Healthy Hunger-Free Kids Act Logs Successes in 5 Years

Marcia Frellick

January 04, 2016

Five years after implementation of the Healthy Hunger-Free Kids Act (HHFKA), schoolchildren are choosing foods higher in important nutrients and lower in energy density, according to a new study.

The higher food standards did not result in significantly lower participation in school lunches, authors found.

HHFKA updated nutritional standards for the National School Lunch Program, which reaches 31 million children, and the School Breakfast Program. The higher standards, which emphasize whole grains, fruits, and vegetables, took effect at the start of the 2012-2013 school year.

Donna B. Johnson, PhD, from the Center for Public Health Nutrition at the University of Washington in Seattle, and colleagues studied changes since implementation of the policy in more than 1.7 million lunches at three middle and three high schools in an urban school district in Washington State from 2011 through 2014. Results were published online January 4 in JAMA Pediatrics.

Nutritional quality was determined by calculating mean adequacy ratio (MAR) and energy density of foods. MAR included six nutrients: calcium, vitamin C, vitamin A, iron, fiber, and protein. Foods with lower energy density have fewer calories per gram.

Researchers found the MAR increased from an average of 58.7 before HHFKA (range, 49.6 - 63.1) to 75.6 after implementation (range, 68.7 - 81.8). Energy density decreased from an average of 1.65 before HHFKA (range, 1.53 - 1.82) to 1.44 after (range, 1.29 - 1.61).

Meal participation remained about the same: 47% before (range, 40.4% - 49.5%) and 46% afterward (range, 39.1% - 48.2%).

The authors say this study, which included high schools and longitudinal data, overcomes limitations of some previous studies, which came to the same conclusions.

"Many of the previous studies sacrificed sample size to measure not only food selection, but also consumption," they write. "Our approach allowed for a larger sample size; the consideration of seasonal changes in menu offerings and available foods; and other factors such as holiday meals, taste tests, and other cafeteria events or promotions that could influence student selection of foods at lunch in the short term."

In an accompanying editorial, Erin R. Hager, PhD, departments of pediatrics and epidemiology and public health at the University of Maryland School of Medicine in Baltimore, and Lindsey Turner, PhD, College of Education at Boise State University in Idaho, write that these results are important because the program is facing funding threats.

They note that in October, the School Nutrition Association and the School Superintendents Association coauthored a letter to Congress asking for flexibility in using the funds for the program, claiming that participation is down.

"[H]owever, these assertions are based on old data and an unfounded connection between dropping rates and the new standards," Dr Hager and Dr Turner write.

"We encourage policy makers to consider the hard evidence rather than anecdotal reports when evaluating the impact of policy changes. On the fifth anniversary of this landmark legislation, it is worth celebrating the successes of the HHFKA, rather than abandoning the recent progress made in keeping our nation's children healthy."

This study was made possible through funding from the US Department of Health and Human Services and the Robert Wood Johnson Foundation through the Healthy Eating Research program office.

JAMA Pediatr. Published online January 4, 2016. Abstract Editorial


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