Pediatric Clinical Care Provider and School Nutrition Professionals Team Up for Smarter Lunchroom Movement in Georgia

serving lunch

In 2014, Children’s Healthcare of Atlanta, a pediatric clinical care provider in Georgia developed Strong4Life Nutrition Program in partnership with a statewide multiagency, multidimensional initiative to address childhood obesity in the state of Georgia. The program applies work conducted by the Cornell Center for Behavioral Economics in Child Nutrition Programs’ Smarter Lunchrooms Movement

The Strong4Life School Nutrition Program packages the evidence-based techniques of the Smarter Lunchrooms Movement into 5 focus areas, called the Strong4Life Smart Serving Strategies:

  1. Sell: Through promotions and signage, make healthy food selections more appealing to students and nudge students toward selecting healthier options.
  2. Taste: Enhance students’ taste expectations by ensuring that food items are presented in an attractive and visually appealing way.
  3. Visibility: Make the healthiest choices the most visible.
  4. Convenience: Make the healthy choices quick and easy to reach, including grab-n-go options.
  5. Price: Give healthy items an advantage by making them more affordable than less healthy options.

842 school nutrition managers and staff members were trained on simple, no-/low-cost changes for the cafeteria to encourage students to select school lunch and make healthier choices in the lunch line. The training comprised of an in-person, interactive training session which included videos and a training manual. Also, managers were given a take-home toolkit including bright, colorful, and functional posters, floor decals, stickers, buttons, ceiling danglers, menu item labels, and fruit bowl stickers to enhance the school cafeteria environment.

School nutrition professionals improved their knowledge and put many new strategies to work in their cafeterias. They learned about ways to enhance the appeal of foods by giving food and menu items creative names, along with how food placement influences food selection. The training also impacted school cafeteria managers and staff members’ beliefs and self-efficacy. School nutrition professionals reported feeling more confident that meals served in school cafeterias play an important role in childhood obesity prevention. Their awareness increased, and they identified childhood overweight and obesity as a serious problem in Georgia.

Approximately 3 months after training, managers reported making changes to the cafeteria environment in the five areas of Strong4Life Smart Serving Strategies. They are:

  1. Providing healthy option in more than 2 locations,
  2. Placing healthy foods in the first spot in the lunch line,
  3. having more than 2 different colors of fruit and vegetables available daily, and
  4. Placing plain milk in front of flavored milk, juice, and sports drinks.

The training is now available online at


Janani Rajbhandari-Thapa, PhD, College of Public Health in the University of Georgia


Thapa, J. R. A. Bennett, F. Keong, W. Palmer, T. Hardy, J. A. Welsh. 2017. Effect of the Strong4Life School Nutrition Program on Cafeterias and on Manager and Staff Member Knowledge and Practice, Georgia, 2015. Public Health Reports, 2017 Nov/Dec;132(2_suppl):48S-56S. doi: 10.1177/0033354917723332.