School Lunches and Cholesterol: Lesson in Bad Nutrition?

As one of the nation’s leading experts in heart disease risk factors sees it, you should send your child and your dog to school every day--the child to learn, the dog to eat the cafeteria lunch.

Not surprisingly, the remark by Dr. William Castelli, medical director of the Framingham Heart Study near Boston, brought down the house at a recent American Medical Assn. cholesterol symposium in New York City. But, to Castelli, there is a serious point behind the quip.

The federal school lunch program, he and other nutrition experts say, is awash in saturated fat and can start children out on a lifetime of unhealthful dietary habits.

Between June, 1986, and July, 1987, the U.S. Department of Agriculture national school lunch and school breakfast programs distributed 1.4 billion pounds of food, worth an estimated $881 million, to 90,000, or 95%, of the nation’s public schools, according to agriculture department figures.

Surplus Foods to Blame

But because the programs rely on surplus foods--some of which Castelli and other nutrition experts say are out of favor with Americans increasingly concerned about their diets--most of the 24 million children in those schools are being given foods that are among the most potentially dangerous in their ability to raise blood cholesterol levels.

And that is the point of Castelli’s dog food joke.

“When you stop and look at it, theirs (dogs’) is a better diet than what we’re getting ourselves,” Castelli said in an interview in New York. “There are three animals that can (safely) eat our diet: the dog, the cat and the rat. It’s hard to give them atherosclerosis. We can’t eat the stuff they’re giving us (in the federal school lunch program). It’s killing us. It’s about time we started to realize that.”

Look at cheese, Castelli suggested.

“They don’t have to smother everything in cheese and take a nice, good serving (of something like) fish and just slaughter it with cheese,” he said. “We ought to start looking at what goes on with school menus.”

Cheese, Cheese Everywhere

Indeed, dishes including generous servings of cheese are a fixture of many school district lunch menus.

In the Los Angeles Unified School District, for instance, a dish called “fish and cheese square” appeared once every three weeks and in optional “alternate menus” in the standardized meal plan for elementary school children this spring. The master menu for elementary schools also included, for the spring term that ends next week, frequent servings of “cheesy chili corn bread,” “cheesy spaghetti” and “cheesy tuna noodle casserole.”

According to USDA figures, almost 165 million pounds of cheese was distributed in the ‘86-87 school year for school breakfast and lunch use, all but 32.5 million pounds of which was processed American or Cheddar--two types identified as rich in saturated fats, a key to cholesterol heightening.

The remaining cheese was less cholesterol-rich mozzarella--made, in part, from low-fat milk. But USDA officials concede that cuts in the amount of surplus dairy products the government buys will mean mozzarella will account for a smaller proportion of the cheese.

The school foods could have been prepared in the 81.5 million pounds of butter and butter oil distributed by the government. In the same year, the government gave away 12.1 million pounds of “chicken nuggets” (a deep-fried item that includes liberal amounts of cholesterol-rich chicken skin), 10.5 million pounds of ground pork and ham, 34.7 million pounds of frozen deep-fried potato products and 222 million pounds of hamburger.

By contrast, the program included only 50.5 million pounds of turkey and chicken, some prepared for deep-frying--a cooking process that introduces a significant cholesterol content to poultry, which is less fatty than red meat.

Fish, ‘Fish Nuggets’

The USDA program used comparatively little fish, mostly canned tuna and salmon. But there were also 1.3 million pounds of deep-fried “fish nuggets” and 39,000 pounds of “frozen fish portions,” the USDA figures showed.

The program does include dozens of other items not involved in the cholesterol controversy. They range from canned and frozen green beans, corn and peas to fresh apples, canned cherries, rolled oats and spaghetti.

The result of the program’s focus on high-cholesterol foods, according to Dr. Frank Franklin, a pediatrician on the American Heart Assn.’s council on cardiovascular disease in the young, can be seen in one of the few heart risk studies on the health ramifications of school lunches.

The Bogalusa Heart Study is a Louisiana project that studied 10-year-old students, their diets and other coronary health risk factors between 1973 and 1982. It found that school lunches contributed disproportionate shares of the children’s total fat and cholesterol. The lunches accounted for 23% of the youngsters’ daily calories, but 26% of the fat in their diets.

“I certainly don’t think you ought to feed (the school lunch menu) to pets, though I feed my egg yolks every morning to my dog,” said Franklin, one of the project’s researchers. “But I think what Dr. Castelli is saying is entirely correct. If anything, the school lunch is a richer source of saturated fat than most of the rest of the child’s day.”

The issue of what is in school lunches--and particularly the nutritional role played by government surplus foods, Franklin said--is about to be addressed more formally in a tri-city study funded by the government’s National Heart, Lung and Blood Institute. The study will include school sites in New Orleans, Houston and San Diego.

The school districts involved, Franklin said, will be assisted in test programs that will attempt to modify lunch and breakfast diets in light of conflicting needs. The cost of food for strapped districts, for instance, must be balanced against what children will eat in general.

“The school lunch is a major challenge,” Franklin said. “But I think (changing it) is doable.”

Another reason school lunches and the cholesterol ramifications are gaining greater urgency is because of a growing certainty among public health experts that cholesterol-related heart attack risk in adulthood results from dietary habits and cholesterol levels in childhood, according to Dr. Peter Kwiterovich.

Clear Link Shown

Kwiterovich, the internationally known Johns Hopkins University expert on cholesterol and children, reviewed data at the AMA symposium that showed a direct relationship between high cholesterol readings in childhood and adulthood.

A child between 5 and 14 with a total cholesterol count of 175 milligrams per .1 liter of blood in the body--or in the top quarter of readings in his or her age bracket--stands to become a high-risk adult with a reading of 240 or more, Kwiterovich found.

While there is some controversy over what cholesterol level is necessary for optimal health, most experts believe adults should try to keep their readings to 200 or below.

“I think Dr. Castelli was exaggerating to make a point,” Kwiterovich said of the dog food theory. “But I think that we can teach our children more about nutrition in the schools, and this would include learning about saturated fats and cholesterol. I think they need to be provided with better food, different foods, in the school lunch program.”

As an example, Kwiterovich said, chicken used in the government “chicken nuggets” could be skinned before it is cooked--skin is now mixed into the product, just as it is in similar items at fast-food restaurants. If frying is the only cooking method economically feasible for a school, he added, kitchens could at least switch to oils with the lowest fat content, like safflower oil.

“This is a concern because not only is it raising the cholesterol levels in these children at that particular moment,” said Dr. Scott Grundy, a University of Texas expert on diet and non-drug methods to improve cardiovascular health, “but it is gearing these (children) to eat a high saturated fat diet. Later in life, it’s going to be hard to get them off of that.”

But the problem goes deeper than that, according to a Washington consultant who is now a major critic of the government department she used to help run.

History, Politics Figure

In fundamental terms, said Carol Foreman, an assistant agriculture secretary for food and consumer services during the Carter Administration, the school lunch that is put on a child’s tray in 1988 is a product of Depression Era history and contemporary agricultural politics as much as it is a nutritional exercise.

The government surplus commodity program began in the Depression as a means to assist farmers too poor to harvest crops that were left to rot and the hungry unemployed, who could not buy food in stores. By the 1940s, the USDA acquired the authority to buy surplus foods to prop up farm prices. Today, the department is required to purchase huge quantities of farm products that cannot be sold on the open market at prices high enough to keep farmers financially afloat.

Now, said Foreman and other school lunch experts, the supply-demand dynamics of the food marketplace are showing the effects of consumers’ heightened health consciousness. As a consequence, because products like butter and cheese are less popular, greater proportional quantities of them are ending up as surplus and the USDA--forced by law to buy them up--sees the schools as the most logical outlet.

And while the nation’s dietary preferences are changing, Foreman and medical experts agreed, unhealthy family eating habits are still widespread as parents struggle to keep households solvent. Many parents, Foreman said, still don’t know how to shape sound family nutrition programs.

Want Kids to Eat It

“This is a mammoth problem because school lunch directors are all scared to death that the kids will throw the lunch out and they’ll get criticized,” she said. “The school lunch director wants to prepare foods that the kids will eat, but it’s what kids eat at home--hamburgers and pizza and macaroni with lots of meat sauce. And that’s what they want at school.

“This is changing as the diet is changing in America, but the school lunch hasn’t led the way, it has followed . It seems to me that, when the public is putting out billions of dollars a year, (school lunch programs) should be teaching the lessons of nutrition, not bringing up the tail end of the parade.”

Suzie Harris, the USDA official who holds Foreman’s former position, agreed that conflicting political and economic forces make quick reform difficult.

But she added: “We are encouraging the school systems to make sure that they keep in mind to reduce saturated fat to levels that are reasonable. What we don’t have for anybody in this country (in official USDA guideline form) is an exact amount of how much they need of these components.

Moving Toward Baking

“If we provide foods that the children won’t consume, we have not done anything useful. We are in the process of slowly altering the types of food in the school lunch, particularly in moving away from everything being fried to the oven-baking method.”

Around the country, many school districts have begun to look aggressively at ways to change menus so that school lunches can minimize cholesterol damage from many items in the USDA food program but at the same time keep costs under control.

Many of the progressive programs belong to the American School Food Service Assn., based in Denver, whose leaders said they believe schools have been unfairly singled out in the concern over the healthfulness of breakfast and lunch menus.

Mary Klatko, chairwoman of the association’s public policy and legislative committee, for instance, said she was appalled by Castelli’s dog food analogy.

“He can’t possibly have an understanding of the commodity program,” she said. “You order what you can successfully use in your program.”

Jane Boehrer, food service director for the San Diego Unified School District, said that using a computer program to track nutritional content in elementary school menus makes it possible to hold down fat levels while retaining the essential cost savings.

“The USDA program is decried a lot, but they offer what they have,” she said. “What it does, though, is give us an opportunity to provide a meal at an affordable price to the student.” Boehrer said that, without the government assistance, San Diego’s full-price elementary school meals would increase from 80 cents to as much as $1.50. High school meals, she said, would go from $1.25 to as much as $2.

Slow Progress

Beth Lourargand, food service director for the Los Angeles Unified School District, said school nutrition officials are making slow progress. She cited use of whole-wheat hamburger buns in the district-wide meal program as an example and noted--as did other lunch program officials--that pressure from school districts has gradually forced the USDA to reduce fat content in ground beef.

Ground beef in the government program, she and other food service executives said, is now about 22% fat--sometimes less--low enough to qualify for labeling as “lean” in California supermarkets.

“Gradually we do as much as we can to convert menu items to ones that de-emphasize the bad side,” she said. “But we have to recognize that we have a priority in seeing that students eat.”

CHOLESTEROL IN SCHOOL LUNCHES

The highest cholesterol food distributed to schools in the 1986-1987 school year by the U.S. Department of Agriculture.

Millions Item of pounds Hamburger 222.8 Cheese 164.9 Butter 81.5 Deep fried potato products 34.7 Shortening 24.7 Peanut butter 12.5 Chicken nuggets 12.1 Ground pork and ham 10.5

Source: U.S. Dept. of Agriculture, Food and Nutrition Service.