Date of Award

Summer 6-22-2015

Degree Type


Degree Name

Master of Science (MS)



First Advisor

Dr. Anita Nucci, PhD, MPH, RD, LD

Second Advisor

Dr. Sarah Henes, PhD, RD, LD

Third Advisor

Farrah Keong, MPH


Background: In 2012, more than one in three American youth were classified as overweight or obese. The cause of obesity is multifactorial. However, environmental influences and behavioral characteristics appear to have more impact on the development of obesity than genetics and/or cultural background. In response to an Institute of Medicine briefing detailing recommendations for changes to school meals, the Healthy, Hunger-Free Kids Act of 2010 was passed to update nutrition guidelines for schools participating in the National School Lunch and School Breakfast Programs. This Act seeks to help reduce childhood obesity through the provision of nutritionally balanced school meals.

Methods: We conducted a secondary analysis of data collected by Children’s Healthcare of Atlanta as part of its Strong4Life School Nutrition Program. School nutrition managers in a South Georgia school district participated in a dietitian-led training, inclusive of a pre- and post-training survey. Food production data including the number

of servings of foods prepared and sold in elementary schools in the same school district were also collected during the weeks preceding the manager training and post training. Observations of the cafeteria organization were also recorded pre and post training. Frequency statistics were used to describe the pre- and post-survey and food production data. A Wilcoxon signed-rank test was used to compare pre- and post-survey scores. Cafeteria organizational changes were compared for improvement pre- and post-training.

Results: Of the 30 school nutrition managers who completed the pre- and post-surveys, 23 (77%) provided identifying information and were included in this analysis. The average pre- and post-survey scores were 4.9 and 5.8, respectively (18.4% increase). Twelve participants received a higher score after the training session, 10 had no change in score, and one participant’s score decreased following the training. The vast majority of managers (>90%) indicated that they would like to encourage changes in the cafeteria to promote healthy choices and that they felt confident in their abilities to provide guidance to cafeteria staff to make such changes. Manager perception of overweight and obesity in the state of Georgia being “very serious” or “somewhat serious” increased from 93% before the training to 100% following the training. Six of the 12 schools in which food production data was obtained showed improvement in the percentage of students who chose skim or 1% plain milk vs. flavored milk. Seven schools showed an improvement in the percentage of fruit sold between March and October, four showed an improvement in vegetables sold.

Conclusions: School nutrition managers showed increased nutrition knowledge and belief in their individual ability to act as a role model in the school cafeteria after completing a dietitian-led training session. No association was found between increased nutrition knowledge of managers and changes in student food purchasing habits. Future iterations of this training program should include collection of the name of the school(s) in which the manager presides to determine association between increased nutrition knowledge and/or changed perception of role in promoting healthy habits and changes in student purchasing habits.