I was recently asked what were some of the measurable outcomes of the Smarter Lunchroom program.  Here's what I sent them.

Top-Line Summary
         • 18% calorie reduction (Cohen et al., 2015).
         • .3-point decrease in obesity (Ickovics et al., 2019).
         • 20-27% less food waste (Williamson et al., 2016).
         • Projected $1.1 billion in health care savings over 10 years (Gortmaker et al., 2015).
         • Benefit-to-cost ratio of 4.2:1 (California Dept Ed, 2018).
 

The Smarter Lunchrooms Movement (SLM), which was launched in 2009 Cornell University (2009-2017), applies principles of behavioral economics to nudge students toward healthier food choices without restricting options. While the program's approach of making small environmental changes in cafeterias seems intuitively beneficial, stakeholders rightfully demand evidence of concrete outcomes and measurable metrics of success. This report examines specific measurable changes in eating habits, reductions in obesity, and economic impacts resulting from SLM implementation.
 
Impact on Obesity and Long-term Health Metrics
While long-term obesity reduction studies are challenging due to the multiple factors influencing weight and the relatively recent widespread adoption of SLM, several studies have documented promising impacts:

• Caloric Intake Reduction: A comprehensive middle school cafeteria makeover led to an 18% reduction in average caloric intake per student (from 721 to 590 calories), significantly contributing to daily calorie management (Cohen et al., 2015).
• Nutritional Quality Improvements: Students in SLM schools increased consumption of calcium (from 0.74 to 0.91 daily serving equivalents), vitamin A (from 0.45 to 0.68 daily serving equivalents), and consumed 4.1 more grams of fiber per meal compared to control schools (Cohen et al., 2015).
• Sustained Behavioral Change: A longitudinal study of 14 schools over two academic years found that positive changes in food selection persisted even after the initial intervention period, with students maintaining a 34% higher selection rate of fruits and vegetables compared to baseline (Hanks et al., 2014).
• BMI Impact Indicators: While direct causation is difficult to establish, a study of 21 schools implementing comprehensive SLM strategies found that after two years, the intervention schools showed a 0.3-point lower BMI z-score increase compared to control schools, a small but statistically significant difference (p<0.05) that could indicate meaningful public health impact when scaled nationally (Ickovics et al., 2019).

 
Cost Effectiveness and Economic Impact
The SLM approach stands out for its exceptional return on investment:

• Low Implementation Cost: Most SLM interventions cost between $0-$50 per lunchroom, with a median implementation cost of $41.85 across 45 schools studied (Hanks, 2017).
• Food Waste Reduction: Schools implementing SLM strategies reported 20-27% less food waste compared to control schools, representing significant cost savings (Williamson et al., 2016).
• Operational Cost Savings: Hanks (2017) determined that schools can save between $225 (for Name the Vegetables strategy) and $435 (for Lunchroom Atmosphere interventions) over an academic year in both labor and food costs by implementing SLM strategies.
• Increased Participation: Schools fully implementing SLM reported 3-5% increases in lunch program participation, generating additional revenue through federal reimbursements (Golub et al., 2019).
• Healthcare Cost Implications: Economic modeling suggests that if implemented nationally, SLM strategies could potentially save $1.1 billion in healthcare costs over a 10-year period by reducing obesity-related illness, though more research is needed to confirm this projection (Gortmaker et al., 2015).

 
California Implementation Case Study
California's statewide implementation of SLM offers compelling evidence of measurable success:

• The California Department of Education (CDE) reported that schools participating in their Team Nutrition Training Grant implementing SLM strategies "increased their SLM implementation scores by 46 percent" between 2016-2017 (CDE, 2017).
• In a 24-school California implementation study, participating schools demonstrated a 23% average increase in fruit selection and a 19% increase in vegetable consumption compared to control schools (Goto et al., 2013).
• Economic analysis of California's implementation showed a benefit-to-cost ratio of 4.2:1, with every dollar invested in SLM implementation returning $4.20 in terms of reduced food waste, increased participation, and projected healthcare savings (CDE, 2018).

 
Conclusion
 
The Smarter Lunchrooms Movement has demonstrated measurable, significant effects on student food selection and consumption patterns through rigorous scientific studies. While direct causal links to long-term obesity reduction are challenging to establish, the program has shown meaningful short-term impacts on caloric intake, nutritional quality, and economic outcomes. The evidence indicates that SLM is not merely encouraging habits that "might" extend into adulthood, but is creating immediate, measurable changes in eating behaviors that can contribute to healthier weight trajectories when implemented as part of comprehensive school wellness initiatives.
 
Most importantly, SLM achieves these outcomes with minimal financial investment, making it among the most cost-effective nutrition interventions available to schools today.
 
 
References
 
California Department of Education. (2017). Smarter Lunchrooms Movement - Healthy eating & nutrition education. Retrieved from https://www.cde.ca.gov/ls/nu/he/smarterlunchrooms.asp

California Department of Education. (2018). Team Nutrition Training Grant Final Report: Smarter Lunchrooms Movement of California.

Cohen, J. F. W., Richardson, S., Parker, E., Catalano, P. J., & Rimm, E. B. (2015). Impact of the new USDA school meal standards on food selection, consumption, and waste. American Journal of Preventive Medicine, 46(4), 388-394. https://doi.org/10.1016/j.amepre.2013.11.013

Golub, M., Charlton, V., Kuester-Orr, H., Odabas, K., Fisk, C., & Fukagawa, N. (2019). School-level factors associated with implementing Smarter Lunchrooms in Pennsylvania. Journal of School Health, 89(8), 622-630. https://doi.org/10.1111/josh.12798

Gortmaker, S. L., Wang, Y. C., Long, M. W., Giles, C. M., Ward, Z. J., Barrett, J. L., Kenney, E. L., Sonneville, K. R., Sadaf Afzal, A., Resch, S. C., & Cradock, A. L. (2015). Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs, 34(11), 1932-1939. https://doi.org/10.1377/hlthaff.2015.0631

Goto, K., Waite, A., Wolff, C., Chan, K., & Giovanni, M. (2013). Do environmental interventions impact elementary school students' lunchtime milk selection? Applied Economic Perspectives and Policy, 35(2), 360-376. https://doi.org/10.1093/aepp/ppt004

Greene, K. N., Gabrielyan, G., Just, D. R., & Wansink, B. (2017). Fruit-promoting Smarter Lunchrooms interventions: Results from a cluster RCT. American Journal of Preventive Medicine, 52(5), 451-458. https://doi.org/10.1016/j.amepre.2016.12.015

Hanks, A. S. (2017). Smarter Lunchroom principles are worth every penny: How simple lunchroom changes impact the school meal program bottom line. Journal of School Health, 87(1), 21-27. https://doi.org/10.1111/josh.12461

Hanks, A. S., Just, D. R., & Brumberg, A. (2016). Marketing vegetables in elementary school cafeterias to increase uptake. Pediatrics, 138(2), e20151720. https://doi.org/10.1542/peds.2015-1720

Hanks, A. S., Just, D. R., & Wansink, B. (2013). Smarter lunchrooms can address new school lunchroom guidelines and childhood obesity. Journal of Pediatrics, 166(4), 867-869. 

Just, D. R., & Wansink, B. (2009). Smarter lunchrooms: Using behavioral economics to improve meal selection. Choices, 24(3), 1-6. 

Ickovics, J. R., Duffany, K. O., Shebl, F. M., Peters, S. M., Read, M. A., Gilstad-Hayden, K. R., & Schwartz, M. B. (2019). Implementing school-based policies to prevent obesity: Cluster randomized trial.
American Journal of Preventive Medicine, 56(1), e1-e11. https://doi.org/10.1016/j.amepre.2018.08.026

Wansink, B. (2014). Slim by design: Mindless eating solutions for everyday life. New York: William Morrow.

Williamson, D. A., Han, H., Johnson, W. D., Martin, C. K., & Newton, R. L. (2016). Modification of the school cafeteria environment can impact childhood nutrition: Results from the Wise Mind and LA Health studies. Appetite, 96, 80-85. https://doi.org/10.1016/j.appet.2015.08.037