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Students Lunch Choices and Nutrition Knowledge Kirsten Matheson University of Colorado at Colorado Springs March 17, 2011

Students Lunch Choices and Nutrition Knowledge Introduction The obesity rates of both children and adults in the United States are at an all time high and show no indication of decreasing.1,2 The health risks for obese children are comparable to those of obese adults: high blood pressure, glucose intolerance or non-insulin-dependent diabetes, high triglyceride or cholesterol circulating levels, fatty liver, physiological issues and general decline in quality of life.3 The current costs in dollars for treating childhood and adolescent obesity are relatively small compared to the treatment costs of adult obesity but since childhood obesity usually progresses into adult obesity, the future projected costs are very high.4,5 6 Many varying factors are contributing to the obesity epidemic. Could school lunches be one of these factors? Almost all school aged children eat lunch at school every day. School children either bring a lunch from home or eat the food offered by the school food service. The average school lunch consists of highly processed foods with added sodium and sugars. The fruits and vegetables offered are also highly processed. This includes both the school food service lunches and as well as the lunches brought from home. Are these school lunches encouraging the children to make poor nutritional choices, in school and outside of school? Schools have been making attempts to offer healthier options but many of the students are still selecting the less healthy options. The eating habits the students develop during their school years will possibly stay with them their whole lives. It is important to know if, and why students are making poor food choices. Multiple factors are believed to influence these choices. Factors such as how the food looks and tastes, peer pressure, parental influences, habit, and nutritional knowledge all contribute to the decision. This study will investigate how the students nutritional knowledge influences what is chosen for lunch.

Review of Literature In a study done by Rosemen and Niblock, the researchers questioned whether adding fruits and vegetables to the lunch options would improved the students perception of the overall school lunch.7 The study also explored the factors that contributed to middle school students lunch choices. The authors wanted to determine the factors that contributed to the students decisions on what to eat and the students overall opinions of the school lunch. For the study, free fruit and vegetables were offered for sampling as part of lunch. The students were asked to complete a questionnaire on the items they sampled as well as what factors affected their lunch choice. The authors reported that the most important determining factors on lunch choice were how the food tasted, how the food looked, how hungry the student was, how healthy the food was and the amount of food served. Of the ten factors evaluated, parental influences, especially with the older students, came last. The results were contradictory with regards to the students overall opinion of the school lunch. Among the students who tried similar amounts of the free samples, the opinions were equally split between those that found the lunch was improved and those who found it worse. This indicates that another level of questioning could have been added to investigate how the students felt about fruits and vegetable prior to the study. This would have determined if the students were already regular fruit and vegetable eaters or not. The study did not determine whether the students perception of the healthiness of a lunch option were in line with the actual healthiness of the lunch option. This exploratory study did determine several key factors that are involved in students' lunch choices including food tastes, appearance, availability of fruits and vegetables and raised other questions such as when does parental influence wane and how do students decide if one lunch option is healthier than another.

A study by Cullenand Zakeri tracked lunch choices of a group of fourth graders as they moved from elementary school to middle school.8 The lunch options in the elementary school were more restrictive than those offered at the middle school where there were also ala carte options. Over the same time period, the study tracked the lunch choices of a group of fifth graders already in middle school and as they went on to sixth grade. This group was used as the control. It was hypothesized the control groups lunch option would not change as they already had access to the wider range of lunch options. It was hypothesized the fourth graders lunch choices would decline in healthy fruits, vegetables and milk and increase in high fat foods and sweetened beverages. The results of the study showed that there was a decrease in the selection of healthy options by both groups. There was a more significant decrease in the fourth-fifth grade group than the fifthsixth grade group. And the fourth grade group did show an increase in consumption of high fat foods and sweetened beverages. The study did not question the students about why they chose the various foods. It was assumed that the choices were based on availability alone. The students were not questioned on the nutrition knowledge and how that might have influenced the lunch choices.

Katz, et al conducted a study to that provided a nutrition education program designed to teach elementary students and their parents to distinguish between more healthful and less healthful choices in diverse food categories.9 The study demonstrated that both the elementary students and their parents showed an increase in nutrition label literacy after completing the educational program. While the participants gained nutritional knowledge, this knowledge did not translate into significant decreases in caloric, sodium or sugar intake for either the students or their parents. The important points made by the study were that there is great potential for schools to

provide nutrition knowledge to students but since most children spend more time away from school than in school, this nutrition knowledge also needed to be provide to and reinforced by the parents. The study was limited by a short time period without a follow-up study to determine if the nutrition knowledge was applied in a positive manner by the involved families.

Summary The review of literature shows that there have been various studies done relating to school lunch choice and how those choices are affecting the obesity rates of children and adolescents. It has been determined that there are multiple factors influencing a students lunch choice. These factors range from parental influence to availability of options to food tastes. It is apparent that more information needs to be obtained on all the factors that influence school lunch choices. It is this purpose of this study to investigate what role nutrition knowledge plays in the lunch choice decision. Do children with more nutritional knowledge do better in making healthy food choices? It is hypothesized that an elementary school student with a higher level of nutrition knowledge will choose the healthier lunch option than a student with less nutritional knowledge. The statistical hypotheses states that there will be no difference in the lunch option chosen by elementary school student with a high level of nutrition knowledge than the lunch option chosen by a student with less nutrition knowledge.

References 1. Hedley A, Ogden C, Johnson C, Carroll M, Curtin L, Flegal K. Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002. J Amer Med Assoc. 2004;291(23):2847-2850. 2. Must A, Anderson S. Effects of Obesity on Morbidity in Children and Adolescents. Nutr Clin Care. 2003;6(1):4-12. Maffeis C, Tat L. Long-Term Effects of Childhood Obesity on Morbidity and Mortality. Horm Res. 2001;55:42-45. 3. Rimm I, Rimm A. Association between Juvenile Onset Obesity And Severe Adult Obesity in 73,532 Women. Am J Public Health [serial online]. May 1976;66(5):479. 4. Long A, Reed R, Lehman G. The Cost of Lifestyle Health Risks: Obesity. J Occup Environ Med. 2006;48(3):244-251. 5. Lightwood J, Bibbins-Domingo K, Coxson P, Wang Y, Williams L, Goldman L. Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of the Coronary Heart Disease Policy Model. Am J Public Health. 2009;99(12):2230-2237. 6. Li J, Hooker N. Childhood Obesity and Schools: Evidence From the National Survey of Children's Health. J School Health. 2010;80(2):96-103. 7. Roseman M, Niblock J. A Culinary Approach to Healthy Menu Items: Middle School Students' Opinion of School Lunch and Lunch Decision Factors. Journal of Culinary Science & Technology. 2006;5(1):75-90. Cullen K, Zakeri I. Fruits, Vegetables, Milk and Sweetened Beverages Consumption and Access to la Carte/Snack Bar Meals at School. Am J Public Health. 2004;94(3):463467. Katz D, Katz C, Michael J, et al. Teaching Healthful Food Choices to Elementary School Sudents and Their Parents: The Nutrition Detectives Program. J School Health. 2011;81(1):21-28. DOI:10.1111/j.1746-1561.2010.00553.x

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