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introduction | the criteria | the report card Introduction 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. 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. 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. 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. 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.
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