Abstract
BACKGROUND: In Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary. OBJECTIVE: This study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students' school food selection and consumption compared with students in control schools. DESIGN: The Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year. PARTICIPANTS/SETTING: Participants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts. INTERVENTION: Chef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards. MAIN OUTCOME MEASURES: Changes in school meal selection and consumption were examined using plate waste methodology. STATISTICAL ANALYSES PERFORMED: Logistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards. RESULTS: After the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption. CONCLUSIONS: Schools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist.