Banning ultra-processed foods brings major hurdles for public schools

Starting in July 2029, public schools are required to start phasing out ultra-processed foods under a new California law that prohibits schools from serving foods high in sugar, fat, salt and certain artificial food additives.

The changes should benefit kids' health, but may be challenging for schools to implement, according to a Stanford Medicine study.

It's easy to say, 'Let's remove ultra-processed foods from school meals,' but school districts will likely face many challenges in implementing this policy."

Anisha Patel, MD, study's senior author, professor of pediatrics, Stanford Medicine

The research team's work, to be published Sept. 28 in Public Health Nutrition, identified the top challenges that school food service directors expect to face. Budget constraints, limited staff, difficulty with food procurement and inadequate kitchen infrastructure were their biggest concerns, the study reports.

Lawmakers will likely need to direct more funding to school food budgets to help put the new legislation into practice, said lead study author Andrea Pedroza-Tobias, PhD. She was an instructor in pediatrics at Stanford Medicine when the study was conducted and is now an assistant professor in residence at the University of California, Irvine. "It's an investment in the future of these kids. For many California children, two of the three meals they eat per day come from their schools."

Evaluating barriers

The new California statute, AB 1264, aka the Real Food, Healthy Kids Act, requires elimination of certain ultra-processed foods considered harmful to children's health from school menus by July 1, 2035. Several other states are considering similar legislation to reduce kids' risk for obesity and related health problems, and the latest version of the Dietary Guidelines for Americans encourages people to consume fewer ultra-processed foods. The U.S. Department of Health and Human Services also recently announced a $32.5 million initiative to help school districts test how to deliver healthier food to students.

Ultra-processed foods can be defined in several ways. Researchers typically use the Nova classification: industrially created food with additives that enhance the item's taste or convenience. The new California law uses a more specific definition, with more details about which food additives are prohibited and the balance of nutrients required. Heat-and-serve foods, flavored yogurt, frozen pizza and breakfast cereals are common examples of ultra-processed foods that currently appear on school menus.

The Stanford Medicine team, along with their colleagues, interviewed food service directors from 20 school districts in California's San Joaquin Valley, an agricultural region with many low-income families whose students depend on school meals. In the interviews, the researchers asked participants to rate how much of a barrier they anticipated certain factors would be in eliminating ultra-processed menu items. The research team also asked open-ended questions to allow detailed responses about various challenges.

Fiscal and logistical challenges

One major category of challenge was fiscal. Eliminating ultra-processed foods - which are cheap and easy to heat and serve with minimal kitchen equipment - will strain budgets, food service directors said.

In 2021, California began providing meals to all K-12 public school students for free, regardless of families' incomes. Federal and state funding reimburse districts around $4.60 per lunch served, and with more kids eating the meals, schools can now offer more and better menu choices.

"That has been something positive for school districts: Universal school meals increased participation, which brought more money to districts' food service programs," Pedroza-Tobias said.

But less-processed items will increase costs, likely outpacing existing budgets, and will make some foods harder to procure.

Amanda Harvey, director of nutrition services for the Fresno Unified School District, who was a member of the community advisory board for study, encountered these problems when her team eliminated products containing food dye from their menus.

For instance, it was difficult for her school district to purchase pickles made without green dye No. 5. "They're pricey for pickles, and it can be quite challenging for our vendor to get them," Harvey said. "So sometimes we have a shortage of pickles because of this food dye."

Measures that reduce food costs may become harder for schools to use, the researchers noted. For instance, districts can purchase inexpensive commodity foods through the U.S. Department of Agriculture - such as raw chicken - which they may send to a food processor in exchange for easier-to-serve items such as chicken nuggets. "While this practice helps schools that don't have the kitchen infrastructure for anything but ready-to-eat foods," Pedroza-Tobias said, "it can inadvertently increase the amount of ultra-processed food on the menu." 

Food service directors also identified challenges related to school staffing and infrastructure. Many schools employ part-time staff to heat and serve foods; these individuals may not be trained to cook similar foods from scratch. Scratch cooking also takes more time, and moving staff from part-time to full-time jobs would require larger budgets for staff salaries and benefits.

Many schools lack fully equipped kitchens, and retrofits are difficult. Harvey's team explored whether they could make sandwiches from scratch in some of the elementary schools in her district that have kitchens designed only for heat-and-serve meals. The local health department denied the request because the kitchens did not meet permitting standards for scratch cooking, she said.

"They said, 'In order to get these 50 schools permitted, you would need to add new sinks, drains and hoods,'" Harvey said. This would have cost millions of dollars, which would have had to come from district infrastructure funds, not the cafeteria budget, she added. The Fresno school district has a central kitchen facility equipped for scratch cooking, so Harvey's team opted to make sandwiches there instead, but smaller school districts may lack that option.

Student preferences may also be a challenge, although some food service directors reported that students like certain fresh menu items. Harvey's district works with chefs in developing scratch-made items they can add to their menus. Students also appreciate having more options on the menu, she said, adding that when her district began offering menu choices at elementary schools, "We definitely saw a huge decrease in parent and student complaints."

Strategies for change

The research team also heard about how some districts have addressed these concerns. Some have bridged fiscal gaps with grant funding, although participants said that "if they get this funding for one year, and are not sure they'll have the same money next year, they don't feel like they can make sustainable changes," Pedroza-Tobias said. Applying for grants also requires staff time, putting smaller districts with fewer support staff members at a disadvantage.

One district succeeded in making most of its food from scratch, in part because the food service director was a chef who also had a background in nutrition. "They also did a lot of engagement with families and students to increase the acceptance of scratch-cooked meals," Pedroza-Tobias said. "For instance, they had a junior chef competition where students submitted a recipe, and they selected some of these recipes to cook in the school kitchen."

The researchers hope their findings will help legislators and school districts navigate the challenges of serving healthier school meals, she said. Patel added, "Moving from ultra-processed food to scratch cooking requires an upfront investment, but healthier school meals can pay off in the long term by preventing health care costs associated with diseases such as obesity, Type 2 diabetes and cardiovascular disease."

Researchers from the Dolores Huerta Foundation, Cultiva la Salud, and the Nutrition Policy Institute of the University of California Agriculture and Natural Resources contributed to the study.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant P30DK092924); the National Heart, Lung, and Blood Institute (grant K24HL169841); Stanford's Maternal and Child Health Research Institute; the William and Nancy Thompson Family Foundation; and Stanford Impact Labs.