News Release

Healthy Hunger-Free Kids Act linked to more nutritious meals

Peer-Reviewed Publication

JAMA Network

The Healthy Hunger-Free Kids Act (HHFKA) was associated with more nutritious school lunches chosen by students with no negative effect on school meal participation, according to an article published online by JAMA Pediatrics.

The 2010 HHFKA updated nutritional standards for the National School Lunch Program and the School Breakfast Program. The revised standards, which took effect at the start of the 2012-2013 school year, increased the availability of whole grains, fruits and vegetables, as well as created other food requirements. The National School Lunch Program reaches more than 31 million students every day and the new standards have the potential to affect the nutritional health of many children.

Donna B. Johnson, Ph.D., of the University of Washington Nutritional Sciences Program, Seattle, and coauthors examined the nutritional quality of foods chosen by students and meal participation rates before and after implementation of HHFKA. The study examined changes in more than 1.7 million lunches at three middle and three high schools in an urban school district in Washington state from 2011 through 2014.

Nutritional quality was assessed by calculating mean adequacy ratio (MAR) and energy density of foods. Foods with lower energy density have lower calories per gram. MAR calculations included six nutrients: calcium, vitamin C, vitamin A, iron, fiber and protein.

The authors found the MAR increased from an average of 58.7 before the HHFKA was implemented to 75.6 after implementation. Energy density decreased from an average of 1.65 before HHFKA to 1.44 after implementation. Meal participation was 47 percent before HHFKA implementation to 46 percent afterward, results indicate.

The authors note their study measured foods selected by students not food consumption. The study also included only students from one urban district in middle and high schools and therefore may not be generalizable to rural and elementary schools.

"We found that the implementation of the new meal standards was associated with the improved nutritional quality of meals selected by students. These changes appeared to be driven primarily by the increase in variety, portion size, and the number of servings of fruits and vegetables," the study concludes.

(JAMA Pediatr. Published online January 4, 2016. doi:10.1001/jamapediatrics.2015.3918. Available pre-embargo to the media at

Editor's Note: This study was made possible through funding from the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation through the Healthy Eating Research program office. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Editorial: Successes of the Healthy Hunger-Free Kids Act

"The Johnson et al study supports other cross-sectional and survey-based studies that demonstrate significant improvements in the nutritional composition of school meals and healthier food consumption among students following the implementation of the meal pattern changes stemming from the HHFKA [Healthy Hunger-Free Kids Act]," write Erin R. Hager, Ph.D., of the University of Maryland School of Medicine, Baltimore, and Lindsey Turner, Ph.D., of Boise State University, in a related editorial.

"The HHFKA created significant improvements in school nutrition, but that progress is now at risk of repeal. ... We encourage policy makers to consider the hard evidence rather than anecdotal reports when evaluating the impact of policy changes. On the fifth anniversary of this landmark legislation, it is worth celebrating the successes of the HHFKA, rather than abandoning the recent progress made in keeping our nation's children healthy," they conclude.

(JAMA Pediatr. Published online January 4, 2016. doi:10.1001/jamapediatrics.2015.4268. Available pre-embargo to the media at

Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, etc.


Media Advisory: To contact corresponding author Donna B. Johnson, Ph.D., call Abby Manishor at 917-539-3308 or email contact corresponding editorial author Erin R. Hager, Ph.D., call Andrea Baird at 410-328-7960 or email

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