We like to say that food is medicine, yet the nation’s largest daily prescription is written with virtually none of the safeguards that govern drugs. Every year, the National School Lunch Program (NSLP) serves about 4.7 billion lunches and 2.4 billion breakfasts to 30 million children, making it, functionally, the biggest fast-food chain in America.
Pediatrician Dr Manasa Mantravadi, founder of Ahimsa, calls those trays “medicine at school,” because for many kids in low-income ZIP codes breakfast and lunch are the only reliable meals they get. But that “medicine” is routinely ultra-processed, sugar-laden, packed in endocrine-disrupting plastics, and reheated in a convenience-first system imported from 1970s food-service commercialization. We have boxed children into an impossible choice: hunger or health.
The rising rates of chronic conditions in children are raising red flags for pediatricians forced to treat these preventable diet-related diseases. Severe obesity diagnosed in a four-year-old can cut life expectancy in half; Type 2 diabetes, once an adult disease, now appears regularly in overweight teens. A scan of 1,200 cereals sold to children between 2010 and 2023 found added sugar up 11% while protein and fiber plunged. Meanwhile, ADHD, anxiety, and autism climb in lock-step with diets stripped of micronutrients and laced with chemicals that act as obesogens. Because low-income students rely most on subsidized meals, they carry the heaviest burden of diet-driven disease — exactly the inequity school food was meant to reduce.
Beyond health, poor cafeteria fare saps learning. Multiple studies link higher fruit-and-vegetable consumption to improved math and reading scores, fewer disciplinary referrals, and better attendance. Districts that have shifted to scratch-cooked menus —Berkeley, CA; Boulder, CO; Minneapolis, MN — report double-digit gains in test performance and lower plate waste, proving kids will eat wholesome food when it tastes good and looks familiar. Financially, every dollar schools spend on local produce returns up to $2.16 in community economic activity, creating rural jobs while feeding urban children. Environmentally, replacing commodity frozen entrées with regionally sourced ingredients can cut cafeteria greenhouse-gas emissions by 35% — another benefit taxpayers care about.
To fix the problem, first, re-classify school meals as healthcare and give FDA and HHS joint authority with USDA, mirroring Europe’s split between medicines and food. Second, purge ultra-processed foods, phase out synthetic dyes and additives, and require scratch-cooked, locally sourced, nutrient-dense menus. Third, the Dietary Guidelines should be rewritten for 2025, and strict added-sugar and sodium caps should be locked in. Fourth, restore and expand the $1 billion in capital grants Congress rescinded — funds schools need for commercial kitchens, staff training, and fresh procurement. Secretary Robert F. Kennedy Jr. has outlined a similar five-point plan, but without funding and cross-agency muscle, it remains a white paper.
Some will argue these changes cost too much. The opposite is true. Staying the course condemns today’s children to lifetimes of chronic disease — and, for the first time in U.S. history, the prospect of dying younger than their parents. Dr. Mantravadi believes school lunch should be viewed as part of pediatric healthcare and as a critical investment into our nation’s health. Treating those chronic conditions already drains hundreds of billions of dollars a year. Serving authentic food at school is preventive medicine with the highest return. She believes a modest 5% percent cut in future diabetes incidence would save Medicare $45 billion over a decade — far more than the price tag of new kitchens and fresh produce.
In April, Spain mandated all public and private schools to prohibit the sale and serving of sugary drinks (including soft drinks, juices, and energy drinks) and processed pastries in school cafeterias and vending machines, offer daily servings of fresh fruits and vegetables, with at least 45% being seasonal and 5% organic, serve fish one to three times per week and include legumes and whole grains in weekly menus, and limit pre-cooked and fried foods to specific frequencies, ensuring healthier preparation methods.
The Healthy, Hunger-Free Kids Act of 2010 set nutritional standards for school meals, but it does not explicitly ban processed foods or sugary drinks. In the US., the first Trump administration relaxed some of the standards, such as schools being allowed to offer refined grains instead of only whole-grain options, the requirement for reducing sodium in school meals was eased, and schools were allowed to offer 1% flavored milk instead of only non-fat options.
Secretary Kennedy wants to swap heat-and-serve, highly processed items for scratch-made meals built around fresh, locally sourced ingredients, while stripping out synthetic dyes, other chemical additives, and excess sugar/salt. Until the NSLP and School Breakfast Program are treated as public-health tools — regulated, financed, and scrutinized with the rigor we apply to pharmaceuticals — our food-as-medicine rhetoric will ring hollow, and kids will pay the price in shorter, sicker lives. It is time to shift school meals from the agriculture ledger to the health ledger and give our youngest citizens the nutrient-rich start they deserve.
On June 5, Littleton Public School District, which has a nationally recognized nutrition program, is hosting The School Nutrition Exchange: Northeast Regional Roundtable, in partnership with Action for Healthy Kids, welcoming over 20 school districts, state and federal legislators, pediatricians, chefs, nonprofits, and USDA leaders to explore how scratch-cooked, locally sourced, and waste-free school meals can reverse chronic disease trends, support local economies, and protect the environment.
Littleton’s program is built on four pillars: scratch cooking, local sourcing, sustainability, and nutrition education. Learn more on June 5 at Littleton Middle School (55 Russell Street, Littleton), 8:00 a.m. – 1:30 p.m. (farm tour to follow). To RSVP or for more information, contact Leah Botko at Littleton Public Schools at [email protected] or 978-751-4565.
Ed Gaskin is Executive Director of Greater Grove Hall Main Streets and founder of Sunday Celebrations
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