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Literature Review
Childhood obesity is a serious public health problem in the US that is associated with significant health complications, including elevated cardiovascular risk, pediatric hypertension, and diabetes (CDC, 2017). Since children spend most of their daytime at school, school food programs are touted as effective interventions for reversing this epidemic. In this section, recent scholarly studies published within the last five years on school-based obesity interventions and perceptions of children and parents will be reviewed. The aim is to determine the efficacy of interventions that cut sugar and fat in school lunches and the behaviors and perceptions that define the success of such programs. The questions that this review will attempt to answer are the following:
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How does the school environment promote unhealthy diets?
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What is known about meals schools serve?
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How are the childrens diets influenced by parental perceptions?
How Does the School Environment Promote Unhealthy Diets?
The consumption of unhealthy food is the leading cause of childhood obesity. Some implemented programs aimed at changing the school cafeteria environment by promoting healthier dietary behaviors.
In the research carried out by Struempler, Parmer, Mastropietro, Arsiwalla, & Bubb, (2014), the intervention aiming at the increase of the intake of fruits and vegetables by primary school students was implemented for the purpose of chronic disease and obesity prevention. The authors found that providing healthier food options with restricted sugary/fatty food availability can improve fruit and vegetable consumption among schoolchildren (Struempler et al., 2014). Even a slight change in the intake of fruits and vegetables by school children can serve as the basis for the further changes in the childrens diets making them healthier. Therefore, school policies/guidelines that control the availability of unhealthy food in school settings can curb childhood obesity.
Other interventions within the school cafeteria environment that promote healthy food choices include placing healthier food first in a buffet, providing multiple healthier options, establishing a salad bar, attractive labeling of fruits/vegetables, and permitting pre-ordering of meals (Struempler et al., 2014). Moreover, promoting vegetarian diets in schools can help prevent childhood obesity. According to Struempler et al. (2014), vegetarian children tend to have a normal BMI because plant-based meals are low in energy density and rich in complex carbohydrates that enhance satiety and metabolism (p. 288). Further, vegetarian diets contain lower levels of cholesterol and unhealthy fats.
The food sold through the school vending machines is also unhealthy. According to the findings of Madden et al. (2013), up to 75% of the beverages/soda and 85% of snacks contained in these machines are rich in sugar and fats, which increases obesity risk. Further, among fourteen-year-olds, more than three servings of sweetened beverages are consumed by 52% of boys and 32% of girls (Madden et al., 2013).
The increased utilization of vending machines is attributed to limited lunchtime and congestion in the cafeterias. Therefore, controlling the dietary content of food sold through vending machines can help curb the problem of childhood obesity. Another strategy includes using credit cards to track the childs food choices from vending machines. The authors concluded that supporting the child to select healthier food leads to good dietary practices, even at home (Madden et al., 2013).
Other studies have focused on the provision of nutrition education as a way of promoting healthy dietary practices extending into adulthood. Toomer (2016) noted that the most effective nutrition education is delivered using a combination of teaching and promotion strategies launched at the policy, community, and individual levels including food marketing and presentation in schools, as well as an advertisement on TV. However, the insufficiency of time and incentives for the educators result in the slow integration and implementation of such programs as parts of curricula (Perera, Fre, Frei, Wong, Bobe, 2015).
In addition, the existing nutrition education programs require regular and ongoing reviews due to the potential changes in the social factors that contribute to the formation of diets and the need to maintain the relevance of nutritional education for all groups of the population (Wunderlich & Gatto, 2016). The important areas that should be addressed through such collaborations include the socio-cultural dimensions of food, preparation, preservation/storage, and healthier food choices. Nutrition education should focus more on fruit/vegetable diets as healthier alternatives to snacks and sweetened drinks.
What Is Known about Meals Schools Serve?
Research on school lunches has focused on caloric intake obtained from programs like the National School Lunch Program (NSLP). The NSLP is part of the USDAs meal program for schoolchildren. Eligible children from poor households receive free school meals.
Hopkins and Gunther (2015) carried out a study focused on the review of the historical changes in the USDA child meal programs for the purpose of finding whether or not the programs are meeting the intended objectives. The authors found a significant association between NSLP meals and high BMI prior to the changes to the national dietary guidelines in 2012. The meals were found to be high in calories, fat, saturated fat, and sodium , but low in fiber (Hopkins & Gunther, 2015, p. 10152). However, in this study, it was also noted that this issue is highly under-researched which can be seen from the lack of published studies on the effect of the Summer Food Service Program (Hopkins & Gunther, 2015).
Bergman et al. (2014) researched the changes in nutrients consumed in NSLP before and after the implementation of the Healthy Hunger-Free Kids Act of 2010 (HHFKA) that became effective in 2012. The authors took digital pictures of the lunch trays of school students for the purpose of evaluating the quality and quantity of food consumed by children before and after the HHFKA. The nutrition contents of the lunches were measured using MANOVA (one-way multiple analysis of variance) and then employing multiple t-tests in order to compare the mean amounts of nutrients. Bergman et al. (2014) concluded that after the implementation of HHFKA there was a significant improvement in the quality of foods consumed at schools, as well as the foods selected by the children for their lunches.
Many researchers found a direct connection between school-based diets and the academic success of children. For instance, Scalora (2016) noted that short lunch breaks that occur due to the overloaded school curricula leave children no time to eat properly, wait for quality foods in cafeterias, or even consume enough food. Moreover, the Center for Ecoliteracy (2011) noted that many research studies document the connection between better nutrition for school children and improved memory, attention, focus, thinking, and cognition. In that way, healthier diets could enhance the academic performance of children and produce higher results on tests.
Haynes-Maslow and OHara (2015) overviewed a wide range of issues related to food served at schools and noted that apart from the lunch programs, many schools also have vending machines that distribute cheap and unhealthy food and beverages to the children; due to this tendency, obesity and excessive weight often persist in children coming from families with a lower level of income.
How Are the Childrens Diets Influenced by Parental Perceptions?
Parents influence the development of healthy dietary habits in their children as primary caregivers. Therefore, the childs diet quality is dependent on parental attitudes and perceptions.
According to the study carried out by Peters, Parletta, and Lynch (2013), children are heavily influenced by the habits and lifestyles of their parents since early childhood. The study presented a systematic review of qualitative research articles focusing on the impact of parents of pre-schoolers on the childrens diets. The authors revealed that there exists a set of barriers and misconceptions that result in flawed parenting in regard to food consumption by children. In particular, the authors specified that some of the most common errors of this type include the parents ideas and heavier children are healthier, that children may begin to starve if their request of food is somehow limited, that the excessive weight is something a child will grow out of, and the use of food as an instrument to influence a childs behavior (Peters et al., 2013).
Researching the issue of the parental impact on childrens diets, Adamo and Brett (2013) conducted a narrative review aimed at the evaluation of the diets of children, as well as the perceptions related to food and diet among parents. The research included a wide variety of studies relying on different designs. Adamo and Brett (2013) noted that there exists an insufficiency of studies researching the problem of correlation between parental perceptions of childrens diets and the actual diets of their children. However, the researchers identified the essential role of parents and the establishers and maintainers of the childrens diets, and thus, as the major contributors to the formation of the childrens eating habits.
Parental perceptions of childrens diet quality in schools are critical in promoting quality nutrition for obesity prevention. However, due to the limited knowledge of nutritional standards, the parental perceptions of a healthy diet may be incorrect. Maternal education, BMI, and occupational status have been shown to predict perceptions of dietary quality of the children (Adamo & Brett, 2013). The mothers nutritional knowledge determines her perceptions of what she considers a healthy meal for the child. Parents often perceive homemade meals, e.g., packed lunch, as healthier than school lunches, even though this may not be the case. Most parents consider a fruit/vegetable diet at the dinner table as a healthier alternative for children than soft drinks (Adamo & Brett, 2013). Therefore, the involvement of parents through nutrition education can complement school-based interventions for childhood obesity prevention.
Summary
The purpose of this review was to provide answers to three major questions. First of all, in regard to the school environment and the promotion of healthy diets, it is known that the programs that increase the childrens intake of fruits and vegetables can impact the students diets making them healthier (Struempler et al., 2014). Also, the use of vending machines at schools serves as a powerful promoter of unhealthy food consumption (Haynes-Maslow & OHara, 2015; Madden et al., 2013). Finally, relevant and updated nutritional education that could help increase students literacy in regard to diets is necessary as the schools contribution to the formation of childrens diets (Perera et al., 2015; Toomer, 2016; Wunderlich & Gatto, 2016).
Also, schools have a history of serving fatty and sugary foods low in fiber; however, this tendency changed with the implementation of the HHFKA (Bergman et al., 2014; Hopkins & Gunther, 2015). This is good not only for the childrens health but also for their academic performance that is tightly linked to students diets (Center for Ecoliteracy, 2011; Scalora, 2016).
The factor that has an even more powerful influence on childrens diets is the parental impact (Adamo & Brett, 2013; Peters et al., 2013). Even though the body of research covering this issue is insufficient, it is known that parental perceptions and lifestyles shape childrens diets and eating habits.
References
Adamo, K. B., & Brett, K. E. (2013). Parental perceptions and childhood dietary quality.
Maternal and Child Health Journal, 18(4), 1-19. doi:10.1007/s10995-013-1326-6
Bergman, E. A., Englund, T., Taylor, K. W., Watkins, T., Schepman, S., & Rushing, K. (2014). School lunch before and after implementation of the Healthy Hunger-Free Kids Act. The Journal of Child Nutrition and Management, 38(2), 1-12.
Center for Ecoliteracy. (2011). Rethinking school lunch (2nd ed.)
Haynes-Maslow, L., & OHara, J. K. (2015). Lessons from the lunchroom childhood obesity, school lunch, and the way to a healthier future. Union of Concerned Scientists, 1-20.
Hopkins, L. C., & Gunther, C. (2015). A historical review of changes in nutrition standards of USDA child meal programs relative to research findings on the nutritional adequacy of program meals and the diet and nutritional health of participants: Implications for future research and the summer food service program. Nutrients, 7(12), 1014510167.
Perera, T., Frei, S., Frei, B., Wong, S. S., & Bobe, G. (2015). Improving nutrition education in U.S. elementary schools: Challenges and opportunities. Journal of Education and Practice, 6(30), 41-50.
Peters, J., Parletts, N., & Lynch, K. C. (2013). Parental influences on the diets of 2- to 5-year-old children: Systematic review of qualitative research. Journal of Early Childhood Reasearch, 12(1), 1-5.
Scalora, V. R. (2016). Have you counted the ingredients on your childs lunch tray?: An economic analysis of sustainability initiatives within the school lunch program. Business and Economics Summer Fellows, Paper 2, 1-32.
Struempler, Parmer, Mastropietro, Arsiwalla, & Bubb, (2014). Changes in fruit and vegetable consumption of third-grade students in body quest: Food of the warrior, a 17-class childhood obesity prevention program. Journal of Nutrition, Education, and Behavior, 46(4), 286292. doi: 10.1016/j.jneb.2014.03.001.
Toomer, O. (2016). Nutrition Education and Promotion in the USA. Journal of Food, Nutrition, and Population Health, 1(14), 1-2.
Wunderlich S, Gatto KA (2016) Impact of government-sponsored nutrition education and physical activity programs on healthy aging in the United States. Healthy Aging Research, 5(9), 1-6.
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