Banning chocolate milk from school cafeterias can have unintended consequences

By Will Boggs MD

NEW YORK (Reuters Health) - Banning chocolate milk from school cafeterias may result in reduced calorie and fat consumption, but it also leads to less milk consumption and other negative consequences, according to a pilot study.

Chocolate milk accounts for more than 60% of the milk available in schools, but some schools are banning flavored milk from cafeterias in an effort to reduce sugar consumption and address the obesity epidemic.

Dr. Brian Wansink and colleagues from Cornell University in Ithaca, New York, wondered if banning flavored milk from schools would influence overall milk selection and consumption, so they conducted a before-after study in 11 Oregon elementary schools.

After the school food service removed chocolate milk and offered skim milk instead, the average number of 8-oz units sold per day in each school dropped from 190 to zero, but 90% of chocolate milk sales were recovered by 1% fat and skim white milk options.

Still, milk sales averaged 30 units per day fewer after the change, according to the April 16 PLoS ONE online report.

Overall, there was an 8.2% decline in the proportion of students who took milk. This may underestimate the actual consumption, though, because students wasted an average of 29.4% more of the milk they took after the change (40.9%), compared with students in schools where chocolate milk was still available (31.7%).

Along with changes in milk consumption after chocolate milk was removed from the menu, there was a significant 6.8% decline in participation in the National School Lunch Program, suggesting that eliminating chocolate milk could decrease the number of students ordering lunches.

"This exploratory study underscores the need for full-scale follow-up studies," the researchers say. "Food service managers need to carefully weigh the costs and benefits of eliminating chocolate milk and should consider other solutions, such as making chocolate milk less convenient to select and making white milk appear more convenient, attractive, and normal."

Dr. Joanne Slavin from the University of Minnesota in St. Paul, who commented on the study for Reuters Health, said in an email, "Policymakers must stop working in a vacuum - perhaps some time running a school lunch program or understanding the life of a typical adolescent would help."

"So the PLoS ONE article tells us the surprising result - only to a bureaucrat - that children walk on by and don't take and consume the low fat, unflavored milk - or if they are forced to take it, it ends up in the trash," Dr. Slavin said. "Hopefully policymakers will appreciate that banning chocolate milk - although it may reduce consumption of 'added sugar' - will seriously decrease intake of protein, calcium, vitamin D, and potassium - nutrients in short supply in many diets."

Dr. Slavin concluded, "We have spent the last 40 years on a failed experiment to micromanage the diet. Food is so much more than 'added sugar' and 'bad fat.' Let's make peace with our food and enjoy eating with our family and friends."

But Dr. Juliana F. W. Cohen from Harvard School of Public Health in Boston, who also commented on the study for Reuters Health, urges caution.

"Anyone considering a change to an existing ban on sugar-sweetened milk should pause for a moment to think carefully about all the available evidence," Dr. Cohen said in an email. "This study has some important methodological issues to consider, and research has previously shown that students will consume just as much white milk as chocolate milk when given enough time to adjust."

"It's important for policymakers to realize the study found that when sugar-sweetened milk was removed, white milk selection (and thus its consumption) increased substantially," Dr. Cohen said. "The authors note that this policy of removing sugar-sweetened milk may reduce calorie and sugar consumption, which is critical to consider given the high rates of obesity among children."

Dr. Wansink did not respond to a request for comments.

SOURCE: http://bit.ly/1jx1w39

PLoS ONE 2014.

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