Evaluating new school meal policy reforms: a natural experiment in two states - 1.1 project summary over 70% of U.S. Children consume excess added sugar and 90% consume excess sodium

The National Institute for Minority Health and Health Disparities awarded Virginia Commonwealth University $795,243 on September 1, 2026, under the Minority Health and Health Disparities Research program (CFDA 93.307) to evaluate the impact and implementation of school meal policy reforms on child dietary intake and health outcomes through a natural experiment design.

The study leverages a unique policy environment in which the U.S. Department of Agriculture's 2024 added sugar limits and sodium restrictions for school meals take full effect in the 2027–28 school year nationally, while Virginia simultaneously implements a synthetic dye ban in schools effective July 2027. The research compares dietary and health outcomes in two matched school districts—one in Richmond, Virginia, and one in South Carolina—with eight randomly selected Title I elementary schools per district participating. Virginia schools will experience both national and state policy changes, while South Carolina schools will experience only the national changes, enabling evaluation of the combined policy impact on children's dietary quality and other health outcomes.

The project runs through June 30, 2030. The award supports evaluation research addressing the public health burden of excess added sugar, sodium, and ultra-processed foods in children's diets, particularly among economically disadvantaged populations who rely heavily on school meals. Over 30 million children participate in the National School Lunch Program and over 15 million in the School Breakfast Program daily.

Moreover, two thirds of children's daily calories come from ultra-processed foods, which are low in nutritional value and often contain synthetic dyes, which have been linked to neurobehavioral problems, raising concerns for learning. Collectively, these dietary patterns increase children's risk for chronic diseases, with the greatest burden falling on those from economically disadvantaged backgrounds who often rely on school meals for the majority of their dietary intake. Over 30 million children participate in the national school lunch program, and over 15 million children participate in the school breakfast program daily, making school meal programs highly influential in shaping children's disease risk. In 2024, the U.S. Department of agriculture introduced the first ever added sugar limit and stronger sodium restrictions for school meals, with full implementation by the 2027- 28 school year. Separately, virginia will soon BAN synthetic dyes in schools, effective july 2027. This combination of national and state school meal pattern changes impacting virginia could result in greater improvements in children's dietary quality, compared to states impacted by the national changes alone (e.g., south carolina). This study leverages the unique opportunity to evaluate both the impact and implementation of these school meal program changes to determine their impact on child dietary intake and other child health outcomes. A natural experiment will be conducted in two matched school districts (one in virginia; one in south carolina). Sixteen randomly selected title I elementary schools will participate (eight schools per district). In the 2027-28 school year, both districts will be impacted by the national school meal pattern changes, yet only virginia will be impacted by the synthetic DYE BAN. Dietary intake will be assessed using digital imagery plate waste methods, collected twice per year (in fall and spring), prior to (2026-27) and after (2027-28) the full implementation of these changes. Assessments will be repeated in 2028-29 to determine the longer-term impacts. Approximately 18,513 total plate waste observations will be collected at breakfast and 24,726 at lunch from ~12,363 students throughout the study duration. Primary outcomes of healthy eating index scores and ultra-processed foods (%kcal) offered and consumed in school breakfast and lunch meals will be calculated and compared over time and between districts. Secondary outcomes include teacher-reported classroom attention and behavior and standards of learning scores. Finally, a comprehensive evaluation of school meal programs at both the local and state level will be conducted. Collectively, these findings will provide novel and rigorous evidence to optimize school nutrition programs, improve children's dietary intake, and ultimately reduce children's long-term chronic disease risk.