“This is a song about the high school experience, sung through the eyes of the person who — more than anyone else — puts young people on the right path,” said Adam Sandler in a 1994 Saturday Night Live sketch. “I’m not talking about the teachers. I’m not talking about the coaches. I’m not even talking about the guidance counselors. I’m talking about a person we call the lunch lady.”
Beyond making us laugh — and providing Chris Farley an opportunity to dance his aproned heart out — it seems Sandler was on to something.
More than 30 million students eat school meals every day, and many of them rely on school foods for up to half of their daily calories.
“Therefore, school-based interventions that encourage the selection and consumption of healthier school food components can have important health implications, especially if they are sustainable and economically feasible,” writes Juliana Cohen, the lead author of a study published Monday in JAMA Pediatrics.
Crafting better M.E.A.L.S.
Researchers at the Harvard School of Public Health teamed up with the non-profit anti-hunger organization Project Bread to create the Modifying Eating and Lifestyles at School (MEALS) study, a randomized clinical trial in two urban, low-income school districts.
Subjects consisted of more than 2,500 third- through eighth-grade students from 14 elementary and middle schools in Massachusetts.
The team set out to examine the short- and long-term effects of a professional chef and the effect of extended daily exposure to a choice architecture intervention on students’ school food selection and consumption. “Choice architecture” is a term that is used to describe the different ways in which choices can be presented to consumers and the impact of that presentation on consumer decision-making.
“Overall, we found that both collaborating with a chef to enhance the school meals and using choice architecture techniques provide benefits,” write the study’s authors. “However, improving food quality and palatability was a more effective long-term method to increase consumption of healthier school foods.”
The percentage of vegetables consumed increased by 30.8% in chef schools, compared with control schools.
“I’m very encouraged by this innovative and effective, chef-based approach to increasing fruit and vegetable consumption, especially considering that the study was done in a lower income population who would likely benefit to an even greater extent from such effective interventions,” says Dr. Melina Jampolis, a physician nutrition specialist not affiliated with the study or its authors.
Presentation is key
Getting kids to eat their veggies may be as simple as a good marketing strategy.
Referencing numerous studies by nutritional scientist Brian Wansink, director of the Cornell Food and Brand Lab, Cohen confirmed that placing healthier foods first in a buffet line increased overall meal selection. Other techniques included placing white milk in front of sugar-sweetened (chocolate) milk, as well as using verbal prompts and lighting on healthier foods.
In a 2012 study by Wansink, changing the name of carrots to “x-ray vision carrots” resulted in a whopping 66% of the orange root vegetable being eaten — far greater than the 32% eaten when labeled “food of the day” and 35% eaten when unlabeled.
Broccoli became “tasty tiny tree tops.” Peas were presented as “power punch peas.”
You might even think about telling your child their favorite sports idol or superhero is a big fan of the food you’re trying to get them to eat.
“These things are just basic tools in marketing,” David Just, a co-author of the 2012 study, told CNN. “These things are well-known by people who try to market less healthy food to our kids. Why not use these things to get our kids to eat healthy foods? We’ve got to use every tool and trick at our disposal.”
Other tricks of the trade
In an accompanying editorial, Dr. Mitesh Patel of the University of Pennsylvania Perelman School of Medicine applauds the study, which was motivated in part by the Chefs Move to Schools program, launched in 2010 by First Lady Michelle Obama to promote more palatable school meals through collaborations with professional chefs.
“Adopting and maintaining … healthier habits is challenging, and new strategies are needed,” Patel writes.
“Framing information and marketing can have a significant influence on decision making,” he says. “Nutritional information presented as serving sizes and calories can be difficult to understand, even for adults. Rather than displaying numerical information, nutritional value might better be displayed using a color-coded scheme that is easily relatable, such as that of a traffic light.”
Another study involving children at 40 schools found that small incentives of 25 cents a day doubled the consumption of fruits and vegetables. Two months after the intervention ended, fruits and vegetables were still consumed at approximately 50% higher rates than at baseline.
Cohen and colleagues noted they had proposed offering fewer containers of chocolate milk, but this was met with strong opposition from schools, who were concerned about needing to refill that section of the lunch line more often.
This is particularly troubling because there are 24 grams of sugar in 1 cup of chocolate milk, compared to just 12 grams in whole or 2% milk, according to the USDA.
“I was disappointed to see the school’s rejections of alternative options, such as offering more white milk than sweetened to make white milk appear to be the more normal choice, due to the potential for slightly increased labor in restocking sweetened (chocolate) milk more frequently,” says Jampolis. “I hope that research continues in this area and I agree with the authors’ suggestion that both school and federal policies and guidelines may need to change in order to have a significant effect.”
What’s for lunch tomorrow?
“Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that increased consumption,” the study concludes. “This was observed only after students were repeatedly exposed to the new foods for seven months. Therefore, schools should not abandon healthier options if they are initially met with resistance.”
“I believe initiatives and interventions like this should be a priority not only in the school setting, but could also be extended to the home and restaurant setting to combat our obesogenic environment and give our country’s youth the best chance at fighting the obesity epidemic and avoiding a lifetime of obesity-related diseases, including heart disease, diabetes, depression, joint disease and certain types of cancer,” says Jampolis.
Perhaps Sandler sang it best. “If it wasn’t for the lunch lady, the kids wouldn’t eat ‘ya. You should be shaking her hand and saying pleased to meet ‘ya. She gives you a purpose and gives you a goal. You should be kissing her feet and kissing her mole.”
Recipes from the study’s “Let’s Cook Healthy School Meals” cookbook can be found here.