Local campaigns to take less healthy foods out of schools may gain strength from a new study showing that where a la carte foods like pizza and fries were offered as choices along with a traditional school lunch, children's diets suffered both in school and at home.

A la carte programs, vending machines, soda, and school stores are basically on trial across the nation for the role they may play in the alarming rise of child obesity over the last 20 years. Overweight and obesity are major risk factors for diabetes, heart disease, and several types of cancer.

In state capitols and school board meetings, dozens of proposals would ban or limit sodas sales in schools. In June, New York City's largest school district decided to ban soft drinks sales. The Los Angeles Unified School District will do the same beginning in January, 2004. LA Unified cited a survey that found 40% of the district's elementary students were obese—and research showing an extra soft drink a day may increase a child's risk for obesity by 60%.

Sodas typify what may people call junk food and nutritionists describe as a food low in nutritional value. They're very high in calories from refined sugar, but contain few other nutrients—and teens often choose soft drinks instead of more healthful drinks like milk.

The foods sold in vending machines, school stores, or a la carte are not required to follow the government's school nutrition regulations, and ideally, they should not be positioned as a regular alternative to more wholesome school lunches. But these foods are big money-makers, and nine out of 10 US schools now run lucrative a la carte programs at lunchtime.

Georgia resident Harriet Hollis was astonished to see what types of food were offered in the a la carte program at her 6th grader's new school—the same foods that dominate such programs across the country. "They sell pizza, soft drinks, chili fries, cheese fries, regular fries, chicken nuggets…. It's nothing but junk food," she said.

The new findings about the influence of a la carte programs come from a broad study of the school food environment, published in the American Journal of Public Health (Vol 93, No. 7: 1168-1173). Martha Kubik, PhD, and colleagues at the University of Minnesota surveyed and evaluated all foods available to 7th grade students at 16 schools in the St. Paul-Minneapolis area and collected 24 hour dietary recall surveys. Of the a la carte foods sold to students, 93% were tactfully described as "foods to limit."

Where a la carte programs existed, students ate fewer fruits and vegetables and consumed more calories from fat and saturated fat than current recommendations. "Our findings suggested that students were not compensating for less healthful choices made at school by choosing more healthful choices when away from school," said Kubik.

In the schools without a la carte programs, students met or came close to meeting the dietary guidelines. And they consumed nearly an entire serving more of fruits and vegetables than children at the other schools.

Of course, parents who want their children to eat better may decide to send a bag lunch from home. But while that may work for younger children, very few teenagers will bring a lunch, according to Enid Hohn, RD, director of child nutrition services for the Vista Unified District near San Diego. When they do, much of it goes in the trash or gets traded.

Hohn launched a healthy vending pilot program at Vista High School that could become a model for other districts fighting the battle of the teenage bulge. Many of the school's 3,500 students weren't making it through the cafeteria line before the half hour lunch period ended—so they'd go hungry or hit the vending machines. "We're not talking about impulse buying here. These are kids' food choices everyday. And good food is important to help them learn," Hohn said.

So two years ago, Hohn took over running the vending machines from outside contractors and bottling companies; she removed all chips and candy, and cut back sodas from 66% of the slots to about 20%.

She added or increased the bottled water, sports drinks, 100% fruit juices, milk, and smoothies. New foods included bagels, cereal with low-fat milk, pretzels, cheeses, trail mix, several varieties of granola bars, animal crackers, small servings of mini chocolate chip cookies, fresh-cut fruit, even Pop-Tarts. By year's end, vending sales were up by $200,000 over the previous year and only 12% of the beverages sold were sodas.

"We put them in an environment that allows them to choose health," said Hohn. Some low-nutrient treats are still available, but they're the exception rather than the rule. "A school official asked me how Pop-Tarts could be healthy. Well, strawberry Pop-Tarts without icing only get 22% of their calories from fat. A Pop-Tart and a milk is much better than a candy bar and a soda at seven o'clock in the morning."

Minnesota researcher, Kubik, says studies have shown that young people will choose healthy foods when they are priced competitively. "It is also likely that students will increase the number of times they select healthy foods if tasty, fairly-priced healthy foods are the majority of what is being offered.

Parents can have great influence over what's on the lunch menu and in the vending machines at their children's schools, according to Beth Stevenson, MPH, director of child and youth initiatives for the American Cancer Society. "Ask if your school district has a school health council, and ask if you can be on it," explained Stevenson.

"The nutrition and physical activity issues touch all income groups," Stevenson stressed. "They're risk factors for all of us." At home, Stevenson recommends four general rules for families to send a message about how important it is to eat a healthful diet and keep active.

• Eat dinners as a family at home, as much as possible during the week. Be a role model by serving and eating healthy foods.
• Buy nutritious snacks, such as fruit, low fat chocolate milk, and cut up vegetables and have them easily available in your home.
• Limit TV viewing and have a family policy not to eat and watch TV at the same time.
• Be active as a family, encourage your children to be physically active for 60 minutes at least five days a week, and get moving yourself for at least 30 minutes, at least five days a week.

Kubik points out that home may not be a place where children will find a balanced diet. Most American adults are now overweight or obese and find it challenging to follow a healthy diet in a rushed, super-sized society.

"By offering young people mostly healthy food choices at school, students get to practice healthy choice and test new and tasty foods that are good for them. A healthy school food environment also exposes the young person to healthy food choice by important others, like peers, teachers, school nurses," explained Kubik.

"As we face a burgeoning epidemic of childhood obesity, schools have an opportunity to make a critical contribution to an emerging national strategy to curb and hopefully reverse this worrisome trend."

ACS Nutrition and Physical Activity Guidelines/Choices for Good Health, Living Smart, Smart Steps

CDC Guidelines for School Health Programs to Promote Lifelong Healthy Eating

CDC Guidelines for School and Community Programs to Promote Lifelong Physical Activity Among Young People

Call 1-800-ACS-2345 for more information about forming a school health council.