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

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As elementary school students return to the classroom this fall, many face more than academic challenges. These children stand on the threshold of obesity, diabetes, and other health problems tied to unhealthful diets. Because the National School Lunch Program (NSLP) plays an influential role in developing children's eating habits, the Physicians Committee for Responsible Medicine (PCRM) has completed its fourth annual review of the food served in school lunchrooms. This report, which examines 11 of the nation's largest school districts, also evaluates nutrition education programs. Results are summarized in a report card.

This year, PCRM used a new and more comprehensive system for rating the districts' school lunch offerings. The goal was the same as in previous years: to rate the NSLP on whether foods served in schools are promoting the health of all children. The new report evaluates elementary school lunches and nutrition programs based on three general categories: Obesity and Chronic Disease Prevention, Health Promotion and Nutrition Adequacy, and Nutrition Initiatives.

The key difference between the new system and the previous one is that ratings have been expanded to include information from nutritional analysis of the menus (levels of fat, saturated fat, cholesterol, fiber, and vitamin C). Also, because many children get a significant number of daily calories from snack foods and foods sold in vending machines, the review evaluated the snack foods available to primary school children in vending machines on school campuses.

The new rating system makes direct comparisons between this report and those from previous years impossible, but it offers more complete information on how well a school lunch program is meeting the nutritional and health promotion needs of the children it serves.

Background

The NSLP was established in 1946 to provide nutritious food to children while also promoting the nation's agricultural interests. The program now operates in nearly 100,000 schools and residential childcare institutions and serves approximately 28 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.

Today, many children in the United States suffer from an over-consumption of calories, fat, cholesterol, salt, and sugar. The prevalence of obesity among our nation's youth is at an all-time high, and some experts estimate that children in the nation's youngest generation may be the first to have shorter lives than their parents. The Centers for Disease Control and Prevention have found that two-thirds of overweight 5- to 10-year-olds already have at least one risk factor for heart disease, such as elevated blood pressure or insulin levels.

The Healthy School Lunch Campaign
In response to these serious health concerns, PCRM-a nonprofit organization that promotes preventive medicine through healthy nutrition-has encouraged lawmakers, the U.S. Department of Agriculture (USDA), and school districts to achieve the PCRM Healthy School Lunch Campaign goal of ensuring 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 health and weight, and these positive effects continue into adulthood.

Child Nutrition Act Reauthorization Passed
In 2004, Congress passed the Child Nutrition and WIC Reauthorization Act, which amends the Richard B. Russell National School Lunch Act and the Child Nutrition Act of 1966. This act expands the fruit and vegetable snack program into more states and Indian reservations, sets requirements for nutrition education programs, and allows schools to provide a non-dairy, calcium-rich beverage as part of a reimbursable meal to a child with a parent's note, rather than requiring one from a physician.

Making the Grade

In reviewing elementary school lunches and nutrition programs using new, more comprehensive criteria, PCRM nutritionists focused on the nutrient content of the menus, menu selections, foods sold in school vending machines, and nutrition education programs. The criteria were grouped into the categories of Obesity and Chronic Disease Prevention, Health Promotion and Nutrition Adequacy, and Nutrition Initiatives. In the Obesity and Chronic Disease Prevention category, subcategories included the percentage of calories coming from fat and saturated fat, and milligrams of cholesterol based on menu analyses, as well as the frequency of featured vegan entrée selections. Health Promotion and Nutrition Adequacy subcategories included menu analysis results for fiber and vitamin C content, as well as the frequency of low-fat vegetable side dishes, fruit, and the availability of calcium-rich, non-dairy beverage alternatives. The Nutrition Initiatives category evaluated nutrition education programs and the presence and contents of vending machines in the schools.

USDA Assessment

The USDA also periodically assesses the nutritional quality of the meals served through the NSLP. In the most recent USDA School Nutrition Dietary Assessment Study, published in April 2001, the department reported that many of the nation's school districts do not meet its basic nutritional requirements. (Note that most of the districts in this year's PCRM review did meet the majority of the USDA nutritional requirements.)

School districts that do not meet these requirements are encouraged by the USDA to adjust the menu selections they offer, but they are not audited again for five years. Therefore, a school district may, in fact, be serving meals that contain more than 30 percent of calories from fat and more than 10 percent of calories from saturated fat for a full five years.

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. Consequently, PCRM grades districts based on more substantial criteria. School districts are not yet required by the USDA to serve plant-based meals, offer non-dairy sources of calcium, restrict vending machine sales, or develop nutrition programs to guide children in selecting healthy foods. Therefore, districts that score well in these areas deserve special recognition.

The Top of the Class
To earn an "A" on PCRM's School Lunch Report Card, school districts must have featured vegan entrée options; low-fat vegetable side dishes; fresh, dried, or canned fruit; and non-dairy, calcium-rich beverages available daily. In addition, the menus must contain less than 30 percent of their calories from fat, less than 10 percent from saturated fat, little or no cholesterol, and-on average-8 to 10 grams of fiber and at least 15 milligrams of vitamin C per meal. School districts must also be initiating nutrition education efforts and teaching healthy eating habits to students through such methods as hands-on healthy cooking, involving children in growing nutritious vegetables, or in-class nutrition education lessons. Finally, an "A" school district either has no vending machines at all in the elementary schools or limits its vending machines to selling healthy foods and beverages such as juice, water, low-fat snacks, fruits, and vegetables.

Encouraging Trends

Each year, PCRM has documented improvement in the types of foods offered to children in elementary schools. Despite USDA barriers to serving healthy vegetarian and vegan entrées in elementary schools (these barriers are detailed below), several districts have made these items more available to students. In fact, eight of the 11 districts surveyed this year had at least one featured vegan entrée in the two-week period reviewed for this report card. The high scorer in this category was San Diego Unified School District, which offered six featured vegan entrées in a two-week period. In addition, some schools-including Fairfax County, Prince George's County, and Detroit City School District-have started to respond to the demand for calcium-fortified soymilk and other non-dairy, calcium-rich beverages. Because soymilk costs lunch programs more than dairy milk (which is offered to schools at discount prices by the federal government), most districts are forced to offer soymilk à la carte only. Nonetheless, this availability is an important step forward for students. Healthier vending policies were common this year, with seven of the 11 school districts reviewed scoring full points in this area.

Most Improved Player
The "most improved player" award goes to the Clark County School District in Las Vegas, which received a failing grade last year. This year, even with the more comprehensive rating system, the county scored much higher because it has revamped its menu to include a number of featured vegan entrées and more fresh fruits and vegetables. Consequently, school meals in Clark County now have less total fat, saturated fat, and cholesterol, as well as a sizable amount of fiber.

USDA Initiatives
The USDA has begun to take some initiative in improving the health of our nation's children. Its fruit and vegetable snack program, which provides locally grown produce to 25 schools in a handful of states, has been a huge success and is expanding its coverage. The USDA has also implemented the Team Nutrition program, which helps educate food service staff about preparing healthy foods that taste good. Team Nutrition, which also promotes nutrition education and physical activity for students, has been successful in several states. However, as described below, the USDA still has much work to do to promote the health of all children.

Healthy School Lunch Resolutions
Parents and state governments have been working to find ways to reverse the obesity epidemic by providing healthier food options in schools. Three states-Hawaii, California, and New York-now have healthy school lunch resolutions that have passed handily through state legislatures. These bills encourage schools to offer healthy vegan and vegetarian menu options daily, promote the consumption of local fresh fruits and vegetables, offer healthier choices in vending machines, and improve nutrition education efforts in both the classroom and the cafeteria. In October 2003, the school board for the Los Angeles Unified School District implemented recommendations offered by the California healthy school lunch resolution. The New York State resolution passed in March 2004.

Roadblocks to Health

School districts face a number of challenges to serving vegan meals and non-dairy, calcium-rich beverages and to offering nutrition education to children participating in the NSLP. These problems include a lack of financial and programmatic support from the USDA and lawmakers, as well as a lack of social support for healthy eating habits from corporate interests, families, peers, and communities.

Commodity Foods
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 hundreds of 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 neglects to provide the healthiest foods possible. For example, it still 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 is because the government subsidizes hamburger and other meats, but not meat alternatives. The same holds true for calcium-rich, non-dairy beverages.

The problem is even more complicated than it appears. Even if soybeans become an agricultural product purchased through the commodities program, a soyfoods manufacturer would have to purchase commodity soybeans and other commodity ingredients to manufacture soymilk, veggie burgers, and other products for these foods to be available at reduced cost to schools. The premier soymilk companies have made a commitment to using organic soybeans that are free of genetically modified organisms (GMOs) to make soymilk, tofu, and other products. Organic, non-GMO agricultural products are not available through the commodities program, so there are many barriers to these healthier foods becoming available to children in schools.

Nutritional Equivalency Standards
Because nutritional equivalency is often narrowly defined by the USDA, many healthy foods do not meet current guidelines. For example, tofu, tempeh, cultured soy (yogurt), soymilk, and soy cheese do not count as meat alternatives because they are not at least 18 percent protein by weight. Therefore, only textured vegetable protein and processed soy protein are permissible meat alternatives. In addition, the USDA has to approve meat alternative products based upon whether they meet USDA requirements of 2 ounces of protein per serving. Most veggie burgers and meat alternative products are not labeled with USDA approval; thus, if a school wants to serve a veggie burger or other meat alternative, the manufacturer must provide the district with documentation that the product meets USDA specifications.

With the current reauthorization of the National School Lunch Act and the Child Nutrition Act, a non-dairy beverage that is nutritionally equivalent to cow's milk will now be an allowed beverage option as part of a reimbursable meal for children with a parent's note. However, the USDA will likely take at least a year to set nutritional equivalency standards before this new ruling can be implemented. For this option to benefit children, the USDA must set reasonable standards and make these purchases simple for districts looking to offer a healthy alternative to students. At this point, calcium-fortified soymilk, for example, can cost three times as much as regular milk and has to be special-ordered from a soymilk company. Schools must shoulder the additional financial burden (over the cost of cow's milk) of providing these beverages as an alternative to cow's milk.

The USDA provides very few 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.

Accountability
Although federal law requires schools to ensure that 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.

In fact, a large proportion of schools 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.

School food service programs and the children they serve would also benefit from community and family support of healthy eating habits. The eating patterns children learn at home and from the media and peers influence the choices they make while eating at school. School food service directors are under pressure to serve foods that students will eat and enjoy. When children have been raised on chicken nuggets, pepperoni pizza, burgers, and fries, it is difficult to get them to make healthy choices because the healthful foods are unfamiliar and the meaty, fatty choices are what they are accustomed to eating. Ideally, children should be offered only healthy menu options in schools. Schools-such as the Central Alternative High School in Appleton, Wisconsin-that have made a commitment to serving only healthy options have noted tremendous health, behavioral, and learning benefits among the students they serve.

The food industry could also be part of the solution to childhood obesity. If food producers and manufacturers put their creative and financial might behind creating healthy food products and marketing healthy foods to children and discontinued a long history of concerted efforts to turn children into sugar and fat addicts, schools would have fewer obstacles to overcome in serving nutritious meals. Food companies could cooperate with the USDA to develop child-friendly foods that exceed USDA nutrition guidelines and thus allow schools to offer children low-fat, high-fiber, nutrient-dense foods that they would enjoy.

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 according to PCRM's nutrition criteria. But many are making an effort, and some districts are doing quite well. To succeed fully in offering healthy lunches, schools need help from Congress, the USDA, the food industry, communities, and families.

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