2001 School Lunch Report Card: IntroductionA Report by the Physicians Committee for Responsible Medicine
School Lunch Program Fails to Make the Grade
Children in the United States have serious health issues. Today, close to 5 million of them, aged 6 to 17, are seriously overweight—a number that has more than doubled in the past 30 years. In 1997, 8 percent of children aged 5 to 17 were limited in their activity due to obesity-related health problems such as asthma and orthopedic conditions. Now, increasing numbers of children, often as young as ten years old, are being diagnosed with Type 2 diabetes (commonly known as "adult-onset diabetes" and most often found in obese individuals). As the crisis worsens, fingers point to fast food, television, and parenting problems. While all of these are potentially important factors, there may be another major risk to our children's health—public school lunches.
Presently, more than one-half of youths in the United States consume close to 27 million lunches provided each day by the U.S. Department of Agriculture's National School Lunch Program (NSLP). This adds up to 180 billion lunches served since the program's inception in 1946.
Is the NSLP providing our children with healthy lunches?
As our children's health problems have overwhelmingly shifted from malnutrition caused by a shortage of food to malnutrition due to excess consumption of high-fat, high-calorie, nutrient-poor foods, this question becomes exceedingly important.
In order to counter this alarming trend, the U.S. Department of Agriculture (USDA) must refine the goals of the National School Lunch Program from simply serving meals to hungry children to providing nutritious lunches, and the food service administrators must improve the delivery of the program to promote healthy eating by children.
The Physicians Committee for Responsible Medicine (PCRM), a nonprofit organization that promotes preventive medicine through healthy nutrition and has led the way for reforms of federal nutrition policies, has reviewed the NSLP on the basis of how well the program promotes healthy eating habits. In August 2001, PCRM nutritionists interviewed elementary school food service coordinators from 12 school districts (See Table A), including some of the largest and smallest districts in each region of the country, and discussed the state of school lunches in each district.
We asked food service coordinators the following questions:
- Are schools meeting the USDA guidelines for nutritional quality?
- What commodity foods do schools most commonly utilize?
- What efforts are schools making to lower the fat content of meals served?
- Are calcium-rich, non-dairy foods available through the school lunch program?
- Are vegetarian meals available through the school lunch program?
Here is a brief summary of the key findings:
Meeting USDA Guidelines
The NSLP is a federally assisted meal program operating in more than 97,700 public and nonprofit private schools and residential child care institutions. Schools that choose to take part in the lunch program receive cash subsidies, donated commodities, and free bonus shipments from the USDA for each meal served. In return, they must serve lunches that meet federal requirements for nutrition, as well as offer free or reduced-price lunches to eligible children.
In order to receive reimbursement, each school is expected to meet requirements set by the USDA in the Dietary Guidelines for Americans, including the limits that no more than 30 percent of calories in a meal may come from fat and no more than 10 percent of calories from saturated fat. In addition, school lunches must provide one-third of the Recommended Daily Allowances (RDAs) for protein, vitamin A, vitamin C, iron, calcium, and calories. Many doctors and nutritionists argue that these guidelines fall short of what is needed to plan truly healthy meals for children. Nonetheless, we evaluated the NSLP on its ability to at least meet these minimum requirements.
When PCRM nutritionists asked school food service coordinators if they were able to meet the USDA's requirements for nutritional quality, 75 percent (9 out of the 12 surveyed) said they had no problem meeting them and cited as evidence either computer analyses of their menus using a nutrient-based system or compliance with a food-based system. The other three school districts (25 percent) said they either did not know if they were meeting the guidelines, or did not care.
In PCRM's survey, school districts generally did not express major concerns with the USDA's requirements. Those districts that had not met the requirements were not concerned that they risked losing reimbursements. Since there is no real incentive for directors to meet the guidelines, some schools continue to serve foods that the food service staffs think are more likely to be eaten, such as french fries and hamburgers.
Utilizing "Commodity" Foods
The commodity system was designed with the dual purpose of providing food at low or no cost to public schools, while, at the same time, guaranteeing a market for agricultural products.
When surveying large and small public school districts across the country, PCRM found that approximately 30 percent of the foods served in schools come from the commodities program. The five most commonly served commodity foods were ground beef, breaded chicken (nuggets or patties), cheese, canned fruit, and flour. Three out of five of these foods are high in fat and cholesterol.
While the USDA supports the farmers who produce healthy fruits, vegetables, and grains, it is also responsible for protecting the markets for meat and dairy products. Therefore, school children are left with the surplus high-fat meats, whole milk, cheeses, and butter that consumers are not purchasing. Of the 111 foods on the list of USDA commodity foods expected to be available in School Fiscal Year 2002, only 5 are fresh fruits and vegetables, with the only fresh vegetable being white potatoes. Anamoose Public School District in North Dakota explained that, because it wants to serve healthy foods to local children, it has to use a large portion of its food budget to purchase fresh fruits and vegetables not offered in the commodity foods list.
Efforts to Lower Fat
Research has shown that many health problems, particularly heart disease, some forms of cancer, high blood pressure, diabetes, and others, are caused to a great degree by diets high in fatty foods and low in fiber-rich foods. Many of these conditions have their roots in childhood. Weight problems are worsening among U.S. children and contributing to many difficulties later in life. By the time they have reached the end of their teen years, 90 percent already have clear evidence of atherosclerosis.
For these reasons, the USDA mandates that school lunches contain no more than 30 percent of calories from fat and less than 10 percent of calories from saturated fat.
Of the school districts surveyed, 10 out of 12 are making an effort to reduce the fat in their meals, but 4 (33 percent) said that it's difficult to meet the low-fat and saturated-fat standards. Two school districts (17 percent) reported they are not even trying. One director in a Virginia public school that still uses a deep-fat fryer explained, "The kids like [foods] better when they're fried. And I'd rather have them eat than not eat."
When asked what methods were employed to lower the fat content of the meals, food service coordinators cited the following:
- Four school districts indicated that they never fried, but grilled and baked instead.
- Five school districts switched to low-fat dressings, leaner beef, and/or lower-fat yogurt.
- Two school districts rinsed, drained, or blotted pizza and burgers.
- One school district replaced 25 to 30 percent of meat dishes with textured vegetable protein.
Although changing cooking methods, choosing leaner products, and removing excess oil help slightly to reduce excess fat and saturated fat in foods, the surprising finding is that only one of the food service directors was substituting lower fat, cholesterol-free protein from plant sources to lower fat in the menus, a choice that would not only reduce the fat, saturated fat, and cholesterol in the menu, but would also incorporate more nutrient-dense, cholesterol-free, and naturally low-fat plant foods. Children who grow up getting their nutrition from plant foods have a tremendous advantage in that they are much less likely to develop health problems as the years go by.
Availability of Calcium-Rich, Non-Dairy Foods
Cow's milk is now commonly cited by many researchers and doctors as a potential factor in a variety of health problems. For one, research shows that milk consumption can impair a child's ability to absorb iron and, in very small children, can even cause subtle blood loss from the digestive tract. Combined with the fact that milk has virtually no iron of its own, the result is an increased risk of iron deficiency. Also, the American Academy of Pediatrics has concluded that milk proteins may contribute to childhood-onset diabetes. Some children have sensitivities to milk proteins that show up as respiratory problems, chronic ear infections, or skin conditions.
The most prevalent problem with drinking cow's milk, especially among children of Asian, Hispanic, Native American, and African descent, is lactose intolerance caused by the loss of the ability to digest the milk sugar lactose. Lactose-intolerant children suffer a variety of symptoms from the ingestion of cow's milk and other dairy products, including gas, bloating, pain, diarrhea or constipation, and indigestion.
Many plant sources of calcium—such as broccoli, kale, collard greens, beans, and calcium-fortified orange juice, cereals, and soymilk—are not only rich in highly available calcium, but are high in other vitamins and minerals and are free of cholesterol and saturated fat.
For these reasons, PCRM asked the school districts whether they offered calcium-rich, non-dairy foods for those children who do not tolerate milk well or who avoid it for health reasons. Six out of the 12 school districts surveyed said that children must take cow's milk, unless they had a note from a doctor or parent. If a child has a note from the doctor indicating he or she is lactose intolerant and unable to digest milk or has a note from a parent saying that the child will not drink milk for religious or ethical reasons, the child may take fruit juice as a replacement. Juice, while rich in vitamin C, is not high in calcium unless fortified. Calcium-fortified soy or rice milk was not offered in any of the school districts surveyed. Only one surveyed school district offered high-calcium vegetables such as kale and collards. This was in the rural Hancock, Mississippi, district of approximately 4,000, where children were said to love turnip greens and broccoli.
Availability of Vegetarian Entr¹es
On the whole, diets in the United States are too high in fat, cholesterol, sodium, and highly processed foods, and, consequently, too low in fiber, complex carbohydrates, and disease-preventing vitamins and minerals. These missing nutrients are the very ones found in abundant quantities in plant foods. Diets built from grains, vegetables, fruits, and legumes are easy to prepare, inexpensive, satisfying to children, and offer the most disease-fighting protection of any dietary pattern.
Childhood is the time when dietary habits are established—habits that exert a life-long effect. Introducing vegetarian foods in the early years of life gives children the chance to learn to enjoy a variety of nutritious foods. A diet built from fruits, vegetables, grains, and legumes provides excellent nutrition for all stages of childhood, from birth through adolescence. Vegetarian children tend to stay slimmer and live years longer than their counterparts.
A varied menu of grains, beans, vegetables, and fruits supplies plenty of protein. With the approval of Alternate Protein Products (APPs) in the NSLP, schools are now given the freedom to provide children with meatless, cholesterol-free entr¹es. Vegetarian burgers and other alternative protein sources can now replace 100 percent of the animal protein in the school lunch, provided they meet the APP guidelines.
Health-conscious food service directors incorporate these foods into their menu plans. However, only 2 of the 12 school districts surveyed incorporated a variety of healthy vegetarian options into their regular menus (beyond the typical peanut butter and jelly or grilled cheese sandwich or salad):
The Leverett Elementary School in Massachusetts serves meatless entr¹es twice a week as the main selection and has meat alternatives available at every lunch. Included in these entr¹es are vegetarian lasagna, spaghetti marinara, taco salad with refried beans, vegetarian hot dogs, and salads on a daily basis. A Chicago school district offers veggie burgers to their elementary school clientele. The kids reportedly enjoy these foods, and there is very little plate waste.
The remaining 10 of the 12 school districts surveyed provide a simple vegetarian option for an individual child only if requested (peanut butter and jelly sandwich, cheese pizza, or a salad); only a small proportion of schools have taken the initiative to incorporate vegetarian options into their meal plans.
From the findings of this survey, it is clear that the National School Lunch Program falls short of routinely serving healthy, low-fat, fiber- and nutrient-rich meals to children. The USDA, school food service directors, school administrators, school board members, and parents need to work together to upgrade the menu offerings of the NSLP to promote the health of children in the United States.