Reports from PCRM's Nutrition Department

Report

2004 School Lunch Report Card
A Report by the Physicians Committee for Responsible Medicine
August 2004

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Review Process

This year’s report evaluated school lunch menus, foods available in vending machines, and nutrition education efforts in elementary schools in 11 of the largest school districts in the United States. PCRM nutritionists evaluated foods and programs at districts in the following areas of the country:

• New York, New York (New York City Public School District)
• Las Vegas, Nevada (Clark County School District)
• Detroit, Michigan (Detroit City School District)
• Fairfax, Virginia (Fairfax County Public School District)
• San Diego, California (San Diego City Unified School District)
• Upper Marlboro, Maryland (Prince George’s County Public School District)
• Rockville, Maryland (Montgomery Country Public School District)
• Towson, Maryland (Baltimore County Public School District)
• Charlotte, North Carolina (Charlotte-Mecklenburg School District)
• Albuquerque, New Mexico (Albuquerque Public School District)
• Austin, Texas (Austin Independent School District)

Criteria and Grading System

This year’s review looked at three different essential categories for children’s nutrition in schools:

• Obesity and Chronic Disease Prevention
• Health Promotion and Nutrition Adequacy
• Nutrition Initiatives

Each category includes subcategories, as described below, to measure different aspects of nutrition, health promotion, and disease prevention.

Obesity and Chronic Disease Prevention: 40 points
This category includes the nutrient composition and frequency of healthy entrée selections that are especially important for the prevention of obesity and obesity-related diseases such as heart disease, diabetes, and cancer. Dietary fat is a rich source of calories, with 9 calories per gram compared to 4 calories per gram for protein and carbohydrates. The easiest way to reduce calorie intake and remain at a healthy weight is to reduce fat intake. Dietary fat, saturated fat, and cholesterol have been linked to high blood pressure, elevated blood lipids, and increased heart disease risk in a number of scientific studies. In addition, being overweight and consuming excess dietary fat puts one at risk for developing type 2 diabetes and hormone-related cancers such as breast and prostate cancer. With nutrition research emphasizing the health risks of cholesterol and fats and the disease-preventive power of many nutrients found exclusively in plant-based foods, it is especially important that schools provide meals that are low in fat, saturated fat, and cholesterol, and provide plant-based (vegan) entrées. Vegan entrées, such as veggie burgers, bean and rice burritos, hummus sandwiches, and veggie chili, taste good, are naturally low in fat and cholesterol-free, and—when offered to children on a regular basis—will help them acquire healthy eating habits to keep them slim and prevent a host of chronic diseases.

Health Promotion and Nutrition Adequacy: 40 points
Separate from nutrition’s relationship to disease prevention is the issue of whether meal patterns are meeting nutrient needs and providing dietary options that promote the health of all children. The Health Promotion and Nutrition Adequacy category specifically measures whether the foods offered in elementary school lunches provide the essential nutrients of fiber and vitamin C, daily low-fat vegetable side dishes, fruit, and calcium-rich, non-dairy beverages for children who do not choose to drink milk for health or other reasons. These components are fundamental to a balanced and nutrient-sufficient meal pattern.

Fiber. Fiber is a vital component of a healthy diet. It helps a person feel satiated, improves digestion by providing bulk, helps the body rid itself of excess toxins and wastes, and helps the immune system run at its best. Fiber intake should be at least 30 grams per day, which is why full credit is given in this report for 10 grams of dietary fiber for an average lunch.

Vitamin C. Vitamin C is an important antioxidant and helps boost a child’s immune system. Citrus fruits and a variety of vegetables are great sources of vitamin C. The USDA requires that school lunches contain a third of the daily recommended intake of vitamin C, or 15 milligrams per lunch. Full credit of five points is given to lunches that meet this requirement. All the school districts in this year’s report card met the vitamin C requirement.

Fruits and Vegetables. Low-fat vegetable side dishes and fruit are essential to meals that are considered nutritionally adequate and promote the health of children. Adults who eat lots of fruits and vegetables often learned to eat them in childhood. Fruits and vegetables are packed with vitamin C, beta-carotene, riboflavin, iron, calcium, fiber, and many other nutrients. Dark green leafy vegetables, such as broccoli, collards, kale, mustard and turnip greens, chicory, and bok choy, are especially good sources of important nutrients for children. Dark yellow and orange vegetables, such as carrots, winter squash, sweet potatoes, and pumpkin, provide the powerful antioxidant beta-carotene. When schools offer tasty, low-fat vegetable side dishes—such as green salads, mixed vegetables, steamed broccoli, corn on the cob, and raw baby carrots with low-fat Italian salad dressing—and fresh, dried, or canned fruit in juice, children begin to develop a taste for these items. In this review, one point was awarded for each day schools served a low-fat vegetable side-dish, and another point was awarded for each day there was whole, dried, or canned fruit available on the elementary menu over a 10-day period.

Calcium-Rich, Non-Dairy Beverages. Calcium-rich, non-dairy alternatives are essential in the NSLP. Many U.S. children are lactose intolerant or allergic to milk; others choose to avoid milk for other reasons, such as taste preferences, religious or ethical considerations, or health needs. According to the American Academy of Pediatrics, approximately 70 percent of African Americans, 90 percent of Asian Americans, 53 percent of Hispanic Americans, and 74 percent of Native Americans are lactose intolerant. Numerous scientific studies link the consumption of cow’s milk to obesity, anemia, ear infections, constipation, respiratory problems, heart disease, and some cancers. Due to the health concerns associated with dairy product consumption, cow’s milk with added lactase, such as LACTAID milk, is not a suitable alternative. The NSLP currently does not offer an alternative beverage to cow’s milk to all children as an option on the lunch line.

With the 2004 reauthorization of the National School Lunch Act and the Child Nutrition Act of 1966, children who require or request an alternative to cow’s milk will be able to receive an alternative as long as they have a note from a parent and as long as the milk substitute is considered to be nutritionally equivalent to cow’s milk according to standards set by the USDA. This is a step forward, however small, as the previous policy required a doctor’s note in order for a child to receive a non-dairy beverage in the school lunch program as part of a reimbursable meal. At this point, calcium-fortified soymilk and calcium-fortified juices are more costly than dairy milk because cow’s milk is purchased by the USDA through the commodities program and distributed at very low cost to schools. Despite the extra expense, some school districts are already offering these beverages in school lunch programs, even if just à la carte. In this review, PCRM awarded up to five points to school districts that provide calcium-rich juices or non-dairy milks to students on a daily basis.

Nutrition Initiatives: 20 points
To truly promote health and ward off obesity, schools must teach children about nutrition. It is also critical for districts to include only healthy vending foods when vending machines are present. This review evaluated districts on what steps they are taking to help children appreciate and choose healthy food and understand why diets built from fruits, vegetables, whole grains, and legumes help prevent obesity and chronic diseases. School districts were awarded two points for every innovative nutrition program in place to assist elementary school children. A district could receive up to 10 points for innovative nutrition programs. Examples of such programs include school gardens where children learn to grow produce, hands-on cooking classes or cooking demonstrations with taste tests for students to try healthy dishes, and in-class nutrition activities.

School vending machines that sell unhealthy snack foods and beverages compete with healthier foods in a child’s daily energy intake. It is important that schools that rely on vending sales to fund extracurricular activities sell only low-fat snack items, juice, water, and nutrient-rich items in order to teach children about proper nutrition in school. For this portion of the review, elementary schools that have vending machines were given points if juice and water, rather than soda, were available; if snack foods were limited to low-fat items; and if fruit and vegetable snacks were sold. Schools received up to 10 points for healthier food offerings in vending machines; schools without vending machines were given full credit for not providing high-sugar, high-fat items to children.

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