Challenging Dogma - Spring 2009

Wednesday, May 6, 2009

Why the National School Lunch Program is Preventing Health Status Improvements Among Children: A Critique Based on Social Behavioral Theories

-Darcie Elliott


The National School Lunch Program (NSLP) is a federally supported meal program throughout the nation’s public and private schools (elementary, middle, and secondary). This provides nutritionally balanced lunches to millions of children every day. For every meal served, school districts taking part in the NSLP receive financial support and donated items from the U.S. Department of Agriculture (1). Such lunches must meet the recommendations of the 1995 Dietary Guidelines for Americans: no more than 30% of calories come from fat, less than 10% of calories from saturated fats, one-third of the Recommended Dietary Allowances (RDA) of protein, Vitamins A and C, iron, calories, and calcium (1). This is known as the School Meals Initiative for Healthy Children (SMI).

While all participating schools must meet this Federal standard, decisions about which particular foods to serve and how to prepare them come from decisions made at the individual state level (9).

The rate of children and adolescents (aged 2 through 19 years old) that are at or above the 85th percentile of the 2000 BMI-for-age growth charts who are considered overweight or obese is 31.9% (7). By creating programs in schools, the nation is reaching the greatest amount of children at a time, in that most children and teenagers attend school. Numerous criticisms have risen in recent years about the NSLP not being efficient enough in the fight to decrease obesity among children and adolescents. In a 2006 study, the Center for Science in the Public Interest graded each state’s nutrition programs; 23 states were graded F (6). This paper will focus on such arguments, as are supported through various behavioral theories.

Argument I

Tracy Fox, vice president of the Society for Nutrition Education claimed, “We don’t expose kids to cigarettes in schools, we don’t teach them comic books in English class, so why would we provide unhealthy options in the cafeteria?”(5). Competitive foods are defined by the USDA as foods offered at school, other than meals served through the USDA’s NSLP, which are school lunches, school breakfasts, and after-school programs (9). The first types of these foods are known as Foods of Minimal Nutritional value (FMNV). FMNV are prohibited for sale during lunch periods, but not throughout the day or throughout the school. These foods have <5%>

The other form of competitive foods is known as: All Other Foods Offered for Individual Sale. These can include items from vending machines, snack bars, school stores, and a la carte sales. These sales can directly profit the school district. The nutrition standards in place from the SMI do not apply to such foods.

Critics of the NSLP claim that competitive foods undermine the nutrition integrity of the programs and discourage participation in healthy choices (9). One study found that 40% of children consumed one or more competitive foods on a typical school day (3). These typically can also take the place of nutrient rich foods meeting a child’s RDA. MeMe Roth, president of the National Action Against Obesity said, “Until healthy food stops competing against junk food, it doesn’t stand a chance.” (6).

It is clear to see that by providing regulated meals while also offering non-regulated side options, the NSLP is assuming that the students will act in a rational manor by choosing the “healthier” option. This program presumes that the student will weigh the benefit of the healthier food choice as opposed to a better-tasting a la carte option. The Health Belief Model takes individual level factors such as perceived susceptibility (how likely am I to become unhealthy if I eat this?), perceived severity (how bad would it be if I did eat this?), perceived benefits (what do I like about this food choice?), and perceived barriers (do I really care about being healthy? Do I have enough money?) (2). However, this theory has been widely discredited in its assumption of rational and planned behavior. Intention to act does not always result in such action (2).

Basing the NSLP off of the Health Belief Model is an ineffective measure, considering that its focus is on individuals, whereas this focus is on entire schools of children. When dealing with mass amounts of children throughout entire districts, it is impossible to expect meaningful change from an individual level. It is important to create mass, lasting, change. This is evident through the Social Networking Theory. This states that groups of people change together in social networks (2). Relationships valued to the students need to be taken into consideration before assuming individual change, especially at such impressionable ages.

Argument II

In correlation with competitive foods surrounding students, is the conflict of environmental pressures. The NSLP does not consider students taking their surroundings into account when making their food choices. Unfortunately, this can be thought of as a vicious cycle. Because the majority of students are affected in one way or another by their peers (especially at the middle-school level,) if the peers do not make the correct health choices, this will be picked up in behaviors of others.

The Social Cognitive Theory covers the idea of operant conditioning; where a student would learn a behavior through reinforcement (2). In this situation, it could be thought that by taking time out of friendly interaction to stand in line for a NSLP lunch, the student could be missing out on socializing time with friends. This is especially true if they are spending time at the snack bar, vending machine, school store, etc. This may seem trivial or petty, however; the Social Networking Theory explains the importance of individual relationships in terms of priority (2). This can be especially true for easily-influenced children and teenagers, with a large desire for acceptance. The intention to purchase a well-balanced meal can easily be thwarted upon hearing of others making a different choice.

Many schools are encouraged to “suggest” fruit, salad, or milk as healthy alternatives; The School Nutrition Dietary Assessment Study-II indicates that these are typically not chosen as the dietary option by students (4). Through Social Learning Theory, vicarious learning takes the forefront in making decisions. By modeling the eating choices of the majority of their peers, students are more likely to choose the vending machine or snack stand for food as opposed to healthy alternatives. If students do not possess the self-efficacy to make their own healthy choices then they obviously will not. Until a mass change in behavior or policy occurs, this cycle will continue to stand in the way of proper nutrition in the cafeteria.

Argument III

Aside from NSLP flaws directed towards policy and the students, the school in itself can also be placed at fault in the programs ineffectiveness. One study from the Department of Education found that while 88% of elementary school teachers taught lessons on nutrition, the average total amount of time devoted to the subject was only 13 hours per school year (10). Additionally, the CDC also conducted a study which found that most schools and grade levels require nutrition to be taught, however, the median time spent on nutrition was 5 hours for elementary and high school and 4 hours for middle school (10).

A major problem with the nutrition education that works to complement the NSLP is how the subject matter is being taught. There is a need to re-frame how to make nutrition appealing to children. When a Cornell researcher told kindergartners that they were eating “X-Ray vision carrots,” the children consumed 50% more of the vegetable (5). Lisa Mancino of the USDA says that, “the problem may not be the presence of junk food after all; it’s that the good food just isn’t appealing enough” (5).

There is a major obstacle for educators to overcome if competitive foods remain in the school. When children are taught about good nutrition yet are surrounded by vending machines, they receive the message that good nutrition is only an academic exercise- one that is not even supported by the school administration, so why should they support it? (9). For this reason, it is imperative for effective education methods to be implemented in schools. The Communications Theory, which will be discussed below, states that setting the agenda to communication is imperative. In order to get people to pay attention to the intended message, the students have to view it as important (2).

If nutrition education in schools is being taught as an unappealing subject matter, students will treat it that way. The Psychological Reactance Theory teaches that the human brain will react to limits placed on its freedom. If such freedom is threatened, the brain works to reject the subject matter (2). Thus, if the only thing being taught about nutrition is the negative aspects of making poor food choices, many students will act out in that manner. If the lessons being taught are not interesting, disengaging, or overly complicated, chances are the students will reject the intended lessons.

An additional paradigm proving educational faultiness with nutrition is Communications Theory. This theory states that the best way to effectively convey a message is to have the sender of the information as similar to the receiver as possible (2). Obviously in schools, the teacher cannot be a student. However, by making the lessons more engaging, social, and easy to understand from the students’ perspective, there would be a greater chance of retaining the information. If the “channels” (methods of teaching) of the information are not appealing or interesting to the students, the message has a better chance of being lost (2).

Because there is not a standard method of teaching the subject, nor on how much of the subject must be covered, nutrition is basically taught based on the individual teacher’s own terms. This, like competitive foods, can be thought of an opportunity for policy change. By requiring educators to undergo training on effective communication methods for nutrition, as well as mandating additional time slots, the chances of students relaying this information towards making better choices in the cafeteria would increase.


With the current state of turmoil that the U.S. healthcare system is in, the school-aged children’s health status is extremely vital. Unhealthy choices starting at a young age are very difficult to change before adulthood. By being overweight or obese, students are putting themselves at a much higher risk of heart disease, diabetes, stroke, and several other conditions. The best place to implement such change is school.

However, the presence of competitive foods, popular (and unhealthy) choices, and a lack of effective education methods stand in the way of this. The National School Lunch Program sets nutritional standards for lunches sold, however do not regulate a la cart, vending machines, or snack bar items. Students are at the impressionable ages that seeing their peers make unhealthy choices increases the likelihood that others will as well. Additionally, there is very little education being mandated nationwide about health and nutrition.

There are several social and behavioral theories that support these faults. Widely-accepted discrediting of the Health Belief Model works as a counter argument. The Social Networking Theory helps prove that mass behavioral change occurs at the group level, as do the Social Learning / Cognitive Theory. Psychological Reactance Theory and the Communication Theory both illustrate the importance of effective education methods for nutrition in schools.

Federal School Nutrition Program: A Counter-Proposal to the National School Lunch Program– Darcie Elliott


The Federal School Nutrition Program (FSNP) is an intervention designed to improve on the health statuses of America’s youth through targeting healthy food options at schools. Much like the National Schools Lunch Program (NSLP), this intervention will provide healthy lunches, regulated by the same United States Department of Agriculture (USDA) standards, as well as the option for breakfasts, for students throughout the nation’s schools (elementary, middle, and high schools).

The FSNP will assist not only in reformatting the food choices allotted throughout schools, but also help to build a solid nutrition education program for both teachers and students. Such proposed education reforms are intended to reverse the stigma that many children have regarding healthy foods, so that students can feel comfortable in their healthy decisions with their peers as well.

Through consistent policy changes and collaboration with schools officials at the state level, this program will hopefully have a substantial effect on the nutrition of America’s youth and reduce the amount of overweight and obese children and adolescents. Howell Wechsler, director of adolescent and school health for the CDC, claims, "There's no question that schools can play a profound role [in fighting the epidemic of obesity]. If all they do is get kids to eat more fruits and vegetables or reduce their saturated fat or transfat intake, that's a major accomplishment." (11).

Argument 1 – Dietary Options Reform

One major shortcoming of the NSLP is the sale of competitive foods throughout the school. Such foods, as described previously in detail, are a substantial hindrance on the selected healthy lunches offered through the NSLP (4). To reiterate the primary concern, these choices are not regulated through the NSLP’s or School Meals Initiative for Healthy Children’s (SMI) standards (9). The FSNP is designed specifically to combat such options. Federal mandates must be created in order to control competitive foods in schools.

Evidence has shown that the availability of competitive foods was associated with a decrease in the consumption of fruits and vegetables and an increase in intakes of total and saturated fat (3). On average, students eating competitive foods consumed 201 additional calories from low-nutrient, energy dense foods. Conversely, data from the National Health and Nutrition Examination Survey from 1988 through 2002 suggested that the increase in body weight among children could have been prevented by reducing an average of 110 to 165 calories per day (3). This further illustrates the faultiness of the Health Belief Model, which the NSLP seems to mirror in its delivery. The Health Belief Model assumes that the children will act rationally and make the healthier choice when deciding what to eat for lunch (2). This statistic proves that incorrect.

The FSNP will focus on this startling statistic in its reform of competitive food sales. While the call for elimination of snack bars, a la carte foods, and school stores can be thought of as extreme, the necessity to improve the food choices is evident. FSNP calls for federal mandates to regulate the nutritional content of foods sold at each of these locations. It will be permitted to keep a popular item prepared in a healthier manner if applicable. Laura Jacobo, director of food services at Woodlake Union schools in California stated the following in regards to switching to whole-wheat chocolate-chip cookies: “Surprisingly, the kids have kind of embraced them” (6). Middle schoolers in the South Orange and Maplewood district in New Jersey also embraced the idea of baked French fries as opposed to deep-fried treats as well (6). This is a prime example of Diffusion of Innovations Theory. By changing the way that competitive foods are distributed and made, the foods should eventually be adopted by the students as alternatives; thus, creating group change (2). Through early adopters of the new foods, more will catch on in time (2).

Some states regulate the times of day that such foods can be sold. The FSNP hopes to abolish the need for this through always providing healthy options for foods, as opposed to unhealthy foods served at varying times. The National Association of State Boards of Education stated in its March 2000 study that, “students’ eating habits are greatly influenced by the types of food and drink that are available to them” (9).

As illustrated through the Social Networking Theory, change is more effective on the group level. Social support is thus achieved (2). Through ridding the school of (unhealthy) options for individual sale and replacing all of them with healthy alternatives for everyone, group change can be achieved.

Argument II – Peer Environment Reform

Shaping Youth, a non-profit organization relating to media’s influence on children, conducted a study marketing trends. In doing so, each participating school voiced the concern of having “peer driven junk food issues at lunchtime, despite new wellness mandates” (12). As previously stated, children of all ages are very susceptible to peer pressure. Students often prefer spending time with friends as opposed to waiting in a long line for a school meal (9). Since money is required to purchase competitive foods, children may view the school meals from the NSLP as primarily for poor children, as opposed to nutritious options for meals. Due to this, low-income children’s acceptance of free or reduced price meals may be reduced (9). This illustrates the effect that peer influence can have on a student’s food choices. The Social Networking Theory further portrays how this is possible: the children respond based on their relationships with their friends and peers (2). Interaction between students in the network plays a pivotal role in how they behave.

A study outlining the features of school-based dietary environments concluded that the healthiness of our (dietary) environments, including social norms regarding food choices, can be more important in determining what students will eat than their individual decision-making (14). A randomized control study involving 20 schools in Minnesota during a two-year period, TACOS: Trying Alternative Cafeteria Options in Schools, focused on three areas to promote low-fat foods in schools. One of which was using student groups as the primary channel of promoting the sale of healthy foods in their schools. Upon collecting cafeteria sales records, schools participating in the program showed higher mean percent sales of lower fat foods in one year (27.5% vs. 19.6%) (15).

The Social Learning Theory ties directly into these findings. The students will learn on a group level in a vicarious manner (2). Through seeing such student groups promote the low-fat food options, they are more likely to consume them themselves. For these reasons, the FSNP will focus its attention on building peer support for healthy choices. This can take place both in the classroom, at home, and most importantly- the cafeteria. Outcomes must be seen on the environmental level as opposed to individual when dealing with schools (14, 2).

Argument IIIEducational Standards Reform

An additional, crucial fault of the NSLP that the FSNP will attempt to improve upon is nutritional education. Under the NSLP, there are no national education standards for school food service directors or managers. As financial pressures increase and resources decrease, nutrition often-times is found as a low priority (9). Team Nutrition was established through Congressional funding after SMI implementation in 1995. One of the two goals of this was to emphasize nutrition education that would encourage students to want to eat NSLP meals. However, a loss of funding has since hindered the necessary tools to train teachers to deliver such educational methods (9). Emphasis through FSNP is placed on increased funding for such programs.

The researchers in the TACOS study, as previously presented, encouraged cafeteria staffs to stage giveaways in which students who bought healthful foods received raffle tickets. They also asked business teachers to have their students develop food-marketing ideas (15). Again, this study found that participating schools had an increase in sales of low-fat food options.

Nora Cody, a mother of two and former health non-profit director, taught her son’s class at Oakland's Chabot Elementary about nutrition. She created games to play and conducted experiments; every student filled a jar with one tablespoon of sugar at a time until it equaled the amount in one can of soda. Another experiment was to rub foods on brown paper bags to show how much grease they left behind. The class was so well-received by the children, that Cody is now the Oakland Unified School District wellness coordinator (11).

It is imperative to consider the delivery of nutrition education. As previously stated, making healthy food appealing is a difficult task for teachers. A federal standard for time allotted towards nutrition education is a necessity. The FSNP’s standards will train teachers to focus on their own students. Let the children portray how they would like to learn about proper nutrition, including their own cultures, values, etc. The Social Networking Theory is useful in this situation, in that it targets specific groups at a time, with the teacher formatting lessons for their specific classes (2). The teachers must be able to relay information in a manner that they see fit, based on their own students’ relationships and interests.

The Communications Theory emphasizes points that are illustrated by such teaching methods. Through creating interesting and relatable “channels” of relaying information, the intended message is less likely to be distorted or lost (2). By building on the relationship between the sender and the receiver, the communication process is further enforced (2). These further illustrate the point that it is more conducive to teach nutrition in a different manner than typical school topics.


As illustrated through the numerous examples in the previous two papers, radical changes are necessary if we, as public health professionals, wish to change the health status of America’s youth for the better. Monitoring both the sales of competitive foods as well as nutritional education is a necessity which will be addressed through the FSNP. Peer support-building exercises are also required in order to further encourage healthy choices for students. As we have seen through the Communications Theory, Social Networking / Learning Theory, and the Diffusion of Innovations Theory, students are more likely to change their health behaviors if changes are made a t the group level- not at the individual level, as the Health Belief Model and NSLP intend.


1. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Competitive Foods and Beverages Available for Purchase in Secondary Schools. Atlanta, GA, 2005.

2. Edberg, M. Essentials of Health Behavior Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett Publishers, 2007.

3. Fox, Mary Kay, Gordon, Anne, Nogales, Renee, Wilson, Ander. Availability and Consumption of Competitive Foods in US Public Schools. Journal of the American Dietetic Association 2009; Volume 109, Issue 2, Pages S57-S66.

4. Fox, M.K., Crepinek, M.K., Connor, P., and Battaglia, M. School Nutrition Dietary Assessment Study-II. Cambridge, MA, 2001.

5. Kliff, Sarah. Stealth Health for Kids: Forget Banning Junk. Try “X-Ray Carrots.” Newsweek. 6 April 2009.

6. Martin, Andrew. The School Cafeteria, on a Diet. The New York Times. 5 Sept. 2007.

7. Ogden, Cynthia L., Carroll, Margaret D., Flegal, Katehrine M. High Body Mass Index for Age Among US Children and Adolescents, 2003-2006. JAMA 2008; 299(20):2401-2405.

8. United States Department of Agriculture. National School Lunch Program. Washington, DC.

9. United States Department of Agriculture. Foods Sold in Competition with USDA School Meal Programs: A Report to Congress. Washington, DC: United States Department of Agriculture, 2001.

10. United States General Accounting Office. School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating. Washington, DC: United States General Accounting Office, 2003.

11. Stacy Finz. Obesity War's Latest Battlefront: the School Cafeteria. School Nutrition is Activists' Passion. How 4 Dedicated People Work to Help Bay Area Students Eat Right. San Francisco Chronicle. 28 Aug. 2006.

12. Shaping Youth. Peer Driven Junk Food Allure and What’s Cool to Kids.

13. King, Paul. Peer Pressure May Outwork Food Bans, Study Suggests. Nation’s Restaurant News. 11 Oct. 2004.

14. Lytle, L. & Fulkerson, J. Assessing the Dietary Environment: Examples From School-based Nutrition Interventions. Public Health Nutrition: 5(6A), 893–899.

15. Jayne A Fulkerson, Simone A French, Mary Story, Helen Nelson and Peter J Hannan (2004). Promotions to Increase Lower-Fat Food Choices Among Students in Secondary Schools: Description and Outcomes of TACOS (Trying Alternative Cafeteria Options in Schools). Public Health Nutrition, 7, pp 665-674. doi:10.1079/PHN2003594.

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