Rolling back school nutrition standards would threaten progress against childhood obesity

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

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

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

In their article, Taveras and lead author Jennifer Woo Baidal, MD, MPH -- a fellow in pediatric health services research at MGHfC and a pediatric gastroenterologist at Boston Children's Hospital -- note the following:

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

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

"Allowing schools to opt out of the new school lunch standards would deny many children access to healthy meals and represent a large step backwards in the efforts to prevent childhood obesity," Woo Baidal says. "Matters of children's health should not be driven by political considerations." Woo Baidal is an instructor in Pediatrics, and Taveras is an associate professor of Pediatrics at Harvard Medical School and an associate professor of Nutrition at Harvard School of Public Health.