Recent changes in nutrition standards for the National School Lunch and School Breakfast Programs assume that modification of the nutritional serving practices of school cafeterias will result in improved childhood nutrition in the school environment. The primary aim of this paper is to summarize the findings from two recent cluster randomized controlled trials (Wise Mind and LA Health) that tested the hypothesis that modification of school cafeteria environments, including changes in nutrition standards, would yield beneficial changes in childhood nutrition and healthy eating in the school lunch environment. A secondary aim was to investigate the association of participant characteristics and changes in nutrition and healthy eating. A third aim was to investigate the relationships between the food intake of children and: (1) foods selected by the children and (2) food that was uneaten during the lunch meal (plate waste). The studies used similar approaches for modifying the school cafeteria environment and both studies used the digital photography method to measure changes in food intake, food selection, and plate waste. Both studies reported significant improvements in childhood nutrition, and the LA Health study reported improved healthy eating, following introduction of the cafeteria modification program in comparison to baseline and/or control arms. These studies confirm the hypothesis that interventions that modify the school cafeteria environment can beneficially impact childhood nutrition.
Trial registration: ClinicalTrials.gov NCT00065039 NCT00289315.
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