Are students throwing away nutrition?

Abstract. The School Breakfast Program (SBP) began in 1966 in order to provide breakfast for children in poor areas and for those who had to travel a great distance to school. Although participation in the SBP has doubled between 1987 and 1997, it is unclear whether children are consuming a well-balanced breakfast. The purpose of this study was to determine whether students in a rural Missouri elementary school were eating the complete SBP meal and thereby obtaining adequate nutrition. The subjects were grades K-2 students who received the SBP meal over three days during one week in February 2001. Researchers observed which meal items were "not taken/not eaten" and noted the information on a Meal Pattern Tally Form for each student. Overall, it seemed that the students in this study consistently did not eat approximately 10% of their milk and grain/meat main menu items, nor about 40% of their fruit/vegetable servings. Consistently, more females than males did not eat the minimum servings of all food items ove r the 3-day period. Implications are discussed.

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Recent experimental studies on children demonstrate that breakfast consumption positively benefits undernourished children's cognitive performance (Pollitt, 1995). Students seem to achieve higher levels of academic performance when they consistently eat breakfast. In addition, skipping breakfast leads to poor nutritional health over time, and thus interferes with the child's overall health and well-being (Grohen, 1988). It also has been suggested that a child's brain function and memory are sensitive to the effects of an overnight fast as well as to nutrient deficiencies (Pollitt, 1995). One study showed that in schools that serve breakfast, students' academic scores increased and their discipline problems decreased (Matsumoto, 1998). Are enough students gaining the benefits associated with eating a healthy breakfast--increased academic achievement, improved psychosocial functioning, less tardiness, and decreased behavioral problems (Association of California School Administrators, 1999)?

The United States began the School Breakfast Program (SBP) in 1966 in order to provide breakfast for children in poor areas and for children who had to travel a great distance to school. Each breakfast served must meet federal requirements, and participating schools must offer breakfast to all students. SBP sponsors must offer free or reduced-priced breakfast to eligible children, including those from families with incomes at or below 130% of the poverty level, those who receive Temporary Assistance for Needy Families, or those who receive food stamps. In addition, children with family incomes between 130% and 180% of the poverty level are eligible for reduced-priced breakfasts (Devaney & Stuart, 1998).

According to the School Breakfast Scorecard released by the Food Research and Action Center (FRAC, 2000), nearly 6 million low-income children throughout the United States are currently participating in the SBP. Each state is rated according to its "over-three-year performance" on an 8-point scale in three areas: overall outcome, recent accomplishments, and effort. Participation in the SBP is measured by comparing the number of children receiving free or reduced-priced school breakfast in each state to the number receiving free or reduced-priced school lunch. Missouri scored among the highest of all the states, with eight total points. Over 165,000 children in Missouri participate in the SBP (FRAC, 2000).

The SBP follows recommendations set by the U.S. Department of Agriculture in order to provide children with important nutrients. The breakfast meal requirements are as follows:

1. A serving of fluid milk

2. A serving of fruit or vegetable, or a serving of full-strength fruit or vegetable juice 

3. Two servings of grains/bread, or two servings of meat, or one serving of meat/ meat alternative and one serving of grains/bread or grains/bread alternative (Devaney & Stuart, 1998).

Participation in the SBP has doubled between 1987 and 1997 (FRAC, 2000). This does not, however, prove that children are consuming a well-balanced breakfast. In the mid-1970s, U.S. Congressional leaders believed that students were throwing away too much food. As a result, Congress implemented Offer versus Serve (OVS) to minimize food waste and encourage more food choices. OVS is a local option for elementary and junior high/middle schools; however, senior high schools participating in the National School Lunch Program are required to implement OVS. Schools that select the OVS option must offer all planned menu items to all students (Holiday, 1998).

Purpose

Although three-quarters of all school breakfasts are offered for free, the SBP still fails to reach about two million or so eligible low-income students (FRAC, 2000). In addition, the mere presence of the program is not enough to get students to eat these meals (Matsumoto, 1998).

Since children in many schools have the option of declining food items (i.e., they are being offered menu items instead of being served), they often fail to choose those correct foods that will provide a nutritious meal (Holliday, 1998). The purpose of this pilot study was to determine whether grade K-2 students in a rural Missouri elementary school using OVS were eating a complete, nutritionally adequate SBP meal.

Method

Subjects

The subjects were grade K-2 students in a rural Missouri elementary school who received the SBP meal over three days (Monday: 123 students; Wednesday: 134 students; and Friday: 144 students) during one week in February 2001. Of the 530 pupils enrolled at this elementary school, 155 (29.2%) received "free" and 50 (9.4%) received "reduced" breakfast and lunch (Kirksville RIII Schools, 2002). Males constituted a little over half of the subjects each day: 54.5% (n=67/123) on Monday, 51.5% (n=69/134) on Wednesday, and 51.4% (n=74/ 144) on Friday. To measure students' breakfast waste, a total of 401 trays were analyzed over the 3-day period.

Instrument

The Meal Pattern Tally Form, based on the SBP's minimum meal item requirements (Figure 1), was used as the data-gathering instrument to note "not taken/not eaten" food items from the students' breakfast trays. The Meal Pattern Tally Form described the student's gender and the day's meal item offerings, with the minimum meal requirements of: 1 serving of milk, 1 serving fruit/vegetable, 2 servings of grain and/or meat. "Not taken/not eaten" was defined as not taking the food item as the student passed through the cafeteria line, or taking the food item but not completely consuming it.

Procedures

The authors contacted the school principal and received permission to analyze the breakfast tray waste of the students who received the SBP meals. The researcher and research assistant were unobtrusive observers at the waste disposal station. Both researchers were trained the previous week in a mock disposal setting in order to become more accurate observers and recorders. The percent of agreement between researchers on the tally records was 99.0% (397/401). Researchers observed which meal items were "not taken/not eaten" and noted the information on a Meal Pattern Tally Form for each student. Because of the varied menu and food preferences of the students, three days (Monday, Wednesday, Friday) were selected for analysis. Monday's menu included cereal/toast or biscuits/gravy; milk, and juice; Wednesday's menu included a choice of cinnamon roll or cereal, milk, and juice; and Friday's menu included breakfast pizza or cereal/toast, milk, and juice.

Analysis

Frequencies and proportions were used to describe the number of food items "not taken/not eaten" by the students. The Chisquare statistic was used to analyze the minimum meal requirements by gender and day of the week.

Results

The food waste from 401 breakfast trays was analyzed over a 3-day period. On average, only about 10% of the students did not drink a full serving of milk during each day of the study. As seen in Tables 1-3, proportionally, most students did not drink their full serving of milk on Friday, followed by Wednesday, then Monday. On Monday and Wednesday, proportionally more females than males did not drink their full serving of milk. However, on Friday; almost twice as many males as females did not drink their milk.

Each day of the study; about 40% of the students did not eat their full serving of fruit/vegetable. Proportionally; most students did not eat their full serving of fruit/vegetable on Friday; followed by Wednesday; then Monday. During every day of the study; more females than males did not eat their fruit/vegetable item.

On average, only less than 8% of the students did not eat their two-serving main menu item during each day of the study. In addition, proportionally; most students did not eat their two servings of grains/meat on Monday; followed by Wednesday; then Friday. However, more females than males did not eat their two servings of grain/meat during the 3-day period. Specifically; on Monday, significantly more females ([chi square]=3.604, df=1, p<.05) than males did not completely eat their main meal item.

Implications for Student Health

Although the school in this study offered a SBP, the results are mixed as to whether offering a SBP improves the likelihood that students will eat breakfast. In an older national study; it was concluded that children in schools that offer a SBP were more likely to eat breakfast than those without a SBP available (Hanes, Vermeersch, & Gale, 1984). More recently; the School Nutrition and Dietary Assessment Study (Devaney; Gordon, & Burghardt, 1993) demonstrated no association between the availability of a SBP and whether or not a student eats breakfast. Possibly because of the availability of a SBP in the school in this study; about 134 (25.3%) of the total elementary school's population of 530 eat the breakfast served in the cafeteria each day.

Overall, it seems that the students in this study consistently did not eat only about 10% of their milk and grain/meat main menu items. Unfortunately; they also consistently did not eat about 40% of their fruit/vegetable servings. These findings closely relate to a Canadian study that found only 30% of elementary students consume the minimal servings from all food groups for the breakfast meal (Bidgood & Gameron, 1992).

Friday was the day when the least amount of grain/meat items were not eaten, possibly because of the positive appeal of a fast food-like meal offering (breakfast pizza). The day the breakfast pizza was served, however, was also when the most milk and fruit/vegetables were not eaten by the students. The fast food-like item also may have had a higher percentage of calories from fat than other foods typically offered. On that day, oddly, almost twice as many males than females did not drink their milk. This may have happened because when high-fat foods are consumed, people tend to compensate by eating less total bulk of food (Lisner, 1987).

However, Monday and Wednesday's two-serving main meal items (biscuits/gravy and cinnamon roll, respectively) were not eaten more often than Friday's very popular breakfast pizza. Wednesday's main menu item was a large, sticky cinnamon roll that the students seemed to play with more than attempt to eat. Monday's biscuits and gravy main course, a more familiar food to rural children, was possibly not visually appealing to the students.

The state of Missouri mandates that SB? offerings will provide one-fourth of the recommended dietary allowance (RDA) of protein, calcium, iron, vitamin A, and vitamin C in accordance with the appropriate levels for specific age groups, as well as appropriate calorie/energy allowances for specific age groups (Missouri Department of Elementary and Secondary Education, 2000). It has been demonstrated that about 40% of schoolchildren receive less than half of the RDA for folate, calcium, iron, and magnesium (Benton & Roberts, 1998).

Iron deficiency is the most common nutrient deficiency in schoolchildren (Splett & Story, 1991). Children who are iron-deficient often become irritable and have low attention spans, problems that may be mistaken by teachers for behavioral problems (Sizer & Whitney, 1994). Fortunately, most students ate the grain/meat servings. Although the students were eating most of the grain/meat items, they were not adequately consuming their fruit/vegetable (which would increase iron absorption). Vitamin C, found in fruits and vegetables, maintains collagen and enhances the immune response. Vitamin A is needed for bone and body growth in children. In addition, vitamin C also slows iron oxidation, thereby enhancing its absorption (Sizer & Whitney, 1994).

Except for milk servings on Friday, more females than males consistently did not take or did not eat the minimum servings of all items over the 3-day period. This insufficient calcium intake by young females is especially troubling. A calcium deficiency in their childhood years may prevent achievement of peak bone mass (Matkovic, 1991). All in all, the students in this study, especially the females, need to increase their intake of fruits and vegetables at breakfast time.

Recommendations

The U.S. Department of Agriculture recently instituted a universal free breakfast program pilot study across the country. The congressionally funded program has decreased absenteeism and visits to the school nurse in the mornings (Staff, 2000), increased breakfast participation to over 90% of students (Pearl, 1998), and improved the nutritional value of foods served (Staff, 2001).

How can school personnel encourage students in the SBP or the universal free breakfast program to gain the academic and nutritional advantages accrued by consuming all of their meal items? Offering incentives, making breakfast convenient, and offering a variety of selections seem to be the keys. Offering T-shirt raffles and prize give-aways, pairing young students with older breakfast buddies, and inviting celebrity guest breakfast speakers have been successful incentives in many districts (Matsumoto, 1998).

Breakfast is eaten more consistently by students when it comes in grab-and-go bags, when students can pack their own breakfast bag, and when a heated breakfast cart delivers the food to the classroom during homeroom period (Pearl, 1998). Offering a variety of prepackaged and brand name foods and serving both hot and cold breakfast items allows students to make choices for themselves. Popular items include egg/cheese croissants, French toast sticks, pita pockets, Trix yogurt, breakfast pizzas, Pop Tarts, bagels, and, of course, cereals (Staff, 2001).

Administrators and staff can evaluate these strategies and determine what might work in their schools. For example, in the study school, a variety of hot and cold selections were offered and students also had ample time to eat before the homeroom bell rang. What was lacking, however, was any positive breakfast promotion or nutrition education. High school "buddies" from the National Honor Society or sport teams could volunteer to eat with the elementary students and encourage them to eat more fruits/vegetables; the health and physical education teacher could use that time as "nutrition lab" to discuss the nutritional benefits of drinking milk at breakfast; or the art classes could create promotional posters to encourage more breakfast consumption. Overall, by creating incentives with promotions and teaching about the benefits of good nutrition, educators may help to improve breakfast participation rates.

Table 1

Servings "Not Taken / Not Eaten" on Monday by Gender

Servings
"Not Taken/Not Eaten"  Male          Female          Total
                       (N) %         (N) %           (N) %

1 Milk                 03/67; 04.5%  04/56; 07.1%    07/123; 5.7%
1 Fruit/Vegetable      23/67; 34.3%  23/56; 41.1%    46/123; 37.4%
2 Grain/Meat           03/67; 04.5%  08/56; 14.3% *  11/123; 08.9%

* p<.05

Table 2

Servings "Not Taken/Not Eaten" on Wednesday by Gender

Servings:
"Not Taken/Not Eaten"  Male          Female        Total
                       (N) %         (N) %         (N) %

1 Milk                 06/69; 08.7%  10/65; 15.4%  16/134; 11.9%
1 Fruit/Vegetable      27/69; 39.1%  26/65; 40.0%  53/134; 39.6%
2 Grain/Meat           03/69; 04.3%  08/65; 12.3%  11/134; 08.2%

Table 3

Servings "Not Taken/Not Eaten" on Friday by Gender

Servings:
"Not Taken/Not Eaten"  Male          Female        Total
                       (N) %         (N) %         (N) %

1 Milk                 12/74; 16.2%  06/70; 08.6%  18/144; 12.5%
1 Fruit/Vegetable      31/74; 41.9%  30/70; 42.9%  61/144; 42.4%
2 Grain/Meat           03/74; 04.1%  06/70; 08.6%  09/144; 06.3%

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