Imagine a world where no child is deprived of healthy food. Governments around the globe have been tackling undernutrition in children by implementing different programmes, including those focused on school meals. Access to free or reduced-cost school meals for children who need it the most is a way to combat what is still one of the major global threats: food insecurity. Providing food to children in school is just one part of the solution. No school meal programme can be good enough if the food provided lacks nutritional value or is unhealthy. Nutritional balance is more important than ever, because overnutrition is also a global problem. Nearly 200 million children under the age of 5 suffer from undernutrition, and another 40 million suffer from overweight or obesity at the same age.
There are well-established school meal programmes in the USA and many countries in Latin America. For example, the National School Lunch Program and the School Breakfast Program are federally-funded projects implemented in public and non-profit private schools across the USA that provided meals to more than 30 million children in 2019. Another example is the Qali Warma (“Vigorous Boy”) programme in Peru, which has evolved and improved over the years, taking the place of previous nutrition assistance programmes initiated in 1977. Qali Warma helped more than 4 million children in 2021. Caribbean countries also have school meal programmes to address the demanding problem of malnutrition.
The benefits of healthy school meal programmes are many. These programmes can help to reduce macronutrient deficiency and improve growth, which in turn can have a positive effect on students’ cognitive development and health. Healthy eating habits at school may also improve fruit and vegetable consumption and promote healthy weight gain. In addition, one of the main objectives of school meal programmes in many countries in Latin America is to increase attendance and retention in schools.
Over the past two decades, ultra-processed food has become more available and affordable. Ultra-processed foods come in the form of snacks, drinks, and ready meals, which commonly have a high content of salt, fat, sugar, and preservatives. The consumption of ultra-processed food is associated with a higher risk of chronic diseases such as obesity, cardiovascular disease, inflammatory bowel disease, and cancer. Higher consumption of ultra-processed food is associated with a 22% higher risk of all-cause mortality. However, ultra-processed foods have been served in schools in many countries, including Brazil and the USA.
There are many possible reasons that ultra-processed food is still offered in schools, from cultural aspects to logistical problems. The United States Department of Agriculture, one of the official entities responsible for the USA's dietary guidelines “sets school meal nutrition standards to ensure that schools offer students the right balance of fruits, vegetables, low-fat or fat-free milk, whole grains, and protein foods”. This statement, however, does not explicitly prohibit ultra-processed food. In fact, the official meal dietary guidelines do not discourage serving pizza or corn dogs, as long as the nutritional specifications are met (total calorie, sugar, fat, and salt content). In addition, the problems associated with perishable food (such as food waste) and the lack of nutritionists, menu planners, cooks, and infrastructure in some schools, might persuade school authorities to opt for the inclusion of ultra-processed food instead of offering cooked, healthy food as the main source of protein and calories.
A programme that appears to depend very little on ultra-processed food is Qali Warma. This programme in Peru relies on cash transfers and supplies to schools of raw or minimally processed food such as eggs, quinoa, and beans and other processed food such as vegetable oil, rice, pasta, evaporated milk, and canned tuna or chicken used for preparing meals. However, the lack of infrastructure for food preservation across the country is a major limitation of the programme, and perishable healthy food such as fruits and vegetables are not distributed to schools. The examples shown here from the USA and Peru tell us that it is time to raise more awareness of the vital importance of healthy food for our children, and to invest more in qualified personnel and infrastructure.
Governments and schools need to be more vigilant and eradicate unhealthy school meals; otherwise, we might not only be battling hunger, but also contributing to the obesity pandemic. Implementing programmes of school meals free of unhealthy products could further promote health and result in healthier eating habits later in life, leading to healthier populations. The implementation of healthier school programmes will require more strict policies and constant monitoring. Switching to healthier meal programmes could be more expensive, but healthier populations could mean lower medical expenses in the long term. When dealing with one of the most vulnerable populations in the context of a childhood obesity pandemic, healthier school meal programmes should be a top priority for public health practitioners and Governments.