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Childhood obesity in America is reaching epidemic proportions. This study explored whether daily online lunch menu information was sufficient to enable parents to advise their children about healthy and unhealthy menu choices in 350 Texas middle schools and whether online menu information strongly correlated with the descriptions of the offerings given by 52 school cafeteria managers in telephone interviews. Although schools are making efforts to describe their offerings, they are not vigorously taking advantage of the opportunity to aggressively inform or educate. They are not coding their descriptions in such a way as to explicitly brand food as healthy or unhealthy. They are also not labeling food as generally required by law for consumer services that provide food (except for the fresh produce that lines supermarket shelves). Instead, they only briefly describe what they are serving in the way of fruit in one or two word snippets. Finally, cafeteria managers’ online descriptions were inconsistent with what they described in interviews. Online and verbal descriptions were sometimes contradictory, raising questions about the accuracy of either type of description.

Master of Science / Department of Hospitality Management and Dietetics / Kevin L. Sauer / The National School Lunch Program (NSLP) seeks to provide nutritionally balanced, low-cost or free lunches to more than 31 million children daily. With the recent increase in childhood obesity, school nutrition programs must follow strict nutrient guidelines in meal preparation. As nutrient requirements have changed, participation in the NSLP has also decreased, especially among older students. To recover lost revenue, many schools offer al a carte items or other snack items often characterized as high in calories, fat, and carbohydrates. The NSLP provides meals with a balance of vegetables, fruits, whole grains, and low-fat and fat-free milk. Some research suggests that unintentional stereotypes or social stigmas exist about the NSLP program among participants. Al a carte and vending machine food options have influenced these stereotypes and in some cases have deterred students from participating in the NSLP. Research about stigma association with the NSLP is scarce and not current. This study investigated if social stigmas exist about the NSLP and their influence on student participation. Middle school students in Kansas comprised the population for this study. A survey instrument was drafted using themes identified from existing research. In addition to demographic variables, the survey contained statements that examined factors that motivate and de-motivate students from participating in the NSLP, and statements about social stigmas and peer influence. A panel of child nutrition program experts and a pilot study with middle school students were used to refine and validate the survey. The survey was distributed to middle school students in thirteen Family and Consumer Science classes in Kansas. A total of 559 students responded to the survey for a response rate of 48%. This study found that few of the motivator statements correlated with participation in the NSLP. However, preference for snack foods was identified as the largest deterrent in respondent participation. Few new social stigmas were identified, but significant variations were found when examining variations between some demographic variables. Respondents who were female, older in age and grade level, frequently ate school lunch, and attended large schools with a high number of students receiving lunch at a free and/or reduced price were more aware of social stigmas and more greatly impacted by the actions of their peers. In contrast, qualitative data showed that some respondents are greatly influenced by peers and the fear of stigmatization.

Canadian scientific literature lacks quantitative information on school meals, which, in Can-ada, are not regulated by law and do not have any national nutritional standard. Nutritional stan-dards and guidelines are essential in evaluation and monitoring studies to maintainor im-proveschool meals quality. This research looked at the nutritional quality of meals served by some elementary schools running a school meal program administered by CHEP Good Food Inc., a non-profit organization, in Saskatoon, SK. Data collected from 1997 until 2006 were combined to those collected in the 2007/08 school-year. Lunches were compared to 1/3 Dietary Reference Intakes (DRI), and breakfasts and snacks, to ¼ DRI. Using one-sample t-tests and ANOVA, p< 0.05, we evaluated nutrients that were suggested to be below the standard. Sas-katchewans food-based standards were also used to evaluate food group content according to the Canadas Food Guide to Healthy Eating. On-site observations in selected schools shed light on childrens choices and plate waste. Focus groups with selected nutrition coordinators (NC) provided insight into their practices. Overall, lunches and breakfasts had a good nutrient profile but were low mainly in energy, vitamin E, potassium, and, in some years, folate and calcium, particularly for 9-13 year-olds. Findings suggested that snacks seem to be below the DRI stan-dards, but they can be an opportunity for nutrition education. We observed no clear or significant trend across the years. All meals offered good amounts of fruits and vegetables, grains, and dairy products. Plate waste was low and related to NCs practices. Analysis of the interviews exposed some possible explanations for the quantitative results and allowed some recommendations. Findings from this study provide support for future establishment of school meals nutritional standards and for possible changes and improvements of the program, and will enrich knowledge regarding school meals.

Canadian scientific literature lacks quantitative information on school meals, which, in Can-ada, are not regulated by law and do not have any national nutritional standard. Nutritional stan-dards and guidelines are essential in evaluation and monitoring studies to maintainor im-proveschool meals quality. This research looked at the nutritional quality of meals served by some elementary schools running a school meal program administered by CHEP Good Food Inc., a non-profit organization, in Saskatoon, SK. Data collected from 1997 until 2006 were combined to those collected in the 2007/08 school-year. Lunches were compared to 1/3 Dietary Reference Intakes (DRI), and breakfasts and snacks, to ¼ DRI. Using one-sample t-tests and ANOVA, p< 0.05, we evaluated nutrients that were suggested to be below the standard. Sas-katchewans food-based standards were also used to evaluate food group content according to the Canadas Food Guide to Healthy Eating. On-site observations in selected schools shed light on childrens choices and plate waste. Focus groups with selected nutrition coordinators (NC) provided insight into their practices. Overall, lunches and breakfasts had a good nutrient profile but were low mainly in energy, vitamin E, potassium, and, in some years, folate and calcium, particularly for 9-13 year-olds. Findings suggested that snacks seem to be below the DRI stan-dards, but they can be an opportunity for nutrition education. We observed no clear or significant trend across the years. All meals offered good amounts of fruits and vegetables, grains, and dairy products. Plate waste was low and related to NCs practices. Analysis of the interviews exposed some possible explanations for the quantitative results and allowed some recommendations. Findings from this study provide support for future establishment of school meals nutritional standards and for possible changes and improvements of the program, and will enrich knowledge regarding school meals.

Purpose: To evaluate implementation and impact of school nutrition policy (SNP) using a qualitative case study approach. Sample/Setting: participants (n=79) from two elementary schools and one secondary school within one school division in Winnipeg, Manitoba consented to participate. Methods: Perceptions of teachers, parents, administrators, students, custodians, education assistants, and food service operators were explored using observations, interviews and focus groups. Results: Implementation and impact varied between schools. Common barriers include: negative attitudes, inadequate school and community resources and ineffective communication. Major impacts include changes to; food sales and nutrition awareness. Conclusions: Impacts of the SNP have been noted however, barriers need to be addressed to provide schools the best opportunity for success. Each key informants group provided useful insights into implementation and impact of SNP. Implications: This study demonstrates the importance of considering multiple perspectives when evaluating SNP. Results will be useful to policy makers to inform future SNP efforts.

Purpose: To evaluate implementation and impact of school nutrition policy (SNP) using a qualitative case study approach. Sample/Setting: participants (n=79) from two elementary schools and one secondary school within one school division in Winnipeg, Manitoba consented to participate. Methods: Perceptions of teachers, parents, administrators, students, custodians, education assistants, and food service operators were explored using observations, interviews and focus groups. Results: Implementation and impact varied between schools. Common barriers include: negative attitudes, inadequate school and community resources and ineffective communication. Major impacts include changes to; food sales and nutrition awareness. Conclusions: Impacts of the SNP have been noted however, barriers need to be addressed to provide schools the best opportunity for success. Each key informants group provided useful insights into implementation and impact of SNP. Implications: This study demonstrates the importance of considering multiple perspectives when evaluating SNP. Results will be useful to policy makers to inform future SNP efforts.

Background: In 2012, more than one in three American youth were classified as overweight or obese. The cause of obesity is multifactorial. However, environmental influences and behavioral characteristics appear to have more impact on the development of obesity than genetics and/or cultural background. In response to an Institute of Medicine briefing detailing recommendations for changes to school meals, the Healthy, Hunger-Free Kids Act of 2010 was passed to update nutrition guidelines for schools participating in the National School Lunch and School Breakfast Programs. This Act seeks to help reduce childhood obesity through the provision of nutritionally balanced school meals. Methods: We conducted a secondary analysis of data collected by Children’s Healthcare of Atlanta as part of its Strong4Life School Nutrition Program. School nutrition managers in a South Georgia school district participated in a dietitian-led training, inclusive of a pre- and post-training survey. Food production data including the number of servings of foods prepared and sold in elementary schools in the same school district were also collected during the weeks preceding the manager training and post training. Observations of the cafeteria organization were also recorded pre and post training. Frequency statistics were used to describe the pre- and post-survey and food production data. A Wilcoxon signed-rank test was used to compare pre- and post-survey scores. Cafeteria organizational changes were compared for improvement pre- and post-training. Results: Of the 30 school nutrition managers who completed the pre- and post-surveys, 23 (77%) provided identifying information and were included in this analysis. The average pre- and post-survey scores were 4.9 and 5.8, respectively (18.4% increase). Twelve participants received a higher score after the training session, 10 had no change in score, and one participant’s score decreased following the training. The vast majority of managers (>90%) indicated that they would like to encourage changes in the cafeteria to promote healthy choices and that they felt confident in their abilities to provide guidance to cafeteria staff to make such changes. Manager perception of overweight and obesity in the state of Georgia being “very serious” or “somewhat serious” increased from 93% before the training to 100% following the training. Six of the 12 schools in which food production data was obtained showed improvement in the percentage of students who chose skim or 1% plain milk vs. flavored milk. Seven schools showed an improvement in the percentage of fruit sold between March and October, four showed an improvement in vegetables sold. Conclusions: School nutrition managers showed increased nutrition knowledge and belief in their individual ability to act as a role model in the school cafeteria after completing a dietitian-led training session. No association was found between increased nutrition knowledge of managers and changes in student food purchasing habits. Future iterations of this training program should include collection of the name of the school(s) in which the manager presides to determine association between increased nutrition knowledge and/or changed perception of role in promoting healthy habits and changes in student purchasing habits.

Doctor of Philosophy / Department of Food, Nutrition, Dietetics and Health / Sara Rosenkranz / The overall aim of this dissertation was to better understand the implications of improving the dietary quality (DQ) of school lunches. Chapter 2 includes a cross-sectional content analysis to determine whether there were significant differences in nutrient content and DQ between a best practice school lunch menu (BPM, with maximized DQ, created regardless of feasibility) and a typical school lunch menu (TM, with average DQ, from an actual school district). Results showed large significant differences in several important macro- and micro-nutrients and in DQ, favoring the BPM. These findings suggest the possibility for statistically and clinically significant variation in nutrient content and DQ of school lunches meeting National School Lunch Program (NSLP) nutrition standards. Building on that possibility for variation, and given schools report financial concerns as barriers to providing high DQ lunches, chapter 3 describes a cross-sectional content analysis to determine whether there were significant differences in nutrient content and DQ between middle school lunch menus from 85 Kansas school districts by socioeconomic status (SES) and rurality. The average DQ across all districts was 62.0±4.0 (Healthy Eating Index (HEI) score) out of 100, indicating a need for improvement. There were minimal differences in nutrient content and DQ by SES and rurality, suggesting efforts to improve DQ of Kansas school lunches should be applied equally across all SES and rurality categories. To determine best practices for improving DQ of school lunches, chapter 4 includes a critical review with the aim of developing school lunch best practices based on child DQ recommendations, and implementation techniques encouraging selection and consumption of healthier school lunches. Twenty-five articles were synthesized, creating a list of evidence-based school lunch best practices. Findings provide evidence that if implemented during menu and service planning, these best practices may help to improve school lunch DQ and increase selection and consumption of higher DQ lunches by schoolchildren. With best practices determined, chapter 5 describes a randomized crossover trial that included 36 elementary school-aged participants for the purpose of investigating the acceptability and feasibility of best practice school lunches (BPSL, implementing best practices, HEI score=90–95/100) as compared to typical school lunches (TSL, meeting baseline NSLP nutrition standards, HEI score=70–75/100). Results showed minimal differences in acceptability (taste, plate waste, and hunger) and feasibility (cost, equipment, and skill to prepare meals). However, preparation time requirements for BPSL were significantly longer than for TSL (~four-fold). When BPSL and TSL were offered concurrently, participants selected TSL significantly more frequently than BPSL (TSL=83.3%, BPSL=16.7%). These findings suggest that BPSL may be as acceptable and feasible as TSL, but when served concurrently, schoolchildren will likely choose the TSL. Collectively, results from this dissertation provide evidence that there is a need for improvement in the DQ of school lunches across the state of KS, which is likely to be feasible and acceptable, challenging previously reported barriers. This improvement may be accomplished by implementing best practices for higher DQ school lunches across rurality and SES categories. Collectively, these results could inform key stakeholders in policy- and decision-making.

A dissertation submitted to the Faculty of Education in fulfilment of the requirements for the Degree of Master of Education in the Department of Educational Psychology and Special Needs Education at the University Of Zululand, South Africa, 2015 / One of the major obstacles to children’s growth and development, including performance in the classroom, is malnutrition. The National School Nutrition Programme (NSNP) is an effective yet essential means of addressing the learners’ hunger needs on a daily basis, thereby serving as a tool in boosting learner attendance, academic performance, health and nutrition, and the overall prospects for the children’s future. The present study seeks to examine the challenges experienced by learners benefitting from the National School Nutritional Programme in urban primary schools in Empangeni. An in-depth literature study was followed by an empirical investigation based on a qualitative research design employing questionnaires, focus groups and drawings. The sample consisted of learners, educators and the facilitators of the NSNP. The research findings revealed that learners experienced the following challenges: stigma, problems with transport, scheduling of meals, peer pressure and bullying, inadequate resources, the schools’ menu compliance and flexibility, behavioural issues and primary care. The study also proposed a host of possible suggestions and recommendations to improve the nutritional programmes in school for the overall benefit of all learners. Further avenues for research were discussed so that researchers could expand the programme into the future.