Nutrition education plays an important role in promoting healthy food choices in elementary school-aged children. Traditionally, nutrition is taught by classroom teachers in elementary schools but is generally ineffective in changing dietary behavior. In contrast, nutrition education programs that include a school cafeteria component have shown great promise in improving students’ food choices [38
]. Surprisingly, there is no publication on if and how SFP want to be involved in nutrition education programs. We were excited that 76% of SFP were interested in becoming involved in nutrition education programs. Reasons for getting involved were the perceived importance of nutrition education, their concern about childhood nutrition, their knowledge about childhood nutrition, and their interest in learning more about childhood nutrition. Most importantly, they expected a positive impact on students’ food choices. In summary, SFP were highly motivated to become involved in nutrition education programs.
There were various barriers for SFP to be part of nutrition education programs, the greatest being time and money in our study. An additional budget is required for many nutrition education activities that involve the school cafeteria, as they not only require delivery of information but include activities such as food preparation and tasting. However, those activities are often cost prohibitive because of budget limitations and indicate a need to provide SFP with additional funding to get involved in nutrition education. Furthermore, experiential learning activities require more preparation, clean up time, and equipment than simply delivering nutrition information; as a consequence, additional staff time is needed. Whereas money was universally perceived as major barrier, time was only for managers and supervisors one of the biggest barriers. This may reflect the greater perceived time demands for managers associated with involving the school cafeteria in nutrition education programs. Previous studies reported that a school cafeteria component requires coordination with classroom teachers as well as training, preparation, and delivery of nutrition information [38
], all of which are primarily the responsibility of managers. Several studies reported that coordination between classroom teachers and SFP is a challenge, as both act as separate entities and have limited time and experience to collaborate with each other [12
]. There appears to be tension between classroom teachers and SFP, as SFP perceived that classroom teachers were not supportive of efforts of the SFP to provide healthy meals [20
]. In our recent survey, classroom teachers were highly critical of the food offered in the school cafeteria [10
]. Others reported that classroom teachers perceive that SFP are not interested in working with them [12
SFP, especially managers and supervisors, were concerned that they might become a substitute for a home economics teacher and would have to teach nutrition education classes (“I feel uncomfortable teaching”). One reason for their concern was lack of teaching expertise (“I don’t have enough nutrition education”). Unfortunately, we did not ask SFP about their educational background, but other publications noted that teaching training is generally not part of the SFPs educational backgrounds [20
]. Another reason was lack of perceived responsibility; although SFP felt responsible to participate in nutrition education, SFP did not consider teaching nutrition classes as part of their responsibilities (“I don’t think I am the right person to teach nutrition”). Others reported that SFP preferred informal teaching methods, such as giving advice at the foodservice line, point out foods that are considered healthy, or non-verbal communication, such as providing healthy meals [20
]. Similarly in our survey, SFP reported “the food we put out” and “offer healthy meals with lots of fruits and vegetables” as means to be involved in nutrition education. When asked about nutrition education training, one person noted “We would love to have Jamie Oliver come teach the district”, indicating an interest in more culinary training rather than learning how to teach, which was similar to others [20
]. In summary, SFP were interested in participating in nutrition education but did not want to teach.
There are opportunities to involve the school cafeteria in nutrition education programs. SFP were highly motivated to participate in nutrition education and preferred activities they felt competent about and were in their domain; i.e., displaying nutrition posters in the cafeteria and offering new recipes and food items. There are various intervention methods in the school cafeteria that can improve students’ food choices [32
], including food marketing and display. Hiring a chef to provide culinary training for SFP (“We would love to have Jamie Oliver come teach the district”) showed recently greatest promise [27
], and may provide a low cost option for food service districts and could supplement current strengths of districts in dietetics expertise. However, culinary training has its own barriers, as time and money is often not available for training, as reported by us and others [20
]. Moreover, culinary training without having the budget to buy healthy food items or time to prepare them, barriers often reported by SFP [20
], will only add to the frustration of SFP. One option to consider is raising awareness in students and classroom teachers about new recipes and food items. Potential activities to raise awareness are inviting chefs for cooking demonstrations in the school cafeteria combined with tasting tables. Unfortunately, we did not list these options under preferences. An option that was not mentioned by our respondents but by SFP in other studies was to limit menu options that are less nutritious [31
]. Similar to others [31
], SFP were not interested in labeling food items based on their health index; an intervention that had shown a positive impact on food choices in a hospital study [44
]. An alternative would be to provide only positive reinforcement by giving attractive names to healthy food choices [45
]. SFP shied away of activities that were outside of the school cafeteria and their job responsibilities, which was giving talks in the classroom and teaching cooking classes. Classroom teachers or nutrition specialists have greater expertise in teaching nutrition than SFP and thus are better suited and more motivated to teach nutrition education classes.
Most studies on nutrition programs that target the school food environment have been conducted in the U.S. [32
]. However, the obesigenic, caloric-dense westernized school food environment is an international problem, as the westernized diet spreads around the world. Since food choices are primarily formed in childhood and are difficult to change in adulthood, it is important to get food choices right during the formative school years. The school is a well-suited environment for improving students’ food choices, as an increasing number of students consumes most meals at school. Studies in countries with a caloric-dense western food environment other than U.S. also demonstrate that a combination of increased availability, tasting opportunities, and easy access of nutritious and appealing meal and beverage items, including shelf-stable fruit and vegetable items, and limited access to less nutritious, calorie-dense, high sugar- and sodium meal and beverage items at school are most successful in improving students food choices [38
]. This can be achieved through restrictive school food policies and governmental assistance for healthy food choices. Such efforts are not without challenges, as stakeholders are concerned about the costs, time, and the restriction of choices associated with such programs [49
]. However, the costs associated with childhood obesity and it’s comorbidities, estimated to be $14.1 billion/year in the U.S. [51
], explain why restrictive school food policies and governmental assistance for healthy food choices are necessary to stop the global obesity epidemic.