Healthier choices and increased participation in a middle school lunch program: effects of nutrition policy changes in San Francisco.

In order to address overall nutritional health, including increases in numbers of overweight children and adolescents, the San Francisco Unified School District implemented a progressive nutrition policy beginning in August 2003. We review this policy and focus on its impact on school and district revenues and students' participation in the federally subsidized school lunch program. We examined changes in menu items and the consequent effects of these changes on student eating patterns and school revenues at Aptos Middle School in San Francisco. This case study and additional district data show that provision of healthy menu options led to increased student participation in the federal school lunch program.