How FNPs Can Navigate Child Nutritional Health and Food Insecurity

On May 1, Sonny Perdue, the new head of the U.S. Department of Agriculture that oversees the 71-year-old National School Lunch Program, visited an elementary school in Virginia to announce that the agency would begin rolling back strict nutritional standards for school lunches set by the Obama administration.

In his remarks, Perdue said the agency would allow schools more nutritional flexibility in their meal programs. For instance, school lunch managers would be allowed to introduce more salt in meals and serve children fewer whole grains. Perdue’s announcement came after years of political debate — sometimes called the Cafeteria Wars — over the federal government’s role in the nutritional health of the country’s children.

Republicans and representatives of big food companies like ConAgra and Schwan (which makes 70 percent of all school lunch pizza) have argued that the Obama administration’s efforts to install healthier nutritional standards in public schools have only led to waste and hunger.

With the political wind at their backs, the Trump administration and a Republican-led Congress see a chance to make changes to the $13 billion National School Lunch Program, which feeds more than 30 million children each day.

In Virginia, Perdue was flanked by Patricia Montague, CEO of the School Nutrition Association, whose 57,000 members (known affectionately as “lunch ladies”) run the country’s school lunch programs. Once champions of federal government efforts to get children to eat healthier at school, “the lunch ladies have become the shock troops in a sometimes absurdly complex battle to roll back the Obama’s administration’s anti-obesity agenda,” according to The New York Times.

Why? Because they believe those more healthful standards were expensive, difficult to implement, and children were turning up their noses at the new offerings.

SNA members receive subsidies from the federal government, but the food they serve has to bring in enough money to cover expenses. They say their budgets are too small, and they’ve come to rely on big, processed food companies and fast food chains that can offer them cheaper food that children will actually eat: less spinach, more pizza.

“We have been wanting flexibility so that schools can serve meals that are both nutritious and palatable,” Montague said. “We don’t want kids wasting their meals by throwing them away.” Her thoughts about what’s called “plate waste” were echoed by Perdue, who said that if kids aren’t eating the more nutritional food, “it’s ending up in the trash, and they aren’t getting any nutrition.”

Howell Wechsler, CEO of the Alliance for a Healthier Generation, which works with schools to prevent childhood obesity, issued a statement in response saying, “we would not lower standards for reading, writing and arithmetic just because students found them challenging subjects, and we should not do it for school nutrition either.”

Read the text-only version of this graphic.

Decades of research point to a variety of environmental factors that influence the food on a child’s plate. With family income being a primary indicator of access to food, the National School Lunch Program has become a fundamental but turbulent federal subsidy that repeatedly sits at the heart of political turmoil.

In 1968, a study of the National School Lunch Program found that “only one-third of the 6 million children living in poverty were receiving free or subsidized lunch,” according to Huffington Post Highline. In response, Congress created a tiered system based on financial need to level the school lunch playing field. In the 1980s, the Reagan administration cut back on the program as part of a broader campaign against welfare.

Almost 50 years after the study, children from families at or below 130 percent of the federal poverty rate are eligible for free meals in the National School Lunch Program. Those kids account for roughly 73 percent of school lunches distributed in the program.

Access to food can impact childhood nutrition beyond the scope of income when families live in food deserts — geographic areas where a grocery store or market is not available within a half mile or walking distance. Without a car or public transportation, venturing out beyond a rural town, college campus, or urban neighborhood on foot is a barrier for families who have to carry groceries home by hand. Families who live in food deserts are less likely to purchase fresh food and pack food for future meals, leaving children unlikely to know when or where they will eat next. This is commonly known as food insecurity.

Food insecurity is as complex as its contributing factors, meaning it can’t be solved with free lunches alone. From a policy level, it’s necessary to have programs like the National School Lunch and the Women, Infants, and Children (WIC) programs, but families can’t make major changes to their health without the support of a medical provider.

Family nurse practitioners have a unique opportunity to talk with families during medical visits, as well as with children when working in school settings. Learning about a family’s lifestyle beyond the clinic walls can make FNPs better able to identify signs of food insecurity as they relate to hunger and nutrition, behavioral health, and physical fitness.

FNPs can help identify at-risk children and advocate for policies that improve access to nutritional food. The Institute of Child Nutrition says there are a number of ways FNPs can help school nutrition programs meet a student’s special nutrition needs. These include: 

Aside from the National School Lunch Program, FNPs can also become familiar with other USDA initiatives, including:

For more information on childhood nutrition, visit: