9.9: Nutrition Environment and Services
Similar to physical activity, healthy eating patterns are also learned behaviors which have a huge impact on health both during childhood and adolescence and in the future. Although nutritional needs vary between individuals and across the lifespan, the Dietary Guidelines for Americans 2020-2025 recommends that children and adolescents eat a variety of fruits, vegetables, whole grains, and proteins, and drink water or 100% fruit juice while limiting sugar-sweetened beverages. According to the Health Eating Index (HEI-2015) nutritional patterns for American children are poor to begin with, and then tend to decline further over adolescence. Of particular concern is the lack of fruits, vegetables, dairy products, and whole grains in the typical-kid diet (although consumption of refined grains is high), as well as low protein intake for teenage girls. Overall, the greatest dietary concerns for children and youth come from a high consumption of sugar-sweetened beverages, and the lack of nutrient-dense plants and protein sources. Particularly during adolescence - a time of rapid growth and physical maturation - this dietary pattern can lead to malnutrition and nutrient deficiencies (USDA and HHS, 2020).
It’s hard for kids to learn in class when they are hungry. One of the strongest associations between nutritional behaviors and getting higher grades is eating breakfast (CDC, 2021). Yet according to the most recent YRBS reports (2021), 22% of high school students reported not eating breakfast, and only 25% ate breakfast all 7 days of the previous week ( Youth Risk Behavior Surveillance System (YRBSS) , 2023). In the 2022-2023 school year, over 14 million children received a free or reduced price breakfast, and twice as many (over 28 million) participated in free or reduced price lunch programs. Compared to the school year prior, this was a decrease of 1.2 million breakfasts and 1.8 million lunches. Due to pandemic-era funding in 2021-2022, federal waivers had supported free breakfast and lunch programs for any student without any means testing (for example, ensuring that their families met low income requirements). Schools had also found creative ways to ensure students got breakfast: by allowing them to eat in the classroom, or serving a late breakfast after the first class of the day. The elimination of federal waivers and “going back to normal” school policies in the 2022-2023 school year have been indicated as causes of reducing the number of students being served school meals. Eight states - including California - instead implemented Healthy Meals for All legislation to keep access to breakfast and lunch free for all students (Hayes & FitzSimons, 2024). These meals tend to be healthier than what students might otherwise eat, since school breakfast and lunch programs have to follow specific standards for nutrition, including providing fruits, vegetables, and whole grains.Students who participate in the school breakfast program tend to miss fewer days of school and do better on tests (CDC, 2022d).
Taking a WSCC approach includes more than just the food in the cafeteria. Children and adolescents can learn about healthy nutrition from health education classes, messaging (posters, labels, marketing etc.) in the school cafeteria, and modeling by staff. All of the competing food on the school campus (vending machines, etc.) should follow similar health standards to the breakfast and lunch programs. Schools can promote drinking water instead of sugar-sweetened beverages by ensuring that drinking fountains are accessible and operational, and allowing water bottles in the classroom (see also Fig 9.3). Direct education on healthy eating patterns alone is probably unlikely to affect behavior change alone, especially since most schoolchildren get 8 hours or less each year. Instead, the WSCC approach encompasses everything from making nutritious food available, providing adequate time to sit down and eat, normalizing healthy eating patterns, and reinforcing positive messaging throughout the school day, as well as implementing special programs like Farm to School programs or school gardens (CDC, 2023a). See Fig. 9.3 below for the CDC’s diagram of the Components of the School Nutrition Environment and Services.