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Glenn D. Braunstein, M.D. Headshot

Why Won't Jane and Johnny Eat Healthier at School?

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Now that the federal government has sought to get schools across the country to make healthier lunches, there's another tough question for us all: Will kids eat them? As an early culinary revamp dished out for students in Los Angeles schools already has shown, swapping corn dogs for lean cuisine can be a hard sell. But lessons learned here and from other pioneering districts, plus growing research on how food choices are influenced, offer useful strategies.

Next fall, the 101,000 schools that participate in the federally subsidized School Lunch Program will begin phasing in new guidelines from the U. S. Department of Agriculture that doubles the number of fruits and vegetables served, increase whole grains, reduce sodium and trans fats and, for the first time, limit calories. Meals also will include nonfat milk (which can be flavored) or low-fat (1%) milk. Tomato paste on pizza, as you've probably heard, will continue to masquerade as a vegetable and potatoes (one of the worst foods for controlling weight according to a Harvard study) can still be served daily, after Congress' caved in to pressure from growers and the processed food industry.

Even so, the new rules, championed by First Lady Michelle Obama and announced in January, provide a big opportunity to improve the diets of American kids, one in three of whom is now overweight or obese.

More kids, more meals

The revisions, the first to be issued in 15 years, carry lots of weight as more children depend now on free or low-cost school lunches, due to economic hardship. In 2010, more than 21 million of the 32 million students in this feeding program received subsidized meals, up from 18 million in 2006-2007; 9.4 million children also receive breakfast at school at no or reduced cost. Some schools provide free snacks and last year a number of after-school programs, including 200 in California, added subsidized dinners.

This all adds up to underscore the point: meals served at school can be a child's only source of nutrition. In 2009, more than 17 million children lived in "food insecure" households, meaning the adults there struggled to provide sufficient food for all members in the house at some time during the year.

The Los Angeles Unified School District, the second largest in the country, has been at the fore of fighting junk food. In 2004, it restricted the sale of chips and soft drinks and in July -- prodded by public ridicule from Jamie Oliver, the noted chef and celebrity crusader for healthy eating for youngsters -- the district banned chocolate and strawberry milk. But last fall, the LAUSD started a veritable food fight with big menu changes that replaced fatty favorites like chicken nuggets and pizza with seemingly exotic offerings like lentil and brown rice cutlets and quinoa and black-eyed pea salad.

As most parents could have predicted, many new meals, with their unfamiliar tastes, textures and names, wound up filling more trash bins than stomachs. The kids staved off their hunger pains with "black market" candy, chips and instant noodles, the Los Angeles Times reported.

Though they aced taste tests, entrees like beef jambalaya and pad Thai flopped when 500,000 servings were prepared, then trucked across the sprawling metropolis to more than 1,100 schools, reheated and served hours later. (Shades of awful airplane meals.) Production limits -- and the 77-cent per meal budget -- long have been major obstacles to improved LAUSD food. In a 2005 customer satisfaction survey, students repeatedly complained that many foods they were served by the district were moldy, soggy or under- or over-cooked.

No match to cooking from scratch

In contrast, more contained school districts with well-equipped and staffed kitchens, such as in Greeley, Colo., can whip up healthy lunches that kids like because the meals are cooked from scratch. Chefs even have been trained to sneak fresh veggies into pasta sauce without youngsters noticing.

At many schools though, including most in LAUSD, cafeterias only can warm up meals prepped elsewhere. Given that limitation, schools may be better off preparing healthful versions of proven winners: LAUSD, for example, is reintroducing pizza with whole wheat crust and less cheese, as well as putting forth uncooked fruits and vegetables.

And while it is true that kids rarely clamor for greens, research suggests they can be nudged into eating them. A recent randomized study, for example, showed that pairing broccoli, carrots and celery with peanut butter as a dip, led to improved vegetable consumption among Mexican-American middle school students in Texas.

Student nutrition programs that focus on growing and cooking veggies, such as Chef Oliver's Food Revolution and Berkeley's Edible Schoolyard, also are providing healthier eating paths. It's worth noting that multiple exposures to less-liked but more nutritious foods can broaden their appeal to youngsters. In a recent study conducted among low-income first-, third- and fifth-graders in Louisiana, it took two tastes to significantly increase youngsters' like for canned apricots, peaches and pears -- and at least four tastings for fresh cantaloupe. At least five tastes were required for kids to take to bell peppers, carrots and tomatoes; for peas, the tally was at least six tastes.

Stealth Health

But getting youngsters to make healthier eating choices also can be as simple as redesigning the lunch line. A growing body of research known as Behavior Economics, also called Stealth Health, suggests that environmental tactics such as moving healthy foods from the middle to the start of the lunch line could coax better eating habits in children. In this kind of study, researchers also observed that youngsters prefer plates with six different colors and seven different components, as opposed to adults who prefer only three different food colors and three different food items.

And consider this snappy move: How about putting photographs of vegetables on students' lunch trays? Researchers at the University of Minnesota put pictures in elementary students' lunch plates in the spots where they got to choose side dishes. For two days, there were photos of carrots and green beans, suggesting those healthy choices belonged there. And guess what? The percentage of students who chose green beans more than doubled, and those who selected carrots increased to 36.8 percent from 11.6 percent.

The motivation to eat healthy must come, of course, from education, too. Beyond nutrition posters and recipes for fruit smoothies, lessons should be hard hitting. Let's borrow a page from successful anti-smoking and anti-drunk driving campaigns and bring in speakers to school assemblies who can show and tell kids what it's like to live with heart disease or type 2 diabetes. If this sounds extreme, consider that there's an estimated $4 billion arsenal in advertising annually that helps fuel just our nation's addiction to fast food.

We need to start early on, educating kids about eating: one in four children between ages two and five already are overweight or obese. Preschoolers are a key population for healthy intervention because they're still developing their food preferences, eating habits and attitudes toward food. Genetics may play a major role in determining children's taste sensitivity and willingness to eat fruits and vegetables but so does an early introduction to these foods.

By educating their tots, we'll also get a shot at changing parents' nutrition and health habits. That could prove to be a big deal because, while school lunch programs are key, ultimately, the most effective ways to get kids to eat healthier is for this to start at home.