Healthier School Meals Could Prevent 10,600 Deaths a Year

Author: Tufts University
Published: 31 Jul 2023 - Updated: 4 Nov 2026
Publication Details: Peer-Reviewed | Study

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research, a peer-reviewed modeling study published in The American Journal of Clinical Nutrition by investigators at the Friedman School of Nutrition Science and Policy at Tufts University, estimates the health and economic effects of aligning U.S. school meals with the 2020-2025 Dietary Guidelines for Americans. Key facts include three modeled changes: keeping added sugar below 10 percent of calories per meal, making all grains whole grain and lowering sodium to the chronic disease risk reduction level. Full compliance was estimated to prevent more than 10,600 deaths a year and save over $19 billion annually in later adult healthcare costs, while even the worst-case scenario delivered a little over half those gains. The findings matter because roughly 1 in 4 school meals is still rated poor in nutritional quality, and they are useful to parents, school nutrition staff, policymakers and families of children with disabilities or chronic conditions who rely on school food programs.*

At a Glance

1 - About 35 percent of the diet changes were assumed to last into adulthood.
2 - High school students saw about half the benefit, since fewer eat school meals.
3 - Fully updating standards may cost at least $1 billion, about 5 percent of the projected savings.
4 - Elementary and middle school students were projected to see BMI fall by 0.14 and systolic blood pressure by 0.13 mm Hg.

Topic Definition

Dietary Guidelines for Americans: The Dietary Guidelines for Americans are federal nutrition recommendations published jointly by the U.S. Department of Agriculture and the Department of Health and Human Services every five years, describing what people should eat and drink to promote health and reduce the risk of chronic disease. The guidelines set limits on added sugars, sodium and saturated fat, encourage whole grains, fruits and vegetables, and serve as the scientific basis for federal food programs such as the National School Lunch Program and School Breakfast Program.

Overview

Today's school meals are much healthier than they were for the parents of American kids, but still 1 in 4 school meals is of poor nutritional quality. The latest Dietary Guidelines for Americans (DGA), in place for 2020-25, call for meals with less sugar and salt and with more whole grains.

Fully synchronizing school meals with these new standards could positively impact hundreds of thousands of children into their adulthood, with the added benefit of saving billions in lifetime medical costs, investigators from the Friedman School of Nutrition Science and Policy at Tufts University report July 31 in The American Journal of Clinical Nutrition. By modeling the national implementation of updated school lunch guidelines, the research team found even incomplete compliance by schools would lead to overall reductions in short- and long-term health issues for participating K-12 students.

"On average, school meals are healthier than the food American children consume from any other source including at home, but we're at a critical time to further strengthen their nutrition," says senior author Dariush Mozaffarian, a cardiologist and Jean Mayer Professor of Nutrition at the Friedman School. "Our findings suggest a real positive impact on long-term health and healthcare costs with even modest updates to the current school meal nutrition standards."

The researchers utilized a simulation model to derive a data-driven estimate of three changes to the school meal program, including limiting percent of energy from added sugar to lower than 10% of total energy per meal, requiring all grain foods to be whole grain, and lowering sodium content to the Chronic Disease Risk Reduction amount for sodium intake in the 2020-2025 DGA. A portion (35%) of these dietary changes were estimated to continue into adulthood.

If all schools fully complied with the new standards, these were estimated to prevent more than 10,600 deaths per year due to fewer diet-related diseases, saving over $19 billion annually in healthcare-related costs during later adulthood. The worst-case estimate, in which schools remained with their current food offerings, saved a little over half as many lives and healthcare dollars.

School meals aligning to new dietary guidelines for added sugars, sodium, and whole grains would have modest, but important, short-term health benefits for children. For example, these changes were estimated to reduce elementary and middle school students' body mass index (BMI) by 0.14 and systolic blood pressure by 0.13 mm Hg. Benefits were about half as large for high school students because fewer older students eat school-provided meals.

"Using a comparative risk assessment model, our estimations are based on the best available, nationally representative data on children and adults and the best available evidence on how dietary changes in childhood relate to BMI and blood pressure, how dietary changes persist into adulthood, and how diet influences disease in adulthood," says first author Lu Wang, a postdoctoral fellow at the Friedman School. "Our new results indicate that even small changes to strengthen school nutrition policies can help students live longer, healthier lives."

The study's findings, which cannot prove the outcomes they describe but are derived from a mathematical model based on the best available demographic and health data, are timely given the United States Department of Agriculture's commitment at the time to updating the school meal nutrition standards to align with the 2020-2025 dietary guidelines. (Update: in April 2024 the USDA finalized new school meal standards that phase in limits on added sugars from July 2025 and reduce sodium by July 2027.) The price to fully implement new school meal standards is yet to be determined, but previous alignments suggest it would add at least another $1 billion nationally to the cost of these programs, or only about 5 percent of the total predicted annual long-term healthcare savings this change would yield.

Research reported in this article was supported by an award from the National Institutes of Health's National Heart, Lung, and Blood Institute (R01HL115189) and the Center for Science in the Public Interest. Complete information on authors, funders, methodology, and conflicts of interest is available in the published paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Reference: Evaluation of Health and Economic Effects of United States School Meal Standards Consistent With the 2020-2025 Dietary Guidelines for Americans. The American Journal of Clinical Nutrition, July 2023.

Resources Providing Related Information

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

How many children eat school meals in the United States?

The National School Lunch Program serves nearly 30 million children on a typical school day, and the School Breakfast Program reaches millions more. Many students get a large share of their daily nutrition from these meals.

What counts as a whole grain food in school meals?

A whole grain food contains the entire grain kernel, including the bran, germ and endosperm, such as whole wheat bread, brown rice and oatmeal. Refined grains remove the bran and germ, lowering fiber and nutrients.

Why is sodium a concern for children?

Diets high in sodium are linked to higher blood pressure, and blood pressure patterns that begin in childhood can carry into adulthood. Most sodium in children's diets comes from processed and restaurant foods rather than the salt shaker.

What is a simulation model in nutrition research?

A simulation model uses existing data on diets, health and costs to estimate what would happen under different policy choices. It cannot prove cause and effect, but it helps policymakers compare likely outcomes.

Can schools accommodate children with special dietary needs?

Yes, schools in federal meal programs must make reasonable modifications for children whose disability restricts their diet, usually with a written statement from a licensed medical authority. Schools may also accommodate other needs when possible.

Most school districts post weekly or monthly menus online, often with nutrition and allergen details. School nutrition directors can answer questions about ingredients and options.

Do healthier school meals cost families more?

Free and reduced-price meals remain available to eligible families, and some states now offer free meals to all students. Program costs for healthier standards are largely covered through federal reimbursement and school budgets.

What can families do at home to support healthier eating?

Offering water instead of sugary drinks, choosing whole grain breads and cereals, and cooking more meals at home can lower sugar and sodium intake. Involving children in planning and preparing meals can also build healthy habits.

Insights, Analysis, and Developments

Editorial Note: School food is one of the few nutrition programs that reaches millions of children every weekday regardless of family income, which is why even modest changes to its standards can add up to large public health effects. Since this study appeared, the U.S. Department of Agriculture has finalized updated school meal rules that phase in limits on added sugars starting in 2025 and a further reduction in sodium by July 2027, moving the program toward the targets modeled by the Tufts team. The research is based on simulation rather than direct observation, so its estimates show likely direction and scale rather than guaranteed outcomes. For parents and caregivers, the practical takeaway is that school meals are already among the healthiest options most children eat, and supporting whole grain and lower sugar choices at home reinforces those gains.*

Attribution/Source(s): This peer-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally issued as a press release by Tufts University and published on 31 Jul 2023. Last updated on 4 Nov 2026. This content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.