A Historical Review of Changes in Nutrition Standards of USDA Child Meal Programs Relative to Research Findings on the Nutritional Adequacy of Program Meals and the Diet and Nutritional Health of Participants: Implications for Future Research and the Summer Food Service Program

Background: The USDA child meal programs (CMPs) (National School Lunch Program (NSLP), School Breakfast Program (SBP), and Summer Food Service Program (SFSP) were established in 1946 (NSLP) and 1975 (SBP and SFSP) to improve the diet and nutritional health of US children. There is concern that participation in these programs may in fact be a contributor to the current childhood obesity epidemic. Objective: The purpose of this study was to determine if the CMPs are meeting their intended goal by reviewing the historical changes to nutrition standards of the CMPs in correspondence with the literature that examines the nutritional adequacy of meals served as part of these programs, as well as the dietary intakes and nutritional status of participants. Methods: Public Law and the Federal Register were reviewed and websites and online databases were systematically searched. Results: NSLP and SBP first underwent updates to the nutrition standards in 1994 and subsequently 2010, whereas SFSP last underwent modifications in 2000. The majority of data, all collected prior to 2010, demonstrate that meals served as part of the NSLP and SBP are not meeting nutrition standards. In addition, the dietary intakes of NSLP and SBP participants are high in calories, fat, saturated fat, and sodium, and low in fiber. Studies examining the weight status and other nutrition-related health outcomes of NSLP and SBP participants have produced mixed results. In contrast, no studies published in the peer-reviewed literature have been conducted examining the nutritional adequacy of SFSP meals or the dietary intakes or nutritional health of SFSP participants. There are public reports available on the nutritionally adequacy of SFSP meals, however, they are severely outdated (1988 and 2003). Due to this dearth of information, a case study on a sample SFSP menu from summer 2015 was conducted; results showed that the meals are high in carbohydrate and protein content and insufficient in vegetable servings. Conclusions: There is critical need for policy change that would enable updates to the SFSP nutrition standards to match those of the NSLP and SBP. In addition, strategies are needed to facilitate development of CMP menus that meet current nutrition standards. Finally, rigorously designed studies are needed to understand the direct impact of CMP participation on child diet and health, particularly the SFSP for which there is limited published data.