United States 

Department of 

Agriculture

Economic

Research

Service

Economic

Research

Report

Number 104

October 2010

How Food Away From Home 

Affects Children’s Diet Quality

Lisa Mancino

Jessica E. Todd

Joanne Guthrie

Biing-Hwan Lin
www.ers.usda.gov

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A Report from the Economic Research Service

Abstract

Based on 2 days of dietary data and panel data methods, this study includes estimates 

of how each child’s consumption of food away from home, food from school (which 

includes all foods available for purchase at schools, not only those offered as part of 

USDA reimbursable meals), and caloric sweetened beverages affects that child’s diet 

quality and calorie consumption. Compared with meals and snacks prepared at home, 

food prepared away from home increases caloric intake of children, especially older 

children. Each food-away-from-home meal adds 108 more calories to daily total intake 

among children ages 13-18 than a snack or meal from home; all food from school is estimated to add 145 more calories. Both food away from home and all food from school 

also lower the daily diet quality of older children (as measured by the 2005 Healthy 

Eating Index). Among younger children, who are more likely than older children to eat a 

USDA school meal and face a more healthful school food environment, the effect of food 

from school on caloric intake and diet quality does not differ significantly from that of 

food from home. 

Keywords: Food away from home (FAFH), food from school (FFS), caloric sweetened 

beverages (CSB), children’s diet quality, 2005 Healthy Eating Index (HEI-2005), fixed 

effects, first difference, Continuing Survey of Food Intakes by Individuals (CSFII), 

National Health and Nutrition Examination Survey (NHANES), ERS, USDA

Acknowledgments

The authors thank the following reviewers for their insightful suggestions and comments: 

Ronette Briefel (Mathematica Policy Research), Hayden Stewart (USDA, Economic 

Research Service (ERS)), Mary Story (Division of Epidemiology and Community Health 

at the University of Minnesota), and Steven Carlson and Jay Hirschman (USDA, Food 

and Nutrition Service). John Weber and Cynthia A. Ray of ERS provided editorial and 

design assistance.

Lisa Mancino, lmancino@ers.usda.gov

Jessica E. Todd, jtodd@ers.usda.gov

Joanne Guthrie, jguthrie@ers.usda.gov

Biing-Hwan Lin, blin@ers.usda.gov

How Food Away From Home 

Affects Children’s Diet Quality Economic

Research

Report

Number 104

October 2010
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Contents

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Previous Research on Food Away From Home . . . . . . . . . . . . . . . . . . . . 3

School Meals and Other Food Obtained at School . . . . . . . . . . . . . . . . . 4

Caloric Sweetened Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Data and Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Estimation Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Effects of FAFH, FFS, and CSB on Diet Quality . . . . . . . . . . . . . . . . . . 13

Discussion and Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Recommended citation format for this publication: 

Mancino, Lisa, Jessica E. Todd, Joanne Guthrie, and Biing-Hwan Lin. 

How Food Away From Home Affects Children’s Diet Quality. ERR-104. 

U.S. Dept. of Agriculture, Econ. Res. Serv. October 2010.
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Summary

In recent decades, more and more American children have become overweight, and most now eat a low-quality diet—consuming too much caloriedense, low-nutrient foods and too little fruits, vegetables, whole grains, and 

milk. Increased consumption of foods prepared outside the home has been 

identified as a possible cause of rising rates of obesity and poor diet quality. 

What is the issue?

Among children ages 6-18, away-from-home foods are most likely to come 

from fast food outlets, restaurants, and schools. Increased consumption of 

such foods may be a cause of overweight, or it may just be correlated with 

other factors that increase risk of overweight, such as individual food preferences and access to myriad food outlets. Consumption of caloric sweetened 

beverages, which is associated with both overweight and eating out, may 

contribute to the effects of away-from-home foods on caloric intake and diet 

quality. In this study, previous research is advanced through an examination of the effects of both commercially prepared food away from home and 

all food from school on the diets of children, where all food from school 

includes foods available for purchase at schools, not only those offered as 

part of USDA reimbursable meals. Also, researchers separate the effects of 

caloric sweetened beverage consumption from the effects of away-fromhome meals. The results may help to inform obesity prevention policies and 

strategies.

What are the findings?

Food obtained from fast food outlets, restaurants, and other commercial 

sources is associated with increased caloric intake and lower diet quality, 

as measured by the Healthy Eating Index (HEI), especially among children 

ages 13-18. These effects hold after employing a methodology that controls 

for the impacts of underlying personal characteristics and circumstances, 

such as access to food outlets, which might also affect food choices. This 

finding strengthens the argument that there is a causal relationship between 

food away from home and both increased caloric consumption and decreased 

dietary quality. It also supports policy and educational efforts to improve 

children’s choices of away-from-home foods and beverages.

Consumption of caloric sweetened beverages when eating meals or snacks 

obtained at commercial food establishments or at school contributes to the 

adverse dietary effects of food away from home. About 35 percent of the 

caloric increase associated with food away from home is attributable to 

caloric sweetened beverages, as is 20 percent of the decline in HEI scores. 

Nevertheless, after controlling for the effects of consumption of caloric 

sweetened beverages, researchers find that, for all children, each away-fromhome meal adds 65 calories and lowers diet quality scores by 4 percent, 

compared with meals prepared at home. For older children, the effect 

amounts to 107 additional calories for each away-from-home meal. These 

results suggest that food away from home and caloric sweetened beverages each contribute to the overall quantity and quality of the foods children 

consume.
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The effects of food from school also differ between younger and older 

children. Again controlling for intake of caloric sweetened beverages, 

researchers find that consumption of all food from school does not appear to 

have negative effects on the diets of younger children (ages 6-13). However, 

among children ages 13-18, all food from school has effects similar to those 

of food away from home, increasing daily caloric intake by 145 calories 

and lowering diet quality scores by 3 percent, compared with food prepared 

at home. Older children and adolescents tend to consume more meals and 

snacks from all away-from-home sources than younger children. Thus, 

efforts to improve the quality of food away from home and food from school 

may especially benefit the older age group. 

How was the study conducted?

Analysis is based on dietary recall data from the 2003-04 National Health 

and Nutrition Examination Survey and the 1994-96 Continuing Survey of 

Food Intakes by Individuals. Researchers used 2 days of dietary intake data 

from school-age children (ages 6-18) to obtain first-difference estimates of 

the effects of individual changes in the number of meals or snacks from foods 

prepared outside the home—from restaurants, fast food vendors and other 

commercial sources, or schools and day care centers—on diet quality. Firstdifferencing, which controls for many personal characteristics and omits a 

great deal of selection bias, is also used to determine the effects of changes 

in consumption of caloric sweetened beverages on diet quality. Controlling 

for changes in beverage consumption provides a clearer picture of how food 

sources affect diet quality. Measures of diet quality include changes in total 

daily caloric intake, total daily HEI scores, and daily HEI component densities, such as fruit and vegetable cup equivalents per 1,000 calories of intake. 
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Introduction

In the last 30 years, the prevalence of obesity among children and adolescents 

in the United States has more than doubled for all age groups and tripled among 

those ages 12-19 (CDC, 2009). Childhood obesity is associated with increased 

risk of Type 2 diabetes, sleep apnea, high blood pressure and cholesterol, as 

well as negative social, emotional, and academic outcomes (Gable et al., 2008). 

In addition, estimates suggest overweight children face a 70-percent chance of 

becoming overweight or obese adults, putting them at increased risk of suffering 

numerous obesity-related health problems later in life (USDHHS, 2007). 

The prevention of childhood obesity has therefore become a major public 

health objective (Healthy People 2010). In searching for the causes of rising 

childhood obesity, researchers have identified increased consumption of food 

prepared away from home as a potential culprit. Like adults, children today 

eat a larger share of their daily calories from foods prepared outside the home 

than they did 30 years ago. In 1977-78, the average child age 2-17 obtained 

20 percent of his or her daily calories from food away from home (FAFH) 

(Guthrie et al., 2002). Analysis of 2003-06 data from the National Health 

and Nutrition Examination Survey (NHANES) finds that, on average, children today get roughly 35 percent of their calories from FAFH. Guthrie et al. 

(2002) find that FAFH is of lower nutritional quality than food prepared at 

home, having more fat and saturated fat and less dietary fiber, calcium, and 

iron. Unsurprisingly, many studies find that energy intake is higher and diet 

quality is lower among children who eat FAFH (particularly fast food) than 

among those who do not (see Bowman and Vinyard, 2004; French et al., 2001; 

Sebastian et al., 2009). Findings in other studies suggest that overweight or 

obese children may consume more FAFH (see Gills and Bar-Or, 2003). 

The consumption of FAFH, however, may not be a direct cause of poor diet 

quality and weight gain. Instead, it may just be linked to these outcomes 

through other factors, such as family time constraints, access to various food 

outlets, and preferences for certain foods. In other words, it is likely that FAFH 

consumption, diet quality, and weight are all shaped by these other factors. 

An analysis of adult diets shows that not controlling for such unobservable 

factors could overestimate the effect of FAFH on energy intake by as much as 

25 percent (Mancino et al., 2009). As such, the potential impact of targeting 

FAFH as a means to curb childhood obesity may be overstated as well. 

The objective of this study is to investigate whether consumption of FAFH 

directly affects children’s energy intake and diet quality. We use a fixedeffects estimator on 2 days of dietary recall data to isolate the effects of 

consumption of FAFH from unobserved fixed characteristics that are likely 

correlated with FAFH consumption. In contrast to previous work, we define 

FAFH as all food not prepared at home and separate food obtained from 

school (FFS) cafeterias from all other FAFH. 

This is an important distinction, as children are likely to have a different 

range of food options in schools than in other food-away-from-home establishments. Moreover, policy levers for influencing food choices at schools 

differ from those available for influencing food choices at restaurants, fast 

food establishments, and other sources of food prepared away from home. 

Lunches and breakfasts served in schools as part of the USDA school meal 
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programs are subject to nutrition standards established by USDA. These 

standards could be modified in response to recent recommendations from the 

National Academy of Sciences’ Institute of Medicine (IOM) (see IOM, 2009) 

or as part of Federal obesity prevention policies. Even foods and beverages 

sold outside the USDA school meal programs from snack bars and other 

sources (popularly referred to as “competitive foods” because they compete 

with USDA school meals) may be limited either by Federal, State, or local 

school policies. USDA now requires schools that participate in the USDA 

school meal programs to develop “wellness policies” that set standards for all 

foods and beverages sold in school. Many schools are trying to offer a more 

healthful mix of foods, sometimes by banning sales of competitive foods or 

limiting the types of these foods that can be sold. In addition, 31 States now 

have policies limiting access to or setting nutrition standards for competitive 

foods (Trust For America’s Health, 2009). 

In contrast, the policy options for altering food choices by children in restaurants, fast food establishments, and other commercial sources focus less on 

sales restrictions and more on informational efforts. Nutrition labeling on 

menus and other efforts to educate consumers may encourage parents—and 

some children—to change the way they typically select from among different 

types of foods and beverages. The shift in consumer demand that may result 

could also spur FAFH establishments to introduce more healthful menu 

options for children.

Given these differences in policy levers, it is important to disentangle the 

dietary effects of consuming school food from the effects of consuming other 

foods prepared away from home. Therefore, we separate them in our analysis 

and hereafter refer to food obtained at school as food from school (FFS) and 

food obtained from other sources as food away from home (FAFH).

We estimate the effects of an increase in the number of meals from FAFH 

and FFS on caloric intake and diet quality. Estimates are made for the entire 

sample of school-age children (ages 6-18)1 and separately for younger children (ages 6-12) and adolescents (ages 13-18). We also test whether the 

effects of FAFH differ significantly from the effects of FFS and whether the 

effects of FAFH and FFS have changed between the two periods for which 

data are available: 1994-96 and 2003-04. 

Additionally, we investigate the extent to which the effects of FAFH and FFS 

on diet quality are driven by the consumption of caloric sweetened beverages 

(CSB). Children’s consumption of CSBs, such as carbonated soft drinks, fruit 

drinks, and sport drinks, has risen in recent years (Wang et al., 2008) and now 

accounts for close to 10 percent of total caloric intake for this age group. As 

with the effects of consumption of FAFH and FFS, researchers hypothesize that 

increased consumption of CSBs is associated with the rise in obesity (see Malik 

et al., 2006; Vartanian et al., 2007). CSBs often accompany FAFH meals and 

are commonly available in vending machines in schools. Thus, it is possible that 

some of the effects attributed to FAFH and FFS could be driven by an association with consumption of CSBs. We therefore control for CSB consumption 

to investigate whether this association changes the magnitude of the estimated 

relationship between diet quality and food source. Findings provide additional 

insight into the effects of food sources on children’s diets and weight status and 

can help inform strategies for the prevention of childhood obesity.

1While many children start school 

by age 5, this is not always the case. 

Our data left some ambiguities as to 

whether or not a child was currently 

attending school. As such, we use age 6 

as our lower range.
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Previous Research on Food Away From Home

Research on the role of FAFH on children’s weight status, energy intake, 

and diet quality has focused primarily on the correlations of these measures 

with either fast food consumption or availability, as measured by distance 

or price. A number of studies show that children who eat fast food or fried 

foods away from home more frequently than other children also consume 

more energy, caloric sweetened beverages, and fat while also consuming less 

milk and fewer fruits and vegetables (see Bowman et al., 2004; French et al., 

2001; Paeratakul et al., 2003; Sebastian et al., 2009). Some evidence suggests 

that children who are overweight or obese eat FAFH more frequently and 

consume more total energy when doing so than healthy-weight children (see 

Gillis and Bar-Or, 2003; Ebbeling et al., 2004). 

Among studies focused on correlations between body weight and access to 

restaurants and fast food establishments, some find that proximity to restaurants has little to no effect on children’s weight (see Burdette and Whitaker, 

2004; Sturm and Datar, 2005). Currie et al. (2009), however, find that having 

a fast food restaurant within one-tenth of a mile of a school correlates with 

increased weight gain and obesity among schoolchildren. Powell and Bao 

(2009) also find that the relationship between local fast food prices and 

elevated Body Mass Index (BMI) is more pronounced among low-income 

adolescents, who may have greater access to FAFH (Block et al., 2004) than 

the general population. 

While demonstrating a strong correlation between either FAFH consumption or FAFH availability and specific outcomes, such as overweight/obesity 

and lower diet quality, these studies do not confirm that FAFH is a cause of 

these outcomes. As stated earlier, FAFH consumption is influenced by many 

of the same factors that affect both diet quality and body weight. Similarly, 

the use of FAFH access as a means to identify consumption poses two potential problems. First, the cited studies lack data on actual FAFH intake or 

purchases. Thus, there is no guarantee that any correlation between weight 

gain and FAFH access is due to increased FAFH consumption. Second, 

retailers choose to locate in areas with high demand. Because the demand 

for FAFH is driven by the same factors that influence diet quality and body 

weight, access is arguably an endogenous variable. 
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School Meals and Other Food Obtained at School

Given the important contribution of food obtained at school to the everyday 

diets of children, the effects of such foods on children’s diets is of interest 

to researchers. Schools, like other nonhome food sources, now offer a more 

extensive and varied mix of eating options than in past decades. As of 2008, 

USDA school meal programs served 30.9 million lunches and 10.6 million 

breakfasts on an average schoolday. For participants, lunch contributes 31 

percent of daily calories, whereas breakfast contributes 22 percent (Gordon et 

al., 2007). Nearly all children who eat school breakfast also eat school lunch; 

for such children, school meals may account for approximately half of their 

daily caloric intake.

USDA-sponsored meals are expected to meet Federal nutrition standards. 

And while most schools serve meals that meet standards for protein, vitamins, and minerals, many schools provide meals that exceed standards for 

fat and saturated fat and are also high in sodium2 (Crepinsek et al., 2009). 

Other foods and beverages are also widely available in schools from vending 

machines, school stores and snack bars, or cafeterias, where they are sold as a 

la carte items. Overall, 40 percent of schoolchildren eat some type of competitive food or beverage on a given day (Fox et al., 2009). These competitive 

foods make up, on average, 13 percent of total daily calories for younger 

children and 15 percent for high schoolers. Competitive foods are not subject 

to the same Federal nutrition standards as foods that make up USDA meals. 

They tend to be low-nutrient, energy-dense foods, such as CSBs, high-fat 

baked goods, and desserts (Fox et al., 2009). As children age, their access to 

competitive foods expands and their consumption of USDA school lunches 

declines3 (Fox et al., 2009). In addition, school lunch program meals appear 

to differ in quality by grade level, with meals served to secondary students 

being higher in fat than meals served to elementary students (Newman et al., 

2009). The combination of less nutritious National School Lunch Program 

(NSLP) meals and more exposure to competitive foods may explain why 

previous research found that the positive qualities of foods consumed at 

school decline as students age (see Lin et al., 2001).

Despite these shortcomings, school meals are found to have several positive 

effects on students’ diets, with program participants significantly more likely 

than nonparticipants to consume milk, fruit, and vegetables at lunchtime 

and less likely to eat desserts and snack items (Briefel et al., 2009). Intakes 

of CSBs at lunch by program participants are sufficiently lower than those 

of nonparticipants, resulting in a lower overall daily CSB intake (Briefel et 

al., 2009). However, as with the effects of FAFH, it is difficult to establish a 

causal relationship between school foods and diet quality because many of 

the same factors that influence school meal choice, such as food preferences 

and parental time constraints, also shape diet quality and body weight. 

2Program regulations require that 

school lunches and breakfast provide 

one-third and one-quarter, respectively, 

of the 1989 Recommended Dietary Allowance of protein, calcium, iron, and 

vitamins A and C. USDA-sponsored 

school meals are expected to limit fat 

content to no more than 30 percent of 

the meal’s calories and limit saturated 

fat to no more than 10 percent of calories. Schools are also encouraged to 

minimize sodium but are not held to a 

specific standard.

3In 2004-05, competitive foods were 

available in 73 percent of elementary 

schools, 97 percent of middle schools, 

and 100 percent of high schools (Fox 

et al., 2009). The likelihood of eating 

competitive foods also increases with 

age, with the share of students doing 

so rising from 29 percent in elementary 

school, to 44 percent in middle school, 

and to 55 percent in high school. At 

the same time, consumption of USDA 

school meals declines, with the share 

of students participating in the program 

dropping from 73 percent in elementary 

school, to 60 percent in middle school, 

and to 44 percent in high school.
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Caloric Sweetened Beverages

Over the past three decades, children’s beverage choices have registered 

a noticeable trend. Consumption of milk has declined, while consumption 

of carbonated soft drinks and fruit drinks has risen (table 1). Consumption 

of CSBs has also risen in recent years (Wang et al., 2009) and now makes 

up close to 10 percent of total caloric intake for this age group. Increased 

consumption of CSBs raises two concerns. First, it may displace consumption of more nutrient-rich beverages, such as low-fat milk. Second, rather 

than serving as a substitute for other foods and beverages, it may add calories 

to the diet, increasing the risk of obesity. Physiological research finds that 

self-compensation for calories consumed as certain liquids, such as CSBs, 

is imprecise and thus increases the likelihood of an individual’s consuming 

excess calories (Mattes, 1996). Ludwig et al. (2001) find that in a sample of 

school-age children, over a 19-month period, CSB consumption is associated 

with increased risk of becoming overweight. Two recent reviews of the literature conclude that CSB consumption is linked with increased risk of obesity 

and diabetes (see Malik et al., 2006; Vartanian et al., 2007). It is noted that 

CSBs often accompany FAFH meals and, during the time data were collected 

for this study, they were commonly available in vending machines in schools 

(CDC, 2006; Briefel et al., 2009). Clearly, obesity, FAFH, FFS, and CSB 

consumption are linked, making it very challenging to sort out the specific 

effects that each may have on obesity. 

Table 1

Daily per capita consumption of beverages among children ages 2-18

Beverage 1977-78 1994-96 2003-06

Ounces

Nondiet soft drinks 4.61 8.94 9.39

Fruit drinks 3.03 5.07 5.66

Milk 14.77 11.30 9.60

Source: USDA, Economic Research Service analysis of Continuing Survey of Food Intakes of 

Individuals and National Health and Nutrition Examination Survey first-day dietary recall data.
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Data and Sample

We use data from two nationally representative surveys covering the periods 

1994-96 and 2003-04. The Continuing Survey of Food Intakes by Individuals 

(CSFII) collected 2 nonconsecutive days of dietary recall data between 1994 

and 1996 for a sample of adults and children. Both days of intake data were 

collected through interviews with survey participants. The National Health 

and Nutrition Examination Survey, conducted by the Centers for Disease 

Control and Prevention, expanded intake data collection from 1 day to 2 days 

in 2002 but only began releasing both days of dietary intake in 2003. Because 

USDA managed the dietary intake component for both surveys, many of the 

questions, such as those asking where foods were eaten and obtained, are the 

same in both surveys. This facilitates combining the two surveys together and 

allows us to link responses to the appropriate MyPyramid Equivalents databases (MPED) (Friday and Bowman, 2006; Bowman et al., 2008) and, consequently, calculate the 2005 Healthy Eating Index (HEI-2005) scores. The 

2003-04 NHANES is the most recent dataset containing 2 days of dietary 

intake for which the HEI-2005 can be constructed.4 As will be described 

in more detail, the index is based on per calorie intake and thus supports 

comparison of intakes that vary in quantity. We limit our sample to schoolage children between ages 6 and 18. 

We examine the effects of FAFH, FFS, and CSB consumption on aggregate and specific measures of diet quality. The aggregate measures are total 

daily caloric (energy) intake and total HEI-2005 score. Excessive energy 

intake is a main factor in weight gain. The HEI-2005, developed by USDA’s 

Center for Nutrition Policy and Promotion (CNPP), is an index that measures 

how well an individual’s diet adheres to the 2005 Dietary Guidelines for 

Americans (see USDHHS/USDA 2005; Guenther et al., 2008). The total 

score is the sum of an individual’s scores on 12 components: total fruit; 

whole fruit; total vegetables; dark-green and orange vegetables and legumes; 

total grains; whole grains; milk; meat and beans; oils; saturated fat; sodium; 

and extra calories from solid fat and added sugar (extra calories). The 

Dietary Guidelines recommend consuming at least a minimum amount for 

the first nine components and consuming no more than a maximum amount 

for the last three components, while also balancing daily caloric intake with 

daily caloric expenditure. 

These component scores are created using a density approach. For fruit, 

vegetables, grains, milk, meat, and beans, densities reflect the number of 

cups or ounce equivalents per 1,000 calories consumed by an individual 

daily. For oils and sodium, the densities measure the grams and milligrams 

consumed per 1,000 calories, respectively. For saturated fat and extra calories, densities measure the share of an individual’s daily caloric consumption. 

This analysis focuses specifically on measures of the component densities 

for which current dietary intake is lacking—total fruit, whole fruit, total 

vegetables, dark-green and orange vegetables, whole grains, and milk—and 

is excessive—saturated fat, sodium, and extra calories (Guenther et al., 2008; 

Fungwe et al., 2009). Table 2 summarizes the intake corresponding to a 

maximum score for each of these components in the HEI-2005.

4The 2005-06 NHANES intake data 

have been released, but the corresponding MyPyramid Equivalents Database 

has not.
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Following the approach used in Todd et al. (2010), in this study, eating 

occasions are classified as FAFH based on the source from which respondents report each food was obtained. Regardless of where the foods were 

consumed, foods obtained from fast food or table service restaurants are 

classified as FAFH.5 Foods obtained from a school cafeteria or day care 

center are identified as FFS.6 The FFS classification includes any food sold 

at school—those sold as part of the USDA school meals as well as competitive foods sold a la carte. Meals that contain foods from multiple sources are 

classified based on the source of the food (excluding beverages) that accounts 

for the majority of the meal’s calories. For example, if a student reports 

eating a lunch or breakfast from school and a dessert from home, the eating 

occasion is identified as a food from school meal as long as the food from 

school provides more than 50 percent of the calories consumed during that 

meal. The final category, food at home (FAH), comprises the remaining food 

sources. The majority (97 percent) of foods classified as FAH come from 

some sort of grocery store or from someone else, such as a dinner prepared 

by a friend. Meals are classified as breakfast, lunch, dinner, or snack based 

on the respondent’s stated definition of the eating occasion. 

Beverages are classified using the USDA eight-digit food-code descriptors 

in the CSFII and NHANES. Regardless of where a respondent obtained 

a beverage, if the product contained some sort of caloric sweetener, such 

as sugar or corn syrup, it is classified as a caloric sweetened beverage. 

Specifically, the caloric sweetened beverages defined as CSBs come from 

one of the following categories—fruit or fruit-flavored drinks, energy drinks, 

flavored water, coffees, teas, and nonalcoholic, or “virgin,” beverages, such 

as nonalcoholic wines and beers. 

Based on an approach that uses Stata 10.1 to account for sampling weights 

and incorporate survey design, sample means are reported in table 3 for the 

explanatory and dependent variables for the full sample of children. The table 

includes both the 2-day mean as well as the 2-day difference for each variable 

for the pooled sample (both the 1994-96 and 2003-04 surveys). Average daily 

caloric intake for children is nearly 2,124 calories, with an average difference 

5For example, a lunch obtained off 

campus during school hours is classified as FAFH, even if the student 

brought that meal back to school.

6For completeness, we include foods 

obtained at day care centers with foods 

obtained at schools. It is possible that 

some of the day care providers were 

located in schools, so foods available 

would be similar in both. These foods 

make up a small portion of this category—less than 4 percent of eating occasions classified as food from school 

contain food from day care.

Table 2

Intake densities corresponding to maximum component score in 

HEI-2005 measure

HEI-2005 component Intake for maximum score 

Total fruit ≥ 0.8 cup equivalents 

Whole fruit ≥ 0.4 cup equivalents

Whole grains ≥ 1.5 oz. equivalents

Milk ≥ 1.3 cup equivalents

Total vegetable ≥ 1.1 cup equivalents

Dark-green, orange vegetables ≥ 0.4 cup equivalents

Saturated fat* ≤ 7 percent 

Sodium ≤ 700 milligrams

Extra calories* ≤ 20 percent 

Note: *Intake is percent of total energy; otherwise, densities are per 1,000 kcal. HEI = Healthy 

Eating Index.

Source: USDA, Economic Research Service using data from Guenther et al. (2007).
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between the 2 days of nearly 114 calories. The mean HEI-2005 score is less 

than 50 (out of a maximum of 100), and the average daily variation is less 

than 1 (0.34). Average intake of milk per 1,000 calories comes closest to the 

recommended amount (1.03 cup equivalents versus 1.3 cup equivalents for a 

maximum component score). For other components in which average intake 

is below the level corresponding to the maximum HEI-2005 score, the deficits range from 40 percent (whole fruit) to 90 percent (dark-green and orange 

vegetables). For components in which intake is above the recommended 

levels, consumption exceeds recommendations by 66 percent for saturated fat, 

92 percent for extra calories, and 114 percent for sodium. 

Because past research shows that the healthfulness of the school food 

environment declines as students progress through the school system (see 

Table 3

Summary statistics, children ages 6-18, 1994-96 and 2003-04 pooled 

Two-day means Two-day differences 

(day 2 - day 1)

2-day means 2-day differences

Dependent variables Mean SE of 

mean

Mean SE of 

mean

Daily energy intake (kcal) 2,124.12 18.36 -113.60 17.19

HEI-2005 48.66 0.34 0.57 0.59

Total fruit density (cup equiv. per 1,000 kcal) 0.49 0.01 0.01 0.02

Whole fruit density (cup equiv. per 1,000 kcal) 0.24 0.01 0.02 0.01

Whole grain density (ounce equiv. per 1,000 kcal) 0.28 0.01 0.00 0.01

Dairy density (cup equiv. per 1,000 kcal) 1.03 0.02 0.02 0.02

Vegetable density (cup equiv. per 1,000 kcal) 0.56 0.01 0.02 0.02

Dark-green, orange density (cup equiv. per 1,000 kcal) 0.04 0.00 0.01 0.00

Percent saturated fat (percent of energy) 11.62 0.06 -0.04 0.10

Sodium density (milligrams per 1,000 kcal) 1,570.98 8.66 26.41 13.00

Percent of energy from extra calories 38.43 0.26 -0.95 0.37

Explanatory variables

Breakfast—1 respondent ate breakfast; 0 otherwise 0.81 0.01 0.03 0.01

Lunch—1 respondent ate lunch; 0 otherwise 0.83 0.01 0.04 0.01

Dinner—1 respondent ate dinner; 0 otherwise 0.93 0.00 0.00 0.01

Snack (number) 1.39 0.02 -0.22 0.02

Number of meals away from home 0.50 0.01 -0.07 0.02

Number of meals from foods sold at school 0.32 0.02 -0.02 0.02

Caloric sweetened beverages consumed (grams) 559.51 12.59 -66.05 12.53

Weekend—1 recall occurred on a weekend; 0 otherwise 0.30 0.01 0.01 0.00

Demographic subgroups

Male 0.52 0.01 n/a n/a

NHANES (observed in 2003-04) 0.52 0.02 n/a n/a

Note: The pooled sample size is 5,285: 1994-96 is 2,690 and 2003-04 is 2,595. Weighted means reported; Stata 10.1 is used to incorporate the 

complex survey design adjust the standard errors. Sample includes only children who reported 2 days of dietary intake data. 

NHANES = National Health and Nutrition Examination Survey. n/a = not applicable.

Source: USDA, Economic Research Service. 
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Finkelstein et al., 2008; Briefel et al., 2009), we separate children into two 

age groups: those in elementary school (ages 6-12) and those in middle and 

high school (ages 13-18). Table 4 presents sample means for each subgroup 

of children. As expected, older children consume more calories per day but 

consume less fruit, whole grains, and milk. Younger children are less likely 

to skip meals and more likely to consume snacks and eat more meals from 

food from school. In contrast, older children consume more meals from 

food away from home. Older children also consume more caloric sweetened 

beverages (68 percent more than younger children).

Table 4

Summary statistics by age group, 1994-96 and 2003-04 pooled data

Children ages 6 to 12 

(n=2,677)

Children ages 13 to 18 

(n=2,608)

Dependent variables Mean SE Mean SE

Daily energy intake (kcal) 1,996.67 23.74 2,269.10 32.27

HEI-2005 49.75 0.46 47.43 0.35

Total fruit density (cup equiv. per 1,000 kcal) 0.54 0.02 0.43 0.02

Whole fruit density (cup equiv. per 1,000 kcal) 0.29 0.01 0.19 0.01

Whole grain density (ounce equiv. per 1,000 kcal) 0.32 0.01 0.23 0.01

Dairy density (cup equiv. per 1,000 kcal) 1.13 0.02 0.91 0.03

Vegetable density (cup equiv. per 1,000 kcal) 0.53 0.01 0.60 0.01

Dark-green, orange density (cup equiv. per 1,000 kcal) 0.04 0.00 0.04 0.00

Percent saturated fat (percent of energy) 11.74 0.08 11.47 0.09

Sodium density (milligrams per 1,000 kcal) 1,556.48 11.22 1,587.48 11.73

Percent of energy from extra calories 37.90 0.28 39.03 0.35

Explanatory variables

Breakfast 0.88 0.01 0.73 0.01

Lunch 0.88 0.01 0.77 0.01

Dinner 0.95 0.00 0.91 0.01

Snack 1.43 0.03 1.34 0.03

Number of meals away from home 0.40 0.01 0.61 0.02

Number of meals at school 0.38 0.02 0.25 0.02

Caloric sweetened beverages consumed (grams) 420.86 12.18 717.24 19.08

Dietary recall occurred on the weekend 0.30 .008 0.01 0.00 0.30

Demographic subgroups

Male 0.52 0.01 0.51 0.01

NHANES (observed in 2003-04) 0.51 0.02 0.53 0.02

Note: Weighted means reported; Stata 10.1 is used to incorporate the complex survey design adjust the standard errors. Samples include only 

children who reported 2 days of dietary intake data. NHANES = National Health and Nutrition Examination Survey. HEI = Healthy Eating Index.

Source: USDA, Economic Research Service. 
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Estimation Approach

Estimates using the pooled data

One common approach to estimating the effect of FAFH and FFS on diet 

quality is to treat them as an exogenous, explanatory variable and estimate a 

regression of the following form:

DQi = a + bXi + γFAFHi + θFFSi + μi + εi (1)

where DQ is a measure of diet quality for individual i; X is a vector of 

control variables, such as age and gender; FAFH is the number of meals from 

FAFH; FFS is the number of meals from school; μi

 is a vector of relevant 

unobservable factors, such as food preferences, parental time constraints, and 

access to various food outlets; and εi

 is a stochastic error term. 

However, as has been argued, FAFH and FFS consumption are driven by 

many of the same unobservable variables in μ. Not controlling for this relationship between μ and either FAFH or FFS will bias estimates of γ and θ. 

To obtain unbiased estimates, one must separate the choice of FAFH and 

FFS from the relevant unobservable factors in μ. Leveraging the fact that the 

number of meals eaten away from home or obtained from school may vary 

across the 2 days of intake, one can isolate the effects of FAFH and FFS 

from the factors in μ that are fixed over time by estimating a regression on 

the differences between days: 

DQi2 - DQi1 = (a- a)+ b(Xi - Xi) + γ(FAFHi2 + FAFHi1) + θ(FFSi2 -

FFS1) + (μi - μi ) + (εi2 - εi1)

Or more simply: 

∆DQi = γ (∆FAFHi) + θ(∆FFSi )+ ∆εi (2)

Equation (2) is a first-difference model, which is equivalent to a fixed-effects 

model when there are only two observations per person. Because the 2 

days of dietary intake in the data are collected 7-10 days apart, it is reasonable to assume that the majority of these relevant, unobservable factors are 

fixed during the survey period.7 Thus, even though data are not available on 

all relevant, unobservable factors, such as food preferences, parental time 

constraints, and access to food outlets, this approach controls for factors that 

remain fixed over the survey period because they simply fall out of equation 

2 when estimating first differences. 

While the first-difference model removes the bias from the estimates of γ

and θ from time-invariant unobserved factors, there may still be some bias 

from unobserved time-varying factors. To help control for time-varying 

unobserved factors, such as daily variations in parental time constraints, 

we also estimate for the effects of changing meal patterns, such as whether 

an individual skipped breakfast on one of the days, whether the number of 

snacks consumed changed, and whether the recall day was on a weekday or 

weekend.

7The fixed-effects estimator has 

been used extensively to remove bias 

from unobservable factors (see, for 

example, Mancino et al. (2009), who 

estimate the effect of FAFH on calories 

and HEI scores among adults; Hersch 

and Stratton (1997), who estimate the 

effect of housework time on wages; and 

Behrman and Deolalikar (1990), who 

estimate the effect of income on nutrient demand).
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 ∆ ∆ DQ FAFH FFS MEAL weekend i i ∆ i j ∆ ∆

j

= + + ∑ ij + i i + =γ ( ) ( ) ( ) ( ) θ φ δ ε 1

4

(3)

Equation (3) is used to estimate the effects on diet quality of obtaining one 

additional meal from FAFH (γ) and one additional meal from FFS (θ). The 

effects of eating occasions (φj

) are indexed by j (for example, breakfast, 

lunch, dinner, or snack).8 Equation (3) estimates total energy consumed in 

a day and the total HEI-2005 score for all children, and then separately for 

elementary school children (ages 6-12) and older children (ages 13-18). 

As discussed previously, it is possible that some of the negative effects of 

FAFH could be attributable to an increase in consumption of CSBs, which 

offer little in the form of nutrition other than calories. To help separate the 

effect of CSBs from FAFH and FFS, we add the change in consumption of 

CSBs (measured in units of 100 grams, or approximately 3.5 ounces): 

∆ ∆ ∆ ∆ ∆

∆

DQ FAFH FFS MEAL CSB

weeke

i i i j

j

= + + ∑ ij +

+ =

γ θ φ λ

δ

( ) ( ) ( ) ( )

( 1

4

1

ndi i ) + ∆ε (4)

In equation (4), γ again estimates the effect of a meal from FAFH, and θ

estimates the effect of a meal from FFS; however, these effects now hold 

the consumption of CSBs constant. Thus, the effect for FAFH and FFS in 

equation (4) is net of the change in consumption of CSBs. A comparison 

of the estimates from (4) with those from (3) reveals the degree to which 

consumption of CSBs accounts for the total effects of FAFH and FFS. 

Dependent variables include total daily calories, total HEI score, and specific 

HEI components—total fruit, whole fruit, whole grain, milk, all vegetables, 

dark-green/orange vegetables, share of calories from saturated fat, and extra 

calories. 

Estimates by survey to test for differences over time

After equation (4) is estimated with the pooled data for all children and for 

both age groups, it is estimated separately for the 1994-96 and 2003-04 

samples to test whether the effect of eating out on various measures of 

diet quality changed over time. Both restaurant and school food environments underwent changes in recent years, possibly modifying the effect that 

consumption of food obtained from these sources has on individual diet 

quality. In the case of restaurants, many establishments voluntarily began to 

provide nutritional information for menu items, as well as to modify their 

menu offerings to include more healthful options. Greater media exposure of 

the potential negative effects of FAFH may have swayed some consumers to 

alter their food choices when dining out.

In the case of schools, a number of legislative acts and policy changes since 

1994 may have spurred changes in the quality of FFS. The 1994 Healthy 

Meals for Healthy Americans Act effected changes in nutrition standards 

for school meals by placing a priority on limiting fat and saturated fat 

(see Ralston et al., 2008, for policies affecting the National School Lunch 

Program). While the average fat content of school meals has declined 

since the 1990s (Gordon et al., 2007 ), USDA breakfasts and lunches in 

8 The breakfast, lunch, and dinner 

variables are all dichotomous. They 

indicate whether an individual ate a 

specific meal or had at least one snack 

on that intake day. Thus, the differenced values used in our estimates take 

on values of -1. As an example, a value 

of -1 for breakfast would indicate an 

individual skipped breakfast on the first 

day of the recall and ate a breakfast on 

the second, a value of 1 would indicate 

he or she ate breakfast on the first day 

and skipped it on the second, and a 

value of zero would indicate no change 

between the 2 days The snack variable 

measures the change in the number of 

snacks eaten on the particular day.
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many schools still do not meet nutrition standards for fat and saturated fat 

(Crepinsek et al., 2009). Schools are encouraged, but not required, to serve 

more dark-green and orange vegetables, more whole grains, and less sodium. 

In 2004-05, few schools served the recommended amounts of these food 

groups. Also, virtually no schools served meals that met the sodium limits 

suggested by the 2005 Dietary Guidelines for Americans. Not surprisingly, 

the American food supply and the average American diet are also excessively 

high in sodium (Carlson et al., 2007; Guenther et al., 2008).

In addition to changes in USDA school meals, changes in the availability of 

competitive foods may affect the relationship between FFS and diet quality. 

In recent years, more States and school districts have taken actions to limit 

or ban the availability of low-nutrient, energy-dense competitive foods in 

schools (Trust for America’s Health, 2009). Despite these efforts, findings 

in the School Nutrition Dietary Assessment Study (SNDA) III reveal that in 

2004-05, such foods were still widely available in American schools, particularly in middle and high schools (Fox et al., 2009).
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Effects of FAFH, FFS, and CSB on Diet Quality

Without controlling for the effect of caloric sweetened beverages, each meal 

away from home adds 106 calories to total daily energy intake; meals from 

school add half as much. 

Our findings suggest that, even after controlling for the unobserved characteristics affecting both FAFH consumption and diet quality, FAFH has an adverse 

impact on various measures of children’s diet quality. Because the analysis 

controls for each meal consumed, the coefficients on FAFH and FFS estimate 

the difference between a meal obtained from either source (FAFH or FFS) and 

a meal obtained from home. Based on estimates obtained using equation (3) 

(first column of results for each sample), for all children, each meal away from 

home is estimated to add 106 calories to the total daily calories that would have 

been obtained if all meals were obtained from home (table 5). FFS is estimated 

to add 55 calories to total daily intake. The estimated effects vary between the 

two age groups. Among children ages 6-12, each FAFH meal adds 65 calories 

to the total daily intake, while each FFS meal has no significant effect. Among 

Table 5

Effects of meals consumed from FAFH and FFS on daily energy intake and HEI-2005 scores of children 

ages 6-18

Energy All children ages 6-18 Ages 6-12 Ages 13-18

FAFH meal 106.417*** 64.915*** 64.738** 17.234 144.388*** 107.499***

(20.974) (18.693) (25.416) (21.180) (31.412) (30.687)

FFS meal 54.711* 76.615** 10.637 44.804 146.435*** 144.819***

(30.009) (29.627) (40.484) (42.765) (48.356) (46.607)

100 grams of CSB 37.026*** 39.216*** 34.742***

(2.728) (5.568) (4.140)

Observations 5285 5285 2677 2677 2608 2608

R-squared 0.11 0.16 0.09 0.14 0.13 0.18

Gap between FFS and FAFH 51.705 -11.699 54.102 -27.570 -2.046 -37.321

HEI

FAFH meal -2.608*** -2.019*** -2.810*** -1.917*** -2.479*** -2.039***

(0.362) (0.355) (0.429) (0.431) (0.432) (0.417)

FFS meal -0.205 -0.515 0.403 -0.239 -1.601*** -1.581**

(0.465) (0.498) (0.784) (0.780) (0.585) (0.600)

100 grams of CSB -0.525*** -0.737*** -0.415***

(0.044) (0.081) (0.041)

Observations 5285 5285 2677 2677 2608 2608

R-squared 0.05 0.09 0.05 0.10 0.05 0.09

Gap between FFS and FAFH -2.403*** -1.504** -3.213*** -1.677* -0.878 -0.457

FAFH = food away from home: FFS = food from school (includes all foods obtained at school). CSB = caloric sweetened beverages.

Standard errors in parentheses; *** significant at 1 percent, ** significant at 5 percent, * significant at 10 percent; additional controls include 

whether the respondent ate breakfast, lunch, dinner, or a snack each day and whether the recall day was on a weekend; survey weights and 

complex design incorporated using svy command in STATA 10.1. HEI = Healthy Eating Index.

Source: USDA, Economic Research Service. 
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older children, FAFH and FFS have similar effects on total calories—each 

adds about 145 more calories to total daily intake than does a lunch from home. 

However, when testing for differences between the effect of FAFH and the 

effect of FFS on total daily calories, we find no significant difference between 

the two food sources for either age group. 

In terms of diet quality, we find that FAFH has a significant and negative 

effect on HEI-2005 scores as well. Each FAFH meal is estimated to decrease 

HEI scores by 2.6 points for all children (about 5 percent of the average HEI 

score of 48.66), 2.8 points for children ages 6-12, and 2.5 points for children ages 13-18. The effect of FFS on HEI varies by children’s age. While 

each FFS meal is found to have no significant net effect on HEI for younger 

children, each meal from school is estimated to significantly decrease diet 

quality by 1.6 points for children ages 13-18. This likely reflects the trend 

toward less healthful food environments in middle and high schools than in 

elementary schools. However, it is important to note that even if the negative effects of FAFH or FFS on diet quality were removed, the expected HEI 

score would still only reach 50 out of a possible 100 points. This highlights 

the fact that issues of poor diet quality relative to dietary recommendations 

are pervasive in our food choices and unlikely to improve solely by adjusting 

FAFH and FFS policies. 

Controlling for intake of caloric sweetened beverages lowers FAFH’s

estimated effect on calories.

After controlling for the change in the amount of caloric sweetened beverages consumed (equation 4), the analysis finds that at least some of the negative effect of FAFH is tied to the consumption of these beverages (table 5, 

second column of results for each sample). For all children, when the change 

in the amount of CSBs consumed is added to the regression, the estimate of 

the effect of FAFH meals drops from 106 to 65 calories added per day but 

the difference between FAFH and FFS remains insignificant. Each 100 grams 

of CSBs is estimated to increase daily caloric intake by 37 calories. (For 

context, a 12-ounce can of soda or other CSB weighs roughly 355 grams,9

with the number of calories per 100 grams varying across beverage type: 

100 grams of nondiet cola contain approximately 40 calories, 100 grams of 

fruit punch contain 50 calories, and 100 grams of a sports drink contain 20 

calories.) Estimates suggest that each calorie consumed from CSBs increases 

daily caloric intake, in general, on a one-to-one basis. The average child in 

this sample consumes about 560 grams of CSBs per day (see table 3), which 

equates to roughly 185 extra calories per day. 

When the sample is split into two age categories, the standard errors increase 

and the estimates become less precise. As such, the coefficients on FAFH and 

FFS after controlling for CSB consumption may overlap with those generated 

without controlling for CSB intake. However, the general pattern is the same 

as that observed in the full sample. For children ages 6-12, neither FAFH 

nor FFS has a significant effect on daily caloric intake after accounting for 

consumption of CSBs, and CSBs are estimated to add 39 calories to intake 

(per 100 grams). For older children (ages 13-18), the effect on intake of all 

FAFH is reduced (107 calories per meal) after accounting for CSB consumption (100 grams of CSB increase intake by 35 calories), and the net effect of 

food from school remains at 145 calories. 

9One fluid ounce is equal to 29.57 

grams. Conversely, 1 gram is equal to 

.03381 ounces.
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Even after controlling for CSB consumption, FAFH adversely affects 

HEI-2005 total scores.

Controlling for CSB consumption reduces the effect of FAFH and FFS on 

calories but not the effect of FAFH on total HEI scores. After controlling 

for CSBs, each FAFH meal reduces the total HEI-2005 score by just over 2 

points for all children (see table 5), which is roughly 4 percent of the mean 

score. Point estimates are similar for both age groups. FFS has no significant 

effect on the HEI score for all children and for children ages 6-12. However, 

each FFS meal reduces the total HEI-2005 score for older children (ages 

13-18) by 1.6 points. Again, this may be due to greater access to competitive 

and a la carte foods for students in middle and high schools. 

On average, every 100 grams of CSBs reduces HEI scores for all children 

by 0.5 points (1.1 percent); the equivalent of a 12-ounce soda is estimated 

to reduce scores by 1.8 points, or 3.5 percent from the mean score. The 

effects of CSBs also differ by age group, with a larger negative effect among 

younger children (0.74 points per 100 grams; 2.5 points per 12 ounces) than 

among older children (0.4 points per 100 grams; 1.4 points per 12 ounces). 

Because CSB consumption is found to have a significant effect on calorie 

intake and diet quality for both age groups, the analysis controls for CSB 

consumption in all remaining regressions.

FAFH lowers children’s diet quality by reducing intake of food groups for 

which consumption is encouraged, while increasing intake of those that 

should be consumed in moderation.

Analysis of the HEI component density scores shows that FAFH negatively 

affects children’s diet quality by reducing dietary density, or share of total 

calories, of the food groups that are encouraged—fruit, whole fruit, whole 

grains, all vegetables, and dark-green vegetables (table 6). At the same time, 

FAFH increases the share of calories from components that are already 

consumed in excess—saturated fat, sodium, and extra calories (added sugar 

and solid fat). The adverse effect of FAFH on HEI component scores, except 

for those on fruits and whole grains, is more pronounced among older 

children.

Among all children, each meal from FFS increases the density of milk in the 

diet. Among younger children, FFS also reduces the density of sodium in the 

diet. Among older children, who typically face a less healthful food environment in schools, each FFS meal has a significant and adverse effect on 

several components of diet quality: it lowers the dietary density of total fruit, 

whole grains, and dark-green vegetables and increases the density of saturated fat and extra calories (those from added sugar and solid fat). Though 

the effect is less pronounced, FFS is also estimated to increase the share of 

calories from saturated fat among younger children. 

For both groups of children, consumption of CSBs reduces the density of all 

healthful meal components (except all vegetables) and increases intake of 

extra calories. As stated earlier, CSB consumption as measured in calories 

has a nearly one-to-one relationship with increases in daily caloric intake. 

These findings suggest that CSBs decrease HEI component measures by 

adding calories that contain little else besides added sugar. Thus, the negative 
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Table 6

Effects of meals consumed from FAFH and FFS on HEI component densities of children ages 6-18

Total fruit Whole fruit Whole grains

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

FAFH meal -0.051*** -0.063*** -0.041** -0.045*** -0.045** -0.040*** -0.041*** -0.059*** -0.027*

(0.012) (0.021) (0.019) (0.011) (0.022) (0.013) (0.011) (0.019) (0.014)

FFS meal -0.022 0.004 -0.079** -0.015 -0.035 -0.000 -0.069** -0.060 -0.066**

(0.027) (0.036) (0.034) (0.021) (0.029) (0.017) (0.030) (0.039) (0.026)

100 grams of caloric 

sweetened beverage -0.021*** -0.025*** -0.018*** -0.009*** -0.015*** -0.006*** -0.002* -0.002 -0.003

(0.002) (0.004) (0.003) (0.001) (0.002) (0.002) (0.001) (0.003) (0.002)

R-squared 0.04 0.05 0.03 0.02 0.03 0.01 0.01 0.02 0.02

Gap between FFS 

and FAFH -0.029 -0.067* 0.038 -0.030 -0.010 -0.040 0.028 0.001 0.039

Dairy All vegetables Dark-green vegetables

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

FAFH meal 0.004 -0.010 0.010 -0.065*** -0.040* -0.082*** -0.026*** -0.018*** -0.032***

(0.022) (0.028) (0.024) (0.018) (0.023) (0.025) (0.003) (0.005) (0.004)

FFS meal 0.203*** 0.221*** 0.173*** 0.023 -0.000 0.049 -0.011* -0.006 -0.023***

(0.027) (0.036) (0.040) (0.023) (0.021) (0.042) (0.006) (0.006) (0.008)

100 grams of CSB -0.025*** -0.024*** -0.027*** -0.004* -0.009*** -0.001 -0.001* -0.001 -0.001

(0.002) (0.005) (0.003) (0.002) (0.003) (0.003) (0.001) (0.001) (0.001)

R-squared 0.10 0.11 0.09 0.02 0.02 0.03 0.02 0.01 0.03

Gap between FFS 

and FAFH -0.200*** -0.232*** -0.163*** -0.088*** -0.039 -0.130*** -0.0146** -0.012 -0.009

Percent saturated fat Sodium Extra calories

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

All 

children 

ages 6-18

Ages

 6-12

Ages 

13-18

FAFH meal 0.466*** 0.456*** 0.491*** -47.773*** -39.557** -50.304** 1.637*** 1.407*** 1.752***

(0.103) (0.147) (0.151) (15.712) (17.175) (23.588) (0.270) (0.305) (0.371)

FFS meal 0.514*** 0.417** 0.737*** -28.508* -56.963*** 21.270 0.835** 0.800 1.293***

(0.140) (0.188) (0.214) (16.547) (19.875) (32.445) (0.340) (0.512) (0.430)

100 grams of CSB -0.113*** -0.098*** -0.124*** -13.027*** -13.363*** -13.133*** 0.803*** 0.938*** 0.731***

(0.013) (0.018) (0.017) (1.653) (2.569) (2.097) (0.045) (0.091) (0.042)

R-squared 0.04 0.03 0.06 0.04 0.03 0.05 0.21 0.20 0.22

Gap between FFS 

and FAFH -0.048 0.040 -0.246 -19.265 17.405 -71.574* 0.802* 0.607 0.459

FAFH = food away from home: FFS = food from school (includes all foods obtained at school): N=5,825. CSB = caloric sweetened beverages. 

Standard errors in parentheses; *** significant at 1 percent, ** significant at 5 percent, * significant at 10 percent; additional controls include 

whether the respondent ate breakfast, lunch, dinner, or a snack each day and whether the recall day was on a weekend; survey weights and 

complex design incorporated using svy command in Stata 10.1. HEI = Healthy Eating Index.

Source: USDA, Economic Research Service.
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effects of FAFH on the diet quality of children may be mitigated by replacing 

the standard beverage in restaurant meals, usually some sort of soft drink, 

with a more healthful alternative, such as water or low-fat milk.

Among both younger and older children, there have been no significant 

changes in the effects of FAFH or FFS on calorie intake or diet quality over 

time. 

Across time periods (1994-96 and 2003-04), there are few statistically significant changes in the effects of FAFH, FFS, and CSB intake for younger children (tables 7 and 8). While in many cases, the point estimates differ across 

the two periods, small sample sizes and subsequent large standard errors lead 

to statistically insignificant differences. The only notable changes between 

the two time periods are in the effect of CSB consumption on diet quality—

between 1994-96 and 2003-04, the adverse effect of CSBs on milk intake 

declined and the effect on extra calories was mixed. For younger children, 

the effect of CSBs grew between 1994-96 and 2003-04. For older children, 

the effect decreased. While statistically significant, the estimated effects were 

quite small.10 10 As an example, among children 

ages 13-18, the estimated impact of 

each 12-ounce can of soda was to 

reduce one’s daily milk density by .10 

cups per 1,000 calories in 1994-96. In 

2003-04, the estimated impact of a can 

of soda was to reduce daily milk density by .07 cups. For a 2,000 caloriea-day diet, the difference between the 

two time periods is roughly equivalent 

to 1 tablespoon of milk.
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Table 7

Effects of FAFH and FFS on total calories, HEI-2005, and component densities of children ages 6 to 12 

Energy Total HEI score Total fruit Whole fruit

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal 3.106 38.909 -1.868*** -1.763** -0.076*** -0.041 -0.050** -0.031

(31.881) (22.563) (0.547) (0.679) (0.025) (0.036) (0.025) (0.037)

FFS meal 41.238 49.427 0.152 -0.623 0.015 -0.009 0.012 -0.077

(33.491) (75.096) (0.654) (1.466) (0.041) (0.059) (0.030) (0.046)

100 grams of 

CSB 38.369*** 42.441*** -0.775*** -0.683*** -0.037*** -0.019*** ++ -0.020*** -0.012*** +

(5.347) (7.583) (0.077) (0.120) (0.005) (0.005) (0.004) (0.003)

R-squared 0.19 0.13 0.11 0.11 0.07 0.04 0.05 0.04

Gap between 

FFS and 

FAFH -38.132 -10.51777 -2.020** -1.1396 -0.091** -0.0322 -0.062** 0.0462

Whole grains Dairy All vegetables Dark-green vegetables

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal -0.021 -0.088** + 0.005 -0.028 -0.024 -0.057 -0.015** -0.021**

(0.021) (0.033) (0.030) (0.055) (0.020) (0.041) (0.007) (0.009)

FFS meal -0.023 -0.093 0.216*** 0.222*** -0.012 0.018 -0.015 0.003

(0.025) (0.077) (0.033) (0.066) (0.023) (0.034) (0.010) (0.007)

100 grams of 

CSB -0.009** 0.006 ++ -0.042*** -0.012** +++ -0.005 -0.010** -0.001 -0.000

(0.004) (0.005) (0.006) (0.005) (0.004) (0.005) (0.001) (0.001)

R-squared 0.01 0.04 0.14 0.10 0.01 0.04 0.01 0.02

Gap between 

FFS and 

FAFH 0.002 0.005 + -0.163*** -0.088*** -0.012 -0.075 0.000 -0.025

Percent saturated fat Sodium Extra calories

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal 0.400** 0.550** -46.007* -29.850 1.853*** 0.796 +

(0.193) (0.216) (23.575) (23.754) (0.365) (0.499)

FFS meal 0.347* 0.456 -79.741** -38.321* 0.628 0.987

(0.183) (0.325) (35.211) (21.720) (0.478) (0.920)

100 grams of 

CSB -0.138*** -0.079** -12.108*** -14.688*** 0.957*** 0.917***

(0.026) (0.029) (4.230) (3.189) (0.070) (0.132)

R-squared 0.04 0.03 0.03 0.04 0.17 0.23

Gap between 

FFS and 

FAFH 0.054 0.094 33.735 8.472 1.225** -0.191 +

FAFH = food away from home: FFS = food from school (includes all foods obtained at schoo)l: N=1,608. CSB = caloric sweetened beverages. 

HEI = Healthy Eating Index. Standard errors in parentheses; *** significant at 1 percent, ** significant at 5 percent, * significant at 10 percent; +++ 

difference between 1994-96 and 2003-04 is significant at 1 percent; ++ difference between 1994-96 is significant at 5 percent, + difference between 

1994-96 is significant at 10 percent; additional controls include whether the respondent ate breakfast, lunch, dinner, or a snack each day and 

whether the recall day was on a weekend; survey weights and complex design incorporated using svy command in Stata 10.1. 

Source: USDA, Economic Research Service. 
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Table 8

Effects of FAFH and FFS on total calories, HEI-2005, and component densities of children ages 13-18 

Energy Total HEI score Total fruit Whole fruit

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal 56.964 151.078*** -2.367*** -1.741** -0.015 -0.065** -0.017 -0.059**

(45.367) (43.520) (0.453) (0.673) (0.029) (0.027) (0.019) (0.021)

FFS meal 171.836** 119.566** -0.499 -2.722*** + -0.063 -0.092** -0.009 0.006

(75.611) (51.902) (0.923) (0.714) (0.055) (0.036) (0.026) (0.020)

100 grams of 

CSB 36.860*** 34.187*** -0.368*** -0.442*** -0.020*** -0.018*** -0.009*** -0.003 +

(5.129) (6.209) (0.060) (0.056) (0.004) (0.004) (0.003) (0.002)

R-squared 0.18 0.20 0.09 0.10 0.03 0.05 0.01 0.02

Gap between 

FFS and 

FAFH -114.872 31.512 -1.867* 0.980 0.048 0.027 -0.008 -0.065*

Whole grains Dairy All vegetables Dark-green vegetables

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal -0.027 -0.027 0.005 0.018 -0.080** -0.077** -0.035*** -0.028***

(0.020) (0.021) (0.020) (0.043) (0.034) (0.032) (0.006) (0.006)

FFS meal -0.061* -0.068 0.127*** 0.220*** 0.035 0.042 -0.020 -0.028***

(0.035) (0.039) (0.044) (0.069) (0.039) (0.067) (0.013) (0.009)

100 grams of 

CSB -0.002 -0.004 -0.031*** -0.024*** -0.004 0.003 -0.001 -0.000

(0.002) (0.003) (0.003) (0.004) (0.004) (0.003) (0.001) (0.001)

R-squared 0.02 0.04 0.12 0.09 0.03 0.04 0.03 0.02

Gap between 

FFS and 

FAFH 0.034 0.041 -0.122** -0.203*** -0.115** -0.118* -0.015 0.000

Percent saturated fat Sodium Extra calories

1994-96 2003-04 1994-96 2003-04 1994-96 2003-04

FAFH meal 0.464*** 0.503* -65.874** -36.513 2.399*** 1.043* +

(0.157) (0.262) (25.961) (39.543) (0.477) (0.506)

FFS meal 0.697** 0.780*** 21.843 14.003 0.620 2.077*** +

(0.308) (0.264) (35.301) (53.752) (0.776) (0.316)

100 grams of 

CSB -0.125*** -0.119*** -14.699*** -11.085*** 0.751*** 0.690***

(0.021) (0.026) (2.316) (3.249) (0.058) (0.057)

R-squared 0.06 0.06 0.05 0.05 0.24 0.21

FAFH = food away from home: FFS = food from school (includes all foods obtained at school): N=1,082. CSB = caloric sweetened beverages. 

HEI = Healthy Eating Index. Standard errors in parentheses; *** significant at 1 percent, ** significant at 5 percent, * significant at 10 percent; + 

indicates the difference between the two time periods is significant at 10 percent; additional controls include whether the respondent ate breakfast, 

lunch, dinner, or a snack each day and whether the recall day was on a weekend; survey weights and complex design incorporated using svy command in Stata 10.1.

Source: USDA, Economic Research Service. 
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Discussion and Policy Implications

This study’s findings support the contention that increased consumption of 

FAFH is a contributing factor in the current epidemic of childhood obesity. 

Compared with foods prepared at home, FAFH is associated with increased 

caloric intake and lower diet quality, especially among older children. These 

effects are found after employing a methodology that controls for underlying 

personal characteristics and circumstances, such as access to food outlets, 

which might affect intake. This strengthens the argument that there is a 

causal relationship between FAFH and increased caloric consumption and 

decreased dietary quality. These findings also support policy and educational 

efforts designed to help children and their parents make more informed food 

and beverage choices when eating away from home.

One of the most common choices when eating away from home is consumption of caloric sweetened beverages. Our analysis finds that much, but not 

all, of the adverse dietary effect of FAFH is driven by its association with 

increased consumption of CSBs. The effect of CSB consumption on caloric 

intake is particularly striking: each calorie consumed from CSBs adds 

almost 1 additional calorie to overall daily intake. CSB consumption also 

lowers diet quality, reducing the overall share of calories of healthful foods, 

such as fruits, whole grains, and milk. The addition of calories lacking in 

any food components other than added sugar will tend to decrease density. 

CSBs may also displace consumption of more healthful beverages, such as 

milk and fruit juice, which may explain reductions in the densities of milk 

and total fruit components in the diets of children. Efforts to reduce children’s consumption of CSBs include restrictions on the availability of these 

beverages at schools and other locations primarily serving children, such as 

community recreation centers (IOM, 2009), and nutrition education efforts. 

Some fast food and other restaurants have begun offering milk or juice as 

beverages with children’s meals. Taxes on CSBs have also been proposed 

as a strategy for limiting general consumption (Brownell and Frieden, 2009; 

Chaloupka et al., 2009; IOM, 2005). The relative effectiveness of these 

approaches deserves further investigation. 

Findings on the nutritional effects of food obtained at school reveal striking 

differences by age group. Among younger children, FFS does not add to 

caloric intake or decrease diet quality. Among older children, the adverse 

effects of FFS on the diets are similar to those of other FAFH, in that each 

adds similar amounts of calories to the daily diet. This likely reflects the 

prevalence of low-nutrient, high-energy competitive foods available as 

snacks in middle and high schools (Fox et al., 2009). These are foods sold 

outside the regular school lunch and breakfast program, which follow guidelines set by USDA. FFS has a somewhat less negative effect than other 

FAFH on overall diet quality for this age group, 

Although these findings do not support arguments that food obtained from 

school contributes to the obesity epidemic, neither does it show that school 

food leads to improvement in the many areas in which the diets of American 

children are lacking. Overall, American children eat too few fruits, darkgreen and orange vegetables, and whole grains. Given the considerable 

Federal investment in school meal programs, it is reasonable to investigate 

how school food can do more to address these shortfalls. The recent IOM 
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report School Meals: Building Blocks for Healthy Children proposes new 

Federal meal standards that would require meals to serve more of these 

underconsumed dietary components. USDA Secretary Thomas Vilsack has 

announced his intention to transform these recommendations into updated 

Federal regulations (USDA, 2009); such actions may have positive impacts 

on FFS quality. USDA has legislative authority to regulate foods sold as part 

of the reimbursable meal, so any updates to the current Federal regulations 

will not apply to many of the other foods that compete for students’ attention, 

such as the a la carte items also sold in school cafeterias. 

In general, our findings suggest that consumption of food prepared outside 

the home has particularly negative effects on the diets of older children and 

adolescents. Foods available to these children from both commercial and 

school sources add calories and decrease diet quality. Moreover, older children eat more nonhome foods: on average they eat 50 percent more FAFH 

meals and twice as many FAFH snacks as younger children. Older children 

and adolescents typically have more freedom, more time with peers, more 

spending money of their own, and, therefore, more opportunities to make 

their own food choices, at school and elsewhere, than younger children. 

Unfortunately, older children are opting for less healthful and nutritious 

foods. 

Several of the most widely discussed proposals for improving children’s 

diets, such as improving the nutritional quality of “children’s meals” sold 

at fast food and other restaurants or restricting food advertising for television programs watched by children under age 12, are targeted to younger 

children and would have little or no effect on older children and adolescents. 

More investigation of appropriate and effective strategies targeting this older 

age group seems warranted. Devising such strategies, however, may be a 

challenge; during adolescence, peer influences on behavior, including food 

choice, are strong and may trump nutrition advice (Stang and Story, 2005). 

Nevertheless, given the importance of this stage to an individual’s growth, 

development, and formation of longer term habits (Kelder et al., 1994), it 

merits more consideration. 

A broad range of public and private groups have expressed a strong interest 

in improving children’s diets. Many of the proposed policy and educational 

efforts aimed at improving child nutrition and preventing obesity focus on 

food obtained from fast food and other restaurant and commercial sources, 

foods obtained at school, and caloric sweetened beverages. Findings in this 

study point to the importance of these areas of policy focus and provide 

insights that can help inform selection and design of nutrition policies and 

strategies. 
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