Morning Meal Makeover

High-sugar, high-fat yogurt
High-sugar cereal
Fruit Juice
Toaster Pastry

Low-fat or skim milk
Low-sugar, low-fat yogurt
High-fiber, low-sugar cereal
Fresh fruit
No margarine
Whole-wheat toast

Something wonderful is happening at the Charlton Street Elementary School in Southbridge, Mass., and the Gerard A. Guilmette and Robert Frost schools in Lawrence: Kids are eating breakfast.

Even children who once skipped breakfast or began the day with sugary, fattening snacks are chowing down on tasty high-fiber, low-fat, low-sugar, zero-trans-fat foods. School cafeterias that formerly served, say, doughnuts and juice, now serve whole-grain cereals, fresh fruit, and muffins. This turnabout is the result of a partnership between the Boston-based nonprofit Project Bread–the Walk for Hunger and the Harvard School of Public Health (HSPH).

In 2003, Project Bread's leaders came to board member Eric Rimm, associate professor of epidemiology and nutrition at HSPH, with two big concerns: Childhood obesity was epidemic, and the U.S. Department of Agriculture's (USDA) breakfast program for low-income public schools was underutilized. The program was benefiting just 44 percent of students eligible to receive free or reduced-price school lunches.

How, Project Bread asked, might schools feed more kids and boost nutritional standards?
It takes a community

Rimm offered to develop standards, grounded in the latest research, that were higher than those set by the USDA. Joining him was Karen Peterson, associate professor of nutrition and society, human development, and health at HSPH. With their recommendations in hand, Project Bread invited three schools to serve as pilot sites for what the agency now calls the Better Breakfast Program. Together these schools enrolled 2,000 students who qualified for federally subsidized free, or reduced-price breakfasts.

Costs & Benefits

Nationwide, the need is great. In Massachusetts alone, about 1,600 schools serve breakfast, according to the state Depart-ment of Education. Of those, 649 are mandated to serve breakfast because 60 percent of their students meet income criteria for free or reduced-price meals.

Breakfast programs are underutilized. Children pay $0 to $1.50, depending on the family income, the town's economic status, and the foods served. Yet in Massachusetts, for example, breakfasts were served to just 44 percent of students who qualified for free or reduced-price meals.

Federal reimbursements make school breakfasts a low-cost intervention. $0.23 to $1.51 is reimbursed to school districts by the USDA for each meal served that meets federal nutritional standards. Since per-meal food costs run from $0.55 to $0.65, not counting labor, most districts break even.

Better breakfasts cost more, but costs could come down. Schools participating in Project Bread's Better Breakfast Program now pay 20 to 30 percent more than schools that don't because they use fresher, higher quality ingredients, which take more time and effort to prepare. But the program's boosters bet that as more kids eat breakfast at more schools, food vendors will lower their prices, and costs per meal served will decline.

HSPH asked Juliana Weinstein and Nadine Feinstein, candidates for the MS and MPH degrees, respectively, to help develop kid-friendly menus that were not only nutritious but appetizing. "We can make breakfast the healthiest thing in the world," Weinstein says, "but if kids don't eat it, it won't matter."

At first some kids complained. What happened to the Cocoa Puffs? But after sampling the fruit smoothies, oatmeal squares, and orange slices, they changed their tune.

At Charlton, more students are lining up for a healthful breakfast than ever ate breakfast before, and teachers are taking note. "Kids are more alert and participate more in class because they haven't had so much sugar and have good nutrients in their systems," attests Barry Sbordy, food services director for the Southbridge Public Schools.

Key to the program's success, Sbordy says, is involving the whole school community. At Charlton Street, then-principal Norm Yvon invited parents to come sample the new menu. Teachers developed lessons related to healthful eating. Students made posters highlighting the link between certain foods and good health. The cafeteria staff made sure the foods were appealing.
Five more schools have since signed up, including three in Orange, one in Southbridge, and one in Revere. That brings the total of participating schools to eight, so far.

Weinstein checks the meal's fiber, calorie, and fat levels, suggesting ways to alter recipes in light of nutritional targets. She's also using her HSPH training in nutrition to develop cost-conscious new products with Chartwells School Dining Services, part of the Compass Group, a leading food-service company.

"If we can influence the vendors that are making the food, we'll have a tremendous impact on lots of kids," says Project Bread Assistant Director Andrew Schiff. Also key, he says, are school food service directors, who must be persuaded to advocate for wholesome ingredients over processed products that are cheaper and easier to prepare.

Affordability is another issue. Start-up costs are low, and Project Bread's modest grants enable schools to buy blenders and other equipment. But the new meals cost more, while the federal reimbursements to schools stay the same--at most, about $1.50 per breakfast served. "The challenge is to increase participation," Schiff says. "As more kids eat breakfast, unit costs will come down."

"Program costs and benefits will continually be evaluated," Rimm adds. "We hope to reach 20 school districts in the near future."

The healthy bottom line? As Weinstein and Sbordy point out: If you can get kids into the healthful-breakfast habit, they just might carry it into adulthood.

Paula Hartman Cohen has written about science and health for Newsday and other major newspapers.

For more Harvard Public Health Review articles regarding nutrition click here


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