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Taking Tater Tots Off the Tray

Recommendations from a panel of nutrition experts seek to make school lunches healthier, but enacting them is easier said than done.

As the recession deepens, more children depend on the National School Lunch Program than before. For many, the program may provide the only complete meal that they eat all day. Yet as child obesity in America reaches epidemic proportions, the nutritional content of these meals is being re-examined.

Healthy school lunches are something all can agree on, right? Not so fast. The Institute of Medicine's science-based suggestions for improving cafeteria menus across the nation — released in October — are a long way from implementation, stymied by funding, implementation challenges and opposition from some agricultural industries.

And with a new set of Dietary Guidelines for Americans coming out in 2010, it is possible that when and if the IOM recommendations are implemented, they might already be five years behind.

The National School Lunch Program is a federal plan designed to provide "nutritionally balanced, low-cost or free lunches to children each school day." It was established under President Harry Truman in 1946 to address two of the problems from the Great Depression — an agricultural surplus that was going to waste because no one could afford to buy it (hence its operation by the U.S. Department of Agriculture) and the inability of many children to pay for school lunches.

Since the program's inception, 219 billion school lunches have been served. Ninety-nine percent of U.S. public schools and 83 percent of private and public schools combined participate in the program. In 2007, 30.6 million children participated in the program, and 10.1 million ate breakfast through its early morning sister, the School Breakfast Program.

Although the USDA boasts that its direct certification program has increased low-income children's access to the "nutritious" meals that they need for good health, the nutrition guidelines the lunch program meets are the "applicable recommendations of the 1995 Dietary Guidelines for Americans." There have been significant advances in nutritional science since 1995, and updated Dietary Guidelines for Americans were published in both 2000 and 2005.

The Richard B. Russell National School Lunch Act requires the meals served under the school lunch and breakfast programs reflect the most recent Dietary Guidelines for Americans. Yet, as of 2007, fewer than 20 percent of schools were serving lunches that followed the 2005 guidelines (as noted earlier).

The current lunch program nutritional standards have a variety of shortcomings: They are nutrient- and not food-based — making it tough sledding for menu planners; they recommend what is now seen as an unhealthy amount of meat; they "encourage" whole grains but set no specifications as to how much should be served; and they include no specifications for vegetable types — meaning that French fries are in the same nutritional category as spinach.

Enter the IOM
The USDA charged the Institute of Medicine with making nutritional guideline revision recommendations in 2008.

The IOM is a nonprofit advisory organization. Its role in the revisions, according to media relations officer Christine Stencel, was to make "an independent, authoritative assessment of scientific evidence." It convened committees that reviewed studies, held meetings with experts and ultimately determined what to recommend.

Dr. Suzanne Murphy, a nutrition researcher at the University of Hawaii and member of the committee responsible for the report, said that while committee members took into account the 2005 Dietary Guidelines for Americans, they also considered the most recent nutrient standards in order to be certain that their recommendations would be nutritionally sound.

The IOM's recent report, titled "School Meals: Building Blocks for Healthy Children," outlines the suggestions. Key recommended changes include a distinction between fruits and vegetables as meal components, an increase in the required daily amount of fruits and vegetables to two servings, and a requirement that dark green, bright orange, legumes, starchy and other vegetables must be included in meals each week. The report also suggested that at least half of all grains and breads served must be whole-grain rich.

The report proposes both a minimum and maximum age-specific calorie requirement, whereas the previous guidelines identified only a minimum.

Whole-fat and reduced-fat milk would be removed from the program and replaced with fat-free (plain or flavored) and plain low-fat milk only.

Perhaps the most significant recommendation that the IOM has made is for the gradual, but marked, reduction in sodium to a specified level by 2020. Recent data show that a typical high school lunch contains around 1,600 milligrams of sodium; the report suggests reducing this to no more than 740 milligrams.

Murphy acknowledges that this reduction will be difficult. Because consumers are less likely to detect incremental changes, the committee recommended a 10-year phase-in of the lower-sodium meals.

Stencel stressed that although sodium is a necessary nutrient, studies show that the vast majority of Americans take in too much. Excessive sodium consumption can lead to increased blood pressure and cardiovascular disease. A recent RAND report highlights the potential benefits of a reduction in American sodium consumption: an estimated $18 billion savings in health care costs and an improved quality of life for millions of people.

The major problem with the IOM suggestions is that they are only that — suggestions. The USDA can still choose whether or not to follow the IOM's guidelines. In a press release, Agriculture Secretary Tom Vilsack said, "Experts at USDA are engaged in a thorough review of the IOM recommendations and will develop a proposed rule to determine the best ways to improve the National School Lunch Program and School Breakfast Program based on IOM's final report. Stakeholders and the public will have ample opportunity to comment on USDA's proposed rule."

When asked how soon the new guidelines for the school lunch program would be implemented, Jean Daniel, public affairs specialist for the Food and Nutrition Service, replied, "We do need some time to digest. We're gearing up for the 2010 Nutritional Guidelines for Americans."

Daniel defined stakeholders as "parents, schools, teachers, food service workers and industries."

Industry has already begun to weigh in. The report's milk recommendations, which include only non-fat flavored milk and plain low-fat milk, have the dairy industry and some parents up in arms. A new ad campaign from the minds behind "got milk?" encourages moms to, "Raise (your) hand for chocolate milk." The campaign highlights the nutritional benefits of chocolate milk and argues that kids will not drink milk that is not flavored.

When asked about the likelihood of the USDA's adoption of the IOM recommendations, Stencel said that it was not her role to speculate.

The largest likely roadblock is the cost of implementing them. Adopting the new standards would result in an estimated 9 percent increase in the cost of lunch and 26 percent increase in the cost of breakfast offered by schools.

This is because the costs of fruits, vegetables and whole grains are generally higher than those of their packaged and processed counterparts. As Murphy observed, "It is unlikely that the recommendations can be fully implemented without an increase in the reimbursement for the school meals."

Before setting the new standards for the lunch program, the USDA will review recommendations and balance cost with science. Margaret Wootan, director of nutrition policy for the Center for Science in the Public Interest, said, "Both cost and science will drive the standards, and cost will be the bigger one."

The National School Lunch Program, an $8.1 billion effort in 2008, is already underfunded, with the federal government providing $2.68 for each free lunch and state governments contributing a few cents. (Rates are adjusted each year.) After accounting for labor, energy and overhead costs, this leaves about $1 per lunch to be spent on food. Additional costs from the new recommendations would include both the price of food and investment in equipment and staff training.

Another concern about the implementation of the new standards is that adherence to the USDA guidelines is not strictly monitored — the current terms of the program require an action plan within the state to bring noncompliant schools up to par, but because states don't usually cut funding as a consequence of non-adherence, schools have no incentives to follow the rules.

In a recent (rare) case of cut funding for the school lunch program, San Francisco schools lost money for providing free lunches to too many students — students whose families made "too much money" to qualify for a free meal.

The Child Nutrition Act, which expired Sept. 30, needs to include a funding increase of $1 billion for child nutrition programs requested by President Obama. However, Congress has yet to determine the source of this money. Congress will begin discussion of a re-authorization bill after Jan. 1.

Unless a funding increase is approved, schools will not be able to implement the IOM guidelines, even if the USDA adopted them. Three-fourths of school nutrition directors said that the National School Lunch Program did not cover the costs of producing a meal in the 2008-09 school year, and they do not expect costs to be covered this year.

A number of people, from Obama's new chef Sam Kass to food intellectual Michael Pollan believe that the inherently contradictory goals of the USDA — to dispose of surplus U.S. agriculture and provide nutritious food for schoolchildren — have prevented nutrition-based reform in the school lunch program. Kass points out that the current system of USDA subsidies results in overproduction of beef, pork and dairy, which are subsequently bought back by the government and disposed of in schools.

A recent editorial by Jonathan Safran Foer, author of Eating Animals, illustrates the effects of the food industry on nutrition policy. He explains that more than $500 million of taxpayer money goes toward the purchase of dairy, beef, eggs and poultry products every year, whereas only $161 million is spent on fruits and vegetables.

Pollan draws attention to the fact the interests of "eaters" are no longer the same as those of agribusiness. He suggests, as does Foer, that getting the school lunch program out of the control of the USDA might help to improve the nutrition of school lunches.

But those are battles for another day. Right now, Murphy is hopeful about the potential benefit to children if the new IOM recommendations are adopted by the USDA.

"There is an enormous impact in the health of youth if the new standards are implemented and children consume these more nutritious meals. The evidence is persuasive that these changes can help address the prevalence of obesity in children and reduce other risk factors for chronic diseases, particularly if these changes are adopted in the home as well as at school," she said.

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