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How to Get Kids to Eat Healthier at School

Dr. Kristine Madsen

One school is challenging the current model of school lunch. Watch the five-minute California Matters episode about it here.

As a pediatrician and an Associate Professor at UC Berkeley's Joint Medical Program and Public Health Nutrition, Dr. Kristine Madsen spends a lot of time in school cafeterias. She and her colleague Lorrene Ritchie (Director of the Nutrition Policy Institute) conduct various research on how kids eat and to how to get them to eat healthier. In some ways she's a food troubleshooter of sorts, refining food systems once they go into practice.

In the California Matters video, you'll see her working with a middle school in San Francisco, figuring out what works best for students during the lunch time rush. Here's an edited version of our conversation about food policies that work, what doesn't, and whether American kids can ever eat like French school children.

What's your role in the discussion about the school lunch program?

Kristine Madsen: As a trained researcher, I'm interested in analyzing and studying the impact of various approaches to improving the nutritional and physical activity environment for kids. I see my role as someone who can suggest directions to take but largely to help evaluate interventions once they're being tried out. My feeling is that researchers on the ground don't necessarily have the best ideas of what's going to work in the real world setting. Often what happens, and this is the situation with Healthy, Hunger-Free Kids Act, is that it seems like a great idea, but what happens on the ground isn't what you thought would happen. People are really concerned about plate waste because requiring kids to take a food or vegetable doesn't mean they're going to eat it. And while it has the best of intentions, it doesn't always translate to the impact that we want. So I go in and evaluate the things people are trying to see whether or not they have an effect.

Which existing food programs for kids do you think are delivering the most impact?

Madsen: I actually think that the Healthy, Hunger-Free Kids Act is exactly the kind of approach that we want to take because it's changing what's served. There are some things that need to be worked out and tweaked, so that food doesn't get wasted as a result, but I do think that policies that change what's available are the right approach.

Another great example is WIC, part of the SNAP system. In 2010 we actually generated a major overhaul because we didn't think we should be supplying sugar-sweetened beverages when the evidence suggests sugar-sweetened beverages are not healthy. So changing what's available in that kind of food package is really important.

Similarly anything happening on a school campus can have a great impact. So corner store conversions is an approach that I find very promising. Through major discussions with community leaders and store owners you try and encourage store owners to promote healthy food and make healthier food more prominent in the store. One thing coming out of this is the need to create distribution systems that make it feasible for these small grocers. There are ways to create policy that support local shop owners in getting access to wholesale prices.

And a really important one is taxes, like the sugary beverage tax we passed in Berkeley, or junk food taxes in other cities that we hope have a two-fold impact: one is to decrease consumption on those products and two is whatever revenues from these taxes can get plugged back into supporting healthier food.

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In the video, Zetta Reicker said that that children find sit down meals to be too institutional. Why doesn't this old model fit their needs anymore? How have kids eating habits changed these days?

Madsen: If you compare how families eat today to how they ate 50 years there are a couple of major shifts. One is that we have many more working parents than we used to. We used to have a model where one parent worked and the other stayed at home and that meant family dinners where they sat down together and had a meal together. For a lot of families that's absolutely impossible. That's not consistent with today's economic reality. So you don't have family meals and kids aren't used to sitting down like they were in the past. The other major shift is the amount of eating out at restaurants and the drastic increase in convenience food.

This is my own pet peeve, but in Europe, no one eats or drinks on the streets. They all sit down to have their coffee. Here, everyone's walking around with food or drink in their hands. So it's not that kids in schools have changed their eating habits, it's that we as a nation changed how we eat.

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So what about the common observation about how French schools offer sit-down lunches and how this should be a model for American school lunches? Is this practical for American students and schools?

Madsen: I think we should be able to absolutely test this before saying it's a good thing or it's not a good thing. I think we would want to see schools try it. Then we can see what the kids think about and if and how it changes their eating patterns.

This is one of the things I'm so impressed with San Francisco Unified School District because I think their leaders in this food system movement, Zetta Reicker and Orla O'Keeffe, are incredibly thoughtful about how kids have changed and how we might really engage them, and they are so willing to go out on the edge. Creating a French dining experience is one of the things that they're hoping do, but there are a lot of barriers because of health issues around it. For instance, can you serve a family-style meal where every kid puts their hand on the meal? It's not without its potential unintended consequences like Healthy, Hunger-Free Kids Act, just as it's not without some logistical barriers. But I love the fact that there are out-of-the-box thinkers trying things and let's see what happens.

In the video you talked about how school environment plays a big role in how kids eat lunch. How do kids eat when they're among their peers and at school?

Madsen: I think the biggest problem is that there remains a significant stigma around eating school meals. To me that's a major player in why children do and don't eat school food in general. In the video, Zetta talks about eliminating a la carte items, so it doesn't matter if you have cash or not. In most schools I've visited, no one knows anymore where your money comes from, because they've eliminated cash and instead have debit cards.

When we interview kids and talk to them they say it's not cool to eat the school meals. That's something that no matter what we do, if we don't make it cool in some way, we're not going to get movement.

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Can these learnings from your research be applied throughout the country or does there need to be a holistic approach for each school?

Madsen: Absolutely, there's a lot of regional differences and it depends on the food service director, how involved parents are, how much of a voice parents have, and what kind of budget the schools have. In San Francisco Unified they go well beyond the budget that would be given to them from their food reimbursement from the government alone. They go outside for funding to supplement that so they can serve healthier meals. And they're not alone in that -- there are other districts that are saying that you really can't serve healthy and appetizing food on that budget.

When it comes to school lunches, what can parents do to encourage their kids to make more nutritious choices at school?

Madsen: Pack a healthy meal when you send your kid to school. Some of the least healthy food I've seen come from home. Most studies suggest that the school meals are healthier than what they'd get from home or if they went off campus to eat. That's changed because it used to be that tater tots and chicken strips were the most common meals, but with the Healthy, Hunger-Free Kids Act what's being offered is often healthier.

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