December 2022

Literature Review
Benefits of Healthy School Meals for All
Sarah Martinelli MS, RD, SNS; Francesco Acciai, PhD; Emily Melnick, MPH, PhD; Punam Ohri-Vachaspati, PhD, RDN

School meals contribute to the health and well-being of children, a fact that became apparent at the
begining of the COVID-19 pandemic when schools were closed and student access to meals was
limited. In response, USDA instituted waivers that allowed all students, irrespective of household income,
to have access to free school meals during COVID-related school closures. The success of these
policies has led several states in the country to continue offering free school meals to all children at no
cost after the USDA waivers ended. This initiative is often referred to as Healthy School Meals for All
(HSM4A) and has become an important policy approach to ensure that all children have adequate
access to food and are able to benefit from healthy school meals. An alternative strategy to HSM4A
that can increase access to school meals for some of the most vulnerable students is to remove the
reduced-price co-pay. Removing this co-pay barrier can benefit many families who qualify for reducedprice meals but cannot afford the required co-pays.
To better understand the wide range of benefits
increased access to school meals provides to
students, families, and schools, a literature
review of published research examining these
benefits was released in 2021. The review outlined
seven key findings associated with the
implementation of HSM4A, including
improvements in (1) school meal participation, (2)
diet quality of students who participate in meals,
(3) food security of participants’ families, (4)
academic performance, (5) attendance, (6) body
mass index, and (7) school finances. Those
findings are summarized below and can also be
found here.
Since the publication of that literature review in 2021, additional studies have been published, which
add to the body of literature showing the benefits of policies that increase access to school meals. Key
findings from these new studies are summarized in the table below. A formal write-up of these
results is also underway and will be shared by the Arizona Food Bank Network (AzFBN) soon.

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Summary of 2021 Literature Review Key Findings1
Participation in School Meals
Nearly all studies found an association between HSM4A
and increased participation in school meals.
Diet Quality
The majority of studies found an association between
universal lunch and better student diet quality.
Food Security
There is evidence that HSM4A improves food security,
especially for low-income families; however, only a few
studies have evaluated this.
Academic Performance
Nearly half the studies found universal lunch is positively
associated with academic performance, none found
adverse effects.
Attendance
Half the studies found HSM4A significantly improves
student attendance among students from low-income and
food-insecure households; no studies found adverse
impacts on attendance.
Body Mass Index (BMI)
HSM4A has been shown to not increase BMI.

School Finances
Some evidence that food service budgets benefit from CEP,
especially in schools with more students eligible for free or
reduced-price meals.

Summary of Key Findings Since 2021
All studies that examined participation, all reported small
increases in meal participation (2-5%) after the implementation
of HSM4A or Universal Free Breakfast.2,3,4,5
None of the newer studies has focused on student diet quality.

Only one study examined the relationship between the
implementation of free school meals in low-income schools
and food security and found no significant associations.2
Only one newer study examined academic achievement.
There was no change in achievement scores resulting from
HSM4A in the full sample, but marginal improvement in
reading scores was observed among Hispanic children.2
Two newer studies examined the association between school
attendance and HSM4A.2,3 The first examined universal free
breakfast only and reported no change in attendance.3 The
second study examined universal free breakfast and lunch and
reported a small increase in attendance.2
The newer studies that examined BMI are consistent with the
prior finding that HSM4A does not increase BMI.1,2 Andreyeva
& Sun add that low-income students from schools participating
in HSM4A had lower BMI.3
One newer study examined school finances and supported the
prior findings. This newer study reports that larger schools see
a greater financial benefit.6

Citations
1.
Cohen, J.F., Hecht, A.A., McLoughlin, G.M., Turner, L. and Schwartz, M.B., 2021. Universal school meals and
associations with student participation, attendance, academic performance, diet quality, food security, and
body mass index: A systematic review. Nutrients, 13(3), p.911.
2.
Andreyeva, T. and Sun, X., 2021. Universal School Meals in the US: What Can We Learn from the Community
Eligibility Provision? Nutrients, 13(8), p.2634.
3.
Bullock, S.L., Dawson-McClure, S., Truesdale, K.P., Ward, D.S., Aiello, A.E. and Ammerman, A.S., 2022.
Associations between a Universal Free Breakfast Policy and School Breakfast Program Participation, School
Attendance, and Weight Status: A District-Wide Analysis. International Journal of Environmental Research and
Public Health, 19(7), p.3749.
4.
Ferris, D., Jabbari, J., Chun, Y. and Sándoval, J.O., 2022. Increased School Breakfast Participation from Policy
and Program Innovation: The Community Eligibility Provision and Breakfast after the Bell. Nutrients, 14(3),
p.511.
5.
Schneider, K.R., Oslund, J. and Liu, T., 2021. Impact of the community eligibility provision program on school
meal participation in Texas. Public Health Nutrition, 24(18), pp.6534-6542.
6.
Long, M.W., Marple, K. and Andreyeva, T., 2021. Universal free meals associated with lower meal costs while
maintaining nutritional quality. Nutrients, 13(2), p.670.

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