{'fraction_non_alphanumeric': 0.030561674008810574, 'fraction_numerical': 0.017345814977973568, 'mean_word_length': 5.452930728241563, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Letters to the Editor

We appreciate the opportunity to comment on the article by Amin et al., “Impact of the National School Lunch Program on Fruit and Vegetable Selection in Northeastern Elementary Schoolchildren, 2012–2013,” which appeared in the September/October 2015 issue of Public Health Reports.1 The topic of fruit and vegetable (FV) waste is central to discussions regarding school lunch policy nutrition changes in the Healthy, Hunger-Free Kids Act (HHFKA).2 Amin et al. reported that students in two northeastern elementary schools selected more FVs but consumed less and wasted more in the post-implementation period than during the preimplementation period.1 Although this important finding suggests challenges associated with implementing federal standards, the study design had several flaws. For one, the study used data from an assessment tool validation study. As such, FV selection, consumption, and waste were measured by using differences in mean values rather than individual-level data. Furthermore, menus before and after HHFKA implementation were not provided. It is likely that recipes changed to meet HHFKA standards, potentially resulting in foods that were less appealing to students. The authors cited four studies, suggesting that their findings may have broad application. However, subject age and time of measurement/program evaluation potentially limited comparison. Byker et al. (2014) evaluated pre-kindergarten and kindergarten students,3 whereas Amin et al. evaluated thirdthrough fifth-grade students.1 It is likely that eating patterns between age groups differ greatly. Wengreen et al. (2014) measured FV selection, intake, and waste during the semester of policy implementation, possibly not allowing for an adequate adaptation period.4 Just and Price (2013) failed to mention study population age and evaluation timeline.5 Finally, in the Limitations section, Amin et al. argued that their findings were consistent with the findings of Cohen et al. (2014). However, in the Discussion section, Amin et al. reported that Cohen et al. demonstrated increased vegetable consumption after HHFKA implementation.6 It is likely that insufficient time has passed to accrue enough evidence to broadly understand HHFKA effects on food waste. However, several pilot studies demonstrated improvements in FV intake without increased waste.7–10 Similar findings were reported in post-implementation studies.11–13 Cullen et al. (2015) evaluated selection, consumption, and waste in eight southeast Texas elementary schools. After HHFKA implementation, students selected more FVs without increased waste (except for legumes).11 In a similar study design among 12 urban middle schools, Schwartz et al. (2015) reported that under HHFKA, fruit selection and consumption increased, while vegetable consumption increased and vegetable selection decreased. Overall, FV waste decreased from the preto post-implementation period.12 Fox measured consumption and waste of middle school students in Cache County, Utah,13 participating in the “Food Dudes” program, a school-based nutrition intervention promoting increased FV intake by repeated taste testing, positive role models, and incentives.14 Initially, students resisted HHFKA changes and increased FV waste; however, less waste and more consumption of FVs occurred during the second semester of the policy compared with the pre-policy period.13 Most studies have demonstrated positive food behavior changes as a result of HHFKA. A complete understanding of reported difficulties and successes is critical as policy makers work to reauthorize HHFKA this year.