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Health Benefits of School Food Programs: An Overview of Canadian Research

The following summary of research has been shared by Rachel Engler-Stringer, Ph.D, Associate Professor, Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan. Rachel is also the Convenor of the Canadian Association for Food Studies School Food Working Group. She sits on the Steering Committee of the Coalition for Healthy School fod as the academic representative.

When the Coalition for Healthy School Food communicates the need for a National School Food Program, we often hear the question “what evidence do you have?” This blog post shares a brief summary of Canadian research on the health benefits of school food programs.


Research shows that the diet quality of Canadian children across the socio-economic spectrum during school hours is poor [1].

  • Only a small proportion of Canadian children meet the 2007 Canada’s Food Guide recommendations; low vegetable and fruit consumption are of particular concern [2,3].

  • Families struggle to introduce minimally processed healthy foods for a variety of reasons [4-6].

  • Provision of healthy school lunches is challenging in the context of parents working long hours [7,8], and families are struggling to adopt healthy food behaviours [8].

  • Parents may rely on highly processed foods, that are low in key nutrients but high in salt, sugar and fat, to cope with demands on time [9].

Introduction of healthy foods in a universal school food program can give all children greater opportunities to learn about and eat healthy foods in a way that is not stigmatizing [12].

  • Socioeconomic Status (SES) affects overall dietary intake [10] and school food programs can reduce disparities in vegetable and fruit consumption between children from higher versus lower SES households [11] and limit intake of minimally nutritious foods among higher SES households [1].

Studies have demonstrated a wide range of health, dietary, and behavioural impacts from school food programs.

  • International research on the health and dietary behaviour impacts of school food programs in high-income countries finds modest positive effects overall, including higher vitamin intakes and increased vegetable and fruit consumption, especially in younger children [13-16].

  • Extensive research from various parts of the world that compares the nutritional quality of food consumed at school that was brought from home versus food acquired through school food programs has found that school food programs provide healthier food overall (regardless of the SES of child participants) [17-24].

  • Studies on school food programs and academic achievement, attendance, tardiness, and drop-out rates point to important impacts of school food programs. Attendance and tardiness appear to be most affected, but some studies have found improvements in academic achievement with the introduction of school food programs [25-35].

  • School food programs can contribute to teaching about culinary heritage, social norms around food, and environmental sustainability [36-38].

Our team at the University of Saskatchewan’s soon to be published research characterized lunches in randomly selected urban schools with a meal program, urban schools without a meal program and rural schools without a meal program in the Saskatoon region.

  • Just over 1/2 of students met recommendations for grain products and meat and alternatives, less than 1/3 met recommendations for vegetables and fruit, under ¼ met recommendations for whole grains, and even fewer met recommendations for milk and alternatives.

  • The overall diet quality scores of students in meal programs were greater because they included whole grains, met meat and alternatives recommendations, and had fewer minimally nutritious foods.

  • Children not participating in meal programs brought about 1/3 of calories as minimally nutritious foods, about double that of meal program student lunches.

Our team has also just completed data collection on a survey of attitudes and preferences with regards to school food programming of over 500 caregivers of children. That data will be analyzed in early 2020 and preliminary results should be available soon!


References:

[1] Tugault-Lafleur CN, Black JL, Barr SI. Examining school-day dietary intakes among Canadian children. Applied Physiology, Nutrition and Metabolism. 2017;00:1-9.

[2] Black JL, Billette JM. Do Canadians meet Canada's Food Guide's recommendations for fruits and vegetables? Appl Physiol Nutr Metab. 2013;38(3):234-242.

[3] Health Canada. Do Canadian Children Meet Their Nutrient Requirements Through Food Intake Alone? In: Health Canada, ed. Ottawa: Government of Canada; 2012.

[4] Engler-Stringer R. The Domestic Foodscapes of Young Low-Income Women in Montreal: Cooking in the Context of An Increasingly Processed Food Supply. Health Education and Behavior. 2009;37(2):211-226.

[5] Daniel C. Economic constraints on taste formation and the true cost of healthy eating. Soc Sci Med. 2016;148:34-41.

[6] Slater J, Sevenhuysen G, Edginton B, O'Neilz J. 'Trying to make it all come together': structuration and employed mothers' experience of family food provisioning in Canada. Health Promotion International. 2012;27(3):405-415.

[7] Griggs TL, Casper WJ, Eby LT. Work, family and community support as predictors of work–family conflict: A study of low-income workers. Journal of Vocational Behavior. 2013;82(1):59-68.

[8] Bauer KW, Hearst MO, Escoto K, Berge JM, Neumark-Sztainer D. Parental employment and work-family stress: Associations with family food environments. Social Science & Medicine. 2012;75(3):496-504.

[9] Slater J, Sevenhuysen G, Edginton B, O'Neil J. 'Trying to make it all come together': structuration and employed mothers' experience of family food provisioning in Canada. Health Promot Int. 2012;27(3):405-415.

[10] Ahmadi N, Black JL, Velazquez CE, Chapman GE, Veenstra G. Associations between socio-economic status and school-day dietary intake in a sample of grade 5–8 students in Vancouver, Canada. Public Health Nutrition. 2014;18(5):764-773.

[11] Longacre MR, Drake KM, Titus LJ, et al. School food reduces household income disparities in adolescents' frequency of fruit and vegetable intake. Preventive Medicine. 2014;69(December):202-207.

[12] McIsaac JD, Read K, Williams PL, Raine KD, Veugelers PJ, Kirk SFL. Reproducing or Reducing Inequity? Considerations for School Food Programs. (1486-3847 (Print)).

[13] Kristjansson EA, Robinson V, Petticrew M, et al. School feeding for improving the physical and psychosocial health of disadvantaged elementary school children. Cochrane Database of Systematic Reviews. 2007(1):CD004676.

[14] Van Cauwenberghe E, Maes L, Spittaels H, et al. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and 'grey' literature. Br J Nutr. 2010;103(6):781-797.

[15] Joshi A, Azuma, A.M., Feenstra, G. Do farm-to-school programs make a difference? findings and future research needs. In. Journal of Hunger and Environmental Nutrition. Vol 32008.

[16] Bontrager Yoder AB, Liebhart JL, McCarty DJ, et al. Farm to elementary school programming increases access to fruits and vegetables and increases their consumption among those with low intake. Journal of Nutrition Education and Behavior. 2014;46:341-349.

[17] Evans CE, Cleghorn CL, Greenwood DC, Cade JE. A comparison of British school meals and packed lunches from 1990 to 2007: meta-analysis by lunch type. British Journal of Nutrition. 2010;104(4):474-487.

[18] Caruso ML, Cullen KW. Quality and cost of student lunches brought from home. JAMA Pediatr. 2015;169(1):86-90.

[19] Neilson LJMR, Macaskill LAMR, Luk JMMR, et al. Students' Food Intake from Home-Packed Lunches in the Traditional versus Balanced School Day. Can J Diet Pract Res. 2016:1-8.

[20] Hur I, Terri B-C, Reicks M. Higher quality intake from school lunch meals compared with bagged lunches. ICAN: Infant, Child and Adolescent Nutrition. 2011;3(2):70-75.

[21] Taylor JP, Hernandez KJ, Caiger JM, et al. Nutritional quality of children's school lunches: differences according to food source. Public Health Nutr. 2012;15(12):2259-2264.

[22] Hubbard KL, Must A, Eliasziw M, Folta SC, Goldberg JP. What's in children's backpacks: Foods brought from home. Journal of the Academy of Nutrition and Dietetics. 2014;114:1424-1431.

[23] Johnston CA, Moreno JP, El-Mubasher A, Woehler D. School lunches and lunches brought from home: A comparative analysis. Childhood Obesity. 2012;8 (4):364-368.

[24] Stevens L, Nelson, M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population. In. Journal of Human Nutrition and Dietetics. Vol 242011.

[25] Meyers AF, Sampson AE, Weitzman M, Rogers BL, Kayne H. School breakfast program and school performance. American Journal of Diseases of Children. 1989;143(10):1234-1239.

[26] Alaimo K, Olson CM, Frongillo EA. Food Insufficiency and American School-Aged Children's Cognitive, Academic, and Psychosocial Development. Pediatrics. 2001;108(1):44.

[27] Symons CW, Cinelli B, James TC, Groff P. Bridging Student Health Risks and Academic Achievement Through Comprehensive School Health Programs. Journal of School Health. 1997;67(6):220-227.

[28] Weitzman M, Klerman LV, Lamb G, Menary J, Alpert JJ. School absence: a problem for the pediatrician. Pediatrics. 1982;69(6):739-746.

[29] Pollitt E, Gersovitz M, Gargiulo M. Educational benefits of the United States school feeding program: a critical review of the literature. American journal of public health. 1978;68(5):477-481.

[30] Florence MD, Asbridge M, Veugelers PJ. Diet Quality and Academic Performance*. Journal of School Health. 2008;78(4):209-215.

[31] Murphy J, Pagano ME, Nachmani J, Sperling P, Kane S, Kleinman RE. The relationship of school breakfast to psychosocial and academic functioning: Cross-sectional and longitudinal observations in an inner-city school sample. Archives of Pediatrics & Adolescent Medicine. 1998;152(9):899-907.

[32] Hollar D, Lombardo M, Lopez-Mitnik G, et al. Effective Multi-level, Multi-sector, School-based Obesity Prevention Programming Improves Weight, Blood Pressure, and Academic Performance, Especially among Low-Income, Minority Children. Journal of Health Care for the Poor and Underserved. 2010;21(2):93-108.

[33] Kleinman RE, Hall S, Green H, et al. Diet, Breakfast, and Academic Performance in Children. Annals of Nutrition and Metabolism. 2002;46(suppl 1)(Suppl. 1):24-30.

[34] Turner L, Chaloupka FJ. Continued Promise of School Breakfast Programs for Improving Academic Outcomes. JAMA Pediatrics. 2015;169(1):13-14.

[35] Anderson ML, Gallagher J, Ritchie ER. School Lunch Quality and Academic Performance. National Bureau of Economic Research Working Paper Series. 2017;No. 23218.

[36] Larson N, Story M. A Review of Environmental Influences on Food Choices. Annals of Behavioral Medicine. 2009;38(1):56-73.

[37] Oostindjer M, Aschemann-Witzel J, Wang Q, et al. Are School Meals a Viable and Sustainable Tool to Improve the Healthiness and Sustainability of Children s Diet and Food Consumption? A Cross-national Comparative Perspective. Crit Rev Food Sci Nutr. 2016:0.

[38] Moffat T, Thrasher D. School meal programs and their potential to operate as school-based obesity prevention and nutrition interventions: case studies from France and Japan. Critical Public Health. 2014;26(2):133-146.

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