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Impact of Portion-Size Control for School a la Carte Items: Changes in Kilocalories and Macronutrients Purchased by Middle School Students

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Abstract

We assessed the impact of a pilot middle school a la carte intervention on food and beverage purchases, kilocalories, fat, carbohydrate, and protein sold per student, and nutrient density of the foods sold. A la carte sales were obtained from six middle schools in three states for 1 baseline week and daily during the 6-week intervention. Intervention goals included reducing sizes of sweetened beverages and chips, and increasing the availability of water and reduced-fat/baked chips. Nutrients sold per day were computed and weekly nutrient means per student and per number of items sold were calculated and compared between baseline and week 6. Five schools achieved all goals at 6 weeks. Four schools showed increases in the percentage of kilocalories from protein and decreases in the amount of sweetened beverages sold; five showed substantial increases in water sales. Changes in regular chips varied by school. There were significant changes in energy density of foods sold. School foodservice changes in middle school snack bar/a la carte lines can be implemented and can lead to a reduction in the caloric density of foods purchased.

Section snippets

Methods

The Studies to Treat or Prevent Pediatric Type 2 Diabetes (STOPP T2D) were funded to develop a type 2 diabetes prevention program for middle schools. The overall goal of the larger intervention study, which began in 2006, is to reduce diabetes risk factors, including body mass index, blood sugar, and insulin levels among middle school students. Dietary outcomes for the main trial include increasing water, fruit, and vegetable consumption, and decreasing sweetened beverage and dietary fat

Results and Discussion

The demographic characteristics of the participating schools are shown in Table 1. The majority of students identified themselves as members of ethnic minority groups (Hispanic, African American, and Native American).

At baseline, only one of the goals was met by one school; North Carolina school 2 offered reduced-fat/baked chips as 25% of their snack chips. At week 6, all goals were achieved by five of the schools. California school 1 did not meet the reduced-fat/baked-chip goal.

Table 2 shows

Conclusions

Results from this pilot study document that school foodservice changes in the school snack bar/a la carte line can be implemented in middle schools. However, changes in revenue were not ascertained, and any deleterious impact on school revenue could be an issue for sustainability. Also, it was apparent that restrictions on portion sizes of other snack foods like dessert foods were needed. Marketing and promotion of the healthful food offerings also appears necessary. Future work should

J. Hartstein is a nutritionist, University of California Irvine.

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J. Hartstein is a nutritionist, University of California Irvine.

K. W. Cullen is associate professor, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

K. D. Reynolds is associate professor, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, University of Southern California, Alhambra.

J. Harrell is professor and P. Kennel is project coordinator, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill.

K. Resnicow is professor, University of Michigan, Health Behavior and Health Education, School of Public Health, Ann Arbor.

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