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Office for Food and Nutrition Programs National School Lunch Program – Question Answers

  1. What is the National School Lunch Program? The National School Lunch Program (NSLP) is a federally assisted meal program operating in nearly 95,000 public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to more than 26 million children each school day. Established under the National School Lunch Act, signed by President Harry Truman in 1946, the program celebrated its 50th anniversary in 1996.The U.S. Department of Agriculture, through its Food and Nutrition Service (formerly the Food and Consumer Service), administers the program at the Federal level. At the State level, the NSLP is usually administered by State education agencies, which operate the program through agreements with local school districts. School districts and independent schools that choose to take part in the lunch program receive cash reimbursement and donated commodity assistance from USDA for each meal they serve. In return, they must serve lunches that meet Federal nutrition requirements, and they must offer free and reduced-price lunches to eligible children.

    In 1994, FNS launched the School Meals Initiative for Healthy Children to teach children the importance of making healthy food choices, and to support school food service professionals in delivering healthy school meals. Supported by legislation passed in 1994 and 1996, the initiative updated nutrition standards so that all school meals meet the recommendations of the Dietary Guidelines for Americans. New regulations implementing the initiative became final in June, 1995, and took effect at the beginning of school year 1996-97.

  2. What is Community Eligibility Provisions for Universal Free Meals?Eligible schools are able to streamline and improve school nutrition programs providing universal breakfast and lunch to all students through this provision.
  3. What are the nutritional requirements for the school lunch?School lunches must meet Federal nutrition requirements, but decisions about what specific foods to serve and how they are prepared are made by local school food authorities.Current regulations require schools to meet the Dietary Guidelines for Americans, which recommend that no more than 30 percent of an individual’s calories come from fat, and less than 10 percent from saturated fat. Regulations also establish a standard for school meals to provide one-third of the Recommended Daily Allowances of protein, Vitamin A, Vitamin C, iron, calcium, and calories.

    Schools have the option to choose one of four systems for their menu planning: Nutrient Standard Menu Planning, Assisted Nutrient Standard Menu Planning, the traditional meal pattern, and the enhanced meal pattern. Both Nutrient Standard and Assisted Nutrient Standard Menu Planning systems base their planning on a computerized nutritional analysis of the week’s menu. The traditional and enhanced meal pattern options base their menu planning on minimum component quantities of meat or meat alternate; vegetables and fruits; grains and breads; and milk.

    USDA has made a commitment to improve the nutritional quality of all school meals. The Department works with state and local school food authorities through the Nutrition Education and Training Program and Team Nutrition initiative to teach and motivate children to make healthy food choices, and to provide school food service staff with training and technical support.

  4. How does the National School Lunch Program work?Schools in the lunch program get cash subsidies and donated commodities from the U.S. Department of Agriculture for each meal they serve. In return, they must serve lunches that meet Federal requirements, and they must offer free or reduced-price lunches to eligible children.
  5. How do children qualify for free and reduced-price meals?Any child at a participating school may purchase a meal through the National School Lunch Program. Children from families with incomes at or below 130 percent of the poverty level (currently $21,710 for a family of four) are eligible for free meals. Those between 130 percent and 185 percent of the poverty level (currently $30,895 for a family of four) are eligible for reduced-price meals, for which students can be charged no more than 40 cents.Children from families with incomes over 185 percent of poverty pay a full price, though their meals are still subsidized to some extent. Local school food authorities set their own prices for full-price meals.
  6. How many schools take part in the school lunch program?Nearly 95,000 schools and residential child care institutions participate in the National School Lunch Program. Public schools or non-profit private schools of high school grade or under, and residential child care institutions are eligible.The program is available in almost 99 percent of all public schools, and in many private schools as well. About 92 percent of all students nationwide have access to meals through the NSLP. On a typical day, about 58 percent of the school children to whom the lunch program is available participate.
  7. How much reimbursement do schools get?Most of the support USDA provides to schools in the National School Lunch Program comes in the form of a cash reimbursement for each meal served.Please check our Financial Management Page for current rates.
  8. What other support do schools get from USDA?In addition to cash reimbursements, schools are entitled by law to receive commodity foods, called “entitlement” foods, at a value of 15 cents for each meal served. Schools can also get bonus” commodities as they are available from surplus stocks. Under the School Meals Initiative, USDA also provides schools with technical training and assistance to help school food service staffs prepare healthy meals, and with nutrition education to help children understand the link between diet and health.Higher reimbursement rates are in effect for Alaska and Hawaii, and for some schools in special circumstances.
  9. What types of foods do schools get from USDA? States select entitlement foods for their schools from a list of more than 60 different kinds of food purchased by USDA and offered through the school lunch program. The list includes fresh, canned and frozen fruits and vegetables; meats; fruit juices; vegetable shortening; peanut products; vegetable oil; and flour and other grain products.Bonus foods are offered only as they become available through agricultural surplus. The variety of both entitlement and bonus commodities schools can get from USDA depends on quantities available and market prices.

    About 17 percent of the total dollar value of the food that goes on the table in school lunch programs is provided directly by USDA as commodities. Schools purchase the remaining 83 percent from their own vendors. As a part of its School Meals Initiative, USDA has placed special emphasis on improving the quality of commodities donated to the school lunch program, including a great increase in the amount and variety of fresh produce available to schools.

  10. What foods are schools required to serve in a school lunch? USDA does not require schools to serve — or not serve — any particular foods. School meals must meet Federal nutrition requirements, but decisions about what foods to serve and how they are prepared are made by local school food authorities.Until the School Meals Initiative for Healthy Children, the Federal nutritional requirements for school meals had not changed significantly since the school lunch program began in 1946. As part of the initiative, USDA published regulations to help schools bring their meals up to date to meet the Dietary Guidelines for Americans. The Dietary Guidelines recommend that no more than 30 percent of an individual’s calories come from fat, and no more than 10 percent from saturated fat.

    The new regulations require schools to have met the Dietary Guidelines by school year 1996-1997, unless they received a waiver to allow an extension for up to two years. They also establish a standard for school meals to provide one-third of the Recommended Daily Allowances of protein, Vitamin A, Vitamin C, iron, calcium, and calories. Schools’ compliance with both the Dietary Guidelines and the RDA’s is measured over a week’s menu cycle.

    Schools have the option to choose one of five systems for their menu planning: NuMenus, Assisted NuMenus, traditional meal pattern, enhanced meal pattern, and other “reasonable approaches.” Both the NuMenus and Assisted NuMenus systems base their planning on a computerized nutritional analysis of the week’s menu. The traditional and enhanced meal pattern options base their menu planning on minimum component quantities of meat or meat alternate; vegetables and fruits; grains and breads; and milk. The fifth menu option allows schools to develop other “reasonable approaches” to meeting the Dietary Guidelines, using menu planning guidelines from USDA.

  11. How many children have been served over the years? The National School Lunch Act in 1946 created the modern school lunch program, though USDA had provided funds and food to schools for many years prior to that. In signing the 1946 act, President Harry S Truman said,

    “Nothing is more important in our national life than the welfare of our children, and proper nourishment comes first in attaining this welfare.”

    About 7.1 million children were participating in the National School Lunch Program by the end of its first year, 1946-47. By 1970, 22 million children were participating, and by 1980 the figure was nearly 27 million. In 1990, an average of 24 million children ate school lunch every day. In Fiscal Year 2011, more than 31.8 million children each day got their lunch through the National School Lunch Program. Since the modern program began, more than 224 billion lunches have been served.

    For more information please visit the National School Lunch Program website.

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England replicates Finland’s school lunch system

Finland’s free school lunch system is gaining attention around the world.

Finland’s free school lunch system is gaining attention around the world.
Lehtikuva / Markku Ulander

Next autumn, England will begin providing free school lunches to children aged between four and seven. The inspiration behind the decision came from Finland’s nearly 70-year-old school food system. Also Scotland will provide free school lunches from the beginning of next year.

An adviser to the project has been the internationally renowned Finnish public health expert Pekka Puska. In addition the Finnish Embassy in London and the Foundation for the Promotion of Finnish Food Culture ELO have set up a school food network designed to encourage British people to develop their country’s school meals. According to the ELO foundation, the transformation of the English school lunch has been long awaited.

The effects of free school lunches were studied in London between 2009 and 2011. A healthy, regular school meal improved learning results as well as children’s behaviour. These research results encouraged the creation of a more thought-out school food plan that is based on the Finnish system.

— The phones have hardly stopped ringing here in Finland. The free school lunches we offer all our school children are a unique phenomenon in the world. England’s school food plan has its own chapter dealing with Finnish school meals and health improvement achievements, says Pekka Puska.

Finnish school meals have also raised interest in other countries.

— Our foreign visitors have always loved what they have seen and experienced here, say both Päivi Palojoki, Professor of Home Economics Pedagogy at the University of Helsinki, and Marjaana Manninen, Counsellor of Education in charge of developing school food at the Finnish National Board of Education.

www.elo-saatio.fi

www.finemb.org.uk

www.wordwareinc.com

 

Food Service Software, Nutrition Softwares, School Lunch Software

MDE School Nutrition Programs Handout on Grains

National School Lunch Program

The National School Lunch Program is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day. The program was established under the National School Lunch Act, signed by President Harry Truman in 1946.

National School Lunch Program (NSLP)

NSLP Legislation

NSLP Regulations

NSLP Policies

Guidance and Resources

Offer Versus Serve (OVS) – Updated 2015-2016 Guidance Manual

Tools for Schools – Tools for Schools offers topic-specific policy and resource materials to assist schools in meeting the new nutrition standards. Refer to the latest regulations, find free nutrition education curricula, or get ideas for adding tasty, kid-friendly foods to enhance your school meals program.

  • Nutrition Education and Promotion
  • Recipes and Culinary Techniques for Schools
  • School Nutrition Improvement
  • Policy Guidance

Nutrition Standards for School Meals – The final rule, Nutrition Standards in the National School Lunch and School Breakfast Programs, updated the meal patterns and nutrition standards for the National School Lunch and School Breakfast Programs to align them with the Dietary Guidelines for Americans. Improvements to the school meal programs, largely based on recommendations made by the Institute of Medicine of the National Academies, are expected to enhance the diet and health of school children, and help decrease childhood obesity.

Certification of Compliance – The Healthy Hunger-Free Kids Act provides an additional 6-cents per lunch reimbursement to school districts that certified to be in compliance with the new meal patterns.

Additional Resources

Related Documents
MDE School Nutrition Programs Handout on Grains PDF icon

Food Service Software, Nutrition Softwares

Children Not Eating Veggies Despite Healthy School Lunch Program

A new paper reported that the healthy lunch program implemented in U.S. schools has not drove children to increase their consumption of fruits and vegetables as projected.

The U.S. Department of Agriculture (USDA) launched the National School Lunch Program with the aim of increasing the intake of fruits and vegetables (FV) of school kids. Through this program, kids were required to choose FVs for their lunch as part of the reimbursable school meal; however, researchers found that the program has been surrounded by numerous negative concerns such as the rising number of school food waste.

The researchers from the University of Vermont Burlington and University of California performed the study by initially conducting 10 school visits and observing about 498 lunch trays before the program was put into action. After a year of program implementation, the researchers then visited 11 schools and observed 944 trays, utilizing the verified dietary assessment tools. For each school visit and observation, the researchers selected pupils in the third, fourth and fifth grade and assigned them with a number. They then took digital photos of the students’ lunch trays before and after eating, after which the researchers tried to quantify what has been consumed and has been dump in the trash.

The findings of the study, published in Public Health Reports, show that more kids chose FVs in larger portions when it was mandated by the program compared to when it was still optional. However, the consumption of FVs slightly decreased when it was required compared to when the program was not yet in place. In numbers, the results can be translated as 29 percent more children took FVs when the program started, 13 percent less consumption of FVs were noted after the requirement and 56 percent more food was thrown away.

“The basic question we wanted to explore was: does requiring a child to select a fruit or vegetable actually correspond with consumption,” says Sarah A. Amin, the lead author of the study from the University of Vermont Burlington. As per the study results, the answer to this query is clearly no, she adds.

Although the study was conducted in only two schools in the Northeast area and cannot generalized the entire country, the study results may still provide valuable insights into the decision-making body that is tasked to reauthorize the Healthy Hunger-Free Kids Act of 2010.

The authors recommend giving the children more time as they will eventually learn how to eat right. Exposures should be increased through school programs and encouragement in the home setting. Schools may devise other ways to encourage children to eat more FVs such as serving sliced instead of whole fruit. “We can’t give up hope yet,” Amin closed.

Photo: US Department of Agriculture | Flickr

Cafeteria Software, Food Service Software, School Lunch Software, Software for Cafeteria

Food Processors and Ingredient Suppliers Study School Lunch Programs for Innovative Ideas

1 Comment

Processors and ingredient suppliers need to collaborate in creating meals that are nutritious and desirable for this picky and often overweight demographic.

By Mark Anthony, Ph.D., Technical Editor

May 30, 2014

School lunch nutrition programs come in as many forms and approaches as there are school districts. But one constant is that budgets are always tight. However, processors who participate in the efforts to better feed our children can find satisfaction in not only doing the right thing but in creating products for a significantly large demographic. Case in point: The New York school system alone serves more than 1 million meals per day.

“Schools meals are expected to be universally acceptable to all students, so we have push back from both ends of the spectrum,” says Twyla Leigh, nutritionist for Collier County Public Schools in Naples, Fla. “They’re either ‘too healthy’ or not organic/vegan/scratch-cooking enough.”

Leigh admits school nutrition professionals realize that “one size does not fit all” and continue to seek out manufacturers of better tasting, healthy options, even as they are “challenged with labor issues, food safety concerns and balanced budgets.”

“School nutrition programs are expected to be self-supporting, paying for all food, labor, uniforms, equipment, water, electricity, gas, trash pick-up, payroll and human resource services.”

That according to Leigh and colleagues Terri Whitacre, director of school food and nutrition services for the Charlotte County Public School System in Punta Gorda, Fla., and Stacey Wykoski, foodservice director for the Jenison/Hudsonville School Food Service group in Jenison, Mich.

The three provide recommendations that manufacturers “should avoid MSG, high-fructose corn syrup, nitrates and items that are known to be issues in the food supply.” They also believe that GMOs are going to be a “big topic” moving forward. “Manufacturers also need to take the lead in better food labels: sugar listed on a label should refer to added sugars, not natural and added combined,” they note.

Food allergens also will become more challenging with the increase in children who have food intolerances or allergies, says Leigh. “Gluten and peanuts are big issues with school-age children. Being involved with national ingredient and food label access, even with scanners and a more usable way to obtain this information, to link it to the school menus would be a huge victory for manufacturers, school nutrition and the children.”

Waste not

There are huge challenges facing any program designed to feed wholesome, desirable meals five days per week to hundreds of kids at a time in three or more 30 minute blocs around the noon hour. The biggest, perhaps, is an endless schoolyard tug-of-war between the cost of production and the staggering cost of plate waste.

Food Service Software, Nutrition Softwares, School Lunch Software

COMMITTEE ON NUTRITION STANDARDS FOR NATIONAL SCHOOL LUNCH AND BREAKFAST PROGRAMS

VIRGINIA A. STALLINGS (Chair),

The Children’s Hospital of Philadelphia, University of Pennsylvania

KAREN WEBER CULLEN,

Children’s Nutrition Research Center, Baylor College of Medicine, TX

ROSEMARY DEDERICHS,

Minneapolis Public Schools, Special School District No. 1, MN

MARY KAY FOX,

Mathematica Policy Research, Inc., Cambridge, MA

LISA HARNACK,

Division of Epidemiology and Community Health, University of Minnesota, MN

GAIL G. HARRISON,

School of Public Health, Center for Health Policy Research, University of California, Los Angeles

MARY ARLINDA HILL,

Jackson Public Schools, MS

HELEN H. JENSEN,

Department of Economics, Iowa State University, Ames

RONALD E. KLEINMAN,

Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA

GEORGE P. McCABE,

College of Science, Purdue University, West Lafayette, IN

SUZANNE P. MURPHY,

Cancer Research Center of Hawaii, University of Hawaii, Honolulu

ANGELA M. ODOMS-YOUNG,

Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL

YEONHWA PARK,

Department of Food Science, University of Massachusetts, Amherst

MARY JO TUCKWELL,

inTEAM Associates, Ashland, WI

Study Staff

CHRISTINE TAYLOR, Study Director

SHEILA MOATS, Associate Program Officer

JULIA HOGLUND, Research Associate

HEATHER BREINER, Program Associate

CAROL WEST SUITOR, Consultant Subject Matter Expert and Writer

ANTON BANDY, Financial Officer

GERALDINE KENNEDO, Administrative Assistant,

Food and Nutrition Board

LINDA D. MEYERS, Director,

Food and Nutrition Board

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Associations Between School Meals Offered Through the National School Lunch Program and the School Breakfast Program and Fruit and Vegetable Intake Among Ethnically Diverse, Low-Income Children

Ramona Robinson-O’Brien, PhD, RD, Assistant Professor,a Teri Burgess-Champoux, PhD, RD, LD, Lecturer,b Jess Haines, PhD, MHScRD, Instructor,c Peter J. Hannan, MStat, Senior Research Fellow,d and Dianne Neumark-Sztainer, PhD, MPH, RD, Professore
Author information ► Copyright and License information ►
The publisher’s final edited version of this article is available at J Sch Health
See other articles in PMC that cite the published article.

Abstract

BACKGROUND

Despite evidence in support of the health benefits associated with fruit and vegetable (FV) intake, national data indicate that FV consumption among school-aged children is below recommended levels, particularly among low-income children. School meals offered through the School Breakfast Program and National School Lunch Program can provide an important contribution to child FV intake. This study examines the proportion of fruits and vegetables consumed from school meals programs among ethnically diverse, low socioeconomic status children.

METHODS

Participants (n = 103) included fourth to sixth grade boys and girls from 4 urban elementary schools in St. Paul, Minnesota serving primarily low-income populations. Research staff interviewed children during school hours and recorded dietary intake via 24-hour recall. Analysis included descriptive statistics using cross tabulations and means.

RESULTS

Average reported mean (SD) daily FV intake was 3.6 (2.5) servings, with 80% of children consuming fewer than 5 daily servings of FV. On average, children consumed over half of their daily FV intake within school. Children with low FV intake (<5 FV servings daily) consumed a higher proportion of their daily intake at school than children with higher FV intake (≥5 FV servings daily) (39% vs 59%; p = .002).

CONCLUSIONS

Child FV intake is below recommended levels. School meals provide an important contribution to the daily FV intake among ethnically diverse, low socioeconomic status children, particularly among those with the lowest FV intake. School meals programs promoting FV intake within the school environment may provide an opportunity to encourage increased FV consumption.

Keywords: child nutrition, fruit and vegetable intake, school cafeteria, 24-hour recall

Despite the evidence in support of the health benefits associated with fruit and vegetable (FV) intake,1 national data indicate that FV consumption of school-aged children is below recommended levels.2 The dietary goals identified by Healthy People 2010 include increasing the proportion of youth who consume ≥2 daily servings of fruit and ≥3 daily servings of vegetables.3 Based on National Health and Nutrition Examination Survey (NHANES) data (1999–2000), the estimated mean daily intake of fruits and vegetables among boys and girls aged 9–13 years was 3.7 servings and only 18% to 20% of children in this age group consumed 5 or more daily servings of fruits and vegetables.2 Furthermore, youth from families with low socioeconomic status are likely to consume the fewest daily servings of fruits and vegetables.4 Based on Consumer Expenditure Survey data (1991 and 2000), per person FV expenditures were significantly less for low-income households compared to other households; $3.59 per capita per week versus $5.02, respectively.5

Although reported student satisfaction with breakfast and lunch could be improved,6 school meals provide an important contribution to the daily FV intake among ethnically diverse, low socioeconomic status children. School meals offered through the School Breakfast Program (SBP)7 and the National School Lunch Program (NSLP)8 make fruits and vegetables available to children from low-income households at a free or reduced rate. In 2006, the NSLP provided nutritionally balanced, low-cost or free lunch to more than 30 million school children.8 It is the position of the American Dietetic Association that the NSLP and SBP are a particularly important source of nutrients for school-age children from low-income families and state that the nutrition goals of the NSLP and SBP should be supported and extended through school wellness policies that enable students to develop lifelong healthful eating habits.9 In three school-based interventions, the lunch meal accounted for approximately 15% to 30% of the total daily intake of fruits and vegetables among school-aged children.10–12 Recent research conducted by the Food and Nutrition Service of the United States Department of Agriculture suggests that elementary school participants in the NSLP were more likely than nonparticipants to consume fruit juice at breakfast and consume at least 1 vegetable at lunch.6 This study provides further examination of the importance of school meals within a specific population believed to be at increased risk for inadequate intake of fruits and vegetables. This investigation examines the contribution of NSLP and SBP to FV intake between male and female fourth to sixth grade students using data from an ethnically diverse, primarily low-income sample of public elementary school children within an urban area in the United States.

The aim of this study examines associations between child daily FV intake and location of eating occasion (school vs nonschool) in a sample of ethnically diverse, low socioeconomic status, fourth to sixth grade students. The following research questions were addressed in this study: (1) What is the total daily FV intake in this population; (2) What proportion of the daily FV intake is consumed at school; (3) Does FV intake differ by gender, race, age, or weight status?; and (4) What role do school meals play in contributing to FV intake among those with the lowest FV intake?

METHODS

Study Population and Design

The study population for these analyses included 103 children (78 females, 25 males) in fourth to sixth grade (ages 9–12) from 4 urban elementary schools in St. Paul, Minnesota, serving primarily low-income populations who participated in an evaluation of the Ready. Set. ACTION! (RSA) program, a theater-based intervention aimed at obesity prevention.13 The present investigation utilizes baseline data collected prior to the intervention. Approximately 90% of the students at each school qualify for free or reduced school lunch.14 Nearly, all (102 of the 103 participants) consumed the school lunch provided by the NSLP while a smaller proportion (61 of the 103 participants) consumed school breakfast. The mean (SD) age of the male and female children included in these analyses was 10.5 (1.1) and 10.2 (1.1) years, respectively. The child self-reported ethnic distribution was as follows: African-American 53% (n = 55), Asian/Hmong 12% (n = 12), White 8% (n = 8), Hispanic 3% (n = 3), and mixed/other 24% (n = 25). Written consent was obtained from parents or primary caregivers for their child to participate in the study. The study population included a sizable proportion of overweight students with 56% of males and 36% of females with body mass index (BMI) ≥85th percentile for age and gender. The children also signed a written assent form.

Assessment of Dietary Intake

Dietary intake was assessed using a 1-day 24-hour dietary recall collected by research staff using Nutrition Data System for Research (NDS-R) on Tuesday—Friday to ensure that only weekday eating patterns were recorded. Dietary recalls were utilized to obtain a record of the type and number of foods and beverages consumed by participants during a complete 24-hour period (from midnight to midnight) for the day preceding the interview. Dietary interviewers trained by the Nutrition Coordinating Center (NCC) used NDS-R dietary data collection computer software to obtain 24-hour dietary recalls from participants via face-to-face interviews utilizing a standardized multiple-pass approach in which NDS-R displays computer prompts to assist interviewers in following a consistent, systematic approach. Interviews were conducted during the school day and took 30–45 minutes to complete. Participants were shown standardized food portion models to assist in estimating amounts of food consumed.

The school meals program provides children with opportunities to eat school breakfast, lunch, and snacks at school. The 24-hour recall data were analyzed using the NDS-R software, version 2006 (University of Minnesota, St. Paul, MN). Servings of fruits, vegetables, and total fruits and vegetables were calculated using the food group serving count system based on the 2005 Dietary Guidelines for Americans. A summed score was created for total FV servings.

Fruit Intake Measure

Fruit servings are defined per the Dietary Guidelines for Americans 2005 as 1 medium apple, banana, orange or pear; ½ cup of chopped, cooked, or canned fruit; ¼ cup of dried fruit or ½ cup of fruit juice. Fruit servings include fruit and juice consumed separately (plain) and in fruit salad, but did not include fried fruits.

Vegetable Intake Measure

Vegetable servings are defined per the Dietary Guidelines for Americans 2005 as 1 cup of raw leafy vegetables, ½ cup of other cooked or raw vegetables, or ½ cup of vegetable juice. Vegetable servings include vegetables and vegetable juice consumed separately (plain) and in recipes containing vegetables, eg, stew, soup, lasagna, pizza, salad, casseroles, and commercial entrees, but did not include fried vegetables such as french fries.

Assessment of BMI

Height and weight measures were assessed by trained research staff using standardized equipment and procedures.15 Age and sex-specific BMI z-scores were calculated based on the Centers for Disease Control and Prevention growth charts, which are age and sex specific.16

DATA ANALYSIS

Descriptively we present the mean intake of fruit, of vegetables, and of fruit and vegetables combined as servings per day (mean and standard deviation) in total and as the proportion of the total eaten at school. These data are then stratified separately by gender, race, age, and weight status. A final stratification contrasts those with the highest FV intake of ≥5 fruits and vegetables per day versus those consuming less than 5 daily FV servings. The cutoff of 5 servings per day was based on the dietary goals identified by Healthy People 2010 which include increasing the proportion of youth who consume ≥2 daily servings of fruit and ≥3 daily servings of vegetables.3 At present, some government-led campaigns no longer specifically promote the consumption of 5 servings of fruits and vegetables per day, and instead focus on a “more is better” message.17

The focus is on the proportion of healthful intake coming from the school meals program, and how this differs across personal characteristics (gender, race/ethnicity, age, weight status) and intake. Analysis of variance was used to generate p-values. The inclusion of p-values for differences in the combined FV intake is primarily used to direct attention to aspects of the data of greater interest, first of differences in daily intake, and secondly in differences of the proportions attributed to the school meals program, rather than for strict statistical testing. Note that in calculating the mean proportion, individual proportions are weighted equally, not by the amount of intake per individual. For example, a participant with a low total intake of fruits and vegetables may have a high proportion coming from the school meals program. SAS Version 9.1 (SAS Institute, Inc., Cary, NC) was used for all analyses.

RESULTS

Daily FV servings consumed by fourth to sixth grade children are shown in Table 1. Average reported mean (SD) daily FV intake was 3.6 (2.5) servings. Children consumed over half of their daily FV intake within school (54%). Daily FV intake among males (3.0 servings) was lower than FV intake among females (3.7 servings). The observed proportion of daily FV consumed at school among males and females were 64% and 51%, respectively (p = 0.09). Of 103 children, 82 (80%) consumed fewer than 5 daily servings of FV. When compared to children with higher FV intake (≥5 FV servings daily), children with lower FV intake (<5 FV servings daily) consumed a higher proportion of their daily intake at school (34% vs 59%) (p = .002). In this small dataset, daily FV intake and proportion of FV consumed at school did not differ statistically by gender, race, age, or weight status.

Table 1

Daily Fruit and Vegetable Servings Consumed by Fourth to Sixth Grade Children and Proportion Consumed at School (N = 103)

DISCUSSION

The primary aim of this study was to examine the cross-sectional associations between child FV intake and location of eating occasion for ethnically diverse, low socioeconomic status school-aged children. Findings suggest that for this population, the school meals program provided an important contribution to overall daily FV intake. The majority of participants reported low FV intake, with only 20% consuming ≥5 FV servings per day. Study participants consumed≥more than half of the daily FV intake at school. The school meals program appears to be particularly important for students with the lowest level of FV intake. Participants with the lowest daily FV intake consumed a significantly greater proportion of FV at school than students with the highest daily FV intake.

Findings indicating low levels of FV intake among children in this study are consistent with national data which indicate that boys and girls ages 9–13 consume 3.7 FV servings/day and only 18% to 20% of children in this age group consume 5 or more daily servings of fruits and vegetables.2 Children in this study consumed greater than 50% of their daily FV intake within the school setting. Previous studies have reported that the lunch meal accounted for an approximate range of 15% to 30% of the total daily FV intake.10–12 School meals offered through the SBP7 and the NSLP8 may provide an important opportunity for increased FV consumption. Previous research suggests that participants in SBP were more likely than nonparticipants to consume 100% fruit juice or some type of fruit for breakfast, compared with nonparticipants.6 Furthermore, about half of all NSLP participants consumed at least one vegetable at lunch, compared with 23% of nonparticipants; however, this pattern was primarily driven by increases in the consumption of potato foods, such as french fries and tater tots.6 The vegetable measure utilized in this investigation excludes fried vegetables (eg, french fries), and yet accounts for 44% of the daily vegetable intake among study participants.

The findings from this study, in conjunction with previous research6 underscore the importance of the School Meals Program for all children, but particularly for children from low-income families. School meals may have the greatest impact on the FV intake for children who may not have a high level of home FV availability and accessibility4,18,19 or exposure to parental modeling of FV intake.4,19–22 This issue becomes of even greater importance during hard economic times when families are making difficult decisions about how best to allocate financial resources. Some families may perceive fruits and vegetables as a costly option when compared to other more energy dense foods. A major strength of this study is the specific focus on children from low-income and ethnically diverse backgrounds who participated in the School Meals Program and who may be at greatest risk for low FV intake.

Limitations

Dietary intake was assessed using 24-hour recall data collected by research staff; however, it was limited to a single day and did not include direct observation. Furthermore, FV servings were somewhat lower than the self-reported daily FV intake reported in a companion survey completed by the children.23 This may have been due in part to the exclusion of fried potatoes from the vegetable 24-hour recall measure, or to bias due to self-report. Finally, because this study utilized a small convenience sample and did not control for a variety of possible confounding variables, we are unable to make generalizations beyond the population measured. A larger sample size may have provided additional insight into associations among participants with differing demographic characteristics and FV intake.

Conclusions

The majority of children consumed fewer than 5 daily servings of fruits and vegetables. School meals provided an important contribution to the daily FV intake among ethnically diverse, low socioeconomic status children, particularly among those with the lowest FV intake. School meals programs promoting FV intake within the school environment may provide an opportunity to encourage increased FV consumption.

IMPLICATIONS FOR SCHOOL HEALTH

The findings from this study support previous research indicating that school breakfast and school lunch make an important contribution to overall dietary intake of youth. Promoting nutrition education messages within the classroom and cafeteria and providing students with multiple opportunities to select fruits and vegetables at school lunch and school breakfast may lead to increased FV consumption long-term and assist in reducing childhood obesity and food insecurity.

Research results support and encourage the ongoing efforts of school administrators, educators, and school food service personnel to embrace the tremendous opportunity to expand and enhance programs promoting increases in intake of fruits and vegetables.

Schools are an ideal venue to promote improvements in FV preferences and increased FV consumption among elementary-aged children. In the past decade, a wide variety of school-based, multicomponent interventions have been developed to promote increased FV intake among elementary school children.11,12,24–26 Future research should involve continued investigation of the most effective intervention strategies aimed at promoting increased FV intake among school-aged children.

Policies and strategies designed to promote and strengthen school meals programs should be encouraged and supported. Recent legislation has prompted a review of the impact of school meals on nutritional intake of youth,27 thus it is an ideal time to consider opportunities to strengthen the school meals program.

Given the positive impact that the school meals program may have on the dietary intake of children we need to also examine dietary intake outside of the school year and promote alternative programs to parents to sustain the FV intake of children year-round. A greater emphasis on establishing school-home partnerships may further contribute to the promotion of health-enhancing habits among youth.

Acknowledgments

Human Subjects Approval Statement This study was approved by the University of Minnesota’s institutional review board and the Saint Paul Schools Research Committee.

This study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases and by the National Institutes of Health. The first author’s time was supported a grant from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

REFERENCES

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2. Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM. Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc. 2006;106(9):1371–1379. [PubMed]
3. Healthy People 2010 . Understanding and Improving Health. 2nd ed US Department of Health and Human Services; US Government Printing Office; Washington, DC: 2000.
4. Rasmussen M, Krolner R, Klepp KI, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act. 2006;3:22. [PMC free article] [PubMed]
5. Blisard N, Stewart H, Jolliffe D. Low-Income Household’s Expenditures on Fruits and Vegetables. US Department of Agriculture; Economic Research Service; Washington, DC: 2004. [Accessed July 27, 2010]. Available at: http://www.ers.usda.gov/Publications/AER833/.
6. Gordon A, Fox M, Clark M, et al. School Nutrition Dietary Assessment Study-III: Vol. II: Student Participation and Dietary Intakes. US Department of Agriculture; Food and Nutrition Service; Office of Research; Nutrition and Analysis; Alexandria, VA: 2007.
7. USDA [Accessed June 20, 2008];School Breakfast Program. Available at: http://www.fns.usda.gov/cnd/breakfast/.
8. USDA [Accessed June 20, 2008];National School Lunch Program. Available at: http://www.fns.usda.gov/cnd/lunch/.
9. Pilant VB. Position of the American Dietetic Association: local support for nutrition integrity in schools. J Am Diet Assoc. 2006;106(1):122–133. [PubMed]
10. Bere E, Veierod MB, Bjelland M, Klepp KI. Outcome and process evaluation of a Norwegian school-randomized fruit and vegetable intervention: Fruits and Vegetables Make the Marks (FVMM) Health Educ Res. 2006;21(2):258–267. [PubMed]
11. Cullen KW, Watson K, Baranowski T, Baranowski JH, Zakeri I. Squire’s Quest: intervention changes occurred at lunch and snack meals. Appetite. 2005;45(2):148–151. [PubMed]
12. Perry CL, Bishop DB, Taylor G, et al. Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota. Am J Public Health. 1998;88(4):603–609. [PMC free article] [PubMed]
13. Neumark-Sztainer D, Haines J, Robinson-O’Brien R, et al. `Ready. Set. ACTION!’ A theater-based obesity prevention program for children: a feasibility study. Health Educ Res. 2008;11 [PMC free article] [PubMed]
14. Minnesota Department of Education [Accessed March 2006];School and District Statistics. Available at: http://education.state.mn.us/MDE/Data/Data_Downloads/School_and_District/Schooland_District_Statistics/index.html.
15. Lohman T, Roche A, Martorell R. Anthropometric Standardization Reference Manual. Human Kinetics Books; Champaign, IL: 1988.
16. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States. Adv Data. 2000;(314):1–27. [PubMed]
17. [Accessed July 27, 2010];Fruits and Veggies, More Matters. Available at: www.fruitsandveggiesmorematters.org.
18. Cullen KW, Baranowski T, Owens E, Marsh T, Rittenberry L, de Moor C. Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables influence children’s dietary behavior. Health Educ Behav. 2003;30(5):615–626. [PubMed]
19. van der Horst K, Oenema A, Ferreira I, et al. A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Educ Res. 2007;22(2):203–226. [PubMed]
20. Cooke LJ, Wardle J, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr. 2004;7(2):295–302. [PubMed]
21. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. Parental influences on young girls’ fruit and vegetable, micronutrient, and fat intakes. J Am Diet Assoc. 2002;102(1):58–64. [PMC free article] [PubMed]
22. Hanson NI, Neumark-Sztainer D, Eisenberg ME, Story M, Wall M. Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods. Public Health Nutr. 2005;8(1):77–85. [PubMed]
23. Robinson-O’Brien R, Neumark-Sztainer D, Hannan P, Burgess-Champoux T, Haines J. Fruits and vegetables at home: child and parent perceptions. J Nutr Educ Behav. 2009;41(5):360–364. [PMC free article] [PubMed]
24. Weber Cullen K, Baranowski T, Rittenberry L, et al. Socioen-vironmental influences on children’s fruit, juice and vegetable consumption as reported by parents: reliability and validity of measures. Public Health Nutr. 2000;3(3):345–356. [PubMed]
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26. Perry CL, Bishop DB, Taylor GL, et al. A randomized school trial of environmental strategies to encourage fruit and vegetable consumption among children. Health Educ Behav. 2004;31(1):65–76. [PubMed]
27. Child Nutrition and WIC Reauthorization Act of 2004 [Accessed February 1, 2007];2004 Available at: http://www.fns.usda.gov/TN/Healthy/108-265.pdf. [PubMed]
Food Service Software

That’s Progress — Advancements in Hospital Foodservice By Maura Keller

By Maura Keller
Today’s Dietitian
Vol. 11 No. 8 P. 28

Today’s successful programs are catering to patients’ unique needs and safety, using technological innovations to streamline processes and personalize meal selection.

New technologies and innovative products can keep any industry fresh, and the hospital foodservice industry is no exception. Medical facilities, both large and small, are embracing technological advancements in food preparation, distribution, and safety. By doing so, they are impacting the health and well-being of their most important customers: the patients.

Current Trends
Gone are the days of paper menus on which patients, with pencil in hand, would “check” their menu choices. These days, hospitals are increasingly taking a more personalized approach to menu selection, preparation, and distribution. That’s because in a rapidly changing foodservice environment where products and merchandise can quickly become obsolete, staying on top of technology and trends is vital to the success of a foodservice program. Changes in the products, advances in technology, a focus on healthy living, and advancements in food safety can contribute to a profound shift in the way hospital chefs and dietitians operate their programs.

According to Sharron Lent, RD, vice president of patient and clinical services for ARAMARK Healthcare, the industry is seeing dining trends that are based on providing freshly prepared items, which are driving hospital foodservice operations to migrate from more batch-style cooking to models such as room service. This, in turn, is designed to allow patients to order what they want to eat, when they are ready to eat.

“This shift to a more individualistic foodservice delivery model has improved the quality, freshness, and convenience of hospital foodservice,” Lent says. “From an ARAMARK Healthcare perspective, our recipes were developed in partnership with The Culinary Institute of America, our internal culinary design team, and chefs across the country working in our partnering facilities to meet the special nutritional requirements of respective patient diets.”

Montefiore Medical Center in Bronx, N.Y., has recently started an a la carte food cart that plates and serves food right on the unit. “We offer breakfast, lunch, and dinner at alternating units,” says Chris Trivlis, director of foodservice at Montefiore Medical Center. “Our breakfast cart includes the preparation on the floor of fresh waffles, fresh fruit, hot cereals, eggs, French toast, bacon, and sausage. The smells are incredible.”
At Montefiore Medical Center, a foodservice advocate visits patients on special diets to try to customize their wants to the nutritional guidelines—in other words, giving them something more palatable within their dietary restrictions.

“Over the past few years, our operation has evolved from room service to what I call ‘a la carte service,’” says Stephen Bello, CEC, CCA, AAC, certified culinary administrator at South Nassau Communities Hospital in Oceanside, N.Y. “Our menu has numerous offerings, such as ethnical cuisine, comfort foods, and wholesome selections. All of our soups are prepared with the freshest ingredients using garden-fresh, local ingredients. When approaching special diets, our philosophy is simple: fresh, homemade selections minimizing the use of fat and sodium. We want our patients to taste the food. All of our deli and salad offerings are made to order. All menu selections come to the kitchen electronically. This system optimizes freshness and minimizes waste.”

Embracing Technology
High-end computer technologies are having a powerful impact on today’s hospital foodservice. For example, ARAMARK Healthcare has partnered with software companies to develop applications to manage the entire food production process—from ordering and receiving food to producing a final product. “This technology enables us to better manage cost, quality, and nutritional content of the food we are preparing,” Lent says.

The production system that ARAMARK Healthcare uses is designed to manage cost, quality, and nutritional outcomes and is integrated with their room service model. “To accommodate a room service approach, more and more hospitals are redesigning their back-of-the-house kitchen, moving away from the traditional timed assembly system to prepare meals more like a hotel does,” Lent says.

More of the kitchens at ARAMARK Healthcare’s partner hospitals are designed so that meals can be cooked to order and delivered when the patient wants to eat. Traditional kitchens prepare fixed menus in large quantities and serve to patients during fixed delivery periods, from 11 am to 1 pm.

“With the traditional model, if the patient is at a test or happens to be resting, they may not have a great meal experience,” Lent says. “With a room service approach, they can order when they like and have a fresh meal cooked to their liking and have it delivered when they want it.”

Montefiore Medical Center has a computer program that converts the doctor-prescribed diets for each patient into a menu. The meals are delivered to the floors on a specially designed cart that is heated on one side and refrigerated on the other. “This way, the foods stay hot and stay cold without blending temperatures on one tray,” Trivlis says.

Going one step further, South Nassau Communities Hospital’s delivery system has the ability to electronically track food from the time it leaves the kitchen to its delivery to the patient. “So if Mrs. Smith calls and wants to know where her food is, we have the ability to identify the tray’s location,” Bello says.

According to MaryPat Wais, RD, LDN, an ARAMARK foodservice manager at Central DuPage Hospital in Winfield, Ill., the hospital is providing patients with a room service menu that is available from 6:30 am to 6:30 pm. “Patients can call the room service call center anytime based on hunger, treatment schedules, their usual home routine, etc,” she says. “It allows patients to have control over their care and decisions.”

This has allowed for less wasted food because patients are calling when they desire the meal, not a day or hours before. In turn, Central DuPage Hospital can spend the extra food cost dollars on better quality and variety.

“The menu allows for over 33 options, and there are 12 different menus available to meet the specific needs of patients with diet restrictions,” Wais says. “The room service software allows the call center to take the order, the software interfaces with the hospital’s medical record system to ensure proper diet restrictions, allergies, and patient preferences are compliant. It then prints the ticket in the kitchen at three places, so the meal can be freshly made to order by the production staff. This ensures the meals are freshly prepared and reduces waste.”

What’s more, Central DuPage Hospital is using an automated robotic TUG, partnering with the company Aethon, to deliver meal trays to the patient unit. As Wais explains, a hostess receives the tray from the robot and delivers it to the patient. Aethon’s TUG Robotic Automated Delivery System is utilized to deliver meals between various locations within a hospital. The TUG’s computer has onboard maps with dedicated pathways and waypoints that the TUG uses to travel between two locations. While en route to a destination via these pathways, the TUG travels through hallways and utilizes an elevator to travel between floors.

“This technology has allowed the hostess more time to assist patients, improving the meal experience,” Wais says.

Advancements in Food Safety
If you’ve worked elsewhere in the foodservice industry—flipping burgers, tossing pizzas, or creating four-course meals—you know the important role cleanliness plays in creating a quality product. Just like you would never cook a fresh burger on an uncleaned fish grill, you also should never improperly store, cook, or handle food. Of course, food safety is a top priority for foodservice industry professionals within the medical industry. And technological advancements in refrigeration, preparation, and allergy indicators make hospital food safety a whole lot easier.

For example, the management of a hospital diet office is linked with ARAMARK Healthcare’s food management software, which enables them to integrate with the patient’s electronic medical records to manage nutrition care orders and take into consideration food allergies, which enhances patient safety.

“The advancements have enabled us to manage quality, nutritional value, safety, and costs more closely,” Lent says.

Likewise, Montefiore Medical Center has redesigned the trayline for maximum tray accuracy and temperature control. “The census increases dramatically at certain times due to such things as ‘swine flu,’ and we have to be able to feed all patients on a timely basis,” Trivlis says. Montefiore also continually monitors temperatures, proper food handling, and overall food safety from delivery to preparation to serving the patient.

While food safety is a priority for any foodservice facility, foodservice employees’ safety is also vital. “In 2008, my team and I started a program called Culinary Ergonomics. The program assessed all areas of the operation and concerns relating to physical repetitive trauma,” Bello says. “My philosophy was that if an athlete prepares himself before the big game, then why wouldn’t members of my cooking team prepare themselves physically to meet the demands of foodservice? Since then we have evolved; we have specific stations in the kitchen where employees can take a short window of time and stretch before or during their shift.” Team members who have become ambassadors of this program wear the ergonomic “patch” on their uniforms.

As part of the hospital foodservice industry, you know how critical cleanliness is to patients’ health. Unswept floors, soiled tables, and employees with poor hygiene can have a dramatic effect on all facets of a foodservice operation. The same can be said for the food safety equipment. While patients may not see how clean a hospital’s foodservice equipment is, they can certainly taste it.

Currently, South Nassau Communities Hospital’s foodservice department has implemented Anamac humidity control systems in its refrigeration and freezer units. “This technology has reduced airborne bacteria, reduced compressor run times, and increases the shelf live of food 100%,” Bello says. “The system also reduces the risk of employee slips and falls associated with wet floors.”

On the Horizon
Improved efficiencies in nutrition, foodservice technology, and patient satisfaction is the “name of the game” for hospitals.

“Hospital food programs have improved with new delivery systems, new computer programs, and new products from different vendors,” Trivlis says. “I envision meals on demand similar to hotel room service.”

Other facilities have embraced additional ways to facilitate their operations from a technological and environmental perspective.

Last year, Bello developed a program called Culinary Organizational Objectives Through Knowledge, or COOK for short, whereby each month someone from his culinary team presents to the group a technique, cuisine, regional ingredient, etc. “This avails members of the team to hone in on their presentation skills, as well as the sharing of knowledge,” Bello says. “Many of the presentation ideas have been incorporated into patient specials.”
Bello also developed an initiative called Controlling Our Spending Through Stewardship, or COSTS. Every week, he presents to the department a specific area of the food market that is volatile. “This knowledge gives our frontline employees a better understanding of costs at work and at home,” he says.

From a technological and ecological perspective, Bello’s kitchen has spearheaded the hospital’s green initiative. “Things like recycling paper, bottles, cans, shrink wrap, cardboard, and paper have proven to eliminate excess tonnage from the waste stream,” Bello says. “And our ‘Power Up Power Down’ energy awareness campaign has been contagious. Great things are happening at South Nassau Communities Hospital, thanks to the vision of our president and chief executive officer, Joseph Quagliata, and administration. They truly understand that food plays a major role in the recovery of our patients. They have and continue to support technology, education, and all of our wonderful initiatives.”

Speedy Solutions
With the hectic pace of the medical industry, speed-scratch cooking is one of the hottest cuisine trends. Speed scratch is, by definition, a system of combining value-added food products with fresh fruits, vegetables, and other components to create unique, signature dishes. Value-added products can be anything from preportioned cuts of veal to premade sauces to frozen dough products.

The concept of using convenience food products to enhance dishes is not revolutionary; home cooks have been using packaged mixes for gravy and canned soups in casseroles for decades. But what is new is the growing acceptance by medical foodservice personnel of using value-added products to cut prepping and cooking times. And in an industry where good help is hard to find, using convenience products to lessen the labor and time involved in food preparation makes sense.

Today’s marketplace allows hospital foodservice operators to choose exactly what level of value-adding they want—from recipe-building sauces and seasonings to fully prepared meal components. Popular examples of commercial ingredients used in speed-scratch cooking include frozen pastas, seasoned rice, packaged sauces, canned tomatoes, and bread and pizza dough.

With the right ingredients and proper preparation, speed-scratch cooking offers an ideal way to integrate value-added ingredients with fresh foodstuffs to create unique, flavorful menu options. Together with some of the latest technologies, foodservice entities within the medical industry are making significant strides in food handling and overall nutritional options for patients.

— Maura Keller is a Minneapolis-based writer and editor.

Cafeteria Software, Food Service Software, Software for Cafeteria

Infinity Retail Café Renovation and Expansion at Aurora Medical Center Kenosha in Kenosha, Wis.

Written by Donna Boss, Contributing Editor

A small linear retail location barely met the needs of visitors and staff at Aurora Medical Center Kenosha for many years. But an ever-expanding outpatient population paired with the hospital’s expansion to 73 inpatient beds eventually rendered the existing space insufficient.

Aurora-Kenosha-Cafeteria-and-Servery-1The mobile cash register station can be moved to the end of the hot food station. This allows the entire retail area to remain open and staffed with one person during weekends and evenings when transactions are low. Photo courtesy of Zimmerman Architectural Studios, Milwaukee, Wis.“The café was outdated, selections were limited due to café design and equipment necessity, customer flow was congested and café seating was limited,” says Bruce Parker, system retail and catering manager, Aurora System food and nutrition services. “We wanted a café with a fresh new look and to expand the space to disperse retail customers more evenly. And we wanted to create a retail experience that would help drive higher revenues and increase customer satisfaction.”

Finding the space to expand and meet goals of what was named Infinity Café proved challenging for the project team. “The coffee shop had a linear shape with only one service line, and back access only to bakery and cold cases,” says Christine Guyott, FCSI, RD, principal at Robert Rippe & Associates, the project’s foodservice design consultant. “Therefore, the space didn’t allow staff to change to self-serve options in low-volume traffic periods. Additional space was critically needed to make this into a right-size retail café.”

However, the project could not add any additional space to the building, so the design team used a former seating space to enlarge the servery to 1,235 square feet. The café also includes a 1,500-square-foot seating area that can accommodate 88 people. A corridor divides the seating area in half, yet allows natural light to penetrate into both areas. A new café feature is a private dining room.

Five Stations and Versatile Equipment

Aurora-Kenosha-Cafeteria-and-Servery-2Creative planning, such as shaping the salad bar to fit in a limited amount of space, opens up space for multiple menu options. Photo courtesy of Zimmerman Architectural StudiosThe larger space allows for increased and better traffic flow, giving customers much more room to see menu options, which also increased substantially. For example, a grill station with a flattop features a new gourmet burger concept called Hungry Burgers as well as daily specials. The entrée station contains an exhibition action station featuring healthy entrées and salads made to order.

Another popular new feature, the display cooking station, necessitated adding an exhaust hood onto the existing building. “This was the biggest challenge so we added it toward the back where it could be the most easily accommodated,” Guyott says.

A new sub concept named First Edition Grinders adds to menu items available in a deli area that also features specials made to order. Naan Za, a new gourmet pizza concept, features naan pizza crust with a variety of toppings.

The hot food and deli stations back up to the kitchen. The positioning allows staff to easily replenish the stations’ food items via a pass-through hot/cold unit from the adjacent kitchen. Refrigeration sits beneath the grill, flattop and charbroiler providing staff with easy access to ingredients during production. Refrigerated prep tables at the hot station and sandwich station also contribute to staff easily moving cold food prep from the kitchen into this space during down times.

Aurora medical center dining-RoomCustomers can choose among 88 dining seats, including single countertop seats overlooking the exterior courtyard, 2-tops for more privacy, banquettes of 2 or 4 for flexibility, a large table for group settings and several 4-tops. Photo courtesy of Aurora Medical Center Kenosha; photography by Bruce ParkerStaff working at the hot food and deli stations use high speed ovens as an alternative to fryers, versatile hot and cold wells, pass-through hot/cold units, open-air merchandising units, shaped steam pan inserts and serving casserole pans.

“Space was still limited so there was a focus on the use of lineal countertop space for merchandising,” Guyott says. “We designed a uniquely shaped salad bar that customers access for salad on the front side and snacks on the back side.” Customers can select from 40 rotating and occasionally themed menu items at the salad bar, which contains color-coated aluminum inserts.

The café also features a dessert station and cold and hot beverages.

Another labor-saving solution puts the cash register station on wheels so staff can move it to the end of the hot food station. “This allows the entire retail area to remain open and staffed with one person during weekends and evenings when transactions are low,” Guyott says.

The renovation generated a 33 percent increase in retail revenue during the past year. “Traffic is up in part by the addition of a new cashless employee-debit system and the acceptance of credit card transactions in the café,” Parker says. With the realization that staffing resources will continue to be crucial to support the new café, he adds, “This renovation project demonstrates that with sound planning and great project partners, an investment like this is bound to pay dividends both in increased revenue and customer satisfaction and loyalty.”

Facts of Note

  • Size of Hospital: 73 beds
  • Daily retail meal transactions: 360 average; up to 450 peak
  • Average check: $4.14
  • Hours of operation: 6:30 a.m. to 6:30 p.m., Monday through Friday; 7 a.m. to 2:30 p.m., Saturday and Sunday
  • Staffing: 2 until 10:30 a.m.; 3 from 10:30 a.m. until 11:30 a.m.; 4 for lunch from 11:30 a.m. until 2 p.m.; 3 until 2:30 p.m.; 2 until 3 p.m.; and 1 from 3 p.m. to 6:30 p.m.
  • Website: www.aurorahealthcare.org

Innovators

  • At Aurora Kenosha: Lisa Schairer, director of support services; Bruce Parker, corporate retail and catering manager, Aurora System food and nutrition service; Margaret Muske, site leader
  • Foodservice design: Robert Rippe & Associates, Minneapolis; Christine Guyott, FCSI, RD, principal; Joy Enge, RD, senior equipment specialist; and Amy Fick, senior project manager.
  • Architect: Zimmerman Architectural Studios, Milwaukee
  • Equipment dealer: Boelter Companies, Milwaukee
Food Service Software, Nutrition Softwares, School Lunch Software

The School Breakfast Program is one of the most important and unique programs run by Foodbank WA.

The School Breakfast Program (SBP) is one of the most important and unique programs run by Foodbank WA. The program commenced in 2001, with 17 schools registering in response to a growing awareness that students were going to school most days without eating breakfast. Over 430 schools across the state are now involved in the Program, stretching from Kalumburu and Kununurra in the north to Esperance and Albany in the south, to remote schools along the South Australia/Northern Territory borders. The Program directly reaches over 17,000 children, serving over 55,700 breakfasts and 22,800 ’emergency’ meals per week.

Foodbank WA supplies quality School Breakfast Program food products to registered schools free of charge, to ensure that all students have an equal opportunity to receive a wholesome, nutritious breakfast on a regular basis. Non-perishable SBP product include canned fruit in natural juice, wheat biscuits, oats, Vegemite, canned spaghetti, canned baked beans and UHT milk.. Where possible (subject to availability) schools are able to access fresh produce, including bread, fresh fruit and vegetables and yoghurt.

The School Breakfast Program would not be possible without the generous support of Foodbank WA’s government, corporate and philanthropic sponsors. These organisations provide funding so that Foodbank is able to purchase the breakfast food items and pay for the freight to deliver the breakfast product to outlying regional schools.

School Breakfast Program Impact

With respect to educational factors, School Breakfast Programs were perceived to contribute positively to:

  • Student punctuality by 81% of schools
  • Student attendance by 83% of schools
  • Student behaviour by 90% of schools
  • Student academic outcomes by 76% of schools
  • Student concentration by 95% of schools
  • Students’ social skills by 89% of schools
  • Student engagement with class activities by 81% of schools

With respect to wellbeing factors, School Breakfast Programs were perceived to contribute positively to:

  • Students’ physical health by 97% of schools
  • Students’ mental health by 91% of schools

With respect to nutrition factors, School Breakfast Programs were perceived to contribute positively to:

  • Students’ awareness of healthy eating by 90% of schools
  • Student food selection and food preparation skills by 75% of schools
  • Student eating behaviours generally by 86% of schools

With respect to social and environmental factors, School Breakfast Programs were perceived to contribute positively to:

  • The health promoting environment of the school by 93% of schools
  • Social relations between students and school staff by 91% of schools
  • Social relations between students and community members by 74% of schools

To view the 2014 School Breakfast Program Survey Report in full, please visit the Research & Evaluation tab.