Clearly, taken together, more can be learned from the experiences in LAC and SCC. Further research using methods such as dietary pattern scores is needed and could provide additional insights on the impacts of these food-based offerings or strategies on student eating behaviors. The LAUSD experience in LAC suggests that a multicomponent approach was beneficial for introducing, integrating, and supporting healthy food modifications to the SY 2011–12 menus. The “I’m IN” public education campaign, for example, augmented the student and parent taste testing by LAUSD by helping to prepare students for the new menu items that were introduced (Table 1). Age-appropriate

portion see more sizes for some of the meal categories also enabled reductions in key nutrients without significant modifications to

food composition or taste. However, this latter action did contribute to unintended effects — e.g., the lowering of desirable nutrients such as protein and fiber. In addition, these complementary strategies do not necessarily improve nutrition for everyone. For instance, for those children whose energy intake is appropriate, simply reducing portion size does not alter the food selection or the composition of their diet, which may still be poor. Children can also compensate for lost energy Alectinib clinical trial intake by consuming undesirable foods from other sources. School districts in the U.S. that are contemplating similar menu changes to their student meal program may find food-based menu planning more logistically feasible and in line with the USDA Final Rule (USDA, 2012). Protein, fiber, and other healthful nutrients are vital for ensuring proper nutrient intake among students and should be taken into account when making menu changes. Another factor to consider is children and adolescents who are not receiving adequate nutrient intake (i.e., poor

diet composition with excess energy intake). This can occur even among children who are obese, not just for those who are underweight. Moderately active children, ages 4–8, for example, need 1400–1600 kcal per day; those, ages 9–13, need 1800–2200 kcal per day. Sedentary children and adolescents require the lower end of this range (USDA, 2010). In LAC and SCC, the average Electron transport chain school meal caloric ranges were between 380 and 830 kcal per meal. Recognizing the influential role that taste can play in food selection, the LAUSD (in LAC) conducted 30,000 + taste tests prior to finalizing the menu for SY 2011–12 (Table 1). SCC took similar actions to improve the appeal of their new menu items to increase student receptivity (Mason et al., 2012). SCC school districts, for example, made changes to the formula of the school meals while concurrently providing public education to parents and students about the benefits of healthy eating (Table 1).