Strategies to Increase Student Participation in School Meals in the United States: A Systematic Review

Amelie A Hecht; Deborah A Olarte; Gabriella M McLoughlin; Juliana F W Cohen

doi:10.1016/j.jand.2023.02.016

Strategies to Increase Student Participation in School Meals in the United States: A Systematic Review

J Acad Nutr Diet. 2023 Jul;123(7):1075-1096.e1. doi: 10.1016/j.jand.2023.02.016. Epub 2023 Feb 28.

Authors

Amelie A Hecht¹, Deborah A Olarte², Gabriella M McLoughlin³, Juliana F W Cohen⁴

Affiliations

¹ Institute for Research on Poverty, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: ahecht2009@gmail.com.
² Center for Health Inclusion, Research and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, Massachusetts.
³ Department of Kinesiology, Temple University College of Public Health, Philadelphia, Pennsylvania; Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St Louis, St Louis, Missouri.
⁴ Department of Public Health and Nutrition, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

PMID: 36863526
DOI: 10.1016/j.jand.2023.02.016

Abstract

Background: School meals play a critical role in promoting child nutrition and advancing equity. An understanding of which evidence-based strategies can increase meal participation is needed to improve student school meal consumption and foodservice finances.

Objective: Our aim was to systematically review the evidence on interventions, initiatives, and policies to increase school meal participation in the United States.

Methods: Four electronic databases were searched (PubMed, Academic Search Ultimate, Education Resources Information Center, and Thomson Reuters' Web of Science) to identify peer-reviewed and government studies conducted in the United States and published in English through January 2022. Qualitative studies; studies focused on snacks, afterschool meals, or universal free meals as the sole exposure; and studies conducted in schools not participating in the federal school meal programs or outside of the school year were excluded. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. Articles were grouped according to type of intervention or policy and were narratively synthesized.

Results: Thirty-four articles met inclusion criteria. All studies examining alternative breakfast models (eg, breakfast in the classroom or grab-and-go breakfast) and restrictions on competitive foods found increases in meal participation. There is also some evidence that stronger nutrition standards do not negatively impact meal participation and, in some cases, may promote meal participation. There is limited evidence on other strategies, including taste tests, modified menu options, changes to the meal period length, changes to the cafeteria environment, and wellness policies.

Conclusions: There is evidence that alternative breakfast models and restrictions on competitive foods promote meal participation. There is a need for additional rigorous evaluation of other strategies to promote meal participation.

Keywords: Meal participation; School breakfast; School finance; School lunch; School meals.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Breakfast
Child
Food Services*
Humans
Meals*
Nutritional Status
Students
United States