Getting kids to take a healthy lunch from home is one way to fight the high-fat, high-sugar, and high-sodium offerings found in many school cafeterias and vending machines, says McAllister, author of Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim.

But even McAllister -- a family practice doctor in Kingsport, Tenn., who specializes in nutrition and weight loss -- concedes that in the end, parents have to let kids make a lot of their own food choices. "You can't be completely hard-nosed about this," she says.

The crusade to get children to eat more healthfully during the school day is one that McAllister and other health-care professionals, educators, and parents are serious about -- and with good reason.

Public school lunches must meet U.S. Department of Agriculture standards for nutrition (for example, no more than 30% of their total calories can come from fat). And many schools take pains to make sure their offerings include healthy choices. But that's not necessarily translating to our children eating better at school.

One reason, many experts say, is the "a la carte" items offered alongside the standard school lunch, or sold at in-school snack bars or vending machines (often, proceeds go to help the schools meet their budgets). Further, some physicians' groups believe that the USDA guidelines don't go far enough to ensure that children eat healthfully.

Several recent studies have offered less-than-encouraging news:

• A 2003 study by University of California-San Diego researchers found that middle school students were taking in too much fat at school. The researchers estimated that the average student was consuming 26 total grams of fat at school -- although a healthy figure would be more like 20 grams. Some of this extra fat came from snack items sold in vending machines and student-run stores. But the study also found that the average cafeteria-cooked lunch had 31 grams of fat, compared with only 21 grams found in lunches students brought from home.
• A May 2004 study by the Center for Science in the Public Interest found that vending machines in public schools are stocked mostly with high-fat snacks and sugary drinks and may be undercutting federal efforts to improve the nutritional quality of school meals. The researchers looked at more than 1,400 school vending machines. They found that 75% of beverages offered in the machines were high-sugar sodas and imitation fruit juices, and 80% of the available snack foods were candies, chips, or sweet baked goods.
• A March 2004 study by Baylor College of Medicine researchers found that when children moved up to middle school from elementary school, they started consuming less fruit, milk, and vegetables, and more sweetened drinks and high-fat vegetables (like french fries). The snack bars often found in middle schools might be part of the reason, the researchers say.

All this is despite the fact that poor eating habits in children not only contribute to childhood obesity but also may increase the risk that they will develop certain chronic diseases as adults, experts say. The prevalence of childhood obesity in the U.S. has doubled since the 1970s.

But things are changing. With the implementation of School Wellness Policies there is greater emphasis on offering healthier options in all food and beverages available in schools.

What's a Parent to Do?

Much as you might like to, you can't follow your children around school all day to make sure they're choosing healthy foods. So what's a parent to do?

McAllister, of course, thinks bringing lunch from home is the best alternative. Not only does this let you decide what they have for lunch, but it also helps keep them away from the vending machines.

"There's no guarantee what the kids will use their lunch money for once they get to school," she says. "You have no control over where that money goes once they leave home."

It's important for kids to have choices, though, she says. So before you pack their lunches or hit the grocery story, ask them what they want: What kind of fruit would they prefer? Which vegetable? What kind of dip? (Kids love to dip, she says; chop broccoli into bite-size pieces and add a container of fat-free dip, and your kids might actually eat their veggies.)

This doesn't mean junk food is an option. "Let the kids have tons of choices, but make sure they're good choices," McAllister says. "A choice between a Ho-Ho and a Ding-Dong is not a choice."

Try to include the five food groups in every lunch, McAllister says: protein, whole grains, fruit, vegetables, and calcium-rich foods. "Kids don't have a lot of time to eat," she says. "You need to get the most nutrition into them in the least amount of time as possible."

And skip the cookies or other sweets. "Dessert is a treat, not a staple," McAllister says.

If bringing lunch to school isn't considered "cool" among your children's friends, make sure your children get to select their own lunch bags -- whether it's a trendy lunch box with their favorite celebrity or action figure, or an attractive insulated bag that looks more like a fashion accessory than a lunch carrier.

If your children want to buy their lunch at school, encourage them to choose the salad bar, if that's an option, says McAllister. Lean ham, shredded cheese, fruits, and vegetables are good choices, she says.

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Avoid Brown-Bag Boredom

If you run out of fresh ideas for brown-bag lunches, here are a few suggested by Jody Villecco, Whole Foods Market's top nutritionist, and Jyl Steinbeck, author of 10 cookbooks for healthy living, including the upcoming Busy Mom's Make It Quick Cookbook:

• Mozzarella cheese sticks with baked tortilla chips, a container of salsa, and orange segments
• Fruit, cheese, and meat kabobs: Alternately thread turkey (or other low-fat meat), cheese cubes, bell pepper, and pineapple chunks on Popsicle sticks.
• Yogurt parfait: A 6-8 oz. container of low-fat yogurt, a snack pack of low-sugar, high-fiber cereal, berries, grapes, apple slices, and/or banana
• A low-fat tortilla spread with low-fat cream cheese, sprinkled with shredded carrots and raisins.
• A pita pocket stuffed with lunchtime favorites like tuna, turkey and/or cheese, and chopped vegetables (or with peanut butter and jelly).
• Cinnamon-raisin pita bread stuffed with cream cheese and grated carrots.
• Whole-wheat bread with peanut butter, banana, and chopped dates.
• A hollowed-out red or green pepper stuffed with tuna salad.
• A hollowed apple filled with a mixture of farmer cheese, granola, and raisins
• Scooped-out dinner rolls filled with tuna or egg salad.

Reality Check

Even if you pack the most delicious lunch imaginable, it's not likely you'll be able to keep your children away from the vending machines 100% of the time.

Not to worry, says McAllister -- as long as your children don't eat the snacks instead of a healthy lunch, and as long as they don't overdo it.

"As long as most of your child's lunches are healthy, an occasional soda, bag of chips, or candy bar is not a problem," she says.

Not all vending-machine choices are bad, either. The Center for Science in the Public Interest notes that some of the best ones include unsweetened applesauce cups and fruit cups, cereal mix, low-fat milk, granola bars, dried fruit, bottled water, and 100% juice

So just how do you get your kids to make these kinds of choices? That's where educating them about good nutrition at home -- and, especially, modeling healthy eating behaviors -- comes in. "Parents should eat healthy meals themselves," says Charles Shubin, MD, director of pediatrics at Mercy FamilyCare in Baltimore and an associate professor of pediatrics at the University of Maryland. "They have to set the example."

Christine Gerbstadt, RD, a spokeswoman for the American Dietetic Association, couldn't agree more.

"Kids need the support of both their family and their school to make sound nutritional choices," she says.

By Carol Sorgen. 
Reviewed By Kathleen Zelman, MPH, RD, July 25, 2007.
Originally published Monday, August 8, 2004
Medically updated July 25, 2007

SOURCES: Rallie McAllister, MD, author, Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim , Kingsport, Tenn. Charles Shubin, MD, director of pediatrics, Mercy FamilyCare, Baltimore. Christine Gerbstadt, RD, spokeswoman, American Dietetic Association, Altoona, Pa. Jyl Steinback, cookbook author, Scottsdale, Ariz. Jody Villeco, nutritionist, Whole Foods Markets. News release, University of Utah. News release, Center for the Advancement of Health. News release, Center for Science in the Public Interest. WebMD Medical News: "Kids Eat Too Much Fat at School,' by Jennifer Warner, published Jan. 10, 2003. WebMD Medical News: "Study Shows Junk Food Rampant in Schools," by Todd Zwillich, published May 11, 2004. WebMD Medical News: "Kids' Diets Worsen as They Move Up in School," by Jennifer Warner, published April 13, 2004. WebMD Medical News: "Best & Worst of School Vending Machines," by Jennifer Warner, published Sept. 15, 2003. WebMD Medical News: "TV and Soda Linked to Childhood Obesity," by Jennifer Warner, published Sept. 8, 2003. Healthyschoollunches.org.