Obesity: Pre-ordered lunch key to healthy eating

May 3, 2013, Medpage Today

By Joyce Frieden

Children who pre-ordered their school lunches are more likely to choose healthy foods than children who made spontaneous lunch choices, a small study found.

“When students did not order but instead selected their entrée as they entered the lunch line, it appears that hunger-based, spontaneous selection diminished healthy entrée selection by 48 percent and increased less healthy entrée selection by 21 percent,” Andrew Hanks, Ph.D., of Cornell University in Ithaca, N.Y., and colleagues reported in a research letter published online in JAMA Pediatrics in conjunction with the Pediatric Academic Societies meeting.

Among a group of 272 elementary school students, those who pre-ordered their lunch selected a more healthy entrée more frequently than those who chose their entrée spontaneously in the cafeteria line (29.4 percent versus 15.3 percent, odds ratio for a less healthy lunch 0.55, 95 percent CI 0.35 to 0.86), they wrote.

National surveys estimate that in the United States as many as a third of children between ages 6 and 19 are obese, and their eating habits at school may contribute to the problem, the authors wrote in their study. Against that background, a number of interventions have focused on school lunches, including pre-ordering, which would eliminate “hunger-based, spontaneous selections” and take away the sights and smells that lead to less healthy choices, they wrote.

Study participants were from two elementary schools in upstate New York in which students normally pre-ordered their lunches using an electronic system. The schools are located in a predominantly white county where 5 percent of students receive free or reduced-price lunches.

The researchers assigned participants in 14 classrooms in grades one through five to one of three groups over a four-week period in 2011: During the first two weeks, all classes pre-ordered lunch. During the third week, four classrooms stopped pre-ordering but then started again during the last week, although the investigators did not use data from this group. During the fourth week, five classes stopped pre-ordering. The final group of five classrooms pre-ordered throughout the study.

Lunch sales records for all participating students were then collected. Entrées with the greatest nutrient density on any given day were considered healthy, while the others were considered unhealthy.

The authors wrote that consumption data collected in the cafeterias using a visual estimation method “suggest pre-ordering the entree also affects selection and consumption of side items. Together, both consumption and selection data demonstrate how a simple environmental change — pre-ordering — can prompt children to choose healthier food.”

Although the schools in the study used an electronic ordering system, “paper-based systems are easy, inexpensive, and an immediately implementable alternative,” the authors wrote.

They concluded that future research should look at pre-ordering in middle and high schools “where menu choices are more expansive. This can also facilitate research in pre-commitment and social pressure by allowing students to retract their initial decision, once they are in the lunch line, surrounded by their peers.”

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