title: Effect of food service nutrition improvements on elementary school cafeteria lunch purchase patterns.
abstract: BACKGROUND
  Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health.
  
  
  METHODS
  Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years.
  
  
  RESULTS
  The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies.
  
  
  CONCLUSIONS
  Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made.
authors.affiliation: Associate Professor of Psychiatry, Retired (clusspa@upmc.edu), University of Pittsburgh, School of Medicine, Pittsburgh, PA 15261; Consultant, UPMC Health Plan, 5889 Forbes Avenue, Suite 320, Pittsburgh, PA 15217.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cluss
authors.forename: Luann
authors.initials: L
authors.lastname: Fee
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Culyba
authors.forename: Kiran B
authors.initials: KB
authors.lastname: Bhat
authors.forename: Kay
authors.initials: K
authors.lastname: Owen
mesh_terms: D002648:Child; D002755:Choice Behavior; D003256:Community Participation; D005247:Feeding Behavior; D005522:Food Services / Q000191:economics / Q000592:standards* / Q000639:trends; D006801:Humans; D062409:Lunch; D018673:Nutrition Policy; D009753:Nutritive Value; D019982:Organizational Case Studies; D063766:Pediatric Obesity / Q000517:prevention & control*; D010414:Pennsylvania; D011204:Poverty Areas; D012574:Schools / Q000191:economics / Q000592:standards* / Q000639:trends; D013334:Students
keywords: community health; nutrition and diet; public health; school food services