Is scratch-cooking a cost-effective way to prepare healthy school meals with US Department of Agriculture foods?

BACKGROUND

Despite the resurgence of interest in scratch-cooking as a way to increase the quality and appeal of school meals, many school districts are concerned about the cost implications of switching to scratch-cooking. US Department of Agriculture (USDA) Foods are the single largest source of ingredients for school meals, and about half of USDA Foods are diverted for processing before being sent to the school district.

OBJECTIVE

We aimed to determine whether school lunch entrées made in a district from basic or raw USDA Foods ingredients can be healthier and less expensive to prepare than those sent to external processors.

DESIGN/SETTING

This cross-sectional study examined the relationship between the extent of scratch-cooking and the nutritional content and cost to prepare entrées. Information was gathered by interview with school foodservice personnel and from school foodservice records from a convenience sample of 10 school districts in California that employed varying degrees of scratch-cooking and is diverse in terms of geographic location and the sociodemographics of the student body. The sample included all elementary school lunch entrées that contain USDA Foods offered during October 2010 for a total sample of 146 entrées.

STATISTICAL ANALYSES

Ordinary least squares regressions were used to test for statistically significant differences in cost and nutrient content of entrées according to the level of scratch-cooking.

RESULTS

There was no significant relationship between total costs and level of scratch-cooking. Entrées with the highest scratch-cooking scores had significantly lower food costs, higher labor costs, and not significantly different total costs compared with entrées with no scratch-cooking. Nutrient content was not consistently associated with scratch-cooking, but scratch-cooked entrées did include a larger variety of non-fast-food-type entrées.

CONCLUSIONS

The findings suggest that scratch-cooking can be a cost-effective way to expand the variety of healthy school lunches prepared with USDA Foods.

Economic incentives and nutritional behavior of children in the school setting: a systematic review

The aim of the present review was to examine the existing literature on the effectiveness of economic incentives for producing sound nutritional behavior in schools. Studies published in the English-language literature that included baseline and/or outcome data regarding food and beverage intake of schoolchildren were eligible for inclusion. A systematic search of the literature was conducted to identify relevant primary studies and relevant systematic reviews of primary studies. Altogether, 3,472 research publications were identified in the systematic search, of which 50 papers were retrieved. Of these, 30 publications representing 28 studies fulfilled the criteria for inclusion. The studies addressing price incentives suggest that such incentives are effective for altering consumption in the school setting. Other types of economic incentives have been included in combined intervention schemes, but the inclusion of other intervention elements makes it difficult to draw conclusions about the effectiveness of the economic incentive instruments per se in these studies.

Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.

The effects of the National School Lunch Program on education and health

This paper estimates the effects of participating in the National School Lunch Program in the middle of the 20th century on adult health outcomes and educational attainment. I utilize an instrumental variables strategy that exploits a change in the formula used by the federal government to allocate funding to the states. Identification is achieved by the fact that different birth cohorts were exposed to different degrees to the original formula and the new formula, along with the fact that the change of the formula affected states differentially by per capita income. Participation in the program as a child appears to have few long-run effects on health, but the effects on educational attainment are sizable. These results may suggest that subsidized lunches induced children to attend school but displaced food consumption from other sources. Alternatively, the program may have had short-run health effects that dissipated over time but that facilitated higher educational attainment.

Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity

CONTEXT

Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity.

METHODS

This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed.

FINDINGS

The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch.

CONCLUSIONS

Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.

Meals offered and served in US public schools: do they meet nutrient standards?

BACKGROUND

Concerns about the diets of school-aged children and new nutrition recommendations for the US population have increased interest in the nutritional quality of meals available through the National School Lunch Program and School Breakfast Program.

OBJECTIVE

This article updates national estimates of the food energy and nutrient content of school meals and compares these estimates to federal nutrient standards established under the 1995 School Meals Initiative for Healthy Children.

DESIGN

Data were collected as part of the third School Nutrition Dietary Assessment Study, a nationally representative cross-sectional study fielded during school year 2004-2005. Menu and recipe data for a typical school week were collected in a mail survey with telephone assistance. Nutrient information for common commercially prepared food items was obtained from manufacturers, to supplement the Food and Nutrient Database for Dietary Studies used to analyze the data. Analyses were conducted for meals offered and meals served to (selected by) children.

SUBJECTS/SETTING

Samples of 130 public school districts that offered federally subsidized school meals, and 398 schools within those districts, participated in the study. Foodservice managers in each school completed a menu survey.

STATISTICAL ANALYSES PERFORMED

Descriptive tabulations present weighted means, proportions, and standard errors for elementary, middle, and high schools, and for all schools combined.

RESULTS

Most schools offered and served meals that met the standards for protein, vitamins, and minerals. Fewer than one third of schools met the standards for energy from fat or saturated fat in the average lunch, whereas three fourths or more met the fat standards in school breakfasts. For both meals, average levels of sodium were high and fiber was low relative to Dietary Guidelines for Americans 2005 recommendations.

CONCLUSIONS

For school meals to meet nutrient standards and promote eating behaviors consistent with the Dietary Guidelines, future policy, practice, and research should focus on reducing levels of fat and sodium and increasing fiber.