Objective. To determine whether making a low-fat entree available as one of two choices in an elementary school lunch program would reduce the fat content of meals selected by children.

Design. In this before-after trial, students had a daily choice between two entrees, one of which was sometimes low-fat. For 93% of school days during 14 consecutive school months, daily entree choices were recorded for 619976 student meals. The fat content of entrees was assessed with a computerized nutrient database supplemented by food manufacturer's data.

Setting. Sixteen elementary schools in the Bellevue (Washington) School District.

Participants. The number of students eating school lunch averaged 2440 per day, of whom 25% were less than 185% of poverty.

Intervention. After a baseline period of 6 months, the intervention increased the number of days per month when one of the two entrees had 30% or fewer calories from fat.

Main outcome measures. Data for the entire district were combined to estimate for each month the percent of students who selected low-fat entrees and the percent of calories from fat in the average meal selected by students.

Results. During the 6 months before the intervention, a low-fat entree was available on 23% of days; it was selected by 39% of students; and the average meal selected by students had 36% of calories from fat. By the end of the 8-month intervention, a low-fat option was available on 71% of days; it was selected by 29% of students; and the fat content of the average meal dropped from 36% to 30% of calories from fat (P = .02).

Conclusions. In this school district, many students, given the choice, selected low-fat entrees. Recommendations for dietary fat were met simply by the environmental intervention of increasing the availability of low-fat foods. Pediatrics 1993;91:1107-1111; child nutrition, food preferences, diet surveys, schools, dietary fat, child, nutrition.

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