Health care savings on a plate

May 02, 2019
Andrew Falacci
Formerly Project Coordinator of Health Law and Policy

Childhood obesity is a rising problem crippling our nation’s health and increasing costs. The prevalence of obesity among children and adolescents has jumped 12 percent since 1970. We know overweight adolescents are more likely to develop health ailments as adults, including type 2 diabetes, asthma, hypertension and heart disease, and that food consumed during the school day accounts for half of a child’s calories. If managed care organizations invest in nutritious solutions for children and adolescents today, we may avoid costs and poor health in the future.

Adequate levels of nutrient dense/low energy content meals during the school day are essential to ensure children grow and stay healthy well past the time of their graduation - instilling healthy eating habits and tastes for the future. Short-term approaches to reduce the expected costs associated with overweight patients has a limit. The long-term solution requires investments to mitigate childhood obesity at the problem’s headwaters – nutrition.

The nutritional changes in the nation’s school lunch program under the Health Hunger-Free Kids Act (HHFKA) of 2010 have already shown signs of improving children’s dietary intake by placing more vegetables and whole grains on lunch trays2. The 2010 legislation3 enacted nutritional standards for the school lunch program which have been shown to help reduce obesity.4 The approach aligns with what Fredrick Douglass said, “It is easier to build strong children than it is to repair broken men.”5 Investing in the well-being of children has benefits continuing into adulthood and will help to reduce health care costs related to obesity. Meeting these standards, however, comes with a cost, and many public school districts face financial barriers to offering nutritious meals for all students. School districts need additional support to move beyond the standard requirements.

The move to value-based health care presents an opportunity for managed care organizations and ACOs to invest in school nutrition programs and avoid the potential future costs of medical conditions in adult populations caused by poor childhood nutrition. Such investments may mitigate the large costs of serious medical conditions once an obese pediatric population reaches adulthood. Food plays a vital role in overall health, and the potential for innovation lies in preventing adult obesity and associated health problems from ever occurring. Childhood nutrition is a critical social determinant of population health, both for today and for the long term. Here, the difference in school food could catalyze medical savings for the future.  

The HHFKA of 2010 initiated the largest reform of the National School Lunch Program (NSLP) in over three decades. The HHFKA changed the nutritional standards for school meals, but many school districts still struggle to meet the new requirements under their current resource structures.6

Since its full implementation in 2012, the HHFKA has required schools to increase quantities of fruits and vegetables (especially leafy greens), limit the levels of sodium and fat and increase the required use of whole grains. The legislation also lowered the socio-economic eligibility requirements for free and reduced meals, which placed a burden on school districts to meet the increased demand of meals. While studies show more children are receiving nutritious meals, many school districts have battled costs and upgrade challenges to meet the requirements.

The current gap between the law’s intentions and complete implementation is the higher cost structure of the new nutritional standards. Meals incorporating more vegetables require larger amounts of preparation compared to carbohydrate-based meals which can easily be defrosted in a convection oven.  The HHFKA only provides an additional 6 cents per meal to upgrade the nutritional levels. School districts with outdated equipment, limited staff and current vendor contracts are struggling to plate the required meals under the new law. Managed care organizations could enhance the effort by making small investments, where additional financial support could help each school district, for example:

I. Meet increased demand of the new meals

II. Provide choice and variety in the types of meals offered

III. Purchase equipment and hire staff

IV. Diversify the menu and implement specialized programs such as farm to school

V. Ease dependence on vendor contracts

The HHFKA has been successful in outlining new nutritious standards for school lunches, but it only works when schools can carry out the changes. So far too many schools cannot. The difference comes from the implementation method a school district chooses and the district’s ability to finance the program beyond the 6-cent reimbursement. Today the task for managed care organizations is an investment to provide more nutritious school lunch. Tomorrow, the savings could be lower medical costs because of a healthier population – health care savings on a plate.

1Centers for Disease Control and Prevention. NCHS Health EStat: Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008. 2010. Accessed 2018.

2Ethan A. Bergman, PhD, RDN, CD, FAND; Tim Englund, PhD; Katie Weigt Taylor, MS; Tracee Watkins, MBA; Stephen Schepman, PhD; Keith Rushing, PhD, RD. “Potential impact of national school nutritional environment policies”. Journal of Child Nutrition & management: volume 38, issue 2. School Nutrition Association. Fall 2014. Web. Accessed 2019

3Frederick Douglass Institute Collaborative. Reference page. 2018

4Healthy, Hunger-Free Kids Act of 2010, Pub. L. No. 111–296 (December 13, 2010).

5Nestle, Marion. “Breaking Down the Child Nutrition Act: Q&A”. The Atlantic. April 8, 2010. Accessed 2018

6Terry-McElrath YM, O’Malley PM, Johnston LD. “Potential impact of national school nutritional      environment policies: cross-sectional associations with US secondary student overweight/obesity”. 2008-2012. JAMA Pediatrics 2015;169(1):78–85. 10.1001/jamapediatrics.2014.204