Advertisement

Processed and Packed: How Refined Are the Foods That Children Bring to School for Snack and Lunch?

Published:October 03, 2020DOI:https://doi.org/10.1016/j.jand.2020.07.017

      Abstract

      Background

      Increasing consumption of highly processed foods has been associated with adverse health outcomes among children. In the US, children consume up to half of their daily energy intake at school.

      Objectives

      We sought to characterize foods that children bring from home to school according to processing level and to evaluate the effectiveness of a school-based intervention, Great Taste Less Waste (GTLW), in reducing the proportion of energy brought from highly processed foods from home compared with control.

      Design

      Secondary data analysis of a 7-month school-based, cluster-randomized trial.

      Participants/setting

      Third- and fourth-grade students (n = 502, mean age: 9.0 ± 0.62 years) at 10 public elementary schools in Eastern Massachusetts (school year 2012-2013).

      Intervention

      GTLW included a 22-lesson classroom curriculum, homework activities, monthly parent newsletters, a food shopping and packing guide for parents, food demonstrations, school-wide announcements, and a poster contest.

      Main outcome measures

      The energy content of foods brought to school was estimated from digital photographs, and foods were assigned to 1 of 3 processing levels (less processed or unprocessed, moderately processed, or highly processed) based on an established classification system.

      Statistical analyses performed

      The percentage of energy brought from foods categorized into each processing level was calculated and compared pre- and postintervention using hierarchical linear models.

      Results

      Most of the food brought from home to school was highly processed (70% of food energy brought). Foods categorized as snack foods and desserts contributed the greatest percentage of total energy to the highly processed category at baseline and follow-up (72% and 69%, respectively). Energy from foods brought for snack tended to be more highly processed than those brought for lunch. No significant differences were observed from pre- to postintervention in the GTLW group compared with control for the percentage of energy brought from highly processed foods in adjusted models (β: −1.1, standard error: 2.2, P = .6) or any other processing level.

      Conclusions

      Highly processed foods were prevalent in home-packed lunches and snacks, and these patterns persisted after a targeted intervention. Further research is needed to identify strategies to improve the healthfulness of foods brought from home to school.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kim E.
        The amazing multimillion-year history of processed food.
        Sci Am. 2013; 309: 50-55
        • Kessler D.A.
        The End of Overeating: Taking Control of the Insatiable American Appetite.
        Rodale Inc, New York, NY2009
        • Monteiro C.A.
        • Cannon G.
        • Levy R.B.
        • et al.
        Ultra-processed foods: What they are and how to identify them.
        Public Health Nutr. 2019; 22: 936-941
        • Monteiro C.A.
        Nutrition and health. The issue is not food, nor nutrients, so much as processing.
        Public Health Nutr. 2009; 12: 729-731
        • Poti J.M.
        • Mendez M.A.
        • Ng S.W.
        • Popkin B.M.
        Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?.
        Am J Clin Nutr. 2015; 101: 1251-1262
        • da Costa Louzada M.L.
        • Martins A.P.B.
        • Canella D.S.
        • et al.
        Ultra-processed foods and the nutritional dietary profile in Brazil.
        Rev Saude Publica. 2015; 38: 49
        • Louzada ML. da C.
        • Martins A.P.B.
        • Canella D.S.
        • et al.
        Impact of ultra-processed foods on micronutrient content in the Brazilian diet.
        Rev Saude Publica. 2015; 49: 1-8
        • Moubarac J.-C.
        • Batal M.
        • Louzada M.L.
        • Martinez Steele E.
        • Monteiro C.A.
        Consumption of ultra-processed foods predicts diet quality in Canada.
        Appetite. 2017; 108: 512-520
        • Luiten C.M.
        • Steenhuis I.H.M.
        • Eyles H.
        • Ni Mhurchu C.
        • Waterlander W.E.
        Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets.
        Public Health Nutr. 2015; 19: 530-538
        • Rauber F.
        • da Costa Louzada M.L.
        • Steele E.
        • Millett C.
        • Monteiro C.A.
        • Levy R.B.
        Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK (2008-2014).
        Nutrients. 2018; 10: 587
        • Cediel G.
        • Reyes M.
        • da Costa Louzada M.L.
        • et al.
        Ultra-processed foods and added sugars in the Chilean diet (2010).
        Public Health Nutr. 2017; 21: 125-133
        • Louzada ML. da C.
        • Ricardo C.Z.
        • Steele E.M.
        • Levy R.B.
        • Cannon G.
        • Monteiro C.A.
        The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.
        Public Health Nutr. 2017; 21: 94-102
        • Vandevijvere S.
        • De Ridder K.
        • Fiolet T.
        • Bel S.
        • Tafforeau J.
        Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium.
        Eur J Nutr. 2018; 58: 3267-3278
        • Rauber F.
        • Campagnolo P.D.B.
        • Hoffman D.J.
        • Vitolo M.R.
        Consumption of ultra-processed food products and its effects on children’s lipid profiles: A longitudinal study.
        Nutr Metab Cardiovasc Dis. 2015; 25: 116-122
        • Lavigne-Robichaud M.
        • Moubarac J.-C.
        • Lantagne-Lopez S.
        • et al.
        Diet quality indices in relation to metabolic syndrome in an Indigenous Cree (Eeyouch) population in northern Québec, Canada.
        Public Health Nutr. 2017; 21: 172-180
        • Fardet A.
        Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods.
        Food Funct. 2016; 7: 2338-2346
        • Wolever T.M.S.
        • Johnson J.
        • Jenkins A.L.
        • Campbell J.C.
        • Ezatagha A.
        • Chu Y.
        Impact of oat processing on glycaemic and insulinaemic responses in healthy humans: a randomised clinical trial.
        Br J Nutr. 2019; 121: 1264-1270
        • da Costa Louzada M.L.
        • Baraldi L.G.
        • Steele E.M.
        • et al.
        Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults.
        Prev Med (Baltim). 2015; 81: 9-15
        • de Deus Mendonça R.
        • Pimenta A.M.
        • Gea A.
        • et al.
        Ultraprocessed food consumption and risk of overweight and obesity: The University of Navarra Follow-Up (SUN) cohort study.
        Am J Clin Nutr. 2016; 104: 1433-1440
        • Juul F.
        • Martinez-Steele E.
        • Parekh N.
        • Monteiro C.A.
        • Chang V.W.
        Ultra-processed food consumption and excess weight among US adults.
        Br J Nutr. 2018; 120: 90-100
        • Nardocci M.
        • Leclerc B.-S.
        • Louzada M.-L.
        • Monteiro C.A.
        • Batal M.
        • Moubarac J.-C.
        Consumption of ultra-processed foods and obesity in Canada.
        Can J Public Health. 2018; 110: 4-14
        • Hall K.D.
        Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake..
        Cell Metab. 2019; 30: 67-77
        • Schnabel L.
        • Kesse-Guyot E.
        • Allès B.
        • et al.
        Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France.
        JAMA Intern Med. 2019; 179: 490
        • Kim H.
        • Hu E.A.
        • Rebholz C.M.
        Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).
        Public Health Nutr. 2019; 22: 1777-1785
      1. Rico-Campà A, Mart∖’∖inez-González MA, Alvarez-Alvarez I, et al. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019:365:l1949.

        • de Deus Mendonça R.
        • Lopes A.C.S.
        • Pimenta A.M.
        • Gea A.
        • Martinez-Gonzalez M.A.
        • Bes-Rastrollo M.
        Ultra-processed food consumption and the incidence of hypertension in a Mediterranean cohort: The Seguimiento Universidad de Navarra Project.
        Am J Hypertens. 2017; 30: 358-366
        • Melo B.
        • Rezende L.
        • Machado P.
        • Gouveia N.
        • Levy R.
        Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents.
        Pediatr Allergy Immunol. 2018; 29: 504-511
        • Schnabel L.
        • Buscail C.
        • Sabate J.M.
        • et al.
        Association between ultra-processed food consumption and functional gastrointestinal disorders: Results from the French NutriNet-Santé Cohort.
        Am J Gastroenterol. 2018; 113: 1217-1228
        • Eichelmann F.
        • Schwingshackl L.
        • Fedirko V.
        • Aleksandrova K.
        Effect of plant-based diets on obesity-related inflammatory profiles: a systematic review and meta-analysis of intervention trials.
        Obes Rev. 2016; 17: 1067-1079
        • Satija A.
        • Bhupathiraju S.N.
        • Rimm E.B.
        • et al.
        Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: Results from three prospective cohort studies. Moore SC, ed.
        PLOS Med. 2016; 13: e1002039
        • McGuire S.
        Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services, 2015.
        Adv Nutr. 2016; 7: 202-204
        • Turner-McGrievy G.
        • Harris M.
        Key Elements of plant-based diets associated with reduced risk of metabolic syndrome.
        Curr Diab Rep. 2014; 14: 524
        • Oddy W.H.
        • Herbison C.E.
        • Jacoby P.
        • et al.
        The Western dietary pattern is prospectively associated with nonalcoholic fatty liver disease in adolescence.
        Am J Gastroenterol. 2013; 108: 778-785
        • Ambrosini G.L.
        • Huang R.-C.
        • Mori T.A.
        • et al.
        Dietary patterns and markers for the metabolic syndrome in Australian adolescents.
        Nutr Metab Cardiovasc Dis. 2010; 20: 274-283
        • Kaikkonen J.E.
        • Mikkilä V.
        • Raitakari O.T.
        Role of childhood food patterns on adult cardiovascular disease risk.
        Curr Atheroscler Rep. 2014; 16: 443
        • US Department of Health and Human Services; US Department of Agriculture
        2015-2020 Dietary Guidelines for Americans. 8th ed. Washington, DC: US Dept of Health and Human Services;.
        December 2015 (http://www.health.gov/DietaryGuidelines)
        • United States Department of Agriculture Food and Nutrition
        National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act (HHFKA) of 2010.
        September 7, 2020 (https://www.govtrack.us/congress/bills/111/s3307)
        • Hawthorne D.L.
        • Neilson L.J.
        • Macaskill L.A.
        • et al.
        Parental reports of lunch-packing behaviours lack accuracy: Reported barriers and facilitators to packing school lunches.
        Can J Diet Pract Res. 2018; 79: 99-105
        • Nadaud P.
        • Song H.-J.
        Formative research: Key drivers affecting diet quality of home-packed lunch in parents of young school children.
        J Nutr Educ Behav. 2017; 49: S14
        • Au L.E.
        • Rosen N.J.
        • Fenton K.
        • Hecht K.
        • Ritchie L.D.
        Eating school lunch is associated with higher diet quality among elementary school students.
        J Acad Nutr Diet. 2016; 116: 1817-1824
        • Caruso M.L.
        • Cullen K.W.
        Quality and cost of student lunches brought from home.
        JAMA Pediatr. 2015; 169: 86
        • Farris A.R.
        • Misyak S.
        • Duffey K.J.
        • et al.
        A comparison of fruits, vegetables, sugar-sweetened beverages, and desserts in the packed lunches of elementary school children.
        Child Obes. 2015; 11: 275-280
        • Bergman E.A.
        • Cashman L.
        • Englund T.
        • et al.
        Healthier U.S. schools challenge lunches are more nutritious than lunches brought from home.
        J Acad Nutr Diet. 2013; 113: A61
        • Hubbard K.L.
        • Must A.
        • Eliasziw M.
        • Folta S.C.
        • Goldberg J.
        What’s in children’s backpacks: Foods brought from home.
        J Acad Nutr Diet. 2014; 114: 1424-1431
        • Johnston C.A.
        • Moreno J.P.
        • El-Mubasher A.
        • Woehler D.
        School lunches and lunches brought from home: A comparative analysis.
        Child Obes. 2012; 8: 364-368
        • Clark M.A.
        • Fox M.K.
        Nutritional quality of the diets of US public school children and the role of the school meal programs.
        J Am Diet Assoc. 2009; 109: S44-S56
        • Briefel R.R.
        • Wilson A.
        • Gleason P.M.
        Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants.
        J Am Diet Assoc. 2009; 109: S79-S90
      2. Gordon A, Fox MK. School Nutrition Dietary Assessment Study III: Summary of findings (No. aaa39732a8284ecbb2faca5dbb5fb0d3). Math Policy Res Reports. 2017, 1-36, https://ideas.repec.org/p/mpr/mprres/aaa39732a8284ecbb2faca5dbb5fb0d3.html.

        • Gleason P.
        • Briefel R.
        • Wilson A.
        • Dodd A.H.
        School meal program participation and its association with dietary patterns and childhood obesity (No. 2239-2019-2869).
        (Accessed September 7, 2020. 2009:1-16.)
        • Nathan N.
        • Janssen L.
        • Sutherland R.
        • et al.
        The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis.
        Int J Behav Nutr Phys Act. 2019; 16: 38
        • United States National Institutes of Health
        The GREEN (growing right: Eating eco-friendly & nutritious) Project lunch box study. NCT01573845.
        (Published 2015. Accessed December 10, 2019)
        • Goldberg J.P.
        • Folta S.C.
        • Eliasziw M.
        • et al.
        Great Taste, Less Waste: A cluster-randomized trial using a communications campaign to improve the quality of foods brought from home to school by elementary school children.
        Prev Med (Baltim). 2015; 74: 103-110
        • Taylor J.
        • Sutter C.
        • Ontai L.
        Appetite AN-, 2018 undefined. Feasibility and reliability of digital imaging for estimating food selection and consumption from students’ packed lunches. ElsevierPaperpile.
        • Schakel S.F.
        Maintaining a nutrient database in a changing marketplace: Keeping pace with changing food products: A research perspective.
        J Food Compost Anal. 2001; 14: 315-322
        • US Food and Drug Administration
        Chapter I, subchapter B: Food for human consumption; part 101: Food labeling; section 101.12 reference amounts customarily consumed per eating occasion.
        (Accessed September 7, 2020)
      3. US Department of Agriculture. USDA Food and Nutrient Database for Dietary Studies 2011-2012. 2014. Food Surveys Research Group Home Page, http://www.ars.usda.gov/ba/bhnrc/fsrg (https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/fndds/fndds_2011_2012_doc.pdf. Accessed September 7, 2020.

        • Monteiro C.A.
        • Cannon G.
        • Moubarac J.-C.
        • Levy R.B.
        • Louzada M.L.C.
        • Jaime P.C.
        The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.
        Public Health Nutr. 2017; 21: 5-17
        • Poti J.M.
        • Mendez M.A.
        • Ng S.W.
        • Popkin B.M.
        Highly processed and ready-to-eat packaged food and beverage purchases differ by race/ethnicity among US households.
        J Nutr. 2016; 146: 1722-1730
        • Ng S.W.
        • Hollingsworth B.A.
        • Busey E.A.
        • Wandell J.L.
        • Miles D.R.
        • Poti J.M.
        Federal nutrition program revisions impact low-income households’ food purchases.
        Am J Prev Med. 2018; 54: 403-412
        • Steele E.M.
        • Popkin B.M.
        • Swinburn B.
        • Monteiro C.A.
        The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study.
        Popul Health Metr. 6, 2017; 15
        • Minaya S.
        • Rainville A.J.
        How nutritious are children’s packed school lunches? A comparison of lunches brought from home and school lunches.
        J Child Nutr Manag. 2016; 40: 1-7
        • Farris A.R.
        • Misyak S.
        • Duffey K.J.
        • et al.
        Nutritional comparison of packed and school lunches in pre-kindergarten and kindergarten children following the implementation of the 2012-2013 national school lunch program standards.
        J Nutr Educ Behav. 2014; 46: 621-626
        • Farris A.
        • Serrano E.
        Elementary parent perceptions on choosing to participate in the national school lunch program or packing their children's lunches.
        J Acad Nutr Diet. 2014; 114: A96
      4. Farris AR, Misyak S, Duffey, KJ, et al. Elementary parent perceptions of packing lunches and the National School Lunch Program. J Child Nutr Manag, 40 (1), 2016, 1-10.

        • Larson N.
        • Story M.
        A review of snacking patterns among children and adolescents: What are the implications of snacking for weight status?.
        Child Obes. 2013; 9: 104-115
        • Gugger C.
        • Bidwai S.
        • Joshi N.
        • Holschuh N.
        • Albertson A.
        Nutrient contribution of snacking in Americans: Results from the National Health and Nutrition Examination Survey 2011-2012.
        (Accessed september 7, 2020)
        • Horning M.L.
        • Fulkerson J.A.
        • Friend S.E.
        • Story M.
        Reasons parents buy prepackaged, processed meals: It is more complicated than “I don’t have time.”.
        J Nutr Educ Behav. 2017; 49: 60-66.e1
        • Moran A.J.
        • Khandpur N.
        • Polacsek M.
        • Rimm E.B.
        What factors influence ultra-processed food purchases and consumption in households with children? A comparison between participants and non-participants in the Supplemental Nutrition Assistance Program (SNAP).
        Appetite. 2019; 134: 1-8
        • Zorbas C.
        • Palermo C.
        • Chung A.
        • et al.
        Factors perceived to influence healthy eating: a systematic review and meta-ethnographic synthesis of the literature.
        Nutr Rev. 2018; 76: 861-874
        • Friel S.
        • Hattersley L.
        • Ford L.
        • O’Rourke K.
        Addressing inequities in healthy eating.
        Health Promot Int. 2015; 30: 77-88
        • McGill R.
        • Anwar E.
        • Orton L.
        • et al.
        Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact health behavior, health promotion and society.
        BMC Public Health. 2015; 15: 457
        • Oldroyd J.
        • Burns C.
        • Lucas P.
        • Haikerwal A.
        • Waters E.
        The effectiveness of nutrition interventions on dietary outcomes by relative social disadvantage: A systematic review.
        J Epidemiol Community Health. 2008; 62: 573-579
        • Monteiro C.A.
        • Cannon G.
        • Lawrence M.
        • Laura Da Costa Louzada M.
        • Machado P.P.
        Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO.
        • Crino M.
        • Barakat T.
        • Trevena H.
        • Neal B.
        Systematic review and comparison of classification frameworks describing the degree of food processing.
        Nutr Food Technol Open Access. 2017; 3 (http://dx.doi.org/10.16966/2470-6086.138)
        • Crino M.
        • Barakat T.
        • Trecena H.
        Systematic review and comparison of classification frameworks describing the degree of food processing.
        Nutr Food Technol. 2017; 3: 138
        • Taylor J.C.
        • Sutter C.
        • Ontai L.L.
        • Nishina A.
        • Zidenberg-Cherr S.
        Feasibility and reliability of digital imaging for estimating food selection and consumption from students’ packed lunches.
        Appetite. 2018; 120: 196-204
        • van Raaij J.
        • Hendriksen M.
        • Verhagen H.
        Potential for improvement of population diet through reformulation of commonly eaten foods.
        Public Health Nutr. 2008; 12: 325-330
        • Buttriss J.L.
        Food reformulation: the challenges to the food industry.
        Proc Nutr Soc. 2012; 72: 61-69
        • Boyland E.J.
        • Whalen R.
        Food advertising to children and its effects on diet: Review of recent prevalence and impact data.
        Pediatr Diabetes. 2015; 16: 331-337

      Biography

      S. A. Blondin is a postdoctoral fellow, Harvard T.H. Chan School of Public Health, Boston, MA.

      Biography

      RF. AlSukait is an assistant professor, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

      Biography

      R. Bleiweiss-Sande is postdoctoral fellow, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      C. D. Economos is a professor, Tufts University Friedman School of Nutrition Science and Policy, Boston, MA.

      Biography

      J. P. Goldberg is a professor, Tufts University Friedman School of Nutrition Science and Policy, Boston, MA.

      Biography

      L. Tanskey is a postdoctoral teaching scholar in the Department of Food, Bioprocessing, & Nutrition Sciences at North Carolina State University.