Food choices in school vending machines and à la carte lines or snack bars are under scrutiny.  The National School Lunch Program (NSLP) meals must offer 2 servings of vegetables/fruits and one cup of milk.  Other studies indicate that fifth-graders who have access to snack bars and those who bring lunch from home consume fewer servings of fruits/vegetables.  This study assessed changes in the consumption of fruits, vegetables, milk and sugar-sweetened drinks as students transitioned from elementary to middle school with access to a snack bar.

Fourth and fifth grade students in one school district completed five-day lunch food consumption records at four intervals (fall and spring) each year for two years (i.e., they were fifth and sixth graders in year two).  At the outset, one-fourth of these students were financially eligible for free and reduced price meals. The elementary school (fourth grade) served only NSLP meals while the middle school (fifth and sixth grade) had a snack bar/ à la carte line.

From fourth grade (elementary) to fifth grade in middle school, servings of fruits, regular (not fried) vegetables, and milk consumed dropped 33%, 42% and 35%, respectively.  In that transition year, high-fat vegetable servings increased 68% and of sweetened drinks increased 62%.  There were no significant ethnicity or gender group differences. Servings of all food types (fruit, regular or high-fat vegetables, and milk) from a NSLP meal line dropped from fourth to fifth grade. In the middle school, 35-40% of students indicated all their selections were from the snack bar.

From fifth to sixth grade years in the middle school, consumption of high-fat vegetables increased 30% and of milk increased slightly (14%).  Servings of regular vegetables dropped 10% and of sweetened drinks decreased 12%. Bottled water became available during the second year and may have accounted for fewer sweetened drink servings.

Fruit and vegetables need to be more accessible and interventions should promote fruits, vegetables and milk in school cafeterias and snack lines.

(Cullen K and Zakeri I. Am J Public Health 2004;94:463-467)

Comment: A mother-school health advocate was dismayed to see so many different brands of candy on her child’s cafeteria snack line. Her study of profits from candy sales resulted in reducing the number of choices -- a step to reducing this type of food sale.  The school cafeteria and food choices should be part of the Back to School Night tour so parents are not naïve about the food environment. --J.O.