Strategies to Improve School Meal Consumption: A Systematic Review

Abstract

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

Breakfast and School-Related Outcomes in Children and Adolescents in the US: A Literature Review and its Implications for School Nutrition Policy

“…A number of strategies can improve school meal access, participation, and consumption [ 50 ]. For breakfast specifically, studies included in this review as well as other research demonstrates that offering breakfast at no charge to all students and innovative models of serving breakfast — e.g., breakfast in the classroom, grab-and-go breakfast, and second chance breakfast — increase student participation in the program [ 51 , 52 ].…”

Increased School Breakfast Participation from Policy and Program Innovation: The Community Eligibility Provision and Breakfast after the Bell

“…While BATB and CEP can help to address stigma and accessibility of meals, food-insecure students may still not participate if foods do not meet their preferences and needs. As Cohen et al find in their recent systematic review, key practices schools can adopt include recipe adaptation, incentivizing fresh food consumption, and increased menu choices [ 33 ].…”

“…Nationally, nearly half of school districts do not require or recommend schools provide students with at least 20 minutes of “seat time” to eat their meal [ 32 ]. A recent systematic review outlines key practices that schools can adopt, which include recipe adaptation, incentivizing fresh food consumption, and increased menu choices [ 33 ].…”

Food consumption and plate waste study in a public hospital food service in Natal, RN, Brazil

“…Here are some of the strategies on the implementation of the USDA Healthy, Hunger-Free Kids Act listed to minimize plate waste in schools: obtain feedback on new menu items, implement the Offer versus Serve option across all grade levels, provide more choices, serve foods with familiar flavors, serve ready-to-eat fruit, invite school staff and teachers to eat meals with students, reward students for trying new foods, encourage principals to schedule recess before lunch, encourage students to keep food items for snacks, offer grab-and-go items, serve breakfast in the classroom, offer sharing/trading tables, and donate intact items to food banks [24].…”