correctional facilities.

What was the result? Problem behaviors fell 47% .

Similarly, in Virginia, 300 particularly hardened juvenile delinquents were put on a diet with no chemical additives and little sugar for two years. During that time, incidences of theft fell 77%, insubordination dropped 55%, and hyperactivity went down by 65% .

Also, in 2008, a comprehensive analysis from the Harvard School of Public Health concluded that students with access to nutritious meals had lower rates of aggression and disciplinary problems .

5) Better Academic Performance

According to a study conducted at the University of California at Berkeley, students who eat healthier school lunches achieve higher standardized test scores .

And a 2008 study published in the Journal of School Health found an association between higher quality diets and better performance on exams .

6) Reducing Obesity

Obesity rates among children nearly tripled from 1970 to 2000. And according to a 2017 projection published in The New England Journal of Medicine , most 2-year-olds in America today will develop obesity by the time they turn 35 . But could school lunches help reduce obesity?

A 2013 study published in JAMA Pediatrics showed that children residing in states with stringent nutritional standards for school meals had lower rates of obesity than those states with more lax regulations.

And a 2018 nationwide study conducted in Japan and published in the Journal of Public Health concluded that “Appropriate nutritional intake through school lunch may be effective to reduce childhood obesity.” (Japan has a relatively low childhood obesity rate and one of the world’s most successful nationwide school lunch programs.)

7) Better Habits for the Future

Researchers say that the eating patterns kids develop early in life typically follow them into adulthood.

A group of Canadian researchers said: “ If children are to learn to prefer and select healthy foods, they need early, positive, repeated experiences with those foods. ”

Federal Changes to Make American School Lunches Healthier

In 2010, Congress adopted the Healthy, Hunger-Free Kids Act — the first significant change to school meal nutrition in more than 15 years .

If children are to learn to prefer and select healthy foods, they need early, positive, repeated experiences with those foods.

The standards went into effect in 2012, with schools that met the new criteria receiving additional funding. And federal funding for school lunches increased — by about six cents per meal — for the first time in more than three decades.

Schools are now required to:

Offer fruit daily at breakfast and lunch
Offer vegetables daily at lunch
Increase the amount of whole grains
Require students to select either a fruit or vegetable with each meal
Reduce the sodium content of meals
Only offer fat-free or low-fat milk varieties
Create grade-specific limits on total calories
Remove trans fats

Researchers who examined 1.7 million meals in an urban Washington State school district found that the overall nutritional quality of meals increased by 29% after the standards took effect .

Problems Faced by School Lunch Programs

But despite these improvements, many nutritional experts still find school lunches to be inadequate. Most meals aren’t prepared from scratch and don’t use fresh fruits and vegetables . Instead, foods are frozen or made elsewhere and then heated before serving. This food preparation creates meals that are far from fresh and, sadly, unappealing.

And the new federal administration is scaling back the updated school meal nutrition requirements, which could lead to less nutritious foods in many schools.

10 Ways You Can Help Improve School Food

Even though it can feel daunting to get involved, simple steps can have meaningful impacts on improving food in schools .

You may want to start by educating yourself about your school’s food-service program by checking the district’s or school’s website.

And here are some ideas for taking action to improve school meals:

Show your support for healthy school lunches in your community .

You can set up a meeting with your local school district’s Food Service Director (or your school superintendent) to find out what changes are already in progress and to see how you can help.

Be an advocate for healthier food in your school district .

The Chef Ann Foundation has a parent advocacy toolkit . Physicians Committee for Responsible Medicine has a healthy school lunch campaign . They offer resources for schools, parents, and schools.

Start a farm-to-school program .

You can find some suggestions from Kids Health here .

Get a school garden in a school .

You can find helpful guides and resources from The Lunch Box here .

Start Meatless Mondays in a school.

Foodservice workers can use this guide from Meatless Monday. Students, parents, and staff can use this ambassador guide from Meatless Monday.

Advocate for more plant-based options .

You can try encouraging a school to offer one plant-based entree per day by sharing recipes and testing them with staff. Amie Hamlin, the executive director of the New York Coalition for Healthy School Food, which offers 13 plant-based, kid-approved recipes , suggests this idea to make an impact

Help increase nutrition education in a school .

You can help implement the Coalition for Healthy School Food’s Wellness Wakeup Call , which provides schools and classrooms with daily, healthy eating tips that can be read in classrooms and over PA systems. This program is free for schools in New York, but out-of-state schools can use it for a small fee.

Advocate for lunchtimes that are long enough for students to get to eat.

You can advocate for lunches that are at least 30 minutes long and for scheduling recess before lunch. Research backs up these changes for getting kids to eat more fruits and veggies. The Peaceful Playgrounds Foundation has resources to help lengthen lunches.

Contact elected officials.

You can support legislation and funding that promote healthier school lunches. Contact your elected officials and let them know why healthy school lunches matter. Call to schedule a meeting with your member of Congress to speak out for federal change, with local school board members, or with a school board superintendent to take action locally. You can sign up for action alerts from the School Nutrition Associate Action Network to stay informed and engaged about school nutrition policy issues.

Students can take action, too .

The School Nutrition Association has 10 tips for students who want to make a difference in the school cafeteria.

What If School Lunches Around the World Encouraged Healthy Eating Behaviors?

Children’s bodies and brains are still developing — and the habits and attitudes they’ll carry with them throughout life are being formed.

Healthy, balanced school lunches could lead to better health and better academic performance for students. They could lead to reduced aggression, hyperactivity, and other problems. And they could help break the cycles that trap low-income children in poor health.

Healthy school lunches could also help reverse childhood obesity trends, which lead to type 2 diabetes and other chronic illness. And they could contribute to a healthier and more productive future for the next generation.

As former President Harry S. Truman said when signing the National School Lunch Act: “ No nation is any healthier than its children or more prosperous than its farmers. ”

Tell us in the comments:

What are your experiences with school lunch, how will you take action.

Featured Image: iStock.com/SDI Productions

10 revolutionary ways school lunch is improving (plus, healthy school lunch ideas)

Lindsay Oberst

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What are the benefits of free school meals? Here's what the research says.

Despite being a highly developed nation, the U.S. is experiencing a rise in children experiencing poverty and hunger — a rise that could be reduced by ensuring that every student receives free meals at school, experts say.

A recent report from the Census Bureau reveals that the child poverty rate skyrocketed from 5.2% in 2021 to 12.4% in 2022 . One catalyst for this shift was the expiration of the enhanced version of the child tax credit program , which offered parents a yearly tax credit (and some much-needed financial relief) to help offset strains like rising unemployment at the start of the pandemic . The temporary pandemic-era Supplemental Nutrition Assistance Program (SNAP) benefits , which millions of families were relying on, also expired this year, while federal school meal waivers ended in 2022.

Activists say that losing these resources has undermined the progress made toward helping families in need.

“ Last year’s annual report saw a record decrease in child poverty because of these expansions,” says Teddy Waszazak, the universal school meals campaign manager at Hunger Free Vermont . “[It] shows just how important and effective programs like the child tax credit, universal school meals and SNAP are in reducing poverty and hunger.”

Stripped of these crucial supports, many parents are struggling to feed their families and depend on free school meals for their children. So why is the concept of universal free school meals still so controversial?

What the research says about school-provided meals

Better health and more food security: A 2023 study in the Journal of the Academy of Nutrition and Dietetics found that children who received onsite meals and snacks provided by their child care center had higher chances of being food-secure, were more likely to be in good health and had lower odds of being admitted to a hospital from an emergency department than those eating meals and snacks from home.

Improved performance at school: A 2021 report from the Brookings Institution analyzed the impact of a program that offered schoolwide free meals and found an improvement in math performance (particularly among elementary and Hispanic students) at school districts where few previously qualified for free meals. Researchers also saw a significant reduction in suspensions among certain students.

Improved test scores and no negative impacts on weight or BMI: A report from the Center for Policy Research at the Maxwell School reinforces the findings that universal free meals have a positive effect on the English language arts and math test scores of all students. Researchers also found no evidence that universal free meals cause any increase in student weight or body mass index.

What support for free school lunch looks like

In 2021, California and Maine became the first two states to pass legislation for universal free lunches at public schools. This school year, six others joined them: Minnesota, New Mexico , Colorado, Vermont, Michigan and Massachusetts . But it doesn’t end there.

“Right now, we know at least 25 states have either formed coalitions or introduced legislation for free school meals,” says Waszazak, noting that both Connecticut and Nevada are working to extend their school meal programs. Illinois, meanwhile, passed legislation to provide free school meals, though there’s been concern over how schools can provide those meals without additional funding.

And in other areas, like at Broward County Public Schools in South Florida, there are ongoing pilot programs making sure students don’t go hungry.

“Universal free breakfast has been in place since 2014. It was successful right away, and it increased the number of kids that ate breakfast with us,” says registered dietitian Casie Maggio, program manager for nutrition education and training at Broward County Public Schools, the sixth-largest district in the nation. This year they’ve adopted a universal lunch pilot program, and she says they’re already seeing more students enjoying school lunches.

Why it matters

Experts say that providing free school meals is vital not only from a financial perspective, but from a health standpoint too.

“There have been numerous studies that have concluded that students perform better academically, behaviorally and emotionally after consuming nutritious meals during the school day. We see this in our schools every day,” Maggio tells Yahoo Life.

“The lack of consistent access to adequate quantity and quality food for a healthy, active life has been shown to increase risks for iron deficiency anemia, asthma, tooth decay, stunted growth and overweight due to intake of high-calorie foods that are low in vitamins and minerals,” says Krystal Hodge , an assistant professor in food science and human nutrition at the University of Illinois Urbana-Champaign. Hodge says hunger keeps students from being able to focus on learning.

“In a study of 500 low-income parents and their children ages 13 to 18 conducted by No Kid Hungry in 2017 , 59% of the children surveyed reported coming to school hungry,” says Hodge. “Research has shown that students at nutritional risk are more likely to skip breakfast, and have poor attendance, to be late [and] to show behavioral problems in school.”

Hodge says a big challenge that remains is that many families who aren’t eligible for income-based assistance still need help obtaining food, including school lunch.

“Offering universal free school meals reduces financial and social barriers to participation, including the stigma associated with receiving free meals that can be negative, even at this age,” she notes.

So what does it take to ensure all schoolchildren are fed?

Every school district and every state has a different process to go through to pass universal school meals, but persistence, collaboration with other vested interests and a vast well of research and data seem to be the most important factors.

“It took four years for the Vermont legislature to pass a permanent universal school meals bill. But Hunger Free Vermont, the School Nutrition Association of Vermont and the Vermont Farm to School Network had been collaborating for a decade before that to lay the groundwork for this effort,” says Waszazak. That groundwork included research and data-gathering to prove that universal meals reduce child hunger while yielding better outcomes for students and even improving local farm economies.

Although a bill was introduced just before the pandemic, state-level advocacy in Vermont slowed down when the federal government stepped in to fund universal meals for all students across the nation. Vermont activists were able to extend the universal school meals program for another year to gather data about the positive impact on students and the state as a whole, which later helped convince the legislature to pass the now permanent program.

Waszazak says the most prevalent criticism of the program is that it provides free meals to affluent families who can afford to pay. He disagrees for a number of reasons, including that universal school meals are one key piece of education equity.

“We do not ‘means’ test for students to have access to [other school resources], nor should we for school meals,” he says.

What can parents do?

To the parents, educators and activists who are hoping to bring universal school meals to other areas, Waszazak says: “Organize and build coalitions! It was much more than a student issue — we engaged teachers, school nutrition professionals, school boards, principals and superintendents, farmers, pediatricians, parents and more. This allowed us to build a campaign that was rural and urban, in schools and out, and tri-partisan.”

Parents who don’t qualify for free or reduced lunch are still encouraged to apply , as this helps determine how much funding schools receive and how many meals they can subsidize. Those who can afford to do so can also help wipe out school lunch debt .

Hodge recommends parents write letters to their school’s superintendents and congressional representatives. She adds, “If there is an opportunity to be part of your school’s wellness committee, this is a great opportunity to allow your voice to be heard.”

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Strategies to Improve School Meal Consumption: A Systematic Review

Juliana f. w. cohen.

1 Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA

2 Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA

Amelie A. Hecht

3 Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA; ude.csiw@2thcehaa

Erin R. Hager

4 Departments of Pediatrics and Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA; ude.dnalyramu.mos@regahe

Lindsey Turner

5 College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA; ude.etatsesiob@1renrutyesdnil

Kara Burkholder

6 College of Liberal Arts and Science, University of Connecticut, Storrs, CT 06269, USA; [email protected]

Marlene B. Schwartz

7 Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA; [email protected]

Associated Data

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

1. Introduction

In the United States, approximately 95% of public and non-profit private elementary, middle, and high schools participate in the school meal programs administered by the United States Department of Agriculture (USDA) [ 1 , 2 ]. Both the National School Lunch Program (NSLP) and School Breakfast Program (SBP) provide children and adolescents with healthy, low-cost meals throughout the school year. Prior to COVID-19, approximately 30 million children received school lunches daily, and roughly three-quarters of school lunch participants come from low-income households, with many relying on school meals for up to half of their daily energy intake [ 3 , 4 ]. Schools are therefore uniquely positioned to promote healthy eating among children.

In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) required the USDA to update many of its regulations for federal school nutrition programs to reflect the concurrent Dietary Guidelines for Americans [ 5 ]. Updates to the NSLP included requirements for more whole grain-rich foods; greater portion sizes for fruits and vegetables; a greater variety of vegetables offered throughout the week; limits on total calories and sodium; and the removal of trans fats. Nutrition standards were also strengthened for “competitive” foods, defined as snacks and beverages sold during school hours, but outside of the school meal programs (i.e., in vending machines, à la carte, snack bars, school stores, and fundraisers) [ 6 ]. Lastly, schools were required to update their local school wellness policies to promote healthier school environments [ 7 ].

The evidence regarding school meal consumption suggests that rates are influenced by multiple intersecting factors, including at the individual, meal, cafeteria environment, and policy levels ( Figure 1 ). At the individual level , consumption varies by student age, gender, and eligibility for free or reduced-priced meals (based on family income), as well as factors such as preferences and prior exposure to foods [ 8 , 9 , 10 ].

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Social Ecological Framework of the Influences on School Meal Consumption (adapted from Graziose and Ang 2018 [ 23 ]).

At the meal level , consumption consistently varies by food type (i.e., the federal meal components: meat/meat alternatives; grains; fruits; vegetables; and milk) with students typically consuming lower quantities of fruits and vegetables compared with the other components [ 11 , 12 , 13 ]. Although schools are not allowed to deviate from the federal meal pattern requirements, they may modify other meal service factors, such as offering students multiple choices of each required meal component; providing taste tests; and changing how the food is prepared (e.g., improving palatability/cultural appropriateness and pre-slicing fruits). Providing multiple food items from which students can choose increases the likelihood that one option will be appealing to a student. Increasing choices for students can occur on the lunch line (e.g., student can select between two fruit options) or through salad bars, which can hold a variety of produce. Palatability is also important to address as it is a primary determinant of food consumption, and familiarity with a food is strongly correlated with preferences [ 14 , 15 ]. Therefore, focusing on culturally appropriate school meals that emphasize familiar flavors and taste may be a key component to ensuring high meal consumption rates. Interventions that involve collaborating with professional chefs or seasoning foods (both prior to serving or at “flavor stations” for students to add their own spices) have the potential to enhance the palatability and cultural appropriateness of school meals. Additonally, pre-slicing fruits may impact consumption because whole fruits, such as apples and oranges, may be challenging to consume if students have a limited amount of time to eat, perceive the fruit as messy, or have difficulty holding and biting the fruit (particularly among younger children or those with braces). Lastly, taste tests may provide the opportunity for repeated exposures to new foods, as well as a chance for students to provide feedback to cafeteria staff, thus influencing the options on the school menu [ 16 ].

At the cafeteria environment level, modifications can potentially influence consumption via choice architecture strategies to nudge students towards healthier options; changing the length of the lunch periods to ensure students have sufficient time to eat; providing nutrition education; and scheduling recess before lunch. Choice architecture, also known as behavioral economics, uses strategies to “nudge” people towards the healthier options available in food environments [ 17 ]. Choice architecture strategies can include rewarding students for selecting and/or consuming meal components; implementing traditional Smarter Lunchroom techniques (e.g., visually appealing displays, verbal prompts, and creative names for foods); altering the portion size of foods; and modifying the timing of different meal components (e.g., making vegetables available before fruit). Ensuring a sufficient amount of time to eat is also important, but school lunch durations vary greatly and typically range from 15–45 min [ 18 ]. Additionally, the time scheduled for the lunch period includes time needed to walk to the cafeteria, wait in line for lunch, and clean up, resulting in substantially less time for students to actually eat their meals [ 19 ]. Nutrition education in schools (which can include a range of activities, such as traditional instruction regarding nutrients and food groups, garden-based farm-to-school lessons, and skill-based cooking classes) can also be important to provide children with the skills and knowledge necessary to make informed and healthy food choices [ 20 ]. Additionally, recess traditionally occurs after school lunch in the United States, but reversing the order may impact school meal consumption. It has been hypothesized that recess before lunch may enable students to expend more energy and thus be hungrier at lunch time, as well as prevent students from rushing through lunch for more play time at recess [ 21 ]. Recess before lunch may also push back the start time of lunch to more traditional lunch hours when students may be hungrier. Of note, implementing offer-versus-serve (i.e., not requiring students to select all the meal components offered) is a commonly recommended strategy to reduce waste, but it cannot increase consumption because students are accessing less food [ 22 ].

Lastly, at the policy level , regulations can be implemented at the local, state, and federal level to support increases in school meal consumption. These can include strong district wellness policies; access to universal free school meals (e.g., participation in the Community Eligibility Provision (CEP) in schools where at least 40% of students come from lower-income households); restricting access to competitive foods; and strengthening meal nutrition standards. Local polices (including district wellness policies) have the flexibility to go beyond state or federal regulations, and also have the benefit of supporting the unique needs of individual schools and districts. There are many different interventions that can be written into policies, including serving breakfast in the classroom, which may increase breakfast consumption because students are given more time to eat than they might otherwise have between when they arrive at school and classes start. Strong polies for competitive foods (i.e., foods and beverages sold outside of meals that may “compete” with school meals) may be important as they potentially impact both participation in the NSLP (via replacement of “competitive foods” that are purchased instead of school meals) and consumption if a student has both a snack and a school lunch.

Additionally, it is important to note the nuanced similarities and differences between the variables of school meal selection, consumption, and waste. Selection is a necessary pre-requisite for consumption. Importantly, when the total number of students selecting a meal component increases, there may be benefits at the population level even without increases in the proportion consumed for each child who selected the food. For example, if there is an increase in the number of students selecting fruit, and the average level of fruit consumption remains at 50% per child who selected fruit, a greater number of students are eating half a fruit at lunch. Therefore, an increase in selection can result in overall increases in consumption for the student population as a whole, even when the proportion of a meal component consumed among children who selected the food remains the same. Waste is the opposite of consumption when examining the percent consumed of an individual meal component. However, waste may not be the opposite of consumption when examining these variables if multiple servings of a meal component can be taken by students (e.g., if a student selects two pieces of fruit and at least one is partially consumed, both consumption [measured in servings] and waste can increase). Additionally, if selection increases, and the proportion consumed per serving selected remains the same, both overall consumption and overall (aggregate) waste at the population level will increase. For these reasons, it is important to address changes in selection when comparing consumption and waste.

The problem of food waste in the NSLP has been documented for decades, and the consistently low levels of consumption for various food types, especially vegetables and fruits, remains a problem [ 24 , 25 , 26 , 27 ]. However, a scoping review of research examining factors that impact school meal consumption has not been conducted. Several systematic reviews have examined techniques to nudge students towards healthier options (i.e., choice architecture), but many of the included studies only measured selection [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Other recent school-based reviews have been limited in scope, such as examining only fruits and vegetables [ 23 , 35 , 36 ]. A better understanding of initiatives, interventions, and policies that can improve school meal consumption more broadly is needed to help inform school food service programs and policies at the district, state, and federal levels. Therefore, the aim of this study was to systematically review the evidence regarding the impact of various strategies to improve school meal consumption.

2. Materials and Methods

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [ 37 ]. This literature review was registered with the PROSPERO International Prospective Register of Systematic Review before data extraction (protocol registration number: CRD42021244688) [ 38 ].

2.1. Data Sources and Search Strategies

Articles were retrieved from four electronic databases: PubMed, Academic Search Ultimate, Education Resources Information Center (ERIC), and Thomson Reuters’ Web of Science. The search strategy used varying combinations of the following keywords: school AND (meal OR breakfast OR lunch) AND (intake OR eat * OR consum * OR waste) AND (atmosphere OR behavioral economics OR breakfast in the classroom OR chef OR choice OR competitive food OR cultur * OR default OR duration OR engag * OR environment OR label * OR length OR marketing OR menu OR minutes OR nudg * OR nutrition education OR offer OR palatab * OR placement OR policy OR promotion OR repeat * OR slic * OR smarter lunchroom OR taste OR wellness). Articles in English published since the start of the literature through May 2021 were reviewed. Manual searches of the articles’ reference lists, as well as a review of all articles citing the resultant literature (using Google Scholar), were conducted to identify other potentially relevant studies.

2.2. Study Selection

Eligible studies were quantitative research articles evaluating interventions, initiatives, and policies to influence school meal consumption. Our inclusion criteria were English, peer-reviewed publications or official government reports conducted in the United States within elementary, middle, and/or high schools participating in the USDA’s SBP and/or NSLP during the academic year. The following types of articles were excluded: non-English articles; qualitative research; articles that did not examine school breakfast or lunch (e.g., only snacks or afterschool programs); studies conducted in private and/or charter schools not participating in the SBP or NSLP; initiatives that occurred outside of the school year (i.e., summer vacations); studies conducted in locations outside the United States; studies that did not quantify the amount of the entire school meal or school meal component consumed (i.e., assessing only school meal selection, binary (yes/no) estimates of consumption, estimates of only the nutrients consumed at lunch, and/or food frequency questionnaires or 24-hour recalls assessing only overall diets); and articles that did not examine initiatives, interventions, or policies (e.g., differences in consumption by age, gender, etc.). Additionally, studies examining universal free school meals and/or the Community Eligibility Provision were excluded as this was recently evaluated in a systematic review [ 39 ]. Titles and abstracts were screened by two independent reviewers, and full texts were screened by the lead author (JFWC) based on the eligibility criteria. The research team reviewed articles with unclear eligibility. The heterogeneity in the methods used to assess consumption and the variability in study designs precluded a meta-analysis; therefore, the results were synthesized in a narrative review.

2.3. Quality Assessment

Study quality and biases were assessed using the previously adapted Newcastle–Ottawa Scales (NOS) for cross-sectional and cohort studies, which are frequently used to assess non-randomized, community-based research [ 39 , 40 , 41 , 42 ]. The studies were evaluated by two co-authors based on selection, comparability, and outcome and categorized as: low risk of bias (≥7 points), high risk of bias (4–6 points), and very high risk of bias (0–3 points) [ 43 ]. Supplementary Materials Table S1 presents the quality assessments of the included studies.

The initial search of the four databases (PubMed, Academic Search Ultimate, ERIC, and Thomson Reuters’ Web of Science) identified 4423 articles. A total of 3367 duplicate records were removed, and primary screening excluded an additional 819 articles. The full text of the remaining 237 publications were examined in detail, and 151 studies were excluded. The primary reasons for exclusion were based on the study objectives (i.e., did not examine initiatives, interventions, or policies related to school meal consumption); the outcomes assessed (i.e., did not quantify the amount of school meals consumed or wasted); publication type (i.e., grey literature); and the study location (i.e., outside the United States). Ten additional articles were identified from the reference lists of the obtained articles or publications citing those studies, resulting in a total of 96 articles included in the review ( Figure 2 ). The quality scores for the articles included in the review ranged from 2 (very high risk of bias) to 10 (low risk of bias) ( Supplementary Materials Table S1 ). Approximately a third of the included studies ( n = 33) were classified as having a low risk of bias, over half of the articles ( n = 55) had a high risk, and the remaining articles ( n = 8) had a very high risk. The studies are presented by the different initiatives, interventions, and policies. Many studies included several components and are thus described in multiple sections.

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Flow chart for systematic review.

3.1. Initiatives and Interventions Related to School Meals

3.1.1. food choices.

Of the 12 peer-reviewed publications that examined offering more options from which students could choose, the majority ( n =8 studies) found significant positive associations with consumption; one found no association; one had mixed findings; and two found a decrease in consumption ( Table 1 ). Three studies were considered to have a low risk of bias, and of those, two found a positive association with consumption.

Characteristics and outcomes of studies examining initiatives and interventions targeting meal-level factors included in the systematic review.

Author, Year	Location; Participant Characteristics	Study Design	Year(s)	Exposure(s)	Outcome Measure(s)	Results
Choices
Adams et al. 2005 [ ]	San Diego, CA; 2 school districts (2 elementary schools per district [288 students total])	QE: Post-only (with comparison group)	2003	Choices: Salad bar and pre-portioned options with varying number of options were provided	Weighed plate waste	Selection: There were no significant associations. Consumption: The presence of a salad bar alone was not associated with F/V selection or consumption. However, a greater number of F/V options was associated with a trend in increased F/V consumption.	High
Ang et al. 2019 [ ]	New York City, NY; 14 elementary schools [877 trays collected from students in grade 2–3)	QE: Post-only (with comparison grou )	2015–16	: Vegetables were pre-plated (vs. optional), and were placed first in line : multiple (2+) fruit and vegetable options were provided	Visual estimation	Selection: Not measured Consumption: Pre-plating vegetables (vs. optional for the student to select a vegetable) was associated with a small increase in consumption (0.02 cups; < 0.001). Positioning vegetables first on the serving line was not associated with vegetable consumption. Among students who selected fruit, pre-sliced fruit was associated with greater consumption (0.23 cups more; = 0.02) than whole fruit.. Recess before lunch was associated with a small increase in fruit consumption (0.08 cups; < 0.001) and vegetable consumption (0.007 cups; = 0.04).Multiple fruit options and attractive serving bowls were not associated with fruit consumption. Lunch duration was not associated with consumption (although less than 15% of measurements had lunch durations of ≥20 min).	Low
Bean et al. 2018 [ ]	VA; 2 elementary schools (725 trays collected from students in grades 1–5)	QE: Pre/post (no comparison group)	2015–16	Choices: Salad bars were added to the serving line with additional fruit and vegetable options	Digital imagery	Selection: Salad bars were associated with an increase in the number of F/V selected (1.81 vs. 2.58 F/V; < 0.001). Consumption: Salad bars were associated with a decrease in F/V consumption by 0.65 cups ( < 0.001).	High
Cullen et al. 2015A [ ]	Houston, TX; 8 elementary schools and 4 middle schools (1576 trays from students in grades K-8)	QE: Post-only (with comparison group)	Fall 2011	Choices: Students in intervention schools were allowed to select one fruit serving and two vegetables servings (three total). Students in comparison schools were limited to no more than two servings of fruits and/or vegetables	Visual estimation	Selection: In the intervention elementary schools, there was significantly greater selection of fruits and starchy vegetables and decreased selection of juice compared with control schools. In the intervention middle schools, there was significantly greater selection of fruit, total vegetables, and starchy vegetables compared with control schools.Consumption: In the intervention elementary schools, students consumed more vegetables compared than the comparison group (0.14 cups vs. 0.10 cups; < 0.01). There was no impact on whole fruit consumption. In the intervention middle schools, students increased their consumption of both vegetables (0.17 cups vs. 0.10; <0.01) and whole fruits (0.19 vs. 0.09; < 0.001).	High
Greene et al. 2017 [ ]	NY; 7 middle schools (8502 trays from students in grades 5–8)	RCT	2014	: Fruits were placed first on the lunch line and were in attractive bowls with descriptive names. Promotional materials (e.g., fruit facts) were posted in the cafeteria : Multiple (2) fruit and vegetable options were provided	Visual estimation	Selection: The intervention was associated with a 36% increase in fruit selection ( < 0.001), but no significant changes in vegetable or milk selection. Consumption: The intervention was associated with a 23% increase in fruit consumption ( < 0.001). There was no association with vegetable or milk consumption.	Low
Hakim et al. 2013 [ ]	Midwest Region; 1 K-8 school (2148 trays from students in grades K-8)	QE: Pre/Post (no comparison group)	2011–2012	Choices: Students were provided with a choice of three F/V options	Weighed plate waste and visual estimation	Selection: Not measured Consumption: The intervention was associated with a 15% increase in fruit consumption and a 16% increase in vegetable consumption.	High
Johnson et al. 2017 [ ]	New Orleans, LA; 21 middle and high schools (718 students in grades 7–12)	QE: Post-only (with comparison group)	N.S.	Choices: Salad bars were added	24-hour recall (interviewer assisted ASA-24 Kids)	Selection: Not measured Consumption: There were no significant differences in vegetable consumption. Among students who reported consuming any fruit, students in schools with salad bars reported lower levels of fruit consumption at lunch compared to students in schools without salad bars.	High
Just et al. 2012 [ ]	N.S.; 22 elementary schools (48,533 trays)	Cross-sectional	N.S.	Choices: The number of fruit and vegetables options available to students was assessed	Visual estimation	Selection: Not measured Consumption: Each additional fruit or vegetable option offered increased the fraction of students who ate at least one serving of fruits and vegetables by 12%.	High
Liquori et al. 1998 [ ]	New York City, NY; 2 elementary schools (590 students in grades K-6)	QE: Pre/post (with comparison group)	1995–96	: The number of vegetable and whole grain options available was increased : 10 food and environment lessons and/or 10 cooking lessons were provided : Students took field trips to a local community garden. There was parent outreach (newsletter, recipes, workshops)	Visual estimation	Selection: Not measured Consumption: The intervention arm with cooking lessons was associated with increased consumption of vegetables and whole grains among younger students ( < 0.01). No association was observed among older children exposed to the cooking intervention. The nutrition education (food environment) intervention was not associated with consumption.	High
Perry et al. 2004 [ ]	St. Paul, MN; 26 elementary schools (1,668 students in grades 1 and 3)	RCT	2000–2002	: Verbal prompts by food service staff encouraging consumption; improved attractiveness of F/V (e.g., placing them in small cups; arranging by color); posters and characters (life size fruit and vegetables); and rewards for eating F/V (classroom receives frozen fruit yogurt if enough students ate 3 servings at lunch) : The quantity of F/Vs was increased	Visual estimation	Selection: Not measured Consumption: The intervention was associated with significant increases in total servings of F/V (excluding potatoes and juice).	Low
Taylor et al. 2018 [ ]	CA; 2 elementary schools (112 students in grade 4)	QE: Pre/post (with comparison group)	2012–13	: Salad bars were added to increase F/V choices : A garden enhanced nutrition curriculum and cooking demonstrations were provided : Parent newsletter, home activities	Digital imagery	Selection: No significant associations Consumption: The intervention was associated with a significant increase in vegetable consumption. There was no association with fruit consumption.	High
Young et al. 2013 [ ]	N.S.; 1 middle school (3810 trays from students in grades 6-8)	Cross-Sectional	2011–12	Policy: A new wellness policy required schools to implement the practices below: : Different fruits and vegetables were served each day of the week : There was an increase in student contact hours for health and physical education	Visual estimation	Selection: Not measured Consumption: After exposure to the wellness policy for over a semester, students consumed significantly more fruits and cooked vegetables.	High

Bates et al. 2015 [ ]	UT; 2 schools (1 middle and 1 high school [2760 school breakfasts from students in grades 7–12]	QE: Pre/post (no comparison group)	Not Stated	Palatability: Smoothies made with whole fruit, yogurt, and milk or fruit juice were offered to students	Visual estimation	Selection: Not measured Consumption: Offering breakfast smoothies was associated with a 0.45 serving ( < 0.01) increase in fruit consumption.	High
Cohen et al. 2012 [ ]	Boston, MA; 4 middle schools (3049 students in grades 3–8)	QE: Post-only (with comparison group)	2009	: A professional chef trained cafeteria staff to prepare healthier school lunches : Chocolate milk was removed	Weighed plate waste	Selection: The intervention was associated with a 51% increase in whole grain selection ( = 0.02). Consumption: Students in the intervention schools consumed 0.36 more servings of vegetables per day ( = 0.01) compared with students in control schools. There was no impact on milk, fruit, or whole grain consumption.	Low
Cohen et al. 2015 [ ]	MA; 14 elementary and middle schools (2638 students in grades 3–8)	RCT	2011–12	: Vegetables were offered at the beginning of the lunch line; fruits were placed in attractive containers; fruits were placed next to the cash register; signage added that promoted F/V; white milk was placed in front of chocolate milk : A professional chef trained cafeteria staff to prepare healthier school lunches	Weighed plate waste	Selection: Both the choice architecture and chef (i.e., palatability) intervention were associated with increased fruit and vegetable selection. There was no impact on white milk selection. Consumption: Only the chef intervention was associated with increased consumption of fruits and vegetables. There was no impact on white milk consumption.	Low
Cohen et al. 2019 [ ]	MA; 8 elementary and middle schools (1309 students in grades 3–8)	QE: Pre/post (with comparison group)	2012-13	Palatability: A professional chef trained cafeteria staff to prepare healthier school lunches	Weighed plate waste	Selection: No significant associations Consumption: The intervention was associated with a significant increase in consumption of vegetables (62.2% vs. 38.2%; = 0.005) and fruits (75.2 vs. 59.2%; 0 = 0.04) compared with control schools. There were no significant differences in entrée consumption.	Low
D’Adamo et al. 2021 [ ]	Baltimore, MD; 1 high school (4570 trays from students in grades 9–12)	QE: Pre/post (no comparison group)	N.S.	Palatability: Spices and herbs were added to vegetable recipes (based in prior pilot taste tests with some students)	Weighed plate waste	Selection: Not measured Consumption: The intervention was associated with an 18.2% increase in vegetable consumption ( < 0.001).	High
Fritts et al. 2019 [ ]	PA; 1 middle/high school (~600–700 students ages 11–18)	QE: Pre/post (no comparison group)	2017	: Spices and herbs were added to vegetable recipes : Repeated (i.e., 5) exposures to vegetables	Weighed plate waste	Selection: Not measured Consumption: The intervention was inversely associated with consumption for some of the vegetables offered. There was no association between repeated exposures to vegetables with added spices/herbs and vegetable consumption.	High
Hamdi et al. 2020 [ ]	IL; 3 elementary schools (1255 trays from students in grades K-8)	QE: Pre/post (no comparison group)	2018–19	: Cafeteria decorations and creative names were introduced : A flavor station with spices and seasonings on a table in the cafeteria was added	Weighed plate waste	Selection: Selection was measured in only one of the participating schools. The odds of selecting a vegetable (i.e., broccoli) increased when students were exposed to taste tests. The odds of selecting fruit increased when all intervention components were implemented simultaneously. Consumption: The intervention components yielded inconsistent, but generally positive consumption results across the schools, particularly for fruits.	Low
Just et al. 2014 [ ]	NY; 1 High School (3330 trays)	QE: Pre/post (no comparison group)	2012	: Chef enhanced recipes for pizza were introduced	Visual estimation	Selection: Student selection of chef-enhanced entrées increased by 5.7% percentage points (91.3% to 97%; = 0.01). Student selection of salad, which was served with the pizza, increased by 21% percentage points ( < 0.001). Consumption: The chef enhanced pizza was not associated with differences in main dish consumption. However, as more students selected salad with the pizza, vegetable consumption increased by 16.5% ( = 0.005).	High
Zellner et al. 2017 [ ]	Philadelphia, PA; 2 elementary schools (students in grades 3–4)	QE: Pre/post (with comparison group)	N.S.	: Chef prepared meals were introduced : Meals were served family-style and an adult (i.e., teacher) ate with students as a role model	Visual estimation	Selection: Not measured Consumption: The intervention was associated with an increase in sweet potato fry consumption at the beginning of the school year and an increase in cauliflower consumption at the end of the school year.	Very High

Ang et al. 2019 [ ]	New York City, NY; 14 elementary schools [877 trays collected from students in grade 2–3)	QE: Post-only (with comparison grou )	2015–16	: Vegetables were pre-plated (vs. optional), and were placed first in line : multiple (2+) fruit and vegetable options were provided	Visual estimation	Selection: Not measuredConsumption: Pre-plating vegetables (vs. optional for the student to select a vegetable) was associated with a small increase in consumption (0.02 cups; < 0.001). Positioning vegetables first on the serving line was not associated with vegetable consumption Among students who selected fruit, pre-sliced fruit was associated with greater consumption (0.23 cups more = 0.02) than whole fruit. Recess before lunch was associated with a small increase in fruit consumption (0.08 cups; < 0.001) and vegetable consumption (0.007 cups; = 0.04). Multiple fruit options and attractive serving bowls were not associated with fruit consumption. Lunch duration was not associated with consumption (although less than 15% of measurements had lunch durations of ≥20 min).	Low
Greene et al. 2017 [ ]	NY; 7 middle schools (8502 trays from students in grades 5-8)	RCT	2014	: Fruits were placed first on the lunch line and were in attractive bowls with descriptive names. Promotional materials (e.g., fruit facts) were posted in the cafeteria : Multiple (2) fruit and vegetable options were provided	Visual estimation	Selection: The intervention was associated with a 36% increase in fruit selection ( < 0.001), but no significant changes in vegetable or milk selection. Consumption: The intervention was associated with a 23% increase in fruit consumption ( < 0.001). There was no association with vegetable or milk consumption.	Low
McCool et al. 2005 [ ]	N.S.; 1 elementary and 1 middle school	QE: Pre/post (no comparison group)	N.S.	Pre-sliced Fruit: Sliced apples and/or whole apples	Aggregate plate waste	Selection: Not measured Consumption: Elementary school students consumed more fruit when apples were pre-sliced than when they were served whole. Middle school students consumed more fruit when they had a choice between pre-sliced or whole apples.	Very High
Quinn et al. 2018 [ ]	King County, WA; 11 middle and high schools (2309 trays)	QE: Pre/post (with comparison group)	2013–14	: : Changes included attractive containers, creative names, signage, food placement (e.g., multiple locations and/or at eye-level), and verbal prompts by cafeteria staff	Visual estimation	Selection: A greater proportion of students selected fruit in the intervention schools compared with control schools. There was no significant change in vegetable selection. Consumption: Pre-sliced fruit and choice architecture were not associated with significant differences in the quantities of fruits, vegetables, or milk consumed.	High
Smathers et al. 2020 [ ]	N.S.; 2 elementary schools (students in grades PreK-5)	QE: Pre/post (no comparison group)	N.S.	Pre-sliced Fruit: Sliced apples were compared with whole apples	Aggregate weighed plate waste	Selection: No significant associations Consumption: Students consumed 2.48 times more fruit by weight when eating pre-sliced versus whole apples ( < 0.001).	Very High
Swanson et al. 2009 [ ]	KY; 1 elementary school (979 students in grades K-4)	QE: Pre/post (no comparison group)	2007	Pre-sliced Fruit: Sliced apples and oranges were compared with whole apples and oranges	Digital imagery	Selection: Pre-slicing oranges was associated with increased selection. No significant differences were observed with pre-sliced apples. Consumption: A greater proportion of students consumed at least half of a fruit serving when pre-sliced (vs. whole) oranges were served. There were differences observed by grade level (i.e., higher consumption rates among younger students with pre-sliced oranges). The intervention was not associated with consumption for apples.	High
Thompson et al. 2017 [ ]	Hennepin County, MN; 2 elementary schools (373 students in grades K-4)	QE: Pre/post (no comparison group)	2013	: Changes included enhanced displays for F/V; attractive labels for F/V; and placement of F/V at the beginning of the lunch line and at the cash register : Sliced apples were compared with whole apples	Weighed plate waste	Selection: The intervention was associated with a significant increase in the percentage of students selecting a fruit serving (95.1% vs. 98.1%; = 0.02). There was no significant change in vegetable selection. Consumption: The intervention was not associated with fruit or vegetable consumption.	Low
Wansink et al. 2013 [ ]	Wayne County, NY; 6 middle schools (334 trays)	RCT	2011	Pre-sliced Fruit: Sliced apples were compared with whole apples	Visual estimation	Selection: There was a significant increase in apple selection in intervention schools when pre-sliced apples were offered (5% difference in sales between intervention and comparison schools; < 0.001). Consumption: Pre-slicing apples was associated with an increase in the percent of students who selected an apple and ate more than half (75% increase; = 0.02).	Low

Alaimo et al. 2015 [ ]	Grand Rapids, MI; 6 elementary schools (4 intervention and 2 control 815 students in grades 3–5)	QE: Pre/post (with comparison group)	2009–10 to 2010–11	: Provided in the cafeteria and classrooms : Nutrition education classes and posters : Healthy eating coaching by teachers, parent education	Digital imagery	Selection: Not measured Consumption: The multi-component intervention was associated with significant increases in fruit consumption. No differences in consumption of vegetables, milk, grains, or protein were observed.	Low
Blakeway et al. 1978 [ ]	Little Rock, AR; 16 elementary schools (5000 students in grades 1-3)	RCT	N.S.	: Provided in the classroom with nutrition education : A nutrition coordinator implemented 10 classroom lessons focused on recognizing and identifying foods in different forms.	Aggregate plate waste	Selection: Not measured Consumption: Students in intervention schools consumed greater amounts of whole wheat rolls (grades 2 and 3 only) and cottage cheese (grades 1 and 2 only) compared to the comparison group. Sweet potato custard consumption increased in both the intervention and control group. No other significant differences were observed.	High
Bontranger Yoder et al. 2014 [ ]	WI; 9 elementary schools (1117 students in grades 3–5)	QE: Pre/post (no comparison group)	2010–11	: A farm to school gardening curriculum was available in some of the participating schools : Available in some of the participating schools : Farm to school activities were introduced (e.g., a school garden, field trips to farms, and local items on the menu) in some of the participating schools	Digital imagery	Selection: Not measured Consumption: The intervention was not associated with differences in F/V consumption, although the farm to school components were inconsistently implemented across the participating schools.	Low
Bontranger Yoder et al. 2015 [ ]	WI; 11 elementary schools (7117 trays from students in grades 3–5)	Cross-sectional and Pre/post (no comparison group)* *For Policy only	2010 to 2013	: A farm to school gardening curriculum was available in some of the participating schools : Available in some of the participating schools : HHFKA : Farm to school activities were introduced (e.g., a school garden, field trips to farms, and local items on the menu) in some of the participating schools	Digital imagery	Selection: Not measured Consumption: The intervention components (i.e., nutrition education, taste tests, and other activities) were not associated with differences in F/V consumption. There was no change in consumption before or after implementation of the HHFKA.	High
[ ]	OR; 1 elementary school (40 students in grade 3)	QE: Pre/post (with comparison group)	1997	: Lessons included the Food Guide Pyramid, healthy meal planning, and how foods grow : Provided in the classroom with nutrition education	Weighed plate waste	Selection: No significant associations Consumption: The intervention was associated with an increase in consumption of calories from fruits (28 kcal; < 0.01). No significant differences in vegetable and grain consumption were observed.	High
Hamdi et al. 2020 [ ]	IL; 3 elementary schools (1255 trays from students in grades K-8)	QE: Pre/post (no comparison group)	2018–19	: Cafeteria decorations and creative names were introduced : A flavor station with spices and seasonings on a table in the cafeteria was added.	Weighed plate waste	Selection: Selection was measured in only one of the participating schools. The odds of selecting a vegetable (i.e., broccoli) increased when students were exposed to taste tests. The odds of selecting fruit increased when all intervention components were implemented simultaneously. Consumption: The intervention components yielded inconsistent, but generally positive consumption results across the schools, particularly for fruits.	Low
Just et al. 2014 [ ]	NY; 1 High School (3330 trays)	QE: Pre/post (no comparison group)	2012	: Chef enhanced recipes for pizza were introduced	Visual estimation	Selection: Student selection of chef-enhanced entrées increased by 5.7% percentage points (91.3% to 97%; = 0.01). Student selection of salad, which was served with the pizza, increased by 21% percentage points ( < 0.001). Consumption: The chef enhanced pizza was not associated with differences in main dish consumption. However, as more students selected salad with the pizza, vegetable consumption increased by 16.5% ( = 0.005).	High
Mazzeo et al. 2017 [ ]	Mid-Atlantic region; 2 elementary schools (2087 trays from students in grades 1–3)	QE: Pre/post (with comparison group)	2014–15	: Students were rewarded for eating F/V (i.e., sticker and praise)	Visual estimation	Selection: Not measured Consumption: The intervention was associated with reduced F/V waste.	High
Morrill et al. 2016 [ ]	UT; 6 elementary schools (2292 students in grades	QE: Pre/post (with comparison group)	2011	: Students were rewarded for eating F/V (i.e., toys or praise from teachers). Adults provided role modeling : Videos and letters	Visual estimation	Selection: Not measured Consumption: The intervention was associated with increased F/V consumption. At 6 months follow-up (after the intervention ended), only the intervention arm with prizes (plus nutrition education and taste tests) was associated with sustained increased consumption.	Low
Perry et al. 2004 [ ]	St. Paul, MN; 26 elementary schools (1668 students in grades 1 and 3)	RCT	2000–2002	: Verbal prompts by food service staff encouraging consumption; improved attractiveness of F/V (e.g., placing them in small cups; arranging by color); posters and characters (life size fruit and vegetables); and rewards for eating F/V (classroom receives frozen fruit yogurt if enough students ate 3 servings at lunch) : The quantity of F/Vs was increased	Visual estimation	Selection: Not measured Consumption: The intervention was associated with significant increases in total servings of F/V (excluding potatoes and juice).	Low
Reynolds et al. 2000 [ ]	AL; 28 elementary schools (425 students in grade 4)	QE: Pre/post (with comparison group)	1994 to 1996	: A 14 lesson curriculum related to F/V was provided and posters were added to the cafeteria : Parent education was provided, including recipes, activities, and information about F/V	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with significant differences in fruits or vegetables consumed.	Low

F/V: fruits and vegetables; QE: Quasi-Experimental; RCT: Randomized controlled trial. 1 Study designs were defined as: (1 ) Cross-sectional - Observational study with the exposure and outcome measured simultaneously (no comparison group); (2) Quasi-Experimental (QE): Post Only —Intervention study with a comparison group and data collected post-implementation (no baseline measurements); (3) Quasi-Experimental (QE): Pre/Post — Intervention studies with pre-implementation (i.e., baseline) and post-implementation measurements, with or without a comparison group (non-random allocation of intervention/comparison groups); (4) Randomized Controlled Trial (RCT) —Intervention study with random allocation to intervention or control status and both pre-implementation (baseline) and post-implementation measurements. 2 Risk of Bias was based on adapted Newcastle–Ottawa Scales (NOS) for cross-sectional and cohort studies ( Supplementary Materials Table S1 ).

In a study using visual estimation in eight elementary and four middle schools in Houston, Texas, Cullen and colleagues found that when students had the ability to select from more fruit and vegetable options, elementary students consumed more vegetables (0.14 vs. 0.10 cups; p < 0.01), and middle school students consumed more whole fruits (0.19 vs. 0.10 cups; p < 0.001) and vegetables (0.17 vs. 0.10 cups; p < 0.01) [ 44 ]. Additionally, this study found significant increases in selection of these meal components. Using similar consumption measures, Just et al. examined the impact of increasing the number of fruit and vegetable options at lunch in 22 elementary schools and found that each additional option available increased the number of students who ate at least one serving of these meal components by 3.3 percentage points ( p < 0.05) [ 45 ]. Hakim and associates also observed increases in both fruit and vegetable consumption by roughly 15% ( p < 0.01) using weighed plate waste and visual estimation in one K-8 school when students were given a choice among three fruit or vegetable options [ 46 ]. Using the same consumption measure, Young and colleagues also found an increase in fruit and cooked vegetable consumption when students in one middle school had access to different fruits and vegetables every day of the week (this intervention also included exposure to increased health and physical education) [ 47 ]. In another multi-component study in 26 elementary schools in Minnesota, Perry et al. used visual estimation to examine the impact of offering multiple fruit and vegetable choices and found a 0.15 serving increase in combined fruit and vegetable consumption ( p = 0.02). This intervention also included pre-slicing fruit and choice architecture techniques (e.g., visually appealing displays, verbal prompts, and rewards) [ 48 ]. A similar multi-component study by Greene and associates in seven middle schools in New York assessed consumption with visual estimation and found that multiple fruit and vegetable options (again, in addition to pre-slicing fruit and choice architecture techniques [e.g., attractive bowls and descriptive names]), was associated with a 23% increase in fruit consumption ( p < 0.017), as well as a significant increase in selection. In the Green study, however, there was no impact on vegetable (or milk) selection or consumption [ 49 ]. While another study by Liquori et al. did find an increase in vegetable consumption (also measured using visual estimation) in two New York City elementary schools, this multi-component study only found an effect when students had a greater number of choices and cooking lessons, but not when choices were combined with traditional nutrition education compared with students in control schools [ 50 ]. Additionally, Ang and colleagues found no impact on fruit consumption using visual estimation when students in New York City elementary schools had access to multiple fruit options [ 51 ].

The results among the four studies examining salad bars were mixed. In a study in two California elementary schools that included both salad bars and nutrition education (including gardening and cooking demonstrations), Taylor and colleagues found a significant increase in vegetable consumption measured using digital imagery: intake went from 0.09 cups pre-intervention to 0.15 cups post-intervention while consumption declined slightly in the control schools from 0.05 to 0.04 cups ( p = 0.03) [ 52 ]. In contrast, Bean et al. found consumption decreased by 0.65 cups ( p < 0.001) using digital imagery when students in two elementary schools in Virginia had access to a salad bar, although there was a significant increase in the number of fruits and vegetables selected (1.81 vs. 2.58; p < 0.001) [ 53 ]. Similar findings were observed in a cross-sectional study by Johnson et al. using 24-hour recalls among middle and high school students attending 21 schools in New Orleans, with less fruit consumption reported among students with a salad bar (and no impact on vegetable consumption) [ 54 ]. Interestingly, Adams et al. found that while salad bars alone did not impact the amount of fruits or vegetables that students ate, a greater number of options was associated with increased fruit and vegetable consumption using weighed plate waste in four elementary schools in San Diego, California [ 55 ].

3.1.2. Food Preparation: Palatability and Cultural Appropriateness

Of the nine peer-reviewed publications that examined palatability, six found a positive association with school meal consumption; one found no association; one had inconsistent findings; and one found an inverse association ( Table 1 ). Four studies had a low risk of bias; four had a high risk; and one had a very high risk. Of the studies with a low risk of bias, all found that enhanced palatability of school meals were positively associated with consumption.

Multiple studies have examined the impact of professional chefs in schools, and nearly all (four out of five) found positive associations with school meal consumption. In a pilot study conducted in four middle schools in Boston, Cohen and colleagues measured consumption using weighed plate waste; they found that students who received chef-enhanced meals consumed 0.36 more servings of vegetables compared with students in control schools ( p = 0.01) [ 56 ]. Additionally, this study found a significant increase in whole grain selection, resulting in more students consuming whole grains. In a study among 14 elementary and middle schools in Massachusetts using similar methods, Cohen et al. found an increase in both fruit (0.34 vs. 0.51 cups; p < 0.05) and vegetable (0.14 vs. 0.30 cups; p < 0.05) consumption among students in schools with a professional chef compared to students in control schools (as well as increased selection of these meal components) [ 57 ]. These findings of increased fruit and vegetable consumption were replicated by Cohen et al. in a third study conducted in eight elementary and middle schools in Massachusetts after implementation of the HHFKA [ 58 ]. A study conducted by Zellner and associates in two elementary schools in Philadelphia examined chef-prepared meals (in addition to family-style service and an adult at the table as a role model) using visual estimation measurement and found that students consumed more of the targeted vegetables (sweet potato fries and cauliflower) [ 59 ]. Lastly, Just et al. conducted a study in one high school in New York with chef-enhanced pizza recipes (and taste tests) using visual estimation measurements; they found no impact on consumption, although increasing pizza consumption was challenging due to its very high baseline consumption rates [ 60 ]. However, an unintended consequence of this study was that more students received a side salad with the pizza, and vegetable consumption increased.

Other studies have used alternate strategies to enhance the palatability of the foods offered. D’Adamo and colleagues added spices and herbs to vegetable recipes and selected recipes based on taste tests with students. Using weighed plate waste, this study found the enhanced recipes were associated with an 18% increase in vegetable consumption ( p < 0.001) [ 61 ]. Conversely, in another weighed plate waste study in 1 middle/high school in Pennsylvania, Fritts et al. found that when spices and herbs were added to vegetables, consumption decreased for several vegetables [ 62 ]. This study also found no impact on consumption of those vegetables with repeated exposures. Hamdi and associates used weighed plate waste in a study in three elementary schools in Illinois [ 63 ]. They evaluated a flavor station where students could add their own spices and seasoning to their lunches (in addition to taste tests and choice architecture techniques) and found inconsistent improvements with consumption with the components differing in effectiveness between the two participating schools, although the odds of vegetable selection were three times greater (95% CI, 1.3–6.5). [ 63 ]. Lastly, Bates et al. conducted a study in one middle and one high school in Utah where fruit smoothies were offered to students at breakfast; using visual estimation, they found offering smoothies was associated with a 0.45 serving increase in fruit consumption ( p = 0.01) [ 64 ].

3.1.3. Food Preparation: Pre-Slicing Fruits

Among the eight studies examining the impact of offering pre-sliced fruit, the majority ( n = 6 studies) found a positive association with consumption, and two found no association ( Table 1 ). Four studies had a low risk of bias and the majorty ( n = 3 studies) found pre-sliced fruit was associated with increased consumption.

In a study conducted by Smathers and colleagues in two elementary schools using aggregate plate waste, pre-slicing apples versus serving them whole was associated with increased consumption (2.48 times more apples by weight [ p < 0.001]) [ 65 ]. Using similar consumption measures, McCool et al. also found that consumption increased when pre-sliced apples were offered in an elementary school, and when middle school students were given the choice of pre-sliced or whole apples (some students preferred pre-sliced while others preferred whole fruit) [ 66 ]. Increased consumption of pre-sliced apples was also observed by Wansink and associates in six middle schools using visual estimation, with the percent of students eating at least half of an apple increasing by 73% ( p = 0.02) [ 67 ]. In the previously described multi-component studies by Ang et al. and Greene et al., student consumption also increased when fruit was pre-sliced [ 49 , 51 ]. Conversely, Swanson and colleagues examined both sliced apples and oranges in one elementary school in Kentucky, and found that orange (but not apple) consumption increased [ 68 ]. Lastly, two multi-component studies found no association between serving pre-sliced apples and fruit consumption: Thompson et al. [ 69 ] used weighed plate waste in two elementary schools in Minnesota and Quinn et al. [ 70 ] used visual estimation in 11 middle and high schools in Washington. Among the six studies that measured selection, five found increases in selection with pre-sliced fruits.

3.1.4. Taste Tests

Taste tests were one of the strategies used in nine multi-component studies, and were the sole intervention in one study. Four studies found positive associations with consumption; two had mixed findings; and four found no association (although in two of the studies, taste tests were inconsistently available in the participating schools [ Table 1 ]). Six studies had a low risk of bias, and most (4 out of 6 studies) found a positive association between taste tests and school meal consumption.

Mazzeo and colleagues examined the impact of taste tests (and choice architecture techniques [i.e., stickers as a reward for trying foods]) using visual estimation in two elementary schools and found they were associated with reduced fruit and vegetable waste by roughly 10% (39% waste in intervention schools vs. 52% in control schools [ p < 0.05]) [ 71 ]. In a multi-component study also using visual estimation and conducted in six elementary schools in Utah, Morril et al. evaluated the impact of taste tests in addition to choice architecture techniques (e.g., a reward for eating fruits and vegetables) and found an increase in fruit and vegetable consumption [ 72 ]. Additionally, the previously mentioned multi-component study by Perry and colleagues found that taste tests combined with more fruit and vegetable choices and choice architecture techniques was associated with an increase in fruit and vegetable consumption [ 48 ]. Alaimo and colleagues examined taste tests and nutrition education using digital imagery in six elementary schools in Michigan and found increases in fruit consumption, but not in consumption of vegetables or other meal components [ 73 ]. Similarly, a government report examining taste tests and nutrition education in one elementary school in Oregon found increases in fruit consumption using weighed plate waste [ 74 ]. While no impact on vegetable or grain consumption were observed, this study found significant increases in their selection (as well as fruit selection). Another study with taste tests and nutrition education in 16 elementary schools in Little Rock, Arkansas was conducted by Blakeway et al. They found inconsistent results using aggregate plate waste; increases in consumption of whole wheat rolls and cottage cheese were observed in some (but not all) grades [ 75 ]. As previously noted, similarly inconsistent results were observed by Hamdi and colleagues in a study that evaluated taste tests in combination with a flavor station and choice architecture techniques [ 63 ]. No association was observed in three studies that involved taste tests and nutrition education in 28 elementary schools in Alabama by Reynolds and associates using visual estimation [ 76 ], and in multiple elementary schools in Wyoming by Bontranger Yoder and colleagues using digital imagery [ 77 , 78 ], although taste tests were not available in all the participating schools in the latter two studies. Similarly, no impact on consumption was observed in the study by Just and colleagues when examining taste tests and chef-enhanced pizza recipes [ 60 ].

3.2. Initiatives and Interventions Related to the Cafeteria Environment

3.2.1. choice architecture.

Of the 23 peer-reviewed publications that primarily examined choice architecture, roughly half ( n =13 studies) found a positive association with school meal consumption; seven studies found no association; and three studies found an unexpected increase in food waste ( Table 2 ). Among the five studies with a low risk of bias, four were positively associated with consumption while one found an increase in food waste. When examining the ten multi-component studies (e.g., including nutrition education, taste tests, choices, and pre-sliced fruit), half found a positive association and half found no association. Seven of these studies had a low risk of bias and the results were also inconsistent. Overall, these mixed findings may be due in part to the fact that there are many different choice architecture techniques and success may vary by the specific strategy implemented.

Characteristics and outcomes of studies examining initiatives and interventions targeting cafeteria environment-level choice architecture techniques included in the systematic review.

Author, Year	Location; Participant Characteristics	Study Design	Year(s)	Exposure(s)	Outcome Measure(s)	Results
Choice Architecture: Rewards
Blom-Hoffman et al. 2004 [ ]	Northeast Region; 1 elementary school (students in grades K-1)	RCT	N.S.	: Students received verbal praise and rewards (i.e., stickers) for consuming F/V : 10 lessons with 5-A-Day information was implemented by the classroom teacher and a school psychology graduate student : Parent component (newsletter and cookbook) included	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with differences in vegetable consumption.	High
Hendy et al. 2005 [ ]	PA; 1 elementary school (188 students in grades 1, 2, and 4)	QE: Pre/post (no comparison group)	N.S.	Choice architecture: Students received a reward for eating F/V (small prize for eating ≥1/8 cup)	Visual estimation	Selection: Not measured Consumption: The reward intervention was associated with an increase in consumption for both fruits and vegetables.	High
Hoffman et al. 2010 [ ]	New England region; 4 elementary schools (297 students in grades 1 and 2)	RCT	2006 to 2007	: Students received verbal encouragement for eating F/V; a reward for tasting F/V (i.e., a sticker); and promotional posters with cartoon characters : There were school wide promotions (announcements about the F/V of the day); a classroom component (computer game with 5-a-Day messaging); and a family component (i.e., cookbook, interactive children’s books)	Weighed plate waste	Selection: Not measured Consumption: The intervention was associated with an increase in fruit consumption in both year 1 (29 g difference; < 0.0001) and year 2 (21 g difference; < 0.005), and an increase in vegetable consumption in year 1 (6 g difference; < 0.01). No significant difference in vegetable consumption was observed in year 2.	Low
Hoffman et al. 2011 [ ]	New England region; 4 elementary schools (297 students in grades 1 and 2)	RCT	2005 to 2009	: Students received verbal encouragement for eating F/V; a reward for tasting F/V (i.e., a sticker); and promotional posters with cartoon characters : There were school wide promotions (announcements about the F/V of the day); a classroom component (computer game with 5-a-Day messaging); and a family component (i.e., cookbook, interactive children’s books)	Weighed plate waste	Selection: Not measured Consumption: The intervention was associated with an increase in F/V at lunch during the study period, but at one year follow-up (after the intervention concluded), there was no longer a difference in F/V consumption.	Low
Hudgens et al. 2017 [ ]	Cincinnati, OH; 1 elementary school (207 trays from students in grades K-6)	QE: Pre/post (no comparison group)	2014–15	Choice Architecture: Students received emoticons and rewards (small prizes) for selecting a lunch with a fruit, vegetable, unflavored milk, and whole grain	Visual estimation	Selection: The intervention was associated with a significant increase in the selection of plain fat-free milk and vegetables, and a decrease in the selection of flavored milk. Consumption: The intervention was not associated with differences in consumption for any meal component.	High
Jones et al. 2014 [ ]	Logan, UT: 1 elementary school (K-5)	QE: Pre/post (no comparison group)	2013	Choice Architecture: Students received rewards (i.e., virtual currency or teacher continuing to read a story) for eating FV. Students also received teacher encouragement to eat more FV when average consumption levels were lower	Aggregate plate waste	Selection: Not measured Consumption: On days when fruits were targeted, fruit consumption was 39% higher ( < 0.01), but there was no change in vegetable consumption. On days when vegetables were targeted, vegetable consumption was 33% higher ( < 0.05), but there was no change in fruit consumption.	Very High
Machado et al. 2020 [ ]	OR; 1 elementary school (797 trays from students in grades K-5)	QE: Pre/post (no comparison group)	2016–17	Choice Architecture: Elements included adult role modeling, verbal prompts, and rewards (i.e., classroom party and t-shirts) for F/V consumption in the cafeteria	Digital imagery	Selection: There was a 16% increase in the proportion of students selecting a vegetable ( < 0.01). Consumption: The intervention was associated with a significant increase in the proportion of students consuming all their fruits (11% increase; < 0.01) and all their vegetables (8.7% increase; < 0.01). There was also a decrease in the percent of students not consuming any of the fruits on their trays (16.0% decrease; < 0.001).	High
Mazzeo et al. 2017 [ ]	Mid-Atlantic region; 2 elementary schools (2087 trays from students in grades 1–3)	QE: Pre/post (with comparison group)	2014–15	: Students were rewarded for eating F/V (i.e., sticker and praise)	Visual estimation	Selection: Not measured Consumption: The intervention was associated with reduced F/V waste.	High
Morrill et al. 2016 [ ]	UT; 6 elementary schools (2292 students in grades	QE: Pre/post (with comparison group)	2011	: Students were rewarded for eating F/V (i.e., toys or praise from teachers). Adults provided role modeling. : Videos and letters	Visual estimation	Selection: Not measured Consumption: The intervention was associated with increased F/V consumption. At 6 months follow-up (after the intervention ended), only the intervention arm with prizes (plus nutrition education and taste tests) was associated with sustained increased consumption.	Low
Perry et al. 2004 [ ]	St. Paul, MN; 26 elementary schools (1668 students in grades 1 and 3)	RCT	2000–2002	: Verbal prompts by food service staff encouraging consumption; improved attractiveness of F/V (e.g., placing them in small cups; arranging by color); posters and characters (life size fruit and vegetables); and rewards for eating F/V (classroom receives frozen fruit yogurt if enough students ate 3 servings at lunch) : The quantity of F/Vs was increased	Visual estimation	Selection: Not measured Consumption: The intervention was associated with significant increases in total servings of F/V (excluding potatoes and juice).	Low
Wengreen et al. 2013 [ ]	UT; 1 elementary school (253 students in grades 1–5)	QE: Pre/post (no comparison group)	2010-11	: Students received rewards (e.g., pencil eraser, pedometer) for trying F/V : Videos and letters were read by the teacher	Digital imagery	Selection: Not measured Consumption: The intervention was associated with significant increases in fruit and vegetable consumption.	High
Choice Architecture: Visual Appeal, verbal prompts, and re-ordering the lunch line
Adams et al. 2016 [ ]	Phoenix, AZ; 2 school districts (3 middle schools per district [students total])	QE: Post-only (with comparison group)	2013	Choice Architecture: The placement of the salad bar was either on the serving line or after the serving line	Weighed plate waste	Selection: Students selected 5.4 times more fresh fruits and vegetables by weight (95% CI, 4.0–7.2) when the salad bar was on the serving line (vs. after the serving line). Consumption: Students consumed 4.83 times more F/V (95% CI 3.40 to 6.81) when the salad bar was on the serving line (vs. after the serving line).	Low
Ang et al. 2019 [ ]	New York City, NY; 14 elementary schools [877 trays collected from students in grade 2–3)	QE: Post-only (with comparison group)	2015–16	: Vegetables were pre-plated (vs. optional), and were placed first in line : multiple (2+) fruit and vegetable options were provided	Visual estimation	Selection: Not measured Consumption: Pre-plating vegetables (vs. optional for the student to select a vegetable) was associated with a small increase in consumption (0.02 cups; < 0.001). Positioning vegetables first on the serving line was not associated with vegetable consumption. Among students who selected fruit, pre-sliced fruit was associated with greater consumption (0.23 cups more = 0.02) than whole fruit. Recess before lunch was associated with a small increase in fruit consumption (0.08 cups; < 0.001) and vegetable consumption (0.007 cups; = 0.04). Multiple fruit options and attractive serving bowls were not associated with fruit consumption. Lunch duration was not associated with consumption (although less than 15% of measurements had lunch durations of ≥20 min).	Low
Blondin et al. 2018 [ ]	N.S.; 6 elementary schools (students in grades 3–4)	Cross-sectional	2015	: Teachers encouraged students to select milk : Distractions (i.e., other activities while eating including working, listening to the teacher, and/or socializing) were assessed and students were offered juice with breakfast on approximately half of the days	Weighed plate waste	Selection: When juice was offered with breakfast, the percent of students selecting milk decreased. Consumption: Offering juice at breakfast was associated with a 12% increase in milk waste ( < 0.001). Teacher encouragement to select milk was associated with a 9% increase in milk waste ( = 0.009). Student engagement in other activities during breakfast was associated with a 10% decrease in milk waste ( < 0.001).	Low
Cohen et al. 2015 [ ]	MA; 14 elementary and middle schools (2638 students in grades 3–8)	RCT	2011–12	: Vegetables were offered at the beginning of the lunch line; fruits were placed in attractive containers; fruits were placed next to the cash register; signage added that promoted F/V; white milk was placed in front of chocolate milk : A professional chef trained cafeteria staff to prepare healthier school lunches	Weighed plate waste	Selection: Both the choice architecture and chef (i.e., palatability) intervention were associated with increased fruit and vegetable selection. There was no impact on white milk selection. Consumption: Only the chef intervention was associated with increased consumption of fruits and vegetables. There was no impact on white milk consumption.	Low
Goto et al. 2013 [ ]	CA; 3 elementary schools (677 students in grades 1–6)	RCT	2011	Choice Architecture: The quantity of white milk was increased compared with the quantity of chocolate milk. Some schools requested to decrease the visibility of chocolate milk from the lunch line.	Weighed plate waste	Selection: When the visibility of chocolate milk was decreased, there was an 18% percentage-point increase in white milk selection. Changing the quantity of white milk available was not associated with changes in selection. Consumption: The interventions were not associated with differences in white milk consumption.	High
Greene et al. 2017 [ ]	NY; 7 middle schools (8502 trays from students in grades 5–8)	RCT	2014	: Fruits were placed first on the lunch line and were in attractive bowls with descriptive names. Promotional materials (e.g., fruit facts) were posted in the cafeteria : Multiple (2) fruit and vegetable options were provided	Visual estimation	Selection: The intervention was associated with a 36% increase in fruit selection ( < 0.001), but no significant changes in vegetable or milk selection. Consumption: The intervention was associated with a 23% increase in fruit consumption ( < 0.001). There was no association with vegetable or milk consumption.	Low
Gustafson et al. 2017 [ ]	Kearney, N; 4 elementary schools (1614 trays from students in grades K-5)	RCT	2014–15	: Posters marketing vegetables were mounted above the salad bar : Students participated in the design of the posters	Digital imagery	Selection: The intervention arm with both student participation in the poster design and the presence of marketing was associated with an increase in the selection of vegetables. Consumption: The intervention arm with both student participation in the poster design and the presence of marketing was associated with a significant increase in vegetable consumption compared with the control group.	High
Hamdi et al. 2020 [ ]	IL; 3 elementary schools (1255 trays from students in grades K-8)	QE: Pre/post (no comparison group)	2018–19	: Cafeteria decorations and creative names were introduced : A flavor station with spices and seasonings on a table in the cafeteria was added	Weighed plate waste	Selection: Selection was measured in only one of the participating schools. The odds of selecting a vegetable (i.e., broccoli) increased when students were exposed to taste tests. The odds of selecting fruit increased when all intervention components were implemented simultaneously. Consumption: The intervention components yielded inconsistent, but generally positive consumption results across the schools, particularly for fruits.	Low
Hanks et al. 2012 [ ]	Corning, NY; 1 high school (1084 trays from students)	QE: Pre/post (no comparison group)	2011	: A convenience line (i.e., faster lunch line) was added with only healthier options	Weighed plate waste	Selection: The intervention was associated with an 18% increase in healthier food selection ( < 0.001). Consumption: There was no significant change in the consumption of healthy foods, but there was a significant decrease in consumption of less healthy foods (27.9% decrease; < 0.001).	High
Hanks et al. 2013 [ ]	NY; Two Middle/High schools (3762 trays from students in grades 7–12).	QE: Pre/post (no comparison group)	2011	Choice Architecture: The following components were included: a convenience line with healthier options; placing healthier foods first in line; adding attractive bowls and descriptive names; and providing verbal prompts to select healthy options	Visual estimation	Selection: Students were 13.4% more likely to take a fruit ( = 0.01) and 23% more likely to take a vegetable ( < 0.001) post-implementation. Consumption: Choice architecture was associated with an 18% increase in fruit consumption ( = 0.004) and 25% increase in vegetable consumption ( < 0.001).	High
Koch et al. 2020 [ ]	New York City, NY; 7 high schools	QE: Pre/post (no comparison group)	2017 to 2018	Choice Architecture: The intervention included a more open lunch line, comfortable seating options, wall art, and promotional signage	Digital imagery	Selection: Fruit and vegetable selection decreased (statistical significance not assessed). Consumption: After a year of exposure to the intervention, there were no changes in vegetable consumption and significant decreases in consumption of fruits and grains.	High
Quinn et al. 2018 [ ]	King County, WA; 11 middle and high schools (2309 trays)	QE: Pre/post (with comparison group)	2013–14	: Changes included attractive containers, creative names, signage, food placement (e.g., multiple locations and/or at eye-level), and verbal prompts by cafeteria staff	Visual estimation	Selection: A greater proportion of students selected fruit in the intervention schools compared with control schools. There was no significant change in vegetable selection. Consumption: Pre-sliced fruit and choice architecture were not associated with significant differences in the quantities of fruits, vegetables, or milk consumed.	High
Reicks et al. 2012 [ ]	Richfield, MN; 1 elementary school (students in grades K-5)	QE: Pre/post (no comparison group)	2011	Choice Architecture: Photographs of vegetables were placed on lunch trays	Aggregate plate waste	Selection: The intervention was associated with an 8.5% percentage point increase in green beans ( < 0.001) and a 25.2% percentage point increase in carrot selection ( < 0.001). Consumption: Among students who selected vegetables, the intervention was associated with a decrease in carrot consumption (27g vs. 31g; < 0.001) and no impact on green bean consumption.	Very High
Schwartz 2007 [ ]	CT; 2 elementary schools (students in grades 1–4)	QE: Post-only (with comparison group)	2005	Choice Architecture: Staff provided verbal prompts on the lunch lune encouraging fruit selection	Visual estimation	Selection: The intervention was associated with significantly greater odds of selecting fruit. Consumption: Among students who selected a fruit, there were no differences in fruit consumption.	High
Thompson et al. 2017 [ ]	Hennepin County, MN; 2 elementary schools (373 students in grades K-4)	QE: Pre/post (no comparison group)	2013	: Changes included enhanced displays for F/V; attractive labels for F/V; and placement of F/V at the beginning of the lunch line and at the cash register : Sliced apples were compared with whole apples	Weighed plate waste	Selection: The intervention was associated with a significant increase in the percentage of students selecting a fruit serving (95.1% vs. 98.1%; = 0.02). There was no significant change in vegetable selection. Consumption: The intervention was not associated with fruit or vegetable consumption.	Low
Wansink et al. 2015 [ ]	Lansing, NY; 1 high school (554 trays from students in grades 9–12)	QE: Pre/post (no comparison group)	2012	Choice Architecture: Salad greens grown by one classroom were added to the school salads, and posters and announcements were introduced to promote this addition	Visual estimation	Selection: The intervention was associated with an increase in salad selection from 2% to 10% ( < 0.001). Consumption: The intervention was associated with a decrease in salad consumption (94% to 67% of a serving consumed; = 0.007).	High
Choice Architecture: Portion Sizes or Modifying When Students Have Access to Meal Components
Elsbernd et al. 2016 [ ]	Richfield, MN; 1 elementary school (~500 students in grades K-5)	QE: Pre/post (no comparison group)	N.S.	Choice Architecture: Students were offered vegetables (red pepper) in the hallway outside the cafeteria while waiting on the lunch line Staff provided verbal prompts to eat the peppers while waiting on the lunch line.	Visual estimation	Selection: The selection of red pepper increased from 8% to 65% (statistical significance not assessed). Consumption: The intervention was associated with an increase in overall vegetable consumption.	High
Miller et al. 2015 [ ]	Richfield, MN; 1 elementary school (~680 students in grades K-5)	QE: Pre/post (no comparison group)	2011	Choice Architecture: There was a 50% increase in portion sizes for F/V	Weighed plate waste	Selection: Larger portion sizes was associated with a significant increase in the proportion of students selecting oranges and a decrease in the proportion of students selecting applesauce. Consumption: Increasing the portion sizes for F/V was associated with increased consumption (range 13–42g increase) among those who selected the meal component.	Low
Ramsay et al. 2013 [ ]	N.S.; 1 Kinder Center (elementary school with only kindergarten)	QE: Pre/post (no comparison group)	2010	Choice Architecture: An increase in the portion size of the entrée (i.e., the number of chicken nuggets offered)	Weighed plate waste	Selection: Students selected more chicken nuggets when they were able to choose larger serving sizes. Consumption: Larger portion sizes of chicken nuggets were associated with greater consumption.	High
Redden et al. 2015 [ ]	Richfield, MN; 1 elementary school (1435 trays [study 1] and 2632 trays [study 2] from students in grades K-5)	QE: Pre/post (no comparison group)	N.S.	Choice Architecture: In Study 1, vegetables (mini carrots) were available on a table while students waited in line for food. In Study 2, vegetables (broccoli) were handed to students while they waited in line for food.	Aggregate plate waste	Selection: No significant associations Consumption: In Study 1, offering mini carrots to students while they waited in the lunch line was associated with an overall increase in carrot consumption at lunch compared with a control day (12.7g vs. 2.4g; < 0.001). In Study 2, with a longer exposure to the intervention, offering broccoli was associated with increased consumption that persisted over time.	Very High
Zellner et al. 2016 [ ]	Philadelphia, PA; 1 elementary school (47 trays from students in grades 3–4)	QE: Pre/post (no comparison group)	N.S.	Choice Architecture: Fruit was served later in the meal versus at the same time as the rest of the school lunch	Visual estimation	Selection: Not measured Consumption: Delaying when fruit was served was associated with greater kale consumption ( = 0.0017) compared with when fruit was served at the same time as the rest of the meal.	Very High

F/V: fruits and vegetables; QE: Quasi-Experimental; RCT: Randomized controlled trial. 1 Study designs were defined as: (1 ) Cross-sectional - Observational study with the exposure and outcome measured simultaneously (no comparison group); (2) Quasi-Experimental (QE): Post Only —Intervention study with a comparison group and data collected post-implementation (no baseline measurements); (3) Quasi-Experimental (QE): Pre/Post —Intervention studies with pre-implementation (i.e., baseline) and post-implementation measurements, with or without a comparison group (non-random allocation of intervention/comparison groups); (4) Randomized Controlled Trial (RCT)— Intervention study with random allocation to intervention or control status and both pre-implementation (baseline) and post-implementation measurements. 2 Risk of Bias was based on adapted Newcastle–Ottawa Scales (NOS) for cross-sectional and cohort studies ( Supplementary Materials Table S1 ).

Eleven studies tested the impact of providing rewards for students within elementary schools. Among those that required students to eat the fruits and vegetables prior to receiving the reward, nearly all (9 out of 10) found a positive association with fruit and vegetable consumption. The one study that only required selection (but not consumption) for a reward found no association with consumption. Hendy and colleagues conducted a study using visual estimation in one elementary school in Pennsylvania and found that providing children with a small prize for eating at least 1/8 cup of fruits and vegetables at lunch was associated with an increase in consumption [ 79 ]. Using the same measure of consumption, the previously described study by Perry and colleagues found that rewards (i.e., frozen yogurt for the classroom), as well as taste tests and more fruit and vegetable choices, were associated with an increase in fruit and vegetable consumption [ 48 ]. Jones et al. used aggregate plate waste in one elementary school in Utah and found that teacher encouragement to eat more fruits and vegetables combined with rewards (medals and points displayed on a board) was associated with a 39% increase in fruit consumption ( p < 0.01) on the days when fruit was targeted and a 33% increase ( p < 0.05) in vegetable consumption on the days when vegetables were targeted. Notably, neither fruit nor vegetable consumption increased when the other meal component was targeted [ 80 ]. In a study using digital imagery measurement in one Utah elementary school, Wengreen and colleagues found an increase in fruit and vegetable consumption when students received a reward for trying those meal components; this intervention also included educational videos and letters read by teachers promoting fruits and vegetables [ 81 ]. Using similar consumption measures in one elementary school in Oregon, Machado and colleagues provided verbal prompts, adult role modeling, and rewarded students for consuming fruits and vegetables with a classroom party and t-shirts. They found that the proportion of students consuming all their fruits increased by 11% ( p < 0.01) and the proportion eating all their vegetables increased by 8.7% ( p < 0.01) [ 82 ]. Increases in fruit and vegetable consumption were also observed in the previously described multi-component study conducted by Morrill et al., and decreases in waste for fruits and vegetables were observed in the study by Mazzeo et al.; both studies included taste tests as well [ 71 , 72 ].

In two studies conducted by Hoffman et al. within four elementary schools in New England, there were promotional posters, verbal encouragement, and students received a small prize (e.g., stickers) for eating fruits and vegetables. Both studies found an increase in consumption of fruits and vegetables using weighed plate waste [ 83 , 84 ]. However, they found the results were not sustained after the intervention concluded [ 84 ]. In another study, Blom-Hoffman et al. used visual estimation in one elementary school and found no impact on vegetable consumption when examining the impact of nutrition education combined with sticker rewards and verbal praise [ 85 ]. Hudgens and associates used visual estimation measurement in one elementary school in Oregon and found that providing a reward for selecting (but not requiring student to taste) a meal with a fruit, vegetable, unflavored milk, and whole grain was not associated with an increase in consumption, although increases in selection of these components were observed [ 86 ].

Smarter Lunchroom Strategies

Sixteen studies examined the visual appeal of the cafeteria environment—such as attractive bowls, signage with creative names—as well as verbal prompts, and/or location of fruits/vegetables. Among these studies, only four found a positive association with consumption; three found an increase in food waste; eight found no association with consumption; and one found inconsistent results.

In a study conducted by Gustafson et al., children in four elementary schools in Nebraska designed posters marketing vegetables that were then displayed over a salad bar. They used digital imagery to measure plate waste and observed an increase in vegetable consumption [ 87 ]. Adams et al. used weighed plate waste for a study in middle schools in Phoenix, Arizona and tested the impact of moving the location of the salad bars. They found that students consumed 4.82 times more fruits and vegetables when the salad bar was accessible from the serving line compared with when salad bars were located after students had left the lunch line [ 88 ]. In the previously described multi-component study by Greene et al., attractive bowls and descriptive names were combined with providing pre-sliced fruit and increased fruit and vegetable choices. They found an increase in fruit consumption, but no impact on vegetable or milk intake [ 49 ]. Hanks et al. found that an intervention that included using attractive bowls and descriptive names in combination with changing the placement of foods, providing verbal prompts, and creating healthy convenience lines was associated with an 18% increase in fruit consumption ( p = 0.004) and 25% increase in vegetable consumption ( p < 0.001) in two middle/high schools in NY using visual estimation [ 89 ].

Although the previous studies found impacts on student consumption, these findings were not replicated in other studies and many studies found null effects. Using consumption measures similar to Hanks et al. [ 75 ], Quinn and associates used Smarter Lunchroom techniques (and pre-sliced fruit) and found no impact on fruit and vegetable intake in 11 middle and high schools in Washington [ 70 ]. Similarly, Thompson et al. found no impact of these interventions (i.e., Smarter Lunchroom strategies and pre-sliced fruit) on intake in two elementary schools in Minnesota using weighed plate waste [ 69 ]. Additionally, Cohen et al. used weighed plate waste to assess similar choice architecture techniques, as well as more prominent white milk (compared with chocolate milk) in 14 elementary and middle schools in Massachusetts, and found that these strategies had no impact on the consumption of fruits, vegetables, or milk [ 57 ]. Goto and colleagues increased the quantity and prominence of white milk in three elementary schools in California, and found no association with milk consumption using weighed plate waste [ 90 ]. Hanks and colleagues examined the exposure of only a healthy convenience line in a high school in New York using weighed plate waste and also found no impact on healthier meal consumption [ 91 ]. Additionally, placing vegetables first on the lunch line had no impact on consumption in a study conducted by Ang and colleagues in 14 elementary schools in New York City using visual estimation [ 51 ]. Promotional signage, a more open lunch line, wall art, and comfortable seating options was associated with reduced consumption of fruits and grain and no impact on vegetable consumption after a year of exposure in a study conducted by Koch et al. in seven high schools in New York City using digital imagery [ 92 ]. In a study conducted by Blondin et al. in six elementary schools using weighed plate waste, verbal encouragement in the classroom was found to increase milk waste [ 93 ]. This study also found that milk consumption was adversely impacted by the presence of juice. Schwartz et al. also examined verbal prompts (on the lunch lune) in two elementary schools in Connecticut using visual observation and found that while there were no differences in individual-level consumption rates between intervention and control schools (~70% consumption in both schools), there were significant increases in selection, and thus 70% of children consumed a serving of fruit in the intervention schools compared with less than 40% in the control schools [ 94 ]. As previously mentioned, inconsistent results were observed by Hamdi and colleagues in a study that evaluated choice architecture (in addition to taste tests and a flavor station) [ 63 ], and another study by Wansink et al. using visual estimation in one high school with posters and student involvement in growing the salad greens was associated with a decrease in salad consumption [ 95 ]. Similarly, Reicks and colleagues found that including pictures of vegetables on lunch trays was associated with a decrease in carrot consumption (and no association with green beans) using aggregate plate waste in one elementary school in Minnesota [ 96 ]. Importantly, nearly all ( n = 12) studies examining Smarter Lunchroom Strategies found increases in selection.

Portion Sizes and Providing Meal Components at Different Times

A small number of publications examined portion sizes (2 studies) and providing meal components at different times (3 studies). While all found positive associations with consumption, only one study had a low risk of bias. Among studies examining portion sizes, Ramsay et al. increased the portion size of chicken nuggets provided to kindergarteners in one school and found increased consumption (and selection) using weighed plate waste [ 97 ], although processed foods such as chicken nuggets tend to have high consumption rates more broadly in schools [ 98 ]. In another study examining portion sizes, Miller and colleagues increased the portion sizes for fruits and vegetables by 50% and found a corresponding increase in consumption by about 13-42 g using weighed plate waste in one elementary school in Minnesota [ 99 ]. In this study, selection of some components increased while other components decreased. Two other studies conducted in an elementary school in Minnesota found that offering vegetables (i.e., red peppers, baby carrots, and broccoli) first while students waited in the lunch line was associated with increases in consumption using visual estimation (Elsbernd et al.) [ 100 ] and aggregate plate waste (Redden et al.) [ 101 ]. However, only the study by Eslbernd et al. found increases in selection as well. Similarly, in one elementary school in Philadelphia, Zellner and colleagues found that when offering fruit was delayed until later in the meal, students consumed more kale compared with when fruit was served at the same time as the vegetable (and entrée and milk) using visual estimation [ 102 ].

3.2.2. Nutrition Education

Of the 11 studies focused on nutrition education alone, or with small additional components, such as parent newsletters, slightly over half ( n = 6 studies) found a positive association with school meal consumption; four found no association; and one found a decrease in consumption ( Table 3 ). Five studies had a low risk of bias, and the majority ( n = 4 studies) found positive associations between nutrition education and consumption. Among the 10 multi-component studies that combined nutrition education with other strategies (e.g., taste tests, more food choices, and choice architecture techniques), slightly fewer than half ( n = 4 studies) found increases in consumption; four found no association; and two found mixed results. Among the three multi-component studies with a low risk of bias, only one found a positive association with consumption.

Characteristics and outcomes of studies examining initiatives and interventions targeting nutrition education included in the systematic review.

Author, Year	Location; Participant Characteristics	Study Design	Year(s)	Exposure(s)	Outcome Measure(s)	Results
Nutrition Education
Auld et al. 1998 [ ]	Denver, CO; 10 elementary schools (3 intervention and 3 comparison) [~850 students in grades k-5]	QE: Pre/post (with comparison group)	1995–96 to 1996–97	: 24 nutrition lessons were taught by special resource teachers : Teacher training and parent education (newsletters) provided	Visual estimation	Selection: Not measured Consumption: The intervention was associated with an increase in F/V consumption by 0.4 serving ( < 0.001).	Low
Auld et al. 1999 [ ]	Denver, CO; 4 elementary schools (2 intervention and 2 control [~760 students total in grades 2–4])	QE: Pre/post (with comparison group)	1997–98	Nutrition Education: 16 nutrition lessons were taught alternatively by teachers and special resource teachers	Visual estimation	Selection: Not measured Consumption: Nutrition education was associated with an increase in F/V consumption by 0.36 servings ( < 0.001).	Low
Burgess-Champoux et al. 2008 [ ]	Minneapolis metropolitan area, MN: 2 elementary schools (150 students in grades 4 and 5)	QE: Pre/post (with comparison group)	2005	: Five lessons that focused on whole grains were implemented by trained research assistants : There was a family component (newsletters, supermarket and bakery tours, and an event at a milling museum). To increase the availability of whole grains in the cafeteria, there was culinary training on whole grains for cafeteria staff focused on menu planning, procurement, quality control and staff taste tests.	Visual estimation	Selection: Not measured Consumption: In the intervention school, whole grain consumption increased by 1 serving ( < 0.0001) and refined grain consumption decreased by 1 serving ( < 0.001) compared with the control school.	High
Epstein-Solfield et al. 2018 [ ]	WA; 1 elementary school (149 students in grades 3 and 5)	QE: Pre/post (no comparison group)	2017	Nutrition Education: Lessons were provided for 8 weeks (20 min per session) focused on the benefits of consuming F/V	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with differences in F/V consumption.	High
Head 1974 [ ]	NC; 4 elementary, 4 middle, and 2 high schools (students in grade 5, 7, and 10)	QE: Pre/post (with comparison group)	N.S.	Nutrition Education: Lessons were provided on basic nutrition, dietary patterns, and food composition	Weighed plate waste	Selection: Not measured Consumption: There was a significant decrease in plate waste with nutrition education.	Low
Ishdorj et al. 2013 [ ]	Nationally representative sample (SNDA-III); 256 schools (2096 students)	Cross-sectional	2004–05	: Availability of nutrition education lessons for every grade in the school : restrictions on competitive foods (e.g., limited à la carte sales, no stores or snack bars selling competitive foods, and fundraisers), French fries, dessert, and whole/ 2% milk; and increases in the amount of fresh F/V available daily at lunch	24 h recall	Selection: Not measured Consumption: Policies that place restrictions on the sales of competitive foods were associated with greater fruit consumption. Policies that restrict desserts were associated with greater vegetable consumption. Policies that limited French fries were associated with lower fruit consumption. Limiting whole and 2% milk was associated with greater fruit and vegetable consumption. Nutrition education and policies that increase the amount of fresh fruit and vegetable available daily at lunch policies were not associated with consumption of fruits or vegetables.	High
Jones et al. 2015 [ ]	SC; 15 elementary and 3 middle schools (students in grades K-8)	QE: Post-only (with comparison group)	2011	: Nutrition and agriculture content was integrated into classroom curriculum : Schools incorporated farm to school activities, including a school garden, field trips to farms, cooking demonstrations and providing local items on the cafeteria menu	Digital imagery	Selection: Not measured Consumption: Students in the intervention schools consumed on average less fruit than students in control schools. There was no significant association with vegetable consumption.	High
Larson et al. 2018 [ ]	Southwest region; 2 elementary schools (159 students in grades 4–5)	QE: Pre/post (with comparison group	N.S.	Nutrition Education: Fruit and vegetable consumption was promoted via cartoon characters, posters, and goal setting	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with differences in F/V consumption.	High
Prescott et al. 2019 [ ]	CO; 2 middle schools (1596 trays from students in grade 6–8)	QE: Pre/post (with comparison group)	2017–18	Nutrition education: The 6th grade curriculum focused on sustainable food systems. 6th grade students created posters to educate the 7–8th grade students	Digital imagery	Selection: No significant associations Consumption: During the intervention, students in intervention school increased their vegetable consumption (due to significantly lower consumption rates at baseline, the intervention eliminated the difference versus control). At 5 months follow-up, the intervention students wasted significantly less salad bar vegetables compared with the control students (24g vs. 50g; = 0.029).	High
Serebrennikov et al. 2020 [ ]	Midwestern Region; 3 elementary schools (98 students in grade 2)	RCT	2016	Nutrition Education: A curriculum related to knowledge and preferences for F/V was implemented bi-weekly for 6 weeks	Digital imagery	Selection: No significant associations Consumption: Nutrition education was not associated with significant differences in fruits or vegetables consumed.	Low
Sharma et al. 2019 [ ]	Houston/Dallas, TX; 3 elementary schools (115 students in grades 4–5)	QE: Pre/post (with comparison group)	2017-18	: A 16-week program was provided : A parent education component included sending home recipes with demonstrations and fresh fruit from local pantries	Weighed plate waste	Selection: There was no change in selection among intervention schools but there was a decrease in the comparison schools, which resulted in a significant difference in selection. Consumption: The intervention was associated with significant decreases in F/V waste at lunch ( < 0.001).	Low
Multi-Component Nutrition Education with Choice and/or Taste Test Components
Alaimo et al. 2015 [ ]	Grand Rapids, MI; 6 elementary schools (4 intervention and 2 control [815 students in grades 3-5])	QE: Pre/post (with comparison group)	2009–10 to 2010–11	: Provided in the cafeteria and classrooms : Nutrition education classes and posters : Healthy eating coaching by teachers, parent education	Digital imagery	Selection: Not measured Consumption: The multi-component intervention was associated with significant increases in fruit consumption. No differences in consumption of vegetables, milk, grains, or protein were observed.	Low
Blakeway et al. 1978 [ ]	Little Rock, AR; 16 elementary schools (5000 students in grades 1–3)	RCT	N.S.	: Provided in the classroom with nutrition education : A nutrition coordinator implemented 10 classroom lessons focused on recognizing and identifying foods in different forms	Aggregate plate waste	Selection: Not measured Consumption: Students in intervention schools consumed greater amounts of whole wheat rolls (grades 2 and 3 only) and cottage cheese (grades 1 and 2 only) compared to the comparison group. Sweet potato custard consumption increased in both the intervention and control group. No other significant differences were observed.	High
Blom-Hoffman et al. 2004 [ ]	Northeast Region; 1 elementary school (students in grades K-1)	RCT	N.S.	: Students received verbal praise and rewards (i.e., stickers) for consuming F/V : 10 lessons with 5-A-Day information was implemented by the classroom teacher and a school psychology graduate student : Parent component (newsletter and cookbook) included	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with differences in vegetable consumption.	High
Bontranger Yoder et al. 2014 [ ]	WI; 9 elementary schools (1117 students in grades 3–5)	QE: Pre/post (no comparison group)	2010-11	: A farm to school gardening curriculum was available in some of the participating schools : Available in some of the participating schools : Farm to school activities were introduced (e.g., a school garden, field trips to farms, and local items on the menu) in some of the participating schools	Digital imagery	Selection: Not measured Consumption: The intervention was not associated with differences in F/V consumption, although the farm to school components were inconsistently implemented across the participating schools.	Low
Bontranger Yoder et al. 2015 [ ]	WI; 11 elementary schools (7117 trays from students in grades 3–5)	Cross-sectional and Pre/post (no comparison group) * * For Policy only	2010 to 2013	: A farm to school gardening curriculum was available in some of the participating schools : Available in some of the participating schools. : HHFKA : Farm to school activities were introduced (e.g., a school garden, field trips to farms, and local items on the menu) in some of the participating schools	Digital imagery	Selection: Not measured Consumption: The intervention components (i.e., nutrition education, taste tests, and other activities) were not associated with differences in F/V consumption. There was no change in consumption before or after implementation of the HHFKA.	High
[ ]	OR; 1 elementary school (40 students in grade 3)	QE: Pre/post (with comparison group)	1997	: Lessons included the Food Guide Pyramid, healthy meal planning, and how foods grow : Provided in the classroom with nutrition education	Weighed plate waste	Selection: No significant associations Consumption: The intervention was associated with an increase in consumption of calories from fruits (28 kcal; < 0.01). No significant differences in vegetable and grain consumption were observed.	High
Liquori et al. 1998 [ ]	New York City, NY; 2 elementary schools (590 students in grades K-6).	QE: Pre/post (with comparison group)	1995-96	: The number of vegetable and whole grain options available was increased : 10 food and environment lessons and/or 10 cooking lessons were provided : Students took field trips to a local community garden. There was parent outreach (newsletter, recipes, workshops)	Visual estimation	Selection: Not measured Consumption: The intervention arm with cooking lessons was associated with increased consumption of vegetables and whole grains among younger students ( < 0.01). No association was observed among older children exposed to the cooking intervention. The nutrition education (food environment) intervention was not associated with consumption.	High
Reynolds et al. 2000 [ ]	AL; 28 elementary schools (425 students in grade 4)	QE: Pre/post (with comparison group)	1994 to 1996	: A 14 lesson curriculum related to F/V was provided and posters were added to the cafeteria : Parent education was provided, including recipes, activities, and information about F/V	Visual estimation	Selection: Not measured Consumption: The intervention was not associated with significant differences in fruits or vegetables consumed.	Low
Taylor et al. 2018 [ ]	CA; 2 elementary schools (112 students in grade 4)	QE: Pre/post (with comparison group)	2012–13	: Salad bars were added to increase F/V choices : A garden enhanced nutrition curriculum and cooking demonstrations were provided : Parent newsletter, home activities	Digital imagery	Selection: No significant associations Consumption: The intervention was associated with a significant increase in vegetable consumption. There was no association with fruit consumption.	High
Young et al. 2013 [ ]	N.S.; 1 middle school (3810 trays from students in grades 6–8)	Cross-Sectional	2011–12	Policy: A new wellness policy required schools to implement the practices below: : Different fruits and vegetables were served each day of the week : There was an increase in student contact hours for health and physical education	Visual estimation	Selection: Not measured Consumption: After exposure to the wellness policy for over a semester, students consumed significantly more fruits and cooked vegetables.	High

F/V: fruits and vegetables; QE: Quasi-Experimental; RCT: Randomized controlled trial. 1 Study designs were defined as: (1 ) Cross-sectional - Observational study with the exposure and outcome measured simultaneously (no comparison group); (2) Quasi-Experimental (QE): Post Only Intervention study with a comparison group and data collected post-implementation (no baseline measurements); (3) Quasi-Experimental (QE): Pre/Post— Intervention studies with pre-implementation (i.e., baseline) and post-implementation measurements, with or without a comparison group (non-random allocation of intervention/comparison groups); (4) Randomized Controlled Trial (RCT)— Intervention study with random allocation to intervention or control status and both pre-implementation (baseline) and post-implementation measurements. 2 Risk of Bias was based on adapted Newcastle–Ottawa Scales (NOS) for cross-sectional and cohort studies ( Supplementary Materials Table S1 ).

In one of the studies that found a positive association between nutrition education and consumption, Sharma et al. implemented a 16-week nutrition education program in three elementary schools in Texas. This intervention also included a parent component with recipes and demonstrations and fresh fruit from local pantries sent home with families. They used weighed plate waste and found a decrease in fruit and vegetable waste at lunch (β = -32.06; p < 0.001), and while no differences in selection were observed in the intervention schools, significant decreases in selection were observed in the control school [ 103 ]. In a study conducted in four elementary schools in Denver by Auld and colleagues, students were exposed to 16 nutrition lessons taught alternatively by teachers and special resources teachers [ 104 ]. This study examined food consumption using visual estimation and found that nutrition education was associated with an increase in fruit and vegetable consumption by 0.36 servings ( p < 0.001). Auld et al. conducted another study using similar methodology in 10 elementary schools in Denver, but with 24 nutrition lessons taught exclusively by a special resources teacher and found a similar effect size for improvements in fruit and vegetable consumption (0.4 servings; p < 0.001) [ 105 ]. A study using visual estimation in two elementary schools in Minnesota conducted by Burgess-Champoux and colleagues focused on whole grains. This intervention included five lessons, cafeteria staff culinary training (e.g., quality control, staff taste tests, etc.) and a parent component (e.g., supermarket/bakery tours, newsletters). They found an average of a one serving increase in whole grain consumption ( p < 0.0001) [ 106 ]. In a study conducted by Head, marginally significant ( p = 0.05) increases in overall consumption were observed using weighed plate waste in four North Carolina elementary schools exposed to nutrition education with a focus on basic nutrition and dietary patterns [ 107 ]. Additionally, higher rates of vegetable consumption were observed using digital imagery among 6th grade students exposed to a curriculum that focused on sustainable food systems in a study conducted by Prescott et al. [ 108 ]. Increases in selection were also observed in the intervention schools in this study, however they were not statistically significant. Lastly, greater consumption was also observed in four previously described multi-component studies that combined nutrition education with cafeteria components including increases in fruit and vegetable choices [ 47 , 52 ] and taste tests [ 73 , 74 ].

Inconsistent results were found in a multi-component study conducted by Blakeway et al. that included both nutrition education and taste tests; improvements were observed in some, but not all, grades [ 75 ]. Additionally, mixed findings were observed by Liquori and associates with a nutrition education program in two New York City elementary schools; while lessons that focused on food and the environment had no impact on consumption (using visual estimation), nutrition education that included a cooking component improved consumption of vegetables and whole grains, but only among younger students [ 50 ]. Jones et al. also evaluated a curriculum that involved both nutrition and agriculture, as well as farm to school activities (e.g., school gardens, field trips, cooking demonstrations) in 18 elementary and middle schools in South Carolina and found a small decrease in fruit consumption (−0.07 servings; p < 0.05) and no significant impact on vegetable consumption using digital imagery [ 109 ]. Another study conducted by Ishdorj et al. examined lunch consumption based on 24-hour recalls from a nationally representative sample of public schools and found that nutrition education was not associated with fruit or vegetable consumption [ 110 ]. No impact was observed in four other studies conducted in elementary schools with nutrition education that all specifically focused on fruit and vegetable consumption, with intake measured using visual estimation [ 85 , 111 , 112 ] or digital imagery [ 113 ]. Lastly, no associations were found in three other previously described multi-component studies that incorporated both nutrition education and taste tests [ 76 , 77 , 78 ].

3.2.3. School Lunch Duration

Of the four peer-reviewed publications that examined school lunch duration, three found a positive association between duration and school meal consumption and one found no association ( Table 4 ). Three studies had a low risk of bias and one had a high risk of bias; of the studies with a low risk of bias, two found a positive association with school meal consumption.

Characteristics and outcomes of studies examining initiatives and interventions targeting other cafeteria environment-level factors included in the systematic review.

Author, Year	Location; Participant Characteristics	Study Design	Year(s)	Exposure(s)	Outcome Measure(s)	Results	Risk of Bias

Ang et al. 2019 [ ]	New York City, NY; 14 elementary schools (877 trays collected from students in grade 2–3)	QE: Post-only (with comparison group)	2015–16	: Vegetables were pre-plated (vs. optional), and were placed first in line : multiple (2+) fruit and vegetable options were provided	Visual estimation	Selection: Not measured Consumption: Pre-plating vegetables (vs. optional for the student to select a vegetable) was associated with a small increase in consumption (0.02 cups; < 0.001). Positioning vegetables first on the serving line was not associated with vegetable consumption Among students who selected fruit, pre-sliced fruit was associated with greater consumption (0.23 cups more = 0.02) than whole fruit. Recess before lunch was associated with a small increase in fruit consumption (0.08 cups; < 0.001) and vegetable consumption (0.007 cups; = 0.04). Multiple fruit options and attractive serving bowls were not associated with fruit consumption. Lunch duration was not associated with consumption (although less than 15% of measurements had lunch durations of ≥20 min).	Low
Bergman et al. 2004 A [ ]	WA; 2 elementary schools (1877 trays from students in grades 3–5)	QE: Post-only (with comparison group)	N.S.	Lunch Duration: The times varied from 20–30 min	Weighed plate waste	Selection: Not measured Consumption: Longer lunch periods were associated with significantly greater school meal consumption (72.8% vs. 56.5% consumed; < 0.0001).	High
Cohen et al. 2016 [ ]	MA; 6 elementary and middle schools (1001 students in grades 3–8)	QE: Post-only (with comparison group)	2011–12	Lunch Duration: The times varied from 20–30 min (the amount of seated time in the cafeteria was calculated)	Weighed plate waste	Selection: Fruit selection was lower when students had less time to eat (46.9% vs. 57.3%; < 0.0001). Consumption: A shorter lunch period (less than 20 min of seated time) was associated with a decreased consumption of entrées (12.8% reduction; < 0.0001), milk (10.3% reduction; <0.0001), and vegetables (11.8% reduction, <0.0001).	Low
Gross et al. 2018 [ ]	New York City, NY; 10 elementary schools (382 students ages 6–8 years)	QE: Post-only (with comparison group)	2013	: The times were ≥30 min vs. <30 min : Noise levels and crowding were assessed	Digital imagery	Selection: On average, 74% of students selected a fruit, 69% selected a vegetable, and 73% selected a whole grain (statistical significance not assessed). Consumption: A longer lunch duration (≥30 min) was associated with higher consumption of fruits (odds ratio [OR] = 2.0; = 0.02) and whole grains (OR = 2.1; <0.05). Quieter cafeterias were associated with eating more vegetables (OR = 3.9; < 0.001) and whole grains (OR= 2.7; < 0.001). Less crowding was associated with eating more fruit (OR = 2.3; = 0.04) and whole grains (OR = 3.3; < 0.001).	Low
Recess Before Lunch
Ang et al. 2019 [ ]	New York City, NY; 14 elementary schools [877 trays collected from students in grade 2–3)	QE: Post-only (with comparison group)	2015–16	: Vegetables were pre-plated (vs. optional), and were placed first in line : multiple (2+) fruit and vegetable options were provided	Visual estimation	Selection: Not measured Consumption: Pre-plating vegetables (vs. optional for the student to select a vegetable) was associated with a small increase in consumption (0.02 cups; < 0.001). Positioning vegetables first on the serving line was not associated with vegetable consumption Among students who selected fruit, pre-sliced fruit was associated with greater consumption (0.23 cups more = 0.02) than whole fruit.. Recess before lunch was associated with a small increase in fruit consumption (0.08 cups; < 0.001) and vegetable consumption (0.007 cups; = 0.04). Multiple fruit options and attractive serving bowls were not associated with fruit consumption. Lunch duration was not associated with consumption (although less than 15% of measurements had lunch durations of ≥20 min).	Low
Bergman et al. 2004 B [ ]	W; 2 elementary schools (2008 trays from students grades 3–5)	QE: Post-only (with comparison group)	N.S.	Recess before lunch	Weighed plate waste	Selection: Not measured Consumption: Recess before lunch was associated with significantly greater school meal consumption (72.8% vs. 59.9% consumed; < 0.0001).	High
Chapman et al. 2017 [ ]	New Orleans, LA; 8 elementary schools (20,183 trays from students in grades 4 and 5)	QE: Post-only (with comparison group)	2014	: Timing of lunch varied (early, midday, or late)	Weighed plate waste	Selection: Not measured Consumption: Recess before lunch was associated with a 5.1% increase in fruit consumption ( = 0.009). There was no association between the timing of recess and consumption of the entrée, vegetable, or milk. Students who had a very early lunch consumed 5.8% less of their entrées ( < 0.001) and 4.5% less of their milk ( = 0.047) compared with students who had lunch at a traditional lunch hour. Additionally, students who had a very late lunch consumed 13.8% less of their entrées ( < 0.001) and 15.9% less of their fruit ( < 0.001).	Low
Fenton et al. 2015 [ ]	CA; 31 elementary schools (2167 students in grades 4–5).	QE: Post-only (with comparison group)	2011–12	Recess before lunch	24 hour recalls (diary assisted)	Selection: Not measured Consumption: Recess before lunch was not associated with differences in FV consumption at lunch.	Low
Getlinger et al. 1996 [ ]	Rockfort, IL; 1 elementary school (67 students in grades 1–3)	QE: Pre/post (no comparison group)	1995	Recess before lunch	Weighed plate waste	Selection: Not measured Consumption: Recess before lunch was associated with significant reductions in food waste for meat/meat alternatives, vegetables, and milk. There were no significant differences observed for fruits or grains.	High
Hunsberger et al. 2014 [ ]	Madras, OR; 1 elementary school (261 students in grades K-2)	QE: Post-only (with comparison group)	2009–10	Recess before lunch	Weighed plate waste	Selection: Not measured Consumption: Students with recess before lunch were roughly 20% more likely to drink an entire carton of milk (42% vs. 25%; < 0.001) and consumed on average 1.3 oz more milk compared with students who had recess after lunch. There were no significant differences in consumption of entrées, vegetables, or fruits.	High
McLoughlin et al. 2019 [ ]	IL; 2 elementary schools (103 students in grades 4–5)	QE: Post-only (with comparison group)	2016	Recess before lunch	Weighed plate waste	Selection: Overall, 57% of students selected fruits, 26% selected vegetables, 68% selected entrées and 64% selected milk (statistical significance not assessed). Consumption: Recess before lunch was associated with on average greater milk consumption. There was no association between recess before lunch and the amount of entrée, fruit, or vegetable consumed.	High
Price et al. 2015 [ ]	Orem, UT; 7 elementary schools (22,939 trays from students in grades 1–6)	QE: Pre/post (with comparison group)	2010–11 to 2011–12	Recess before lunch	Visual estimation	Selection: Not measured Consumption: Recess before lunch was associated with a 0.16 serving increase in fruit and vegetable consumption ( < 0.01).	Low
Strohbehn et al. 2016 [ ]	Midwestern Region; 3 elementary school (students in grade 3)	QE: Pre/post (no comparison group)	2012	Recess before lunch	Digital imagery and weighed plate waste	Selection: Not measured Consumption: Recess before lunch was associated with inconsistent findings; while the average waste was reduced for grains, meat/meat alternatives, and fruits, the average waste increased for vegetables.	High
Tanaka et al. 2005 [ ]	Oahu, HI; 1 elementary school (students in 6th grade)	QE: Pre/post (no comparison group)	2004	Recess before lunch	Weighed plate waste	Selection: Not measured Consumption: Recess before lunch was not associated with consumption of F/V, milk, or other school meal components.	High

In a study conducted by Bergman et al. using weighed plate waste in two elementary schools in Washington, students with a 30 min lunch period consumed on average 72.8% of their meal, while students who had a 20 min lunch period consumed on average only 56.6% of their meal ( p < 0.0001) [ 114 ]. In a similar study conducted by Cohen and colleagues using weighed plate waste in six elementary and middle schools in Massachusetts, students who had less than 20 min of seated time for lunch consumed on average between 10–13% less of their meal compared with students who had more than 25 min to eat lunch (corresponding with a 30 min lunch period; p < 0.0001) [ 19 ]. This study also found that students were more likely to select a fruit when they had more time to eat. Using digital imagery to assess consumption, Gross et al. examined 10 elementary schools in New York City and found that lunch periods that were at least 30 min long were associated with an increased odds of consuming fruits (OR = 2.0; p = 0.02) and whole grains (OR = 2.1; p < 0.05) [ 115 ]. Lastly, in another study conducted in New York City among elementary school students, Ang et al. found that lunch period duration was not associated with consumption [ 51 ]. However, less than 15% of the students had schedules with lunch periods greater than 20 min, which may have limited the ability to detect significant differences.

3.2.4. Recess before Lunch

Of the 10 peer-reviewed publications that examined recess before lunch ( Table 4 ), seven found a positive association with school meal consumption, one found mixed results with different meal components, and two found no association. Of the studies examining the timing of recess that were considered to have a low risk of bias, the majority (3 out of 4) found positive associations with school meal consumption for differing meal components.

Seven studies examining recess before lunch used weighed plate waste methodology. Bergman and colleagues examined two elementary schools in Washington and found that students who had recess before lunch consumed on average 72.8% of their meal compared with students who had recess after lunch and consumed on average 59.9% of their meal ( p < 0.0001) [ 116 ]. In a study conducted by Chapman et al. among students attending eight elementary schools in New Orleans, recess before lunch was associated with a 5% increase in fruit consumption, but no differences were observed for other meal components [ 117 ]. This study also found that students with lunch periods early or late in the day consumed less than students with traditional lunch hours. Getlinger and associates also found overall reduction in food waste from 34.9% to 24.3% in one elementary school in Illinois [ 118 ] Strohbehn et al. used a combination of weighed plate waste and digital imagery in three elementary schools, similarly finding reduced waste for fruits, as well as grains and meat/meat alternatives, but found increases in waste for vegetables [ 119 ]. Two additional studies, conducted by Hunsberger et al. in one elementary school in Oregon and McLoughlin et al. in two elementary schools in Illinois, found recess before lunch was associated with greater milk consumption, but found no association with other meal components [ 21 , 120 ]. Lastly, Tanaka et al. examined one elementary school in Hawaii and found no association with school meal consumption using weighed plate waste [ 121 ]. Among studies using other consumption measures, research conducted by Ang et al. among elementary students in New York City examined consumption with visual estimation and found recess before lunch was associated with small increases in the amount of fruits (0.08 cups; p < 0.001) and vegetables (0.007 cups; p = 0.04) eaten [ 51 ]. Another study conducted by Price et al. in seven elementary schools in Utah using visual estimation to assess diet also found that recess before lunch was associated with greater fruit and vegetable consumption (0.16 servings; p < 0.01) [ 122 ]. However, a study conducted by Fenton and associates using diary assisted 24-hour recalls among students attending 31 elementary schools in California found no association between the timing of recess and fruit and vegetable consumption at lunch [ 123 ].

3.3. Policies

3.3.1. federal policies: the healthy hunger free kids act (hhfka).

Out of the six studies that examined the impact of the HHFKA, most (4 of 6) found increases or no impact on consumption, with two studies finding a decrease in intake for certain meal components ( Table 5 ). Among the studies with a low risk of bias, two out of three found that this federal policy was associated with increases in school meal consumption.

Characteristics and outcomes of studies examining policy-level factors included in the systematic review.



Amin et al. 2015 [ ]	Northeast Region; 2 elementary schools (1442 trays from students in grades 3-5)	QE: Pre/post (no comparison group)	Spring 2012 and Spring 2013	Policy: HHFKA	Digital imagery, weighed plate waste, and direct observation	Selection: The policy was associated with a significant increase in FV selection (97.5% vs. 84.3%; < 0.001). Consumption: The policy was associated with slightly lower FV consumption (0.51 cups vs. 0.45 cups, 0.01)	High
Bontranger Yoder et al. 2015 [ ]	WI; 11 elementary schools (7117 trays from students in grades 3–5)	Cross-sectional and Pre/post (no comparison group) * * For Policy only	2010 to 2013	: A farm to school gardening curriculum was available in some of the participating schools : Available in some of the participating schools : HHFKA : Farm to school activities were introduced (e.g., a school garden, field trips to farms, and local items on the menu) in some of the participating schools	Digital imagery	Selection: Not measured Consumption: The intervention components (i.e., nutrition education, taste tests, and other activities) were not associated with differences in F/V consumption. There was no change in consumption before or after implementation of the HHFKA.	High
Cohen et al. 2014 [ ]	MA; 4 elementary/K-8 schools (1030 students in grades 3–8)	QE: Pre/post (no comparison group)	Fall 2011 and Fall 2012	Policy: HHFKA + removal of chocolate milk	Weighed plate waste	Selection: The HHFKA was associated with a 23% increase in the percent of students selecting a fruit ( < 0.0001). There was no association with vegetable selection. Milk selection decreased by 24.7% ( < 0.0001) when chocolate milk was removed. Consumption: The HHFKA was associated with increased entrée consumption (15.6% increase; < 0.0001) and vegetable consumption (16.2% increase; < 0.0001). Milk consumption decreased by 10% when chocolate milk was removed ( < 0.0001). There was no impact on fruit consumption.	Low
Cullen et al. 2015B [ ]	TX; 8 elementary schools (1045 trays from students in grades	QE: Pre/post (no comparison group)	Spring 2011 & Spring 2013	Policy: HHFKA	Visual estimation	Selection: After implementing the HHFKA, a significantly greater proportion of students selected fruit (17.8% percentage point increase); < 0.001) and whole grains (67.4% percentage point increase; < 0.001). There was no association with overall vegetable selection. Consumption: The HHFKA was associated with a decrease in milk consumption (61.1% vs. 78.8% consumed; < 0.01). There was no association with total fruit, total vegetable, or whole grain consumption among those who selected the meal component.	Low
Ishdorj et al. 2015 [ ]	Texas; 3 elementary schools (students in grades K-5)	QE: Pre/post (no comparison group)	Spring 2012 and Fall 2012	Policy: HHFKA	Aggregate plate waste	Selection: Not measured Consumption: The HHFKA was not associated with differences in consumption of entrées or vegetables.	Very High
Schwartz et al. 2015 [ ]	N.S.; 12 middle schools (students in grades 5–7)	QE: Pre/post (no comparison group)	2012, 2013, and 2014	Policy: HHFKA	Weighed plate waste	Selection: The HHFKA was associated with a significant increase in fruit selection. Consumption: The HHFKA was associated with an increase in vegetable and entrée consumption. There was no association with fruit or milk consumption.	Low
Access to Competitive Foods
Cullen et al. 2000 [ ]	TX; 4 elementary schools and 1 middle school (594 students in grade 4–5)	Cross-sectional	1998–1999	Policy: Access to competitive foods	Lunch food records (student self-report)	Selection: Not measured Consumption: Compared with students who had access to competitive foods, students who did not have access consumed significantly more fruits (0.24 vs. 0.11 servings; < 0.001) and vegetables (0.54 vs. 0.47 servings; < 0.05).	High
Cullen et al. 2004 [ ]	TX; 4 elementary schools and 1 middle school (594 students in grade 4–5)	QE: Pre/post (with comparison group)	1998–99 to 1999–2000	Policy: Access to competitive foods	Lunch food records (student self-report)	Selection: Not measured Consumption: When students gained access to competitive foods, they consumed on average significantly fewer servings of fruits, vegetables (excluding high-fat vegetables), and milk.	High
Cullen et al. 2006 [ ]	Harris County, TX; 3 middle schools (7473 food diaries from students in grades 6–8)	QE: Pre/post (no comparison group)	2001–02 to 2002–03	Policy: Local competitive food policy that included the removal of vending machines from inside cafeteria (moved to hallways near the cafeteria by the gyms) and removal of chips, desserts, and SSBs from snack bars (but still available in vending machines)	Lunch food records (student self-report)	Selection: Not measured Consumption: The policy was associated with a significant increase in milk consumption, and a significant decrease in SSB and vegetable consumption. Compensation was observed between a decrease in a la carte sales from the snack bars and an increase from the vending machines (in their new locations).	High
Cullen et al. 2008 [ ]	TX; 3 middle schools (18,178 food diaries from students in grades 6–8)	QE: Pre/post (no comparison group)	2001–02, 2002–03, and 2005–06	Policy: State competitive food policy that restricted the portion size of snacks and SSBs; limited the total fat content of snacks; and limited the frequency of serving high-fat vegetables (i.e., French fries) to ≤3 times per week	Lunch food records (student self-report)	Selection: Not measured Consumption: The policy was associated with greater school meal consumption of vegetables and milk. It was also associated with a decrease in competitive foods (i.e., SSB and snack chips).	High
Ishdorj et al. 2013 [ ]	Nationally representative sample (SNDA-III); 256 schools (2096 students)	Cross-sectional	2004–05	: Availability of nutrition education lessons for every grade in the school : restrictions on competitive foods (e.g., limited à la carte sales, no stores or snack bars selling competitive foods, and fundraisers), French fries, dessert, and whole/ 2% milk; and increases in the amount of fresh F/V available daily at lunch	24 h recall	Selection: Not measured Consumption: Policies that place restrictions on the sales of competitive foods were associated with greater fruit consumption. Policies that restrict desserts were associated with greater vegetable consumption. Policies that limited French fries were associated with lower fruit consumption. Limiting whole and 2% milk was associated with greater fruit and vegetable consumption. Nutrition education and policies that increase the amount of fresh fruit and vegetable available daily at lunch policies were not associated with consumption of fruits or vegetables.	High
Marlette et al. 2005 [ ]	Frankfort, KY; 3 middle schools (743 students in grade 6)	Cross-sectional	2002	Policy: Competitive Foods. When competitive foods are available, the impact of purchasing snacks on meal consumption was assessed	Weighed plate waste	Selection: Not measured Consumption: Students who purchased competitive foods consumed on average significantly less fruits, grains, meats, and mixed dished from their school lunch compared with students with only a school lunch.	Low
Other Local Policies
Canterberry et al. 2017 [ ]	New Orleans, LA; 7 elementary schools with 3 food service providers (18,070 trays from students in grades 4 and 5)	QE: Post-only (with comparison group)	2014	Policy: A local policy exceeded the HHFKA and included more fresh, less processed ingredients including: fresh/frozen F/V; more whole grains; no mechanically separated meat or animal by-products; no processed cheese with additives/fillers; and no deep-fried foods	Weighed plate waste	Selection: Not measured Consumption: On average, there were lower school meal consumption rates among the intervention schools, although this was primarily driven by low consumption rates with one of the food service providers. With another food service provider, there were no significant differences in consumption between the intervention schools and control schools.	Low
Cohen et al. 2012 [ ]	Boston, MA; 4 middle schools (3049 students in grades 3–8)	QE: Post-only (with comparison group)	2009	: A professional chef trained cafeteria staff to prepare healthier school lunches : Chocolate milk was removed	Weighed plate waste	Selection: The intervention was associated with a 51% increase in whole grain selection ( = 0.02). Consumption: Students in the intervention schools, consumed 0.36 more servings of vegetables per day ( = 0.01) compared with students in control schools. There was no impact on milk, fruit, or whole grain consumption.	Low
Cohen et al. 2014 [ ]	MA; 4 elementary/K-8 schools (1030 students in grades 3–8)	QE: Pre/post (no comparison group)	Fall 2011 and Fall 2012	Policy: HHFKA + removal of chocolate milk	Weighed plate waste	Selection: The HHFKA was associated with a 23% increase in the percent of students selecting a fruit ( < 0.0001). There was no association with vegetable selection. Milk selection decreased by 24.7% ( < 0.0001) when chocolate milk was removed. Consumption: The HHFKA was associated with increased entrée consumption (15.6% increase; < 0.0001) and vegetable consumption (16.2% increase; < 0.0001). Milk consumption decreased by 10% when chocolate milk was removed ( < 0.0001). There was no impact on fruit consumption.	Low
Farris et al. 2019 [ ]	VA; 7 elementary schools (1813 breakfasts from students in grades PK-5)	QE: Pre/post (no comparison group)	2014–15	Policy: Breakfast in the classroom	Visual estimation	Selection: Not measured Consumption: Breakfast in the classroom was associated with decreased overall food waste (43.0% to 38.5%), including decreases for entrée items, juice, and savory snack foods ( < 0.01).	High
Hanks et al. 2014 [ ]	OR + Midwest and Eastern Regions: 25 elementary schools (students in grades K-5)	QE: Post-only (with comparison group)	2010–11 to 2011–12	Policy: Removal of chocolate milk	Aggregate waste and Visual estimation	Selection: When chocolate milk was removed, 90.1% of sales were replaced with white milk. Consumption: Milk waste was higher in schools that did not have chocolate milk compared with schools that did have chocolate milk.	High
Schwartz et al. 2018 [ ]	New England region; 2 K-8 schools (13,883 trays from students in grades K-8)	QE: Pre/post (no comparison group) and Post-only (no comparison group) * *For Policy only	2010–11 to 2012–13	: Removal of chocolate milk : Availability of juice	Weighed plate waste	Selection: Significantly fewer students selected milk when juice was available. There was approximately a 20 percentage point increase in milk selection in the second year of the policy compared with the in the first year. Consumption: Among students who selected milk, milk consumption was lower in the second year of the policy compared with in the first year. On days when juice was offered, students consumed significantly less milk (at both time points).	High
Young et al. 2013 [ ]	N.S.; 1 middle school (3810 trays from students in grades 6–8)	Cross-Sectional	2011–12	Policy: A new wellness policy required schools to implement the practices below: : Different fruits and vegetables were served each day of the week : There was an increase in student contact hours for health and physical education	Visual estimation	Selection: Not measured Consumption: After exposure to the wellness policy for over a semester, students consumed significantly more fruits and cooked vegetables.	High

F/V: fruits and vegetables; QE: Quasi-Experimental; RCT: Randomized controlled trial. 1 Study designs were defined as: (1 ) Cross-sectional - Observational study with the exposure and outcome measured simultaneously (no comparison group); (2) Quasi-Experimental (QE): Post Only —Intervention study with a comparison group and data collected post-implementation (no baseline measurements); (3) Quasi-Experimental (QE): Pre/Post— Intervention studies with pre-implementation (i.e., baseline) and post-implementation measurements, with or without a comparison group (non-random allocation of intervention/comparison groups); (4) Randomized Controlled Trial (RCT)— Intervention study with random allocation to intervention or control status and both pre-implementation (baseline) and post-implementation measurements. 2 Risk of Bias was based on adapted Newcastle–Ottawa Scales (NOS) for cross-sectional and cohort studies ( Supplementary Materials Table S1 ).

Cohen and colleagues measured consumption using weighed plate waste in four elementary and K-8 schools in Massachusetts and found a 15.6% increase in entrée consumption ( p < 0.0001) and a 16.2% increase in vegetable intake ( p < 0.0001) [ 24 ]. Additionally, significantly more students selected fruit, resulting in more students consuming this meal component. Consistent results were found by Schwartz et al. in 12 middle schools using the same measure of consumption; entrée consumption increased from 71% to 84% ( p < 0.05) and vegetable consumption increased by roughly 20% ( p < 0.05) [ 25 ]. Greater fruit selection was also observed in this study. Ishdorj and colleagues examined consumption using aggregate plate waste in three Texas elementary schools, and found no impact on consumption [ 98 ]. Similarly, Bontranger Yoder et al. found no association with school meal intake using digital imagery in 11 elementary schools in Wisconsin [ 78 ]. Cullen et al. found no association with fruit, vegetable, or entrée consumption, and a decrease in milk consumption using visual estimation after implementation of the HHFKA, although they observed significant increases in the selection of fruits, vegetables, legumes, and protein foods [ 26 ]. Contrasting with the results of the other studies, Amin et al. found a small decrease in fruit and vegetable consumption by roughly 0.05 cups ( p < 0.01) in two elementary schools (using both digital imagery and weighed plate waste) after the HHFKA went into effect, although increases in fruit selection were observed [ 124 ].

3.3.2. Local and State Policies: Access to Competitive Foods

Six studies examined the impact of limiting student access to competitive foods (either via state or local policies or based on student purchases) and nearly all (5 of 6) found that consumption of school meals was inversely associated with access to competitive foods. Only one study had a low risk of bias and found that students consumed more of their healthier school meals when access to competitive foods was limited.

Cullen and colleagues examined Texas elementary schools without access to competitive foods and a middle school where students could purchase snacks/beverages and observed that the elementary students without access to competitive foods consumed significantly more fruits and vegetables than the middle school students based on self-reported measures of intake [ 125 ]. Additionally, they found greater selection of fruit, vegetables, and milk when students did not have access to competitive foods or beverages. Similarly, Cullen and colleagues examined the transition from elementary school to middle school and found that students consumed significantly fewer fruits and vegetables and less milk when they entered middle school and had new access to competitive foods [ 126 ]. Marlette et al. used weighed plate waste in three Kentucky middle schools and found similar decreases in school meal consumption when students purchased competitive foods [ 127 ]. Using a nationally representative sample with 24-hour recall data, Ishdorj et al. found that students attending schools with policies that placed restrictions on the sale of competitive foods and desserts reported greater vegetable consumption. They also found that when policies were in place limiting access to higher fat milk (whole or 2%), students reported increases in both fruit and vegetable consumption. In contrast, students reported reduced fruit intake when there were policies limiting French fries [ 110 ]. When Cullen and associates used lunch food records to examine a Texas state policy that strengthened the standards for competitive foods, they found that students in three middle schools reported greater vegetable and milk consumption [ 128 ]. Of note, when a local policy in Texas only limited access to vending machines in the cafeteria (but vending machines with competitive foods were available in other parts of the school), Cullen et al. observed that students in three middle schools compensated by increasing their competitive food purchases from the other vending machines. Students also increased their milk consumption but decreased their vegetable consumption [ 129 ].

3.3.3. Other Local Policies

Limiting flavored milk is a policy that has been addressed in some locations. Four studies have examined the impact of local policies limiting access to chocolate milk, and among the two studies with a low risk of bias, one found increases in waste and one found no impact. Among the three studies examining other local policies, two studies with a high risk of bias found an increase in consumption and one study with a low risk of bias had mixed findings.

Cohen and colleagues examined weighed plate waste in four elementary/K-8 schools in Massachusetts where access to chocolate milk was limited and found a 10% decline in unflavored milk consumption within the first year of implementation (as well as reduced selection of milk) [ 24 ]. Greater unflavored milk waste was also observed by Hanks et al. using visual estimation in 25 elementary schools after chocolate milk was removed [ 130 ]. Among the studies with longer exposure to the policy (i.e., two years), Cohen et al. found that students adjusted to the policy and there was no adverse impact on average milk intakes (nor selection) in four Boston middle schools using weighed plate waste [ 56 ]. While Schwartz et al. found that individual-level consumption of milk was lower using weighed plate waste in two K-8 schools after two years of exposure to a policy that removed chocolate milk, importantly this study found that school-wide per-student consumption significantly increased from 2.1oz to 2.5oz due to the large increases in selection (from 51.5% to 72%) [ 131 ]. Interestingly, this study also found that milk consumption was adversely impacted by offering juice on the lunch menu.

Another practice included in local policies is serving breakfast in the classroom. Farris et al. examined breakfast in the classroom within seven elementary schools in Virginia and found that the policy was associated with decreases in food waste from 43% to 38.5% of overall meals discarded [ 132 ]. Another study mentioned earlier assessed the impact of a wellness policy that included provisions for more fruit and vegetable choices, as well as an increase in contact hours for health and physical education. This was associated with increases in fruit and vegetable consumption [ 47 ]. Lastly, a study conducted by Canterberry and associates in seven elementary schools in New Orleans assessed a local policy that required an increase in fresh and less-processed ingredients, as well as a restriction on deep-fried foods. There were three food service providers and the findings were mixed: some lower intakes were observed in the schools with one of the food service providers, but there were no associations with consumption in the schools with the two other food service providers [ 133 ].

4. Discussion

To our knowledge, this is the first systematic review of the literature that comprehensively examined initiatives, interventions, and policies associated with school meal consumption. The factors were at the school meal level (choices, food preparation, and taste tests); the cafeteria environment level (choice architecture, nutrition education, school lunch duration, and recess before lunch); and the policy level (local, state, and federal policies). The findings suggest that several practices are consistently associated with improved meal consumption. These include: (1) offering students choices within each meal component (particularly fruits and vegetables); (2) enhancing the palatability/cultural appropriateness of meals; (3) pre-slicing fruit; (4) incentivizing students to taste fruits and vegetables with rewards; (5) providing more time to eat lunch with longer lunch periods; (6) implementing recess before lunch; and (7) limiting access to competitive foods.

Many of these strategies can be implemented with minimal costs and/or additional labor. First, providing students with 30-min lunch periods can help to ensure that students have enough time to eat after accounting for time spent getting to the cafeteria and waiting in the lunch line. While some schools may be apprehensive to replace academic time with longer lunch durations, in prior research, teachers have reported that students are more attentive in class (and thus more efficient learners) with this policy and that this time in the cafeteria can be valuable for social and emotional learning [ 134 ]. Another concern that has been raised regarding longer lunch periods is disruptive student behavior in the cafeteria if they finish their meals quickly; however, implementing recess before lunch has been found to create a calmer lunchroom environment, suggesting that combining these two strategies would be beneficial for consumption and student behavior [ 134 ].

Offering more fruit and vegetable choices (especially with pre-sliced fruits such as apples and oranges) was also found to be an effective method to increase consumption. Cost-effective strategies to increase the amount and variety of fruit available in schools include using USDA commodity foods; integrating foods from school gardens; and procuring locally grown produce. The USDA Department of Defense Fresh Fruit and Vegetable Program also provides fresh produce for schools. Restricting access to competitive foods can also be implemented in a cost-neutral manner; prior research has documented that when students have limited access to competitive foods, they instead participate more in the NSLP [ 135 ]. These increases in school meal sales have been found to offset revenue losses from the decreased sales of snacks and beverages [ 135 ]. While chef-based initiatives to enhance the palatability and cultural appropriateness of meals can be expensive, partnering with volunteer chefs from local restaurants can be a cost-effective solution. Additionally, schools can hire a chef when an existing cafeteria staff member retires, thus enabling this to be a more affordable strategy. Lastly, various free resources are available to schools through the USDA, state departments of educations, and non-profit organizations such as those that provide recipes and culinary workshops.

The findings from this review also highlight some strategies with mixed empirical support. Nutrition education was found to have mixed results when examining its impact on consumption in the cafeteria. This may have occurred due to several reasons. First, the nutrition education curricula across the studies varied in intensity, dose, and content. It is possible that greater time is necessary to dedicate to nutrition education, as well as more staff development and training to have improved effectiveness [ 136 ]. Second, it is possible that nutrition education is necessary but not sufficient on its own to reliably influence consumption, especially if there are other obstacles, such as insufficient time to eat. Although it may be possible to improve student intake in the short term without incorporating nutrition education, understanding how our food choices affect our health should still be considered an integral component of the Whole School, Whole Child, Whole Community model and may have several other benefits outside of the lunchroom and over the long term as students become more independent and make their own food choices [ 136 , 137 ].

The Smarter Lunchroom movement has gained traction in the United States with over 29,000 schools implementing these techniques to nudge students towards the healthier options available. Somewhat surprisingly, the results of this systematic review found that some of the commonly cited Smarter Lunchroom techniques had little to no impact on school meal intake [ 89 ]. One exception was when students were rewarded with small prizes such as stickers, classroom parties, or t-shirts for eating school meal components. While there may be additional concerns that providing rewards for a preferred behavior may potentially decrease the motivation and/or create negative associations with performing that activity, parenting research more broadly has found inconsistent results [ 138 ]. However, this strategy may be burdensome and expensive to implement and maintain. Additionally, the results were mixed when examining the sustained impact on consumption after the interventions concluded. Importantly, the more traditional techniques (e.g., attractive bowls, verbal prompts, creative names, etc.) have generally been found to be effective at improving the selection of certain meal components, especially fruits and vegetables, in prior systematic reviews [ 29 , 30 , 31 , 32 ]. Therefore, schools should not abandon these practices, but also not rely only on these approaches to improve students’ school meal intakes. Future studies should examine the combined effect of choice architecture techniques with other potentially successful strategies, such as longer lunch periods, recess before lunch, enhanced palatability/cultural appropriateness of meals, and limited access to competitive foods.

This study has several limitations. First, many studies had a high or very high risk of bias based on NOS scores. Conducting studies with sufficiently large sample sizes, longer periods of observation, obtaining informed consent from students for repeated data collection, and using validated dietary assessment methods can be expensive, highlighting the need for additional resources and grant funding for researchers. It is also noteworthy that when examining the studies with a low risk of bias, the conclusions did not change. Second, publication bias may have been an issue; however, a substantial number of studies examined found no significant associations with school meal intake. Third, the measures of school meal consumption varied between the studies, and some methods may not have been sensitive enough to detect the levels of change often observed in school-based interventions. However, multiple strategies were still found to improve intakes using the various measures. Additionally, while many studies of breakfast in the classroom have been conducted, most were excluded as they were evaluating universal school meals and not the independent impact of breakfast in the classroom. Therefore, future studies should examine this policy to determine whether it has additional benefits beyond universal free breakfast in the cafeteria. Lastly, the studies included in this systematic review were conducted only in the United States. While the findings are likely generalizable to other economically developed countries with strong nutrition standards, future studies should examine these strategies in other locations. A strength of this systematic review was the large number of studies evaluated. In addition, this review began with the conceptual framework outlined in Figure 1 and had strict consumption measurement criteria (described in Table 1 ).

5. Conclusions

Overall, this review suggests that many strategies have the potential to improve school meal consumption. The majority of studies in the current review found improvements in school meal intake when students were provided with multiple choices on the lunch line; pre-sliced fruits; recipes that focused on improving the palatability and cultural appropriateness of the foods offered; longer lunch period; recess before lunch; limiting access to competitive foods; and providing incentives for students to taste the fruits and vegetables offered at lunch. However, commonly used Smarter Lunchroom techniques were not found to be an effective strategy to increase intake of school lunch. While findings were mixed regarding nutrition education’s impact on meal consumption, research has found other benefits of nutrition education to students. Further research is needed regarding school wellness policies and other district-level policies, including limited access to chocolate milk. Importantly, the results suggest that weakening the HHFKA would not be an effective strategy to reduce school meal waste. Instead, school districts and policy makers should consider the multiple strategies found to improve school meal consumption.

Acknowledgments

The authors would like to thank the Healthy Eating Research staff at Duke University for their support.

Supplementary Materials

The following are available online at www.mdpi.com/article/10.3390/nu13103520/s1 , Table S1: Quality Assessment for Cross-Sectional, Cohort, and Quasi-experimental Studies based on the Newcastle Ottawa Quality Assessment Form.

Author Contributions

Conceptualization, J.F.W.C. and M.B.S.; Methodology, J.F.W.C., M.B.S., A.A.H., E.R.H., K.B., and L.T.; Data Curation, J.F.W.C., A.A.H., K.B.; Writing—Original Draft Preparation, J.F.W.C.; Writing—Review and Editing, J.F.W.C., M.B.S., A.A.H., E.R.H., K.B., and L.T. All authors have read and agreed to the published version of the manuscript.

This paper was supported by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Getting a Better School Lunch

By working with schools, parents can make their kids’ cafeteria lunches healthier and more planet-friendly.

Students sit at long tables in a school cafeteria

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Picture a school cafeteria lunch. What comes to mind? Pizza, Tater Tots, chicken nuggets? The quality of school food has improved in the last 20 years—thanks in large part to 2010’s Healthy Hunger-Free Kids Act , which mandates that schools serve a fruit and vegetable every day, increase the number of whole-grain foods, and limit trans fats and sodium. Of course, there’s still work to be done. “Many schools are still hard at work increasing fruits and veggies and phasing out more processed foods,” says Margaret Brown , an NRDC staff attorney who spearheads NRDC’s regional food efforts and is working closely with the Urban School Food Alliance, a nonprofit coalition of six of the largest school districts in the United States.

And the potential health impact of improving school meals is enormous. Some 32 million kids eat school meals every day, and for many low-income students, those meals supply more than half their daily calories. And the waste created by all-too-common polystyrene trays is adding to the already-astronomical pollution in our waterways.

It’s great to get excited about making change in your child’s school, but before you march into the principal’s office or a PTA meeting, do your homework. “Talk to the administrators who are involved in food-related decision-making—often the school food director—and ask how the process works and what they’re up against,” Brown says. With an average of $1.30 to spend per child, most public schools face significant challenges. So build relationships first. Then ask, How can I help? “Most schools want to make healthy changes and would welcome parents’ assistance,” Brown says. Here’s where to start.

Strive for a salad bar.

“Getting kids to eat more vegetables and fruits is something we can all get behind,” Brown says. “Salad bars are usually a huge hit because kids like to choose what they eat,” (To reduce waste, suggest posting a sign saying ‘Take What You Want, But Eat What You Take.’) Because the equipment for a salad bar can cost $3,000 or more, you may need to get creative on funding. “I did a lot of grant writing and talked to any business owner who would listen. A lot of them donated funds,” says Jessica Shelly, food services director for Cincinnati Public Schools, which installed salad bars in every one of its schools in less than a year. Let’s Move Salad Bars to Schools, an alliance among chef Ann Cooper and produce associations and grocers whose goal is to have a salad bar in every school in the country, offers additional suggestions .

Children are served vegetables in a school cafeteria

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Check out new vendors.

To improve the quality of cafeteria food in general, visit Focus on the Plate , which lists 50 healthy food products, like poultry free of unnecessary antibiotics and vegetarian burritos as well as the suppliers that offer them. “More and more companies are offering healthier options,” says Kathy Lawrence, cofounder of Focus on the Plate’s parent organization, School Food Focus , which links school districts with healthy food producers and suppliers. “Parents can make a big impact by researching local or regional proprietors who are willing to work within the school’s budget.” Or encourage your school to offer one plant-based entrée every day by sharing recipes and testing them with the staff, suggests Amie Hamlin, executive director of the New York Coalition for Healthy School Food, which has 13 plant-based, kid-approved recipes of its own.

Get fresh and (really) local.

Building a garden has significant upfront costs—as much as $40,000—but a surprising number of companies have made a practice of contributing funding to schools willing to take on the challenge, including Whole Foods and Lowe’s, says Lisa Ely, a mother and TV producer in Valencia, California, who consults with schools on how to build gardens. “I’ve found that the best way to sell schools on the idea is to help them see it as a learning tool for kids, as well as a potential resource for the cafeteria,” she says. “You can get PTAs interested by telling them about research showing that kids who spend 20 minutes outside are better able to focus.” Also, she says, when kids plant and harvest the produce themselves, they’re more likely to eat it.

Lengthen lunchtime.

Fitting lunch into the school day can be a struggle for many schools—kids may get only 20 minutes for lunch or eat as early as 10:45 a.m. “It’s hard to get kids excited about eating their fruits and vegetables when they aren’t hungry yet or simply don’t have the time,” says Brown. One way to ensure that kids are hungry when they hit the cafeteria: Ask your school district to schedule recess before lunch, Lawrence suggests. ( Peaceful Playgrounds offers helpful guidance.) In 2014, researchers at Cornell University found that students who had recess first ate 54 percent more fruits and vegetables compared with those who had lunch first. If your school has 20 minutes or fewer for lunch, convince the principal, school board, and other parents that it should be extended by at least 10 minutes; studies also show that kids eat more—and healthier—food when they have more time.

Slash waste.

The first step is a messy one: Sort the cafeteria’s garbage and do a waste audit, so you know what’s being thrown away, suggests Debby Lee Cohen, founder of Cafeteria Culture , an organization aiming to achieve zero-waste school cafeterias. What you’re likely to find: lots of polystyrene trays. “There are 30 million or so daily meals served in U.S. schools—many of those trays end up contributing to the 270 million metric tons of plastic floating in our oceans,” Cohen says. Replacing trays with reusable dishes is the ideal solution, but Cohen points out that many schools no longer have dishwashers. Push for compostable paper food boats (imagine what ballpark hot dogs are served in), even for just one day a week. “When we started Trayless Tuesdays in New York City, we reduced the waste by 20 percent,” she says. "Paper boats cost 3 to 4 cents a piece, about the same as polystyrene." Compostable trays that look more like regular lunch trays are about twice as expensive, so you may need to fund-raise to pay for it, or band together with other districts to lower the price by increasing your purchasing power. The success of Trayless Tuesdays in 2010 led the city to completely eliminate polystyrene foam from schools and other restaurants citywide in 2015. And with NRDC’s assistance, all of the Urban School Food Alliance cities have also committed to ditching polystyrene trays for compostable plates . (For ideas and inspiration, check out Cafeteria Culture’s Sort2Save program.)

An infographic shows the benefits of eco-friendly plates

Focus on flavor.

Back to that garbage audit. You’ll also likely find lots of uneaten food. And this raises an important point: Serving healthy meals is only half the battle. It needs to taste good, too. Revamping the menu with input from a talented local chef can significantly increase students’ consumption of fruits and vegetables, according to 2015 research at Harvard T.H. Chan School of Public Health. Wellness in the Schools has chefs that will come to schools in New York, New Jersey, Florida, and California and teach the existing kitchen staff how to create nutritious fare that kids will gobble up.

This NRDC.org story is available for online republication by news media outlets or nonprofits under these conditions: The writer(s) must be credited with a byline; you must note prominently that the story was originally published by NRDC.org and link to the original; the story cannot be edited (beyond simple things such as grammar); you can’t resell the story in any form or grant republishing rights to other outlets; you can’t republish our material wholesale or automatically—you need to select stories individually; you can’t republish the photos or graphics on our site without specific permission; you should drop us a note to let us know when you’ve used one of our stories.

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Eating Healthier at School

Elementary school girls eating healthy meal in cafeteria lunchroom.

Kids can practice better eating habits when schools provide healthy foods. Learn what schools can do to promote the nutritious foods that are served.

Educate Families About School Meal Programs

Schools play an important role in shaping lifelong healthy eating habits by offering nutritious meals through federal child nutrition programs . School meals include milk, fruit, vegetables, and whole grains, and they provide key nutrients like calcium and fiber. Schools can communicate with families about participation in school meal programs and let them know some students are eligible to receive free or reduced-price meals.

Encourage Students to Start Their Day With School Breakfast

Healthy students are better learners. Research shows that eating habits [PDF – 480 KB] and healthy behaviors are connected to academic achievement. Student participation in the School Breakfast Program is associated with better grades and standardized test scores, reduced absences, and improved memory. Some schools provide breakfast in the classroom or during a morning break to ensure that all students can have a nutritious breakfast at school.

Give Students Enough Time to Eat School Meals

Whether school meals are served in the cafeteria or classrooms, it’s important for students to have enough time to eat, connect with peers , and enjoy their meal. Schools should ensure that students have at least 10 minutes once they are seated (seat time) for breakfast and at least 20 minutes for lunch . Having enough seat time is linked to more consumption of fruit, vegetables, lunch entrées, and milk, and less waste. 1-3

Promote Healthy Eating Throughout the School Day

Schools can use the Whole School, Whole Community, Whole Child (WSCC) approach to promote federal school meal programs and nutritious snacks outside of school meal programs. Parents can take part in promoting healthy eating in school by asking that healthy foods and beverages are available at school events, celebrations, and fundraisers. CDC’s Parents for Healthy Schools offers more ideas on how to get involved and advocate for your child’s health and well-being.

Elementary age students are working in school garden with teacher, planting vegetables and learning about plant life.

Make Nutrition Education Part of Instruction

Nutrition education empowers children with knowledge and skills to make healthy food and beverage choices. Nutrition education is part of a well-rounded health education curriculum but can also be included in other classes. For example, students could:

Count with pictures of fruits and vegetables.
Learn fractions by measuring ingredients for a recipe.
Grow vegetables at school.
Learn about cultural food traditions.

More information

Healthy Eating Learning Opportunities and Nutrition Education
Comprehensive Framework for Addressing the School Nutrition Environment and Services [PDF – 2.95 MB]
School Health Guidelines to Promote Healthy Eating and Physical Activity [PDF – 973 KB]
CDC Research Brief: Making Time for School Lunch [PDF – 313 KB]
CDC Research Brief: Opportunities for Nutrition Education in School [PDF – 2.1 MB]
Bergman EA, Buergel NS, Englund TF, Femrite A. The relationship between the length of the lunch period and nutrient consumption in the elementary school lunch setting . J Child Nutr Manage. 2004;28(2):1–11.
Cohen JFW, Jahn JL, Richardson S, Cluggish SA, Parker E, Rimm EB. Amount of time to eat lunch is associated with children’s selection and consumption of school meal entrée, fruits, vegetables, and milk. J Acad Nutr Diet . 2016;116(1):123–8.
Gosliner W. School-level factors associated with increased fruit and vegetable consumption among students in California middle and high schools. J Sch Health . 2014;84:559–568.

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Public Health

Hunger advocates want free school meals for all kids. it's tough sell in congress.

Bridget Huber

A third-grader punches in her student identification to pay for a meal at Gonzales Community School in Santa Fe, N.M. During the pandemic, schools were able to offer free school meals to all children regardless of need. Now advocates want to make that policy permanent. Morgan Lee/AP hide caption

When the government made school meals temporarily free to virtually all public school students in 2020, the intent was to buffer children and families from the spike in hunger and economic hardship caused by the pandemic. It also inadvertently turned out to be a pilot project for something anti-hunger groups had been pushing for years: making school food free, permanently, for all public school students, regardless of income.

Once free meals were in place, albeit temporarily, many advocates thought that they would at least remain that way for the rest of the pandemic—if not longer. That didn't turn out to be the case; this spring, Republicans blocked an extension of the waivers that allowed schools to serve free meals to all, which made the prospect of legislation establishing universal school meals remote.

Shots - Health News

The u.s. diet is deadly. here are 7 ideas to get americans eating healthier.

This fall, schools are once again charging for lunch and breakfast, and people who run school food programs are back to the familiar scramble to get students signed up for free and reduced-price meals — and to the familiar worry that some kids will feel stigmatized for getting free meals, end up in lunch debt or go hungry.

Those arguing for universal free meals say that it would put an end to that stigma and to administrative hurdles that can prevent parents from signing their kids up.

While advocates say Republican opposition to expanding school feeding programs is daunting, they haven't given up on the idea of making school meals free for all. Instead, they're trying to keep the momentum going by backing state-level efforts that could eventually lay the groundwork for federal action.

States move to free school meals for all kids

This year, California, Maine, Vermont, Massachusetts and Nevada will offer free meals to all public school students, regardless of their family's income. Connecticut has also funded free meals for part of this year, and Colorado voters will decide in November whether to make school meals free to all. Universal meals legislation has been introduced in a number of other states, including Minnesota, Wisconsin, New York, Maryland and North Carolina.

A state-by-state approach isn't ideal, says Clarissa Hayes, deputy director of school and out-of-school time programs at the Food Research & Action Center, but it's still an important step — one that never would have happened if the pandemic hadn't hit.

"It really moved the needle," she says. "We are excited to see what's happening in the states, and in most cases, it is a bipartisan effort and there are a lot of partners at the table."

Biden's goal to end hunger by 2030 and his new food conference, explained

But whether action at the state level will translate into more support for federal universal school meals legislation is unclear, says Katie Wilson, the executive director of the Urban School Food Alliance. "You can roll the dice," she says.

While state initiatives could help popularize the idea of universal meals, they could also give federal lawmakers cover to argue that the question of whether to make meals universally free is best left to state legislatures, she says. That would sell kids short, Wilson says, noting that children's access to healthy food should not depend on their zip codes.

No matter how much support universal school meals have at the state level, Republican opposition in Congress is formidable, she says.

"Right now, there is just not the desire to do universal school meals at a national level from one side of the aisle," she says. "So how do you change that? We don't know. We've been trying for decades."

Federal lawmakers will likely hear from constituents upset that kids' access to school meals has been curtailed at a time when so many families continue to struggle with food insecurity, and high food and fuel prices, says Diane Pratt-Heavner, director of media relations at the School Nutrition Association.

But she says that passing universal meals legislation , of the sort that Sen. Bernie Sanders, Rep. Ilhan Omar and other Democrats have introduced in recent years, is going to be "an uphill climb."

Another workaround to help hungry kids

Pratt-Heavner and other advocates point to an upcoming opportunity to increase kids' access to free school meals in a less sweeping, but still significant way — the child nutrition reauthorization process. Every five years, Congress is required to reauthorize school feeding programs, and it's a critical chance to strengthen them, advocates say.

Congress is overdue to reauthorize the program, but there was finally some movement in July when House Committee on Education and Labor Chairman Bobby Scott, a Virginia Democrat, introduced a childhood nutrition reauthorization bill that was praised by anti-hunger advocates.

Millions of children will miss healthy school meals when pandemic relief expires

The bill, if enacted as written, would alter the rules governing the Community Eligibility Provision. In its current form, the provision allows schools where at least 40% of students are "directly certified" — that is, enrolled in federal safety net programs like SNAP or TANF or are in the foster care system — to offer free meals to all students at the school, regardless of need.

In the 2021-22 school year, 33,300 schools serving 16.2 million children used the provision, according to a USDA spokesperson — that's nearly a third of the nation's 49.5 million public school students.

But advocates say that the program isn't reaching as far as it could. That's because under the current rules, schools that have between 40% and 62.5% of their students directly certified still have to pay for a portion of the meals they serve, which not all schools or districts can afford or want to do. It's only when 62.5% or more of the student body is directly certified that the federal government pays the entire amount.

The Scott bill would change reimbursement rates so that schools would only have to have 40% directly certified students to be fully reimbursed for all meals served. And it would allow schools or districts in which 25% of students are directly certified to participate in the program if they were willing to cover a portion of the cost.

Pratt-Heavner says the bill's provisions would help many more schools in high poverty communities offer meals to all students. But she says that it still wouldn't help the economically-stressed families who live in wealthier communities.

"At the end of the day, these meals are important to all students," she says. "And that's why it's important to just offer meals to all students, without an application, just like we offer them textbooks and bus service."

This story was produced by Ag Insider, a publication of the Food & Environment Reporting Network . FERN is an independent, nonprofit news organization, where Bridget Huber is a staff writer.

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What are the benefits of free school meals? Here's what the research says.

Activists say that losing these resources has undermined the progress made toward helping families in need.

What the research says about school-provided meals

What support for free school lunch looks like

And in other areas, like at Broward County Public Schools in South Florida, there are ongoing pilot programs making sure students don’t go hungry.

Why it matters

Experts say that providing free school meals is vital not only from a financial perspective, but from a health standpoint too.

Hodge says a big challenge that remains is that many families who aren’t eligible for income-based assistance still need help obtaining food, including school lunch.

So what does it take to ensure all schoolchildren are fed?

“We do not ‘means’ test for students to have access to [other school resources], nor should we for school meals,” he says.

What can parents do?

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School Education /

Essay on Food for School Students: 100, 200, 300 Words

Updated on
Nov 15, 2023

Did you know the potato was the first fruit planted in zero gravity? Food is both a basic human requirement and the fuel for sustenance. It’s critical that kids and the younger generation recognize the significance of food in our lives. Acknowledging its significance will not only aid in appreciating its worth but also help in decreasing food waste. In order to help schoolchildren comprehend the value of food and develop healthy eating habits for a quality life, in this blog we will be providing an essay on food in 100, 200, and 300 words. Continue reading to know more.

Essay on Food in 100 Words

Food is a necessary nourishment for every living being to survive. Every living creature needs food in addition to clothing and shelter in order to exist. It provides us with energy and makes our bodies capable of functioning properly. To ensure that our body gets all the vital nutrients it needs to function properly, we must eat a variety of foods.

Living cells require a balance of all nutrients, including minerals, fiber, vitamins, proteins, and fats, in order to be healthy and fit. This implies that in order to sustain health and vitality, a variety of foods in the proper proportions must be consumed. Consuming a variety of foods boosts our immune system and helps us fight against a range of diseases because each type of food has a special nutritional value.

Also Read: 10 Unique World Food Day Activities

Essay on Food in 200 Words

When we observe those who lack access to wholesome food, the significance of food becomes easy to understand. A distinct demographic of impoverished individuals does not have access to two meals a day and doesn’t think about the option of enhancing their meals with additional nutrients. Some people are fortunate enough to have the ability to choose what they eat and can prepare or order anything they choose, but others are not as fortunate and have to settle for whatever is provided to them or whatever they get.

It’s important to recognize that food is necessary for survival. In light of this, we ought to raise awareness and urge people to avoid wasting food.

Food not only provides us with energy, but a varied diet also maintains us healthy and allows our bodies to operate as intended. All of the necessary elements found in food, such as vitamins, minerals, fats, proteins, and carbs, must be present.

With time, choosing reasonable, healthful foods not only reduces our chance of contracting multiple illnesses but also improves our overall well-being and mood. Thus, in order to live an ideal life, we must stay away from junk food and cultivate good eating habits.

Essay on Food in 300 Words

Food is vital to our survival and keeps our bodies in a functioning state. Food becomes a necessary component of our body’s functioning the moment we are born. A balanced diet improves our ability to fend off sickness, boosts our immunity, gives us energy throughout the day, and controls our mood. It further aids in meeting our body’s developmental benchmarks at various growth stages.

Furthermore, food plays a significant role in fostering global cultural experiences and connections with a diverse range of individuals. It’s interesting to note that food has the ability to strengthen bonds between people and reach the heart. A common way that we can show one another how much we care and how connected we are is by sharing our meals together with family and friends. It’s also the easiest method for making wonderful memories.

People who share common food preferences, love to cook, or are curious to try new cuisines often feel connected quickly. It is also frequently the focal point of celebrations of any kind.

It is a representation of the various cuisines around the world. A diverse array of food options is available to fulfill our eating preferences, ranging from basic meals like grains, cereals, fruits, and vegetables, to meat and dairy products.

Unfortunately, food waste is becoming a more pressing worldwide issue. One of the main causes of the major negative effects on the environment and the economy is food waste.

Cereals, fruits, vegetables, dairy, meat, and fish are some of the most common types of food sources.

Italian, Chinese, and Indian cuisines are some of the most popular cuisines in the world.

Junk food does not have essential nutrients that are required for our body to function that is the reason why it is called junk.

Nidhi Mishra

Nidhi Mishra is a seasoned senior content writer with more than eight years of diverse experience in the field of education. Her varied career encompasses work in teaching, training, counselling, developing curriculum, and content creation. Nidhi has a solid background in education and has developed her abilities to meet the diverse needs of students, especially students who want to study abroad. Throughout her career, Nidhi has been an invaluable resource to students with their test-taking efforts, offering thorough career assistance and insightful advice on how to navigate the complexity of the system of education. Her speciality is creating interesting and educational content that is specifically designed to fulfil the needs of students who want to pursue higher education abroad. Together with her wonderful writing skills, Nidhi's love of education has allowed her to produce content that has a lasting impression on readers, educators, and students alike. She is committed to providing high-quality, timely, and insightful content because she believes that education can empower people.

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COMMENTS

Importance Of School Lunches: [Essay Example], 568 words
School lunches are a critical part of a student's daily routine, providing essential nutrition to fuel their learning and development. While the importance of school lunches may seem obvious, the impact of these meals goes far beyond simply satisfying hunger. In this essay, we will explore the significance of school lunches in promoting student ...
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Harding Senior High, a public school in St. Paul, Minn., has long been known as a 90-90-90 school: 90 percent of students are minorities, nearly 90 percent come from poor or struggling families ...
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School foods in the U.S. have come a long way. In 2010 they received a complete makeover when The First Lady Michelle Obama spearheaded a school meals initiative, the Healthy, Hunger-Free Kids Act (HHFKA), which was signed into law in December of that year. The act targeted childhood obesity by funding child nutrition programs and setting new ...
How the quality of school lunch affects students ...
We find that in years when a school contracts with a healthy lunch company, students at the school score better on end-of-year academic tests. On average, student test scores are 0.03 to 0.04 ...
Six Brilliant Student Essays on the Power of Food to Spark Social
Grace Williams, a student at Kirkwood High School in Kirkwood, Missouri, enjoys playing tennis, baking, and spending time with her family. Grace also enjoys her time as a writing editor for her school's yearbook, the Pioneer. In the future, Grace hopes to continue her travels abroad, as well as live near extended family along the sunny ...
School Lunch In America: Why It's Unhealthy & How to Improve It
The National School Lunch Program provides low-cost or free school lunches to 31 million students at more than 100,000 public and private schools per day. Meals must meet nutritional standards based on the Dietary Guidelines for Americans. Participating schools receive approximately $1.30 to spend for each child.
What are the benefits of free school meals? Here's what the research
Every school district and every state has a different process to go through to pass universal school meals, but persistence, collaboration with other vested interests and a vast well of research and data seem to be the most important factors. "It took four years for the Vermont legislature to pass a permanent universal school meals bill.
Why nutritious meals matter in school
The program declined significantly in the 1980s and '90 s, largely as a result of Reagan-era budget cuts. During that time, many children lost their qualifying status for school meals; the nutritional quality of those meals plummeted (as epitomized by the Reagan administration's 1981 decision to classify ketchup as a vegetable), and childhood obesity rates soared ().
Strategies to Improve School Meal Consumption: A Systematic Review
1. Introduction. In the United States, approximately 95% of public and non-profit private elementary, middle, and high schools participate in the school meal programs administered by the United States Department of Agriculture (USDA) [1,2].Both the National School Lunch Program (NSLP) and School Breakfast Program (SBP) provide children and adolescents with healthy, low-cost meals throughout ...
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Lengthen lunchtime. Fitting lunch into the school day can be a struggle for many schools—kids may get only 20 minutes for lunch or eat as early as 10:45 a.m. "It's hard to get kids excited ...
PDF Let Them Eat Lunch: The Impact of Universal Free Meals on Student
schools and districts with the option of applying to implement UFM. 9. UFM eliminates all fees charged to students who participate in the school meals programs, making school lunch and breakfast free to all students regardless of their income. UFM may increase meals participation through two key mechanisms.
Eating Healthier at School
Schools play an important role in shaping lifelong healthy eating habits by offering nutritious meals through federal child nutrition programs. School meals include milk, fruit, vegetables, and whole grains, and they provide key nutrients like calcium and fiber. Schools can communicate with families about participation in school meal programs ...
School meals should remain free for all children
Congress and USDA responded: free school meals for all are now available through June 2022, and the Pandemic-EBT program has provided families affected by school closures with additional ...
Essay about School Lunch
3. This essay sample was donated by a student to help the academic community. Papers provided by EduBirdie writers usually outdo students' samples. Cite this essay. Download. The education system must provide the right tools for students to be able to succeed. The most vital tool is providing free school lunches for students.
To fight hunger, advocates want to make school meals free for all ...
Now advocates want to make that policy permanent. Morgan Lee/AP. When the government made school meals temporarily free to virtually all public school students in 2020, the intent was to buffer ...
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Improved performance at school: A 2021 report from the Brookings Institution analyzed the impact of a program that offered schoolwide free meals and found an improvement in math performance ...
Persuasive Essay on School Lunches
History of school lunches. Bernard Gifford, former Deputy Chancellor of the New York City Public School System, said, "The service of meals to school children was first undertaken in 1853 by the Children's Aid Society of New York, which organized a number of industrial schools for vagrant boys and girls." (Gifford 3).
Essay on Food for School Students: 100, 200, 300 Words
Essay on Food in 300 Words. Food is vital to our survival and keeps our bodies in a functioning state. Food becomes a necessary component of our body's functioning the moment we are born. A balanced diet improves our ability to fend off sickness, boosts our immunity, gives us energy throughout the day, and controls our mood.
Persuasive Essay On Why Should Schools Have Free Lunches
Open Document. Should schools provide free lunches is the question being asked quite frequently. Over 60 percent of students eat Hot lunch, 30 percent of students´ eat a cold lunch and 10 percent of students don't even eat any kind of lunch at all. For the student that do eat hot lunch 80 percent of student are accepted for a deducted priced ...
Figures at a glance
29.4 million refugees under UNHCR's mandate. 5.9 million Palestine refugees under UNRWA's mandate. Low- and middle-income countries hosted 76 per cent of the world's refugees and other people in need of international protection. 14 June 2023 Disclaimer: figures do not add up to 100 per cent due to rounding.

Importance of School Lunches

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Why School Lunches in America Are Unhealthy and 10 Ways You Can Take Action to Improve Them

The State of School Lunches In America

But School Lunches Can Improve

Why Are School Lunches in America Unhealthy?

The USDA Foods Program

The School Milk Program

Unhealthy School Vendors

Why the Quality of School Lunches Matters for Students

1) Better Learning and Memory

2) Improved Concentration

3) Better Overall Health

4) Better Behavior and Fewer Problems

5) Better Academic Performance

6) Reducing Obesity

7) Better Habits for the Future

Federal Changes to Make American School Lunches Healthier

Problems Faced by School Lunch Programs

10 Ways You Can Help Improve School Food

Show your support for healthy school lunches in your community .

Be an advocate for healthier food in your school district .

Start a farm-to-school program .

Get a school garden in a school .

Start Meatless Mondays in a school.

Advocate for more plant-based options .

Help increase nutrition education in a school .

Advocate for lunchtimes that are long enough for students to get to eat.

Contact elected officials.

Students can take action, too .

What If School Lunches Around the World Encouraged Healthy Eating Behaviors?

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10 revolutionary ways school lunch is improving (plus, healthy school lunch ideas)

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Food Science & Human Nutrition

What are the benefits of free school meals? Here's what the research says.

What the research says about school-provided meals

What support for free school lunch looks like

Why it matters

So what does it take to ensure all schoolchildren are fed?

What can parents do?

Strategies to Improve School Meal Consumption: A Systematic Review

Amelie A. Hecht

Erin R. Hager

Lindsey Turner

Kara Burkholder

Marlene B. Schwartz

Associated Data

1. Introduction

2. Materials and Methods

2.1. Data Sources and Search Strategies

2.2. Study Selection

2.3. Quality Assessment

3.1. Initiatives and Interventions Related to School Meals

3.1.2. Food Preparation: Palatability and Cultural Appropriateness

3.1.3. Food Preparation: Pre-Slicing Fruits