In a study published in 2020, researchers scored the diets of more than thirty thousand US children in the two- to nineteen-year-old range.[1] The nationally representative data, which came from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016, were scored using the goals of the American Heart Association (AHA), which include eating a certain amount of fruits, vegetables, and whole grains, and limiting sodium and sugar-sweetened beverages. Poor diets were classed as those that reached less than 40 percent of the AHA goals; ideal diets, at least 80 percent; and intermediate diets, everything in between.
I suspect that the authors (who disclose numerous conflicts of interest, including personal fees from the National Dairy Council, PepsiCo, Unilever, Danone, and several pharmaceutical companies) might have liked to spin the data more positively. They conclude, “The estimated overall diet quality of US youth showed modest improvement, but more than half of youth still had poor-quality diets.”
Modest improvement is a stretch. It’s true that the average daily consumption of sugar-sweetened beverages decreased by one serving in the nearly twenty years they assessed. And sure, there were statistically significant increases in a few of the food groups we’d like to see an increase in; however, when we scratch beneath those headline findings, we essentially see diets that were unhealthy and have remained unhealthy.
Consider whole grains, the food group with perhaps the most dramatic improvement: a 109 percent increase in consumption sounds great, but it’s hard to be too excited when you realize that the average child is still eating less than one serving per day (that’s less than a slice of whole-wheat bread). Moreover, the consumption of refined grains—more than six servings per day on average—really puts this “modest improvement” into perspective. Meanwhile, egg and poultry consumption increased; saturated fat and sodium intake, too. Whole fruit consumption increased but only to 0.68 servings per day. In other words, the average kid took another bite or two of their apple. Dark green vegetable consumption increased—from 0.04 servings per day . . . to 0.06 servings per day. Maybe by 2050 kids in the US will be eating one-tenth of a serving of dark green vegetables?
Likewise for larger measures the improvement has been “modest.” As the authors write, “The estimated proportion meeting ideal quality significantly increased but remained low.” No kidding. The baseline of 0.07 percent increased to 0.25 percent; in other words, by the end of the period they surveyed, one out of every four hundred US children were consuming an “ideal” diet according to AHA measures (which, incidentally, would still fall short of what many consider an ideal diet).
All this is to say that the state of pediatric health in this country is neither good nor improving at a rate that most would consider encouraging. We’ve discussed some of the reasons why in a previous article, but here we’re going to focus on another large piece of the puzzle: school meals. These meals make up a large proportion, even the majority, of many children’s daily calorie intake “and are considered to be the most nutritious meals many children consume.”[2] We’ll look at the current nutrition standards determining school meals, what those standards allow for, and how they might be improved.
Although provisional school lunch programs did exist and serve millions of children before 1946, it was not until June of that year that President Truman signed into law the Richard B. Russell National School Lunch Act. As highlighted by Truman’s statement, the purpose of child nutrition programs has been twofold from the very beginning: “No nation is any healthier than its children or more prosperous than its farmers; and in the National School Lunch Act, the Congress has contributed immeasurably [to both.]”[3] This dual focus on children’s health and US agribusiness, described in the opening paragraphs of the legislation as a matter of national security, has been a critical feature of the program ever since.[4]
The next major legislative step in the evolution of US child nutrition programs was the Child Nutrition Act of 1966, signed into law by President Johnson.[5] This established the School Breakfast Program and permanently authorized the Special Milk Program (these programs, as well as the lunch program and other special nutrition programs, are administered by the USDA’s Food and Nutrition Service [FNS]). Fast-forward a few decades to 2010 and the Healthy, Hunger-Free Kids Act, which provided the opportunity to update the nutrition standards, and we find what is essentially the basis for school meals today.[6]
The final rule on nutrition standards following the passage of the 2010 law was published about a year later, following a comment period during which the USDA received more than 133,000 comments; everyone from parents and nutritionists to school administrators, food industry representatives, and lobbyists weighed in.[7] The summary of the rule highlights the need to address the rising childhood obesity rates. Highlights from the regulations include
More recent rulemaking has also targeted added sugars, required schools to provide potable water, and strengthened requirements to buy American products.[8] On the surface, several of these regulations seem like steps in the right direction: more fruits, vegetables, and whole grains stand out; however, enough flexibility remains built into these rules that it is very easy to craft unhealthy diets that meet all of the requirements.
As mentioned above, rules for fruits, vegetables, and grains have improved marginally in recent years, but they leave a lot to be desired. Although the wording encourages schools to provide fresh fruit, the rule also allows schools to meet up to half of the fruit requirement with juices, which have significantly different health consequences than whole fruits due to their lack of fiber, and allows the remaining amount to include fruits canned in light syrup.[7]
For vegetables, children in kindergarten through the eighth grade must be offered three-fourths of a cup per day for lunch; high schoolers, one cup per day.[9] Additional requirements target five subgroups of vegetables: dark green; red/orange; beans, peas, and lentils; starchy; and the catch-all other. While this might sound like good variety, it is very easy, in practice, to meet these requirements by serving relatively unhealthy foods. For example, one could meet up to 80 percent of the vegetable requirement for high schoolers by serving some combination of french fries, hash browns, tomato sauces (as served on pizza or pasta), and salsa.[9][10] The most difficult category to replace with unhealthy choices would be the dark green subgroup, but schools are only required to serve one-half a cup of dark green vegetables per week (about one broccoli floret, maybe two, per day).
The whole grain requirement sounds good—“at least 80 percent of the weekly grains offered in the school lunch and breakfast programs [must be] whole grain-rich . . . the term designated by FNS to indicate that the grain content of a product is between 50 and 100 percent whole grain with any remaining grains being enriched”—until you realize all the junk that qualifies as whole grain rich.[11] A food manufacturer can take a flour blend with 51 percent whole wheat, throw in some palm oil, egg yolks, milk, sugar, salt, and various tongue-twisting preservatives, and before you know it, they are selling hyperpalatable cinnamon chip scones or churro bites fully compliant with the grain requirement.[12][13] Sure, these products could be even less healthy than they are, but that doesn’t make them healthy. Arguably, the higher whole grain content is only papering over the cracks of an insufficient diet. Recall the pediatric nutrition survey described above: whole grain consumption has more than doubled, but the average kid still eats less than one serving of whole grains (compared to more than six servings of refined grains).[1]
As lacking as these requirements may be, the fluid milk component stands apart as the most baffling piece of these meal standards. Numerous observational and interventional studies have linked dairy consumption with poor health outcomes, including a higher risk of certain cancers, a potential role in the initiation of type 1 diabetes, and elevated cholesterol. Data suggests that kids concerned about acne should avoid milk. Even the frequently advertised claims for consuming dairy—such as the idea that it promotes bone health—are not nearly as well supported as many believe. Research has shown that greater milk consumption during teenage years is not associated with a lower risk of hip fracture in adulthood; if anything, the association is with increased risk.[14]
What’s most bizarre is not that milk is an option but that it’s a requirement. Cow’s milk is one of the most common allergens in the world, and more than two-thirds of the global population lose the ability to properly digest lactose after infancy, according to expert estimates.[15] Defenders of the milk requirement would likely point out that lactose-free and reduced-lactose milk may also be offered in school cafeterias, but this ignores the many other health concerns, including those mentioned above.
It gets worse: although sugar-sweetened flavored milk is allowed with no questions asked, students and parents preferring a nondairy substitute, such as unsweetened soy milk, must submit a written request to the school explaining the reason.[16] One might think, based on these requirements, that cow’s milk is more essential to human health than even water. Indeed, the policy history bears that suspicion out—rules mandating milk’s inclusion in child nutrition programs came several decades before the requirement to serve potable water!
The milk requirement demonstrates the fundamental flaw in these programs. As mentioned above, these programs are only partly focused on providing for children’s nutrition needs. Recall Truman’s statement quoted before: these programs are just as focused on serving American agribusiness as they are on serving children. There may be many situations where such a double purpose functions just fine, where neither of the two parties suffers. But what happens when the interests of children and agriculture are incompatible—who loses out then? Is it the increasingly consolidated industry, with all its wealth and power? I don’t think so.
Here’s how a mid-50s leaflet described the Special Milk Program, employing the hollow language of marketing, not substantiated evidence: “Milk is the most nearly perfect of all foods and is an essential part of the diets of growing children. Yet many children do not consume milk in adequate amounts.”[17] The leaflet continues with this revealing statement: “At the same time, there is need to expand markets for the products of our dairy farms.”
So it was, so it has been, and so will it likely continue to be unless something drastically changes.
Children, then, are the victims of not only low dietary quality but also the society entrusted with caring for them. Of course, such programs are not all bad. Anything that helps to reduce the number of hungry kids does not deserve total condemnation, and a substantial number of children do get their healthiest foods from these programs.
What’s needed is overhaul, not obliteration. The administration of these programs must be separated from industry interests. This is not a novel concept, but it is radical in the sense that it requires disentangling these programs from their roots.
Many people and organizations are trying to do just that, and many have succeeded. You can read about some of their work, as well as other helpful tips for feeding children a healthy diet, in the following articles:
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