School Lunch Report Card

A Report by the Physicians Committee for Responsible Medicine
August 2003

As children head back to school this fall, many face a daunting array of diet-related health problems—and a challenging environment in school cafeterias. Because meals eaten at school play a major role in childhood health and adult eating habits, the Physicians Committee for Responsible Medicine (PCRM) graded the nutritional quality of the menus offered by 18 of the nation’s largest school districts participating in the U.S. Department of Agriculture’s (USDA’s) National School Lunch Program (NSLP).

The results, which are summarized in a “report card” found on page nine, demonstrate a wide range of commitment to nutrition among the nation’s schools. PCRM nutritionists handed out grades ranging from the “A” awarded to the Detroit City School District to an “F” given to District of Columbia Public Schools. PCRM also found innovative nutrition programs, special challenges confronting food service coordinators, and opportunities for school districts to dramatically increase the nutritional value of school lunches.

Background

The NSLP was established in 1946 with the goal of reducing malnutrition caused by a shortage of food. The program now operates in nearly 100,000 schools and residential childcare institutions and serves almost 27 million lunches a day. Schools participating in the NSLP receive cash subsidies, donated commodities, and free bonus shipments for each meal served. In return, they must serve lunches that meet federal nutrition requirements, as well as offer free or reduced-price lunches to eligible children.

But times have changed. Today, many children in the United States suffer from an over-consumption of calories, fat, salt, and sugar. Consequently, the prevalence of obesity among our nation’s youth has more than doubled in the past 20 years, with close to five million youths aged 6–17 seriously overweight or obese. The Centers for Disease Control and Prevention recently found that 60 percent of overweight five- to ten-year-olds already have at least one risk factor for heart disease, such as raised blood pressure or insulin levels.

In response to these serious health concerns, PCRM, a nonprofit organization that promotes preventive medicine through healthy nutrition, has encouraged lawmakers, the USDA, and school districts to achieve the PCRM Healthy School Lunch Campaign goal of assuring that foods served at school promote the health of all children.

Numerous scientific studies have concluded that vegan diets—those built from whole grains, vegetables, fruits, and beans/legumes—satisfy hungry children and offer the most weight-controlling and disease-fighting protection of any dietary pattern.

Encouraging children to eat plant-based diets from the start has a positive impact on their health, weight, and need for medical treatment. These positive effects continue into adulthood.

Making the Grade

For the third year, PCRM nutritionists conducted a review of elementary school lunches served through the NSLP. This year, nutritionists focused on meals served in schools in the nation’s largest districts. PCRM then graded lunches based on the presence of low-fat vegetable side dishes, fruit offerings, meatless and vegan entrées, and non-dairy beverage sources of calcium, and whether or not the district elementary menus met the USDA nutrition guidelines.

A recent government study found that many of the nation’s school districts do not meet the USDA’s basic nutritional requirements. However, all school districts graded in this report say they are in compliance with these rules. Thus, if these school districts were graded based solely on meeting the USDA requirements, all would receive an “A.”

But many leading experts believe that the USDA requirements are profoundly inadequate, in part because the department downplays the fact that plant-based meals and menu choices are crucial for health. Therefore, PCRM grades districts based on more meaningful criteria. School districts are not yet required by the USDA to serve vegetarian or vegan meals, nor are they required to offer non-dairy sources of calcium, so districts that score well on this report deserve special recognition.

Encouraging Trends

This year, PCRM saw improvement in the types of foods offered to kids in some elementary schools. Despite USDA barriers to serving healthy vegetarian and vegan entrées in elementary schools (these barriers are discussed in detail below), a number of districts have made these items more available to the kids.

This year’s report differs from those of previous years in that more credit is given for vegetarian entrée items available in school districts. Previously, vegetarian entrées were only counted if they appeared as featured items on the menu. This year, vegetarian entrées are credited if they are simply available to kids. Some grades improved this year solely because of this change. For the most part, however, improved scores indicate that districts have made notable changes in their overall menu and nutrition programs to promote the health of children.

The “most improved player” award goes to the Detroit City School District, which scored 94 percent this year—a remarkable improvement over last year’s score of 57 percent. The menu changes triggering this improvement include daily offerings of fruits and vegetables, calcium-fortified juices, meatless entrées, and whole-grain breads, as well as vegan burgers three times per week. The district is also investigating the possibility of offering calcium-fortified soymilk and more soy-based and legume-based entrées for the lunch menu.

Innovative Nutrition Education Programs

This year’s report also highlights innovative nutrition education efforts. Most districts surveyed this year appear to recognize the need for imaginative nutrition education programs in the schools.

For example, the Philadelphia City School District has teamed up with Drexel University to offer several programs in elementary schools to help children learn about nutrition and health. These programs include “Dragon Detective Agency,” which helps kids discover the world of nutrition with lessons such as “ReThink Your Drink” and “Inspector Veg. E. Table,” and a healthy eating and physical activity program for weight management with “Power Down to Power Up” and “Go for the Green” lessons.

Clark County School District in Las Vegas also has numerous nutrition programs and has conducted acceptability studies for fruits and vegetables. One unique curriculum, titled “Calcium Isn’t Just Milk,” focuses on such calcium-rich foods as beans and dark green, leafy vegetables.

Roadblocks to Health

This year’s report recognizes that school districts face a number of challenges in serving low-fat vegetarian and vegan meals and non-dairy, calcium-rich beverages to kids participating in the NSLP. These problems include a lack of financial and programmatic support from the U.S. Department of Agriculture (USDA) and lawmakers.

The USDA commodities program, which supplies food items to the NSLP, puts the needs of U.S. agriculture ahead of the health needs of children and provides few low-fat, plant-based entrée ingredients for use in school lunch menus.

Every year, the USDA buys millions of pounds of excess beef, pork, milk, and other meat and dairy products to bolster sagging prices in the livestock industry. These high-fat, high-cholesterol products are then distributed at very low cost to the NSLP, where they fuel many children’s life-long struggle against obesity and heart disease.

Meanwhile, the USDA drops the ball on providing healthy foods. For example, it costs a school district more than twice as much to provide a high-fiber, low-fat, cholesterol-free veggie burger than it does to provide a higher-fat, fiber-free hamburger. That’s because the government subsidizes hamburger meat, but not veggie burgers.

Also, despite enormous public interest and input from health experts, the NSLP has not made the provision of calcium-fortified soymilk or calcium-fortified orange juice a reimbursable option for school lunches. This forces schools to shoulder the financial burden of providing these beverages as an alternative to cow’s milk. Moreover, if soymilk is offered in place of cow’s milk, the USDA will not reimburse school districts for the entire meal.

The USDA does not provide recipes featuring plant-based entrées, purchasing or distribution support, or any incentive to encourage schools to better serve children’s nutritional needs in this way.

Additionally, while federal law requires schools to ensure their menus meet the U.S. Dietary Guidelines, including creating menus that derive less than 30 percent of their calories from fat, this is not well enforced.

Indeed, a large proportion of schools still do not meet these USDA requirements, yet they are not held accountable. The most recent School Nutrition Dietary Assessment Study showed that, on average, 33 percent of calories in elementary school lunches came from fat, with only 20 percent of schools keeping calories from fat under 30 percent, and only 14 percent keeping calories from saturated fat under the recommended 10 percent. Moreover, even most schools that comply with USDA regulations still offer more fat than should be found in a healthy diet. PCRM’s research has demonstrated that a diet deriving 10 to 15 percent of calories from fat offers benefits ranging from cholesterol reduction to weight control.

As the scores below indicate, many of the nation’s largest school districts still have a long way to go to achieve an outstanding grade with PCRM’s nutrition criteria. But many are making an effort, and some districts are doing extremely well. To fully succeed in offering healthy lunches, school districts need help from Congress and the USDA.

Review Process and Grading System

PCRM dietitians looked at 15 days of recent elementary school lunch menus for 18 school districts in the following cities and counties: Detroit, Miami, Gwinnett County (Georgia), Charlotte, Fairfax County (Virginia), Pinellas County (Florida), Broward County (Florida), Hillsborough County (Florida), New York City, Philadelphia, Montgomery County (Maryland), Prince George’s County (Maryland), Dallas, Palm Beach County (Florida), Los Angeles, San Diego, Clark County (Nevada), and the District of Columbia.

One point was awarded each time the menu included a low-fat vegetable side dish, a whole or dried fruit, a vegetarian entrée (meatless, hot or cold), a featured vegan entrée (meatless, dairy-free, and egg-free), and a vegan option by request over the 15-day period, for a total of 75 possible points.

Twenty points were then awarded to each school district meeting the NSLP nutrition requirements, which include a menu featuring less than 30 percent of calories from fat, less than 10 percent of calories from saturated fat, and one-third of the Recommended Daily Allowances (RDAs) for protein, vitamin A, vitamin C, iron, calcium, and calories.

An additional five points were given to school districts offering non-dairy, calcium-rich beverages, such as calcium-fortified orange juice or enriched soymilk or rice milk, on a daily basis to help meet the calcium needs of students who either cannot or do not drink cow’s milk.

A district could score a total of 100 possible points.

PCRM dietitians mailed elementary menu questionnaires to the nation’s 25 largest school districts, plus the organization’s home district of Washington, D.C. These questionnaires asked food service directors about the meatless and vegan entrées and options available in the schools, the frequency of low-fat vegetable and fruit side dishes offered, the availability of non-dairy, calcium-rich beverages, and whether or not their menus met the NSLP nutrition standards. The questionnaires also asked respondents to describe healthy nutrition programs, changes, or initiatives taking place in their districts.

When a school district did not respond to the questionnaire, PCRM attempted to consult directly with the school district’s nutrition staff. Eight of the 25 districts did not provide enough information to permit PCRM to evaluate their programs. Each district that did respond received a percentage score, which was then converted into a letter grade.

Note: All of the school districts included in this survey are using the “Offer vs. Serve” (OVS) menu system. OVS is a federal regulation designed to reduce food waste in the lunch program by allowing students to choose only foods they intend to eat. The school lunch pattern includes five food items: 1. meat or meat alternative, 2. bread or bread alternative, 3. milk, 4. fruits, 5. vegetables. Students are permitted to select from three to five of the five offered components of the meal. Students are not allowed to choose two of the same component, but they can request a second portion of fruit or vegetable at no extra charge.

Below are the possible points awarded for each category. One point is given each time the menu includes each of the following items in 15 days of sample lunch menus, plus an additional 20 points for meeting NSLP nutrition guidelines and 5 points for offering non-dairy, calcium-rich beverages.

The Criteria:

Low-Fat Vegetable Side Dishes: 0 – 15 points

Research indicates that adults who regularly eat vegetables tend to have consumed them from childhood. 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, children adopt healthy eating habits that will stay with them for the rest of their lives. In this survey, one point was awarded for each day the school district offered a low-fat vegetable side dish. Points were not given for such high-fat side dishes as French fries, mashed potatoes, or tater tots.

Whole or Dried Fruit Offered as a Side Dish or Dessert: 0 – 15 points

As with vegetables, research shows that adults who eat fruits in adulthood also consumed them as children. Fruits are rich in fiber, vitamin C, beta-carotene, and many other nutrients. Fruit juices contain less fiber than whole fruits. In this survey, one point was awarded for each day the school district offered a whole or dried fruit on the menu. Points were given for applesauce, but not for fruit juice or frozen fruit bars, which are not rich in fiber and often feature added sugar.

Vegetarian and Vegan Entrées and Vegan Options: 0 – 45 points

Nutrition research now emphasizes the importance of fiber, the health risks of cholesterol and fats, and the disease-preventive power of many nutrients found exclusively in plant-based foods. Researchers have also discovered that the plant kingdom provides excellent sources of nutrients once associated only with meat and dairy products.

A diet drawn from varied plant sources easily satisfies calorie, calcium, and protein requirements, providing all essential amino acids—even without intentional combining or “protein complementing.” There is ample protein in whole grains, vegetables, and legumes and plenty of calcium in dark green, leafy vegetables, fortified juices, and other plant foods.

The major killers of Americans—heart disease, cancer, and stroke—have a dramatically lower incidence among people consuming primarily plant-based diets. The condition of overweight, which contributes to a host of other health problems, can also be brought under control by following plant-based diets, even in children.

With the approval of Alternate Protein Products (APPs) in the NSLP, schools are now allowed to provide children with meatless, cholesterol-free entrées. However, many of the healthier meat substitutes are not available in the commodity food program and cost schools more to include in their menus.

In this survey, a maximum of 45 points was awarded for the frequency of both vegetarian (meatless) and vegan (meatless, dairy-free, and egg-free) entrées. However, due to the dangers of dairy product consumption (which are explained below), completely plant-based meals are preferred. When featured vegan entrées appeared on the menu, the school district received one point in the vegetarian entrée category and one point in the vegan entrée category, unless the item featured was a peanut butter and jelly sandwich, in which case, the district only received credit in one of the categories. It is important for districts to expand beyond peanut butter as a vegan menu item and explore other healthy vegan dishes.

Because many schools have not yet begun to feature vegetarian main entrées (but still include some plant-based selections in their menus), the category of “vegan option” was included in this review. Having a daily vegan choice, such as a peanut butter and jelly sandwich or a salad bar, guarantees that children at least have the option to eat something that is meatless and dairy-free for lunch. The vegan option category accounted for 15 of the 45 vegetarian and vegan entrée points.

Ideally, schools will begin offering vegan entrées, such as veggie burgers, bean and rice burritos, hummus sandwiches, and veggie chili, on a regular basis so that children will be presented with nutritious selections, develop tastes for health-promoting foods, and acquire healthy eating habits that will stay with them for the rest of their lives.

Non-Dairy, Calcium-Rich Beverages: 0 or 5 points

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 dangers of dairy product consumption, cow’s milk with added lactase, such as Lactaid® milk, is not a suitable alternative.

Moreover, since many children, particularly those of African, Asian, Hispanic, or Native American heritage, are unable to digest lactose (a dairy sugar), relying on dairy products as the sole source of calcium in child nutrition programs can cause kids to have digestive problems. According to the American Academy of Family Physicians’ 2002 report on lactose intolerance, 60 to 80 percent of blacks, 50 to 80 percent of Hispanics, 80 to 100 percent of American Indians, 95 to 100 percent of Asians, and 6 to 22 percent of American whites are lactose intolerant. Lactose intolerance, which develops gradually over the childhood and early adult years, causes flatulence, cramping, diarrhea, and bloating in some individuals. Therefore, the USDA should mandate the offering of non-dairy, calcium-fortified beverages as a reimbursable alternative in child nutrition programs so that milk and other dairy products are not the only source of calcium available in school lunches.

Despite the extra expense, many school districts are already offering calcium-fortified juices in their school lunch programs. In this review, PCRM awarded five extra points to school districts that provide calcium-rich juices to students on a daily basis.

Grading Scale

The Report Card

Detroit City School District (Detroit, Mich.): 94%

The Detroit City School District is the 12th largest district in the United States, with 265 schools enrolling 166,675 students. Fifteen days of elementary school lunches from the fall 2003 menu were analyzed.

Detroit won the most improved nutrition award this year as it jumped from a failing grade of 57 percent in 2002 to an “A” grade of 94 percent this year. The Detroit schools’ fall 2003 menu reflects a number of healthy changes, including a daily offering of such nutrient-rich, low-fat vegetable side dishes as sweet potatoes, green leafy vegetables, and black-eyed peas, as well as a daily choice of such fruit as spiced apples, fresh oranges, and fresh pears.

In addition, Detroit lunchrooms dish up a meatless entrée to kids daily and a dairy-free garden burger three times per week. Students can also always find peanut butter and jelly sandwiches, and calcium-fortified juices are available so that students who are unable to tolerate dairy products or choose not to consume them can have a beverage rich in calcium. Whole grains now appear throughout the Detroit menu.

The Detroit Schools Office of Food Services is working to implement additional meatless entrées as they become available from suppliers. The district will receive a perfect score in future reports if it is able to make a featured vegan entrée item available on a daily basis.

The frequency of each of the following on 15 sample lunch menu days:

Miami-Dade County School District (Miami, Fla.): 89%

The Miami-Dade County School District is the fifth largest district in the United States, with 363 schools enrolling 375,836 students. Fifteen days of elementary school lunches from the April 2003 menu were analyzed.

Miami-Dade made huge improvements in the nutritional quality of its elementary lunch menus this year, jumping from 71 percent last year to 89 percent this year. This increase is a result of offering daily options of low-fat vegetable side-dishes such as sliced tomato salads and mixed vegetable salads with light dressing, as well as plantains and a variety of fresh fruits. Meatless entrées are featured on a near daily basis, including cheese lasagna, toasted cheese sandwiches, and yogurt and fruit entrées. Vegan entrées appear about two times per week on the menu and include baked potatoes with broccoli and cheeseless vegetarian chili. Vegan salads and peanut butter sandwiches are available at every meal.

Miami-Dade will offer calcium-fortified juices in the upcoming school year and is currently looking into offering calcium-fortified soymilk. Also worthy of mention are Miami-Dade’s “Eat Your Colors Every Day” pilot program and its elementary gardening programs, which both encourage young kids to appreciate healthy fruits and vegetables.

The frequency of each of the following on 15 sample lunch menu days:

Gwinnett County Public School District (Lawrenceville, Ga.): 88%

The Gwinnett County Public School District is the 23rd largest district in the United States, with 86 schools enrolling 116,339 students. Fifteen days of elementary school lunches from the August 2003 menu were analyzed.

The Gwinnett menu features such healthy side dishes as okra, fresh vegetables with dip, a vegetable medley, and fresh or chilled fruit daily. The vegetarian entrées featured in the elementary schools are quite extensive and include such selections as cheese ravioli, a veggie sub, a veggie sandwich, and a bean and cheese burrito. Vegan entrée items are available on a weekly basis and include choices like a baked potato bar, spaghetti with marinara sauce, and a bean burrito. A cholesterol-free veggie burger would be an excellent and simple entrée for Gwinnett to include in its elementary menu cycle to help improve its grade.

Gwinnett offers additional vegan menu options, including a peanut butter and jelly sandwich and a veggie sandwich and veggie chef salad without cheese upon request. Calcium-fortified juices are available for those who don’t choose milk at Gwinnett, and calcium-fortified soymilk is provided upon request.

In the upcoming school year, Nutrition Education Leaders will appear in each school to implement nutrition bulletin boards, classroom nutrition lessons, and take the kids on kitchen tours with cooking lessons to help them appreciate good nutrition as a vital part of health.

The frequency of each of the following on 15 sample lunch menu days:

Charlotte-Mecklenburg School District (Charlotte, N.C.): 87%

The Charlotte-Mecklenburg School District is the 25th largest district in the United States, with 137 schools enrolling 106,312 students. Fifteen days of elementary school lunches from the April 2003 menu were analyzed.

Charlotte-Mecklenburg features such healthy vegetable side dishes as calcium-rich turnip greens, squash and onions, cabbage, and spinach, and such healthy fruits as cantaloupe, apples, and pears on a regular basis. Vegetarian entrée items like a vegetarian hoagie, nachos, and a toasted cheese sandwich are available daily, with such vegan selections as black-eyed peas with Italian bread and nachos with refried beans appearing approximately once a week on the menu. A vegan peanut butter sandwich with sunflower seeds option is available daily. The orange juice at the Charlotte-Mecklenburg elementary schools is fortified with calcium and is available as a replacement for milk.

This district will be moving to a nutrient-based menu plan next year, which will make it easier to serve vegetarian and vegan entrée items. The district is currently testing a vegan beans and rice dish that has gone over well with the kids.

The frequency of each of the following on 15 sample lunch menu days:

Fairfax County Public School District (Fairfax, Va.): 86%

The Fairfax County Public School District is the 14th largest district in the United States, with 198 schools enrolling 160,584 students. Fifteen days of elementary school lunches from the September 2003 menu were analyzed.

Fairfax elementary menus have a number of healthy fruit and vegetable offerings every day, including unique selections such as jicama and carrots with dip, watermelon, and apricots. The menu features meatless entrée items every day and includes such items as cheese lasagna and macaroni and cheese with a wheat roll.

There are two vegetarian entrée options available daily—yogurt and a pretzel and a grilled cheese sandwich. The daily vegan option is a peanut butter and jelly sandwich, and one of the fifteen analyzed days includes a veggie burger on a bun with or without cheese.

Including more vegan entrée items on a regular basis would help Fairfax reach a perfect score. Entrée items such as cheeseless vegetarian chili, bean and brown rice burritos, and garden salads with beans or soynuts are all vegan items that kids love. These dishes are also low in fat, free of cholesterol, and rich in health-promoting fiber.

Fairfax was the first school district in the United States to start serving calcium-fortified juices and has been doing so for the past three years. In addition, Fairfax County has won a number of national awards for innovative and educational nutrition programs that help children adopt healthy eating habits.

The frequency of each of the following on 15 sample lunch menu days:

Pinellas County School District (Largo, Fla.): 86%

Pinellas County School District is the 22nd largest district in the United States, with 169 schools enrolling 114,583 students. Fifteen days of elementary school lunches from the September 2003 menu were analyzed.

Pinellas received full credit for offering nutritious vegetable and fruit side dishes, vegetarian entrées, and a vegan entrée option on a daily basis. Examples of these include sweet potatoes, fresh veggies with dip, steamed broccoli, assorted fresh fruit, vegetable pizza, veggie chili, and baked ziti with cheese, as well as a peanut butter and jelly sandwich daily. Only one of the days analyzed includes a featured vegan entrée (meatless, dairy-free, and cholesterol-free)—specifically, a bean burrito.

However, to improve the healthy entrée options in the district, the dietitian in charge of Pinellas County’s menus is currently looking into an inexpensive vegan burger. The district dietitian is also working to educate elementary school kids about nutrition in classroom presentations about the benefits of healthy eating.

The frequency of each of the following on 15 sample lunch menu days: