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Cohen J.F.W.,Merrimack College | Jahn J.L.,Harvard University | Richardson S.,Project Bread | Cluggish S.A.,Project Bread | And 2 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2015

Background: There are currently no national standards for school lunch period length and little is known about the association between the amount of time students have to eat and school food selection and consumption. Objective: Our aim was to examine plate-waste measurements from students in the control arm of the Modifying Eating and Lifestyles at School study (2011 to 2012 school year) to determine the association between amount of time to eat and school meal selection and consumption. Design: We used a prospective study design using up to six repeated measures among students during the school year. Participants/setting: One thousand and one students in grades 3 to 8 attending six participating elementary and middle schools in an urban, low-income school district where lunch period lengths varied from 20 to 30 minutes were included. Main outcome measures: School food selection and consumption were collected using plate-waste methodology. Statistical analyses performed: Logistic regression and mixed-model analysis of variance was used to examine food selection and consumption. Results: Compared with meal-component selection when students had at least 25 minutes to eat, students were significantly less likely to select a fruit (44% vs 57%; P<0.0001) when they had <20 minutes to eat. There were no significant differences in entrée, milk, or vegetable selections. Among those who selected a meal component, students with <20 minutes to eat consumed 13% less of their entrée (P<0.0001), 10% less of their milk (P<0.0001), and 12% less of their vegetable (P<0.0001) compared with students who had at least 25 minutes to eat. Conclusions: During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk, and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake. © 2015 Academy of Nutrition and Dietetics.


Cohen J.F.W.,Harvard University | Smit L.A.,Harvard University | Parker E.,Project Bread | Austin S.B.,Harvard University | And 3 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2012

School cafeterias can play an important role in providing healthy meals. Although schools participating in the National School Lunch Program are required to meet minimum program standards, advocates recommend that innovations be sought to enhance menu dietary quality. This study evaluated the Chef Initiative, a 2-year pilot study in two Boston middle schools, designed to increase the availability and consumption of healthier school foods. Between 2007 and 2009, a professional chef trained cafeteria staff to prepare healthier school lunches (ie, more whole grains, fresh/frozen fruits and vegetables, and less sugar, salt, saturated fats, and trans fats). Meal nutrient compositions were monitored from 2007 to 2009, and a plate waste study conducted in the spring of 2009 compared food selection and consumption patterns among students at Chef Initiative schools, with students receiving standard school lunches at two matched control schools. Paired t tests and descriptive statistics were used to examine differences in menus and mixed-model analysis of variance was used to analyze differences in students' food selection and consumption between Chef Initiative and control schools. Overall, the Chef Initiative schools provided healthier lunches and the percent of foods consumed at Chef Initiative and control schools were similar (61.6% vs 57.3%; P=0.63). Of the areas targeted, there was greater whole-grain selection and vegetable consumption; 51% more students selected whole grains (P=0.02) and students consumed 0.36 more vegetable servings/day (P=0.01) at Chef Initiative schools. The potential of chefs collaborating with cafeteria staff to improve the availability, selection, and consumption of healthier meals is promising. © 2012 Academy of Nutrition and Dietetics.


Cohen J.F.W.,Merrimack College | Cohen J.F.W.,Harvard University | Jahn J.L.,Harvard University | Richardson S.,Project Bread | And 3 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2016

Background: There are currently no national standards for school lunch period length and little is known about the association between the amount of time students have to eat and school food selection and consumption. Objective: Our aim was to examine plate-waste measurements from students in the control arm of the Modifying Eating and Lifestyles at School study (2011 to 2012 school year) to determine the association between amount of time to eat and school meal selection and consumption. Design: We used a prospective study design using up to six repeated measures among students during the school year. Participants/setting: One thousand and one students in grades 3 to 8 attending six participating elementary and middle schools in an urban, low-income school district where lunch period lengths varied from 20 to 30 minutes were included. Main outcome measures: School food selection and consumption were collected using plate-waste methodology. Statistical analyses performed: Logistic regression and mixed-model analysis of variance was used to examine food selection and consumption. Results: Compared with meal-component selection when students had at least 25 minutes to eat, students were significantly less likely to select a fruit (44% vs 57%; P<0.0001) when they had <20 minutes to eat. There were no significant differences in entrée, milk, or vegetable selections. Among those who selected a meal component, students with <20 minutes to eat consumed 13% less of their entrée (P<0.0001), 10% less of their milk (P<0.0001), and 12% less of their vegetable (P<0.0001) compared with students who had at least 25 minutes to eat. Conclusions: During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk, and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake. © 2016 Academy of Nutrition and Dietetics.


Cohen J.F.W.,Harvard University | Richardson S.,Project Bread | Parker E.,Project Bread | Catalano P.J.,Harvard University | And 2 more authors.
American Journal of Preventive Medicine | Year: 2014

Background The U.S Department of Agriculture (USDA) recently made substantial changes to the school meal standards. The media and public outcry have suggested that this has led to substantially more food waste. Purpose School meal selection, consumption, and waste were assessed before and after implementation of the new school meal standards. Methods Plate waste data were collected in four schools in an urban, low-income school district. Logistic regression and mixed-model ANOVA were used to estimate the differences in selection and consumption of school meals before (fall 2011) and after implementation (fall 2012) of the new standards among 1030 elementary and middle school children. Analyses were conducted in 2013. Results After the new standards were implemented, fruit selection increased by 23.0% and entrée and vegetable selection remained unchanged. Additionally, post-implementation entrée consumption increased by 15.6%, vegetable consumption increased by 16.2%, and fruit consumption remained the same. Milk selection and consumption decreased owing to an unrelated milk policy change. Conclusions Although food waste levels were substantial both pre- and post-implementation, the new guidelines have positively affected school meal selection and consumption. Despite the increased vegetable portion size requirement, consumption increased and led to significantly more cups of vegetables consumed. Significantly more students selected a fruit, whereas the overall percentage of fruit consumed remained the same, resulting in more students consuming fruits. Contrary to media reports, these results suggest that the new school meal standards have improved students' overall diet quality. Legislation to weaken the standards is not warranted. © 2014 American Journal of Preventive Medicine.


Cohen J.F.W.,Harvard University | Richardson S.A.,Project Bread | Cluggish S.A.,Project Bread | Parker E.,Project Bread | And 3 more authors.
JAMA Pediatrics | Year: 2015

IMPORTANCE: Little is known about the long-term effect of a chef-enhanced menu on healthier food selection and consumption in school lunchrooms. In addition, it remains unclear if extended exposure to other strategies to promote healthier foods (eg, choice architecture) also improves food selection or consumption. OBJECTIVE: To evaluate the short- and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption. DESIGN, SETTING, AND PARTICIPANTS: A school-based randomized clinical trial was conducted during the 2011-2012 school year among 14 elementary and middle schools in 2 urban, low-income school districts (intent-to-treat analysis). Included in the study were 2638 students in grades 3 through 8 attending participating schools (38.4% of eligible participants). INTERVENTIONS: Schools were first randomized to receive a professional chef to improve school meal palatability (chef schools) or to a delayed intervention (control group). To assess the effect of choice architecture (smart café), all schools after 3 months were then randomized to the smart café intervention or to the control group. MAIN OUTCOMES AND MEASURES: School food selection was recorded, and consumption was measured using plate waste methods. RESULTS: After 3 months, vegetable selection increased in chef vs control schools (odds ratio [OR], 1.75;95% CI, 1.36-2.24), but there was no effect on the selection of other components or on meal consumption. After long-term or extended exposure to the chef or smart café intervention, fruit selection increased in the chef (OR, 3.08;95% CI, 2.23-4.25), smart café (OR, 1.45;95% CI, 1.13-1.87), and chef plus smart café (OR, 3.10;95% CI, 2.26-4.25) schools compared with the control schools, and consumption increased in the chef schools (OR, 0.17;95% CI, 0.03-0.30 cups/d). Vegetable selection increased in the chef (OR, 2.54;95% CI, 1.83-3.54), smart café (OR, 1.91;95% CI, 1.46-2.50), and chef plus smart café schools (OR, 7.38, 95% CI, 5.26-10.35) compared with the control schools, and consumption also increased in the chef (OR, 0.16;95% CI, 0.09-0.22 cups/d) and chef plus smart café (OR, 0.13;95% CI, 0.05-0.19 cups/d) schools; however, the smart café intervention alone had no effect on consumption. CONCLUSIONS AND RELEVANCE: Schools should consider both collaborating with chefs and using choice architecture to increase fruit and vegetable selection. Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that also increased consumption. This was observed only after students were repeatedly exposed to the new foods for 7 months. Therefore, schools should not abandon healthier options if they are initially met with resistance. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02309840.

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