Comparison of Food Selection with the National School Lunch Program Meal Pattern Guidelines and Assessment of Children’s Food Intake and Waste Using Digital Photography in a School Cafeteria

Abstract

Background:

School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection.

Methods:

In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children’s food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation.

Results:

About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades.

Conclusions:

Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.

Introduction

School environments play an important role in children’s health and nutrition since children spend about 180 days per year at school and frequently receive breakfast and lunch at school.^1–3 Consuming a healthy diet helps children meet recommended energy and nutrient intakes, which promotes optimal growth and development.^4,5 Many children in the United States are not meeting the recommended intake of nutrient-dense foods, such as fruits and vegetables, and often replacing these with a higher intake of energy-dense foods, such as sugary beverages and desserts.^6,7 Selection or provision of meals is an essential prerequisite for food intake.^8–11 Research suggests that provision of more varieties of food options gives children an opportunity to have an increased selection of more food components such as fruits and vegetables.^8–11 Therefore, the availability of healthy food choices in school environments is crucial to improving children’s dietary intake.^6,7

The National School Lunch Program (NSLP), part of the United States Department of Agriculture (USDA) Food and Nutrition Service, is federally funded and the second largest food and nutrition assistance program.¹² The NSLP aims to offer nutritious and balanced meals by providing low-cost or free lunches to children each school day.¹² About 29.6 million children participated in the NSLP in 2019. For schools to receive reimbursement for meals served to children through the NSLP, meals must meet the Federal meal pattern guidelines. These were updated in the Healthy, Hunger-Free Kids Act of 2010 to promote intake of whole grains, fruits, and vegetables, limit calorie intake by age group, and reduce sodium intake.¹² The proposed new guidelines raised concerns about a potential increase in plate waste.^13,14 A study measured food waste over 4–5 days in elementary and middle schools, and the results showed that children wasted more than one-third of the fruits, vegetables, and grains served during lunch.¹⁵

Though the USDA meal pattern guidelines are in place for the NSLP, evaluating food selection during lunch at the school cafeteria compared to the NSLP meal pattern guidelines¹⁶ is important to understand if these guidelines have achieved their goals and to better understand actual food intake in relation to selection and waste in school cafeterias. To date, few empirical studies have evaluated children’s food selection during school lunches in relation to the NSLP meal pattern guidelines, as well as food intake and waste in relation to food selection. Adams and colleagues conducted a study involving elementary school children and assessed their energy and nutrient selection (following the offer vs. serve [OVS] model) and intake compared to the meal pattern guidelines.¹⁷ However, they only captured lunch selection and intake for a single day and did not report food waste.¹⁷ Cohen and colleagues reported plate waste and the percentage of children who selected each meal component during lunch.¹⁸ Another study reported that plate waste ranged from 28% to 53% of the food served during school lunch, indicating that reducing food waste (especially nutritious, high-quality foods) requires further attention.¹⁹ To our knowledge, this is the first study to report the selection, intake, and waste of food, as well as adherence to the NSLP meal pattern guidelines in children from three grades (1st, 6th, and 10th) for a 3-week observation period in a school setting. A detailed assessment of food selection, intake, and waste in the school setting can support policymakers in evaluating whether food selection of children from different grades meets the current NSLP meal pattern guidelines and the extent to which children from different grades consume and waste meal components in relation to their selected school lunch. Therefore, the primary aim of this pilot study was to assess food selection and compare it to the NSLP meal pattern guidelines. The secondary aim was to assess food intake and waste in relation to children’s food selection.

Methods

The pilot study protocol was approved by the Pennington Biomedical Research Center (IRB FWA 00006218). Prior to data collection, parents were informed of the study in writing and given the opportunity to opt their child out of participation.

Participants and Recruitment

Participants from the 1st (about 6 or 7 years old), 6th (about 11 or 12 years old), and 10th (about 15 or 16 years old) grades were recruited for this study from a K–12 public school located in the southern United States with a population of 91% economically disadvantaged students.²⁰ All meals were free to all children every day.²¹ In the school recruited for this study, children experienced the OVS model (see Supplementary Data S1).

We attempted to collect data on 150 children (50 from each grade) at lunch each day for 3 consecutive weeks in May 2019. An opt-out method of recruitment was utilized, with letters sent to parents and guardians through children (from the selected study grades), providing an option for their child to be excluded from data collection. After that, children were selected from a convenience cohort each day, and the same children were not necessarily followed over the observation period, and thus, the children who participated were potentially different throughout the data collection. We were aware of the children’s lunchtime, and each grade wore a different colored shirt, going through the line only with peers from the same grade. Occasionally, children from two different grades went at the same time, but they would go through separate sides of the kitchen, in addition to wearing different colored shirts. The school had about 100–150 children per grade, and we aimed to assess the first 50 children who went through the line each day.

Procedures, Data Collection, and Food Image Analysis

For the 3-week observation period, each child was given one food tray with a bar code at the beginning of the line each day to collect individual-level food selection, intake, and waste. The digital photography of foods (DPF) method is a validated method that has been employed for more than 20 years to assess food selection, intake, and waste in large samples in different settings such as school cafeterias.^22–31 The DPF method was used in previous research to assess portion size, food selection, waste, and intake in the school and university cafeteria settings.^{23,26,27,29–31} Research evidence supports that DPF methods are reliable and accurate to assess children’s food selection, plate waste, and food intake.^22,23,25 The agreement in assessing food intake with analyzing food images between two trained raters is consistently high and the intra-class correlation coefficients for energy intake was 0.93.²³ Olafsdottir et al. found that estimated food intake (g) and energy intake (kcal) via DPF method were correlated with weighted meals in school cafeteria settings.²⁵ Another study also found that estimated energy intake from DPF methods did not differ significantly from the estimated energy requirement in school children.²²

Data on food selection and plate waste were collected within seconds using digital video cameras (GoPro devices) by grade, with virtually no participant burden. We also collected images of standard lunch portions of foods provided each day in the cafeteria and carefully recorded the foods provided, including recipes and ingredient lists. As a result, for each day, we randomly assigned each tray/child a sample number from 1 to 150. A research team of 1–2 members collected data during the entire 3-week period and were assisted by 1–2 school staff members, ensuring strategies were identified to seamlessly integrate the study methods into the cafeteria.

The trained staff recorded all foods on the serving line and salad bar using the food standards form and obtained a standard tray from the cafeteria manager. They took a digital photograph of each food component served separately. These photographs were used as the standard photograph during food selection estimation. Measuring cups/scoops were used to determine the serving size of each food item on the standard plate. The collected food images using the DPF method were uploaded to a server on the same day. Later, images were analyzed using a custom computer application.³² This application displayed an image of the standard portion of food alongside the participants’ images of their food selection and plate waste. Trained raters then assessed the amount of the standard portion represented in the participant’s food selection and plate waste images. Subsequently, by utilizing a link to the Food and Nutrient Database for Dietary Studies (FNDDS, 2017–2018),³³ the application automatically calculated energy and nutrient values.

Data Analysis

Data were analyzed and presented in two segments. First, we performed an analysis of the percentage of children whose food selections met, fell below, and fell above grade-specific lunch meal targets set by the NSLP meal pattern guidelines. We accounted for the range values of NSLP meal pattern guidelines for specific grades. Although the primary aim of this study was descriptive, we performed chi-square tests to compare the percentage of children from different grades (such as 1st graders vs. 6th graders, 10th graders vs. 6th graders) whose energy selections met, fell below, and fell above grade-specific lunch meal targets. Second, for the total participants and each respective grade, we calculated the mean and standard deviation for the selection, intake, and waste of multiple food component variables. We also performed t-tests to compare the differences in energy selection, waste, and intake between each grade. We ran the analysis only for energy (kcal). We considered significant digits when presenting the results, using 49% instead of 49.0%. Results were presented in two decimal places, except for the significant digit to report the average of food selected, returned, and consumed because many nutrients and food groups had small values for amounts or servings.

Results

On average, 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day in this study. In total, 2163 meals of children were assessed over the 3 weeks (∼15 days).

Primary Objective

Average energy selection vs. NSLP meal pattern guidelines for energy selection

Table 1 shows that the percentage of children from the 1st grade whose selection met (fell within the grade-specific energy range) the NSLP meal pattern guidelines for daily energy over the 3 weeks was significantly higher compared to children from the 6th grade (21.8% vs. 13.4%, p < 0.0001, respectively) and the 10th grade (21.8% vs. 9.1%, p < 0.0001).

Table 1.

Percentage of Participants Whose Energy Selection Met, Was Below, and Was Above the NSLP Meal Pattern Guidelines for Daily Energy Selection During Lunch

	W1			W2			W3			Overall
	Met	Below	Above	Met	Below	Above	Met	Below	Above	Met	Below	Above
1st Grade (%)	34.1	52.6	13.3	23^a	64^a	13^a	8.4	89.2	2.4	21.8	69	9.3
6th Grade (%)	12.9	77.4	9.7	19	77	4	8.4	84.8	6.8	13.4	79.8	6.8
10th Grade (%)	6.6	86.9	6.6	16.9	78.3	4.8	3.3	95.8	0.8	9.1	86.9	4

Only 4 days of data were collected.

p-Value of chi-square test for comparisons (met, below, and above) between groups: Grade 1 vs. Grade 6: p < 0.0001, Grade 1 vs. Grade 10: p < 0.0001, and Grade 6 vs. Grade 10: p = 0.0011. W, week.

The average energy selection of children from the 1st, 6th, and 10th grades was 448.2 [standard deviation (SD) = 6.53] kcal, 448.05 (SD = 6.28) kcal, and 522.93 (SD = 6.41) kcal, respectively, from school lunch during the observation period (Table 2). Over the 3 weeks, the average amount of energy from food selection was low among the children of all three grades, and even lower among 10th graders, compared to the NSLP meal pattern guidelines [average energy selection: 522.93, SD = 6.41 kcal (Table 2) vs. NSLP meal pattern guidelines for energy intake for 10th graders: 750–850 kcal, Table 3].

Table 2.

Daily Nutritional Averages (Standard Deviation) in School Lunch for All Participants During the Observation Period

	1st grade^a			6th grade			10th grade			Overall
	Selection	Returned	Consumed	Selection	Returned	Consumed	Selection	Returned	Consumed	Selection	Returned	Consumed
	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD	M ± SD
Energy (kcals/day)	448.2 ± 6.53	237.5 ± 6.53	210.69 ± 6.83	448.05 ± 6.28	179.94 ± 6.28	268.11 ± 6.57	522.93 ± 6.41	160.31 ± 6.41	362.62 ± 6.71	473.06 ± 3.7	192.58 ± 3.7	280.47 ± 3.87
Protein (%)	23.51 ± 0.26	13.12 ± 0.26	10.39 ± 0.29	22.29 ± 0.25	9.15 ± 0.25	13.14 ± 0.28	21.55 ± 0.25	6.42 ± 0.25	15.12 ± 0.28	22.45 ± 0.15	9.57 ± 0.15	12.88 ± 0.16
Fat (%)	26.16 ± 0.33	13.42 ± 0.33	12.74 ± 0.39	28.89 ± 0.32	10.31 ± 0.32	18.58 ± 0.38	29.74 ± 0.33	8.91 ± 0.33	20.82 ± 0.38	28.26 ± 0.19	10.88 ± 0.19	17.38 ± 0.22
Carbohydrate (%)	51.67 ± 0.43	26.29 ± 0.43	25.37 ± 0.57	50.5 ± 0.42	22.04 ± 0.42	28.46 ± 0.55	50.36 ± 0.43	15.84 ± 0.43	34.52 ± 0.56	50.84 ± 0.25	21.39 ± 0.25	29.45 ± 0.32
Total Sodium (mg)	977.66 ± 20.18	549.66 ± 20.18	428 ± 19.05	962.67 ± 19.43	388.34 ± 19.43	574.33 ± 18.34	1130.65 ± 19.82	321.68 ± 19.82	808.97 ± 18.71	1023.66 ± 11.44	419.89 ± 11.44	603.77 ± 10.8
Total sugar (g)	28.83 ± 0.42	15.15 ± 0.42	13.68 ± 0.42	24.88 ± 0.4	12.63 ± 0.4	12.25 ± 0.4	29.59 ± 0.41	9.51 ± 0.41	20.08 ± 0.41	27.77 ± 0.24	12.43 ± 0.24	15.33 ± 0.24
Added sugar (tsp)	1.39 ± 0.04	0.56 ± 0.04	0.83 ± 0.04	1.04 ± 0.04	0.34 ± 0.04	0.71 ± 0.04	1.63 ± 0.04	0.39 ± 0.04	1.24 ± 0.04	1.35 ± 0.02	0.43 ± 0.02	0.92 ± 0.02
Saturated fat (g)	5 ± 0.09	2.66 ± 0.09	2.34 ± 0.09	4.81 ± 0.09	1.84 ± 0.09	2.97 ± 0.09	5.63 ± 0.09	1.74 ± 0.09	3.89 ± 0.09	5.15 ± 0.05	2.08 ± 0.05	3.07 ± 0.05
Vegetables (cup)
Total	0.27 ± 0.01	0.15 ± 0.01	0.12 ± 0.01	0.4 ± 0.01	0.18 ± 0.01	0.22 ± 0.01	0.45 ± 0.01	0.15 ± 0.01	0.3 ± 0.01	0.37 ± 0.01	0.16 ± 0.01	0.21 ± 0.01
Dark green	0.04 ± 0.01	0.03 ± 0.01	0.01 ± 0	0.07 ± 0.01	0.04 ± 0.01	0.02 ± 0	0.08 ± 0.01	0.03 ± 0.01	0.04 ± 0	0.06 ± 0	0.04 ± 0	0.03 ± 0
Red/orange	0.11 ± 0.01	0.06 ± 0.01	0.05 ± 0	0.12 ± 0	0.05 ± 0	0.07 ± 0	0.15 ± 0.01	0.05 ± 0.01	0.1 ± 0	0.13 ± 0	0.05 ± 0	0.07 ± 0
Beans and peas	0.03 ± 0	0.01 ± 0	0.02 ± 0	0.04 ± 0	0.02 ± 0	0.02 ± 0	0.05 ± 0.01	0.03 ± 0.01	0.02 ± 0.01	0.04 ± 0	0.02 ± 0	0.02 ± 0
Starchy	0.08 ± 0.01	0.03 ± 0.01	0.04 ± 0.01	0.16 ± 0.01	0.05 ± 0.01	0.11 ± 0.01	0.15 ± 0.01	0.04 ± 0.01	0.11 ± 0.01	0.13 ± 0	0.04 ± 0	0.09 ± 0
Fruits (cup)	0.65 ± 0.02	0.3 ± 0.02	0.35 ± 0.02	0.76 ± 0.02	0.40 ± 0.02	0.37 ± 0.02	0.83 ± 0.02	0.27 ± 0.02	0.56 ± 0.02	0.75 ± 0.01	0.32 ± 0.01	0.42 ± 0.01
Milk (cup)	0.91 ± 0.02	0.58 ± 0.02	0.33 ± 0.02	0.61 ± 0.02	0.39 ± 0.02	0.22 ± 0.02	0.68 ± 0.02	0.26 ± 0.02	0.42 ± 0.02	0.73 ± 0.01	0.41 ± 0.01	0.32 ± 0.01
Grains (oz eq)	1.64 ± 0.03	0.85 ± 0.03	0.79 ± 0.04	1.55 ± 0.03	0.5 ± 0.03	1.05 ± 0.03	1.88 ± 0.03	0.55 ± 0.03	1.33 ± 0.03	1.69 ± 0.02	0.63 ± 0.02	1.06 ± 0.02
Whole grain (oz eq)	0.69 ± 0.02	0.43 ± 0.02	0.26 ± 0.02	0.46 ± 0.02	0.2 ± 0.02	0.25 ± 0.02	0.61 ± 0.02	0.22 ± 0.02	0.39 ± 0.02	0.58 ± 0.01	0.28 ± 0.01	0.3 ± 0.01
Total meat (oz eq)	1.24 ± 0.04	0.66 ± 0.04	0.57 ± 0.03	1.4 ± 0.03	0.47 ± 0.03	0.93 ± 0.03	1.61 ± 0.03	0.42 ± 0.03	1.2 ± 0.03	1.42 ± 0.02	0.52 ± 0.02	0.9 ± 0.02

Only 4 days of data were collected in week 2.

M, mean; SD, standard deviation.

Table 3.

National School Lunch Program Meal Pattern¹²

Food components	Grades K–5	Grades 6–8	Grades 9–12
	Amount of food per week (minimum per day)
Fruits (cups)	2½ (1/2)	2½ (1/2)	5 (1)
Vegetables (cups)	3¾ (3/4)	3¾ (3/4)	5 (1)
Dark green	½	½	½
Red/orange	¾	¾	1 ¼
Beans and peas (legumes)	½	½	½
Starchy	½	½	½
Other	½	½	¾
Additional vegetables to reach total	1	1	1½
Grains (oz eq)	8–9 (1)	8–10 (1)	10–12 (2)
Meats/meat alternates (oz eq)	8–10 (1)	9–10 (1)	10–12 (2)
Fluid milk (cups)	5 (1)	5 (1)	5 (1)
	Daily amount based on the average for a 5-day week
Min-mix calories (kcal)	550–650	600–700	750–850
Saturated fat (% of total calories)	<10	<10	<10
Sodium interim target (mg)	≤1230	≤1360	≤1420
Trans fat	Nutrition label or manufacturer specifications must indicate zero grams of trans fat per serving

Average selection of food group servings vs. NSLP meal pattern guidelines

On average, only 6.7% of children from the 1st grade met the selection of daily (minimum) NSLP meal pattern guidelines for vegetables. On average, 13.5% of 6th and 11.1% of 10th-grade children’s selections met the daily (minimum) guidelines for vegetables (Table 4). The average selection of vegetables for the 1st, 6th, and 10th grades was 0.27 (SD = 0.01), 0.4 (SD = 0.01), and 0.45 (SD = 0.01) cups, respectively (Table 2).

Table 4.

Percentage of Participants Whose Daily Food Selection Met the NSLP Meal Pattern Guidelines for Food Component Selection per Week

	1st grade				6th grade				10th grade
	W1	W2^a	W3	Overall	W1	W2	W3	Overall	W1	W2	W3	Overall
Fruits (cups)	68.7	46	65.2	60.9	71	59.7	60.4	63.7	49.3	45.8	40	45
Vegetables (cups)	3.2	7.5	9.6	6.7	5.2	6.5	28.8	13.5	2.2	14.9	15.8	11.1
Grains (oz eq)	77.9	74.5	40.4	63.5	73.8	71.4	40.4	61.8	60.7	55.8	10.4	42.2
Meats/meat alternates (oz eq)	63.1	71	59.6	64.1	63.3	76.2	62	67.2	52	22.5	41.3	38.2
Milk (cups)	60.6	72.5	78.4	70.4	37.1	50.4	46.8	44.8	40.6	59.4	52.9	51.3
Saturated Fat (% of total calories)	57.8	40	41.6	46.9	83.5	46.8	40.8	57	66.8	54.2	37.9	52.8
Sodium (mg)	60.6	71.5	93.6	75.5	71.4	78.2	89.2	79.6	72.5	66.7	88.3	75.8

Only 4 days of data were collected. W, week

The percentage of children in the 1st and 6th grades whose fruit selection met the daily NSLP meal pattern guidelines (minimum) over the 3 weeks was 60.9% and 63.7%, respectively, while only 45% of the children from 10th grade met the daily NSLP meal pattern guidelines for selection of fruits (Table 4).

For milk selection, the percentage of children in the 1st, 6th, and 10th grades who met the daily NSLP meal pattern guidelines (minimum) was 70.4%, 44.8%, and 51.3%, respectively (Table 4). Table 2 shows that the average milk selection for the 1st, 6th, and 10th graders was 0.91 (SD = 0.02), 0.61 (SD = 0.02), and 0.68 (SD = 0.02) cups, respectively.

Of the three grade levels, the highest percentage of 1st graders met the daily minimum NSLP meal pattern guidelines for grains (63.5%) and 6th graders for meat or meat alternates (MMA, 67.2%) selection, as shown in Table 4. The average MMA selection by 1st, 6th, and 10th graders was 1.24 (SD = 0.04), 1.4 (SD = 0.03), and 1.61 (SD = 0.03) ounce equivalents over the 3 weeks, respectively (Table 2).

Average selection of saturated fat and sodium vs. NSLP meal pattern guidelines

About 53% of the 10th graders’ food selection met the NSLP meal pattern guidelines for the selection of saturated fat (<10% of total calories) during school lunch over the 3 weeks (Table 4). On average, about 76% of children from all three grades met the NSLP meal pattern guidelines for the selection of sodium (Table 4). Overall, the average sodium content in food selection during school lunch was 1023.66 (SD = 11.44) mg (Table 2).

Secondary Objective

Average energy intake and waste. The mean energy intake was 280.47 (SD = 3.87) kcal during the observation period (Table 2). Participants wasted 40.7% of their energy selection. The percentages of plate waste from energy among children from 1st, 6th, and 10th grades were 53%, 40.2%, and 30.7%, respectively. The probability values for comparisons between energy selection, waste, and consumption are presented in Supplementary Table S1, and the daily nutritional averages during school lunch over the 3 weeks for each grade are presented in Supplementary Tables S2, S3, and S4.

Average food group serving intake and waste

The average vegetable intake was 0.21 (SD = 0.01) servings, and vegetable waste was 0.16 (SD = 0.01) cups, indicating that children wasted 43.2% of their selected vegetable servings. Children from 1st grade wasted a higher proportion of selected vegetables (55.5%) compared to those in 6th grade (45%) and 10th grade (33.3%). Children wasted 0.32 (SD = 0.01) cups of fruits, showing that they wasted 42.7% of selected fruit servings.

Over the 3 weeks, children consumed an average of 0.32 (SD = 0.01) cup of milk daily during school lunch (Table 2). They wasted more than half of the selected milk (mean = 0.41, SD = 0.01 cups) during the observation period. The average serving of MMA wasted was higher among 1st graders (mean = 0.66, SD = 0.04, 53.2% of selection) than 6th (mean = 0.47, SD = 0.03, 33.6% of selection), and 10th graders (mean = 0.42, SD = 0.03, 26.1% of selection). Children wasted 0.63 (SD = 0.02) oz eq of grains, indicating that they wasted 37.3% of grain servings selected during the observation period.

Discussion

The study explored school children’s food selection compared to the NSLP meal pattern guidelines, and food intake and waste at lunch during a 3-week observation period in the school cafeteria. Most of the children’s meal selections failed to meet the daily NSLP meal pattern guidelines for energy and vegetables, yet food waste was high. More children in 1st grade met energy guidelines for selection but also wasted the most, while fewer children in 10th grade met energy guidelines but also wasted less. Regarding food waste across food groups, younger children (1st grade) wasted a higher percentage of selected food, including fruits, vegetables, grains, MMA, and milk compared to their 10th-grade counterparts.

Most lunch meals selected by children fell below the range set by the NSLP meal pattern guidelines and these results need to be interpreted in the context of OVS and in relation to plate waste data. Specifically, the percentage of energy selection that was consumed vs. wasted was 59.3% vs. 40.7%, respectively, for the entire sample. However, there was variability across the grades. The availability of competitive foods (other foods of minimal nutritional value or offered for individual sale outside of meals) and beverages in the school environment and limited food choices during school lunch may reduce school meal intake.^34–36 It has been suggested that it is necessary to improve school food environments and policies by implementing multicomponent nutrition interventions such as class-based nutrition education, farm to school, cooking sessions, taste tests, cafeteria staff culinary training, school gardening, nutrition newsletters to parents, and taking away unhealthy food options, including vending machines.^{10,34,37–41} Adding familiar foods to school menus can improve food selection and intake in children.^4,10,42 Research shows increasing vegetables in mixed dishes, such as casseroles, can decrease energy density.^8,10,43 The updated NSLP standards consider fruits and vegetables as two different food categories and require either a fruit and/or vegetable must be selected to get a reimbursable meal.¹² Thereby, significantly more children choose to select a fruit over a vegetable.^13,14,18 Research evidence shows that the promotion of taste-focused labels (such as Sizzlin’ Szechuan Green Beans with Toasted Garlic) or incorporating sampling events (taste tasting) increases vegetable serving selection and intake compared with healthy-focused labels and basic labels.^44–46 Solutions to combat waste could lie in increasing quality and variety offered each day as well as reexamining portion sizes to meet meal patterns or offering potential alternative food items, such as cottage cheese and yogurt as alternatives to the milk component, rather than just as an MMA.^37,47–49 Indeed, offering varieties of alternative food items creates significant challenges for menu and recipe planning to meet compliance.^47–49

Despite the majority of children in this study meeting the sodium NSLP meal pattern guideline, the sodium content might be high for a single meal (school lunch) in relation to daily target for sodium or the percentage of daily required energy. In the recent guidelines, the USDA has proposed a multiyear approach, including three sodium reductions for school lunch (10% each in fall 2025, fall 2027, and fall 2029).⁵⁰

The present study results indicate that participants from 1st and 6th grades had higher plate waste in terms of energy, fruit, vegetable, and milk servings compared to those from 10th grade. Smith and Cunningham-Sabo also found that children from middle school left almost 50% of fruits unconsumed and had one-third of vegetable waste consistent with our study findings.¹⁵ High plate waste, primarily of fruits, vegetables, and milk, in relation to food selection led to nutrient wastage, hindering participants’ ability to eat adequate amounts of essential nutrients such as dietary fiber, vitamins, and minerals.^15,39,51,52 Therefore, a re-examination of school-level and public policies is needed to create guidelines that improve diet quality, increase food intake of selected components, and reduce food waste.^42,53 It is necessary to promote nutrition education on topics such as healthy food choices and the health benefits of consuming foods such as fruits, vegetables, milk, and grains.^{10,11,34,37,38} This approach can help improve diet quality, increase the variety and quantity of food selected and consumed, and reduce food waste.^{10,11,34,37,38} A qualitative study found that undesirable food quality, satiation, and unsupportive school meal policies such as no choice on what types of food items to be served for lunch, less time to finish eating the lunch, and could not save their leftovers are some of the factors that enhance school lunch plate waste.⁵⁴ The study also found that supportive social influence and school policy, for example, allowing children to share food with peers and save food to eat later may help to reduce plate waste in school.⁵⁴ Furthermore, behavioral nudges and choice architecture interventions targeting school lunches, such as marketing, promoting the menu patterns, incorporating attractive servings, sampling fruits, vegetables and whole grains (taste tasting), and serving fruits and vegetables first in the school cafeteria may improve fruit and vegetable selection and intake.^10,11,55 Future work could engage students and the community in the NSLP process to help with menu design and choice.

The present study has some limitations. First, we did not collect the background characteristics (such as age, sex, race, BMI z-score, and food insecurity status), food preferences, and level of nutrition knowledge of the children. The NSLP guidelines are based on the children’s grade level; therefore, we collected grade level in this study. Second, we did not track the same children each week over the 3 weeks, and thus, we could not conduct weekly food selection analysis for the same child. Third, we used the FNDDS dataset to assess the selection and intake of energy and nutrients. This may have underestimated or overestimated the nutrients, including selection and intake of whole grain. Fourth, the study was conducted only in one public school site located in the Southern United States.

Conclusions

The selection of energy (kcal) and vegetables was low compared to the NSLP guidelines in overall children. Furthermore, food waste was high among children, specifically in younger children (children from 1st grade and 6th grade compared to 10th grade), as reflected by the high plate waste of total energy, vegetables, fruits, and milk. Considering the low selection of energy and vegetables and the high food waste, supportive school strategies, policies, and multicomponent nutrition interventions are needed to improve school lunch meal component selection and intake and reduce food waste.

Impact Statement

Most children’s food selection consistently fell below the meal pattern guidelines for the daily amount of energy and vegetables, yet ∼41% of selected energy was wasted. The evidence of high levels of vegetable, fruit, and milk waste suggests that efforts are needed to improve the intake of nutritious foods.

Footnotes

Acknowledgments

The authors are grateful to the participants for their time and effort in this study. They are thankful to the PBRC research support team, including Karissa Neubig, for conducting measurements and facilitating training for participants.

Authors’ Contributions

C.K.M., J.W.A., M.M.L., and J.L.D.: Designed the research protocol. C.K.M., J.W.A., J.L.D., and K.H.: Implemented the study. S.S. and R.A.B.: Conducted the data analysis and interpretation. S.S.: Drafted the article. All the authors read and critically reviewed the final draft of the article.

Funding Information

The study was funded by IDEA Public Schools. Pennington Biomedical was supported by a Nutrition Obesity Research Center (NORC) grant (P30 DK072476) entitled “Nutrition and Metabolic Health Through the Lifespan” sponsored by NIDDK and the Louisiana Clinical and Translation Science Center grant (U54 GM104940). J.L.D. received support from the American Heart Association (20POST35210907).

Author Disclosure Statement

No potential conflict of interest was reported by the authors.

Supplementary Material

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