摘要：In order to address overall nutritional health, including increases in numbers of overweight children and adolescents, the San Francisco Unified School District implemented a progressive nutrition policy beginning in August 2003. We review this policy and focus on its impact on school and district revenues and students’ participation in the federally subsidized school lunch program. We examined changes in menu items and the consequent effects of these changes on student eating patterns and school revenues at Aptos Middle School in San Francisco. This case study and additional district data show that provision of healthy menu options led to increased student participation in the federal school lunch program. THE UNITED STATES IS FACING a dramatic surge in the number of children and adolescents defined as either overweight (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] at the 95th percentile or above for their age and gender) or at risk for overweight (BMI between the 85th and 95th percentiles for their age and gender). 1 A recent study showed that, in addition to a range of adverse medical consequences, overweight and decreased fitness levels in childhood are associated with poorer academic achievement. 2 , 3 In the United States, the escalating prevalence of overweight among school-aged children has been directly linked to declining levels of school-related physical activity, poor eating behaviors, proliferating consumption of fast foods and soda, and increased television viewing. 4 – 6 The Health Behavior in School-Aged Children Study surveyed more than 128000 students aged 11, 13, and 15 years in 28 industrialized countries (including countries in Europe and North America) about their health behaviors and lifestyles. 7 Of note, the United States ranked in the top 3 countries in the frequency at which schoolchildren consumed soft drinks, candy, and chocolates. 7 In California, a state law eliminating soda sales at elementary and middle schools went into effect on January 1, 2003 (SB 677, the California Childhood Obesity Prevention Act of 2003). To be in compliance with the law, elementary and middle schools had to remove all soft drinks during school hours. No restrictions were made for high schools because of logistic difficulties, including many students obtaining meals off campus. In addition, concern about losing revenues generated by the sale of these items, particularly in support of high school sports and other programs, led to lobbying and other negative influences, such as protests and letter writing, by school districts and the food industry. Local school districts, however, have the opportunity to institute more comprehensive policies than states. Schools are an ideal setting to institute healthier diets because they are responsible for administering at least one third of a child’s food intake during the school day and they can function as educational and role models for healthier food choices. At the beginning of the 2003–2004 school year, the San Francisco Unified School District (SFUSD) addressed problems associated with childhood overweight and responded to pressure from various parent groups by changing its nutrition standards to eliminate the sale of unhealthy foods, snacks, and beverages from all lunch line, snack bar, and vending machine locations in all public elementary, middle, and high schools. 8
