Milk is a nutrient dense beverage that has been a part of the National School Lunch Program (NSLP) since its inception.  Offering flavored milks as an option in school remains a topic of debate. The objective of this study was to examine the relationship between NSLP participants’ milk choice and the nutritional content of their NSLP lunches. The study was conducted at two elementary schools in South Carolina over a two-week period (n= 619 students and 968 NSLP lunches). In accordance with the Health, Hunger-Free Kids Act, students were required to choose three out of five meal components (meat/meat alternative, grain, fruit, vegetable, and milk). Nutrient consumption was estimated by using observational plate waste through the Digital Photography of Foods Method. Consumption data was then linked to student-level sociodemographic data characteristics provided by the school district. Results showed that 75% of lunches contained fat-free chocolate milk, 17% contained low-fat white milk, and 8% contained no milk. Students who choose fat-free chocolate milk consumed more energy and total sugar (p<0.001) than students who chose low-fat white milk with their NSLP lunch. Students who chose low-fat chocolate milk also consumed significantly more protein (p=0.023), calcium (p=0.082), magnesium (p<0.001) and vitamin A (p=0.049) compared to students who chose low-fat white milk. Milk consumption varied by sociodemographic characteristics. Of note, Black and Hispanic students consumed 14.2% less milk compared to White students (p=0.001). Students receiving free- and reduced-price lunch were less likely than those paying full price to choose no milk instead of low-fat white milk (p = 0.001) or fat-free chocolate milk (p = 0.064).

Study strengths: This study included a large sample size and was conducted following the implementation of the Healthy, Hunger-Free Kids Act.  This study also examined the relationship between milk consumption and other nutrients in the NSLP when children were given the choice between flavored and unflavored milks.

Study limitations: This study only included data from one meal; previous research has highlighted the importance of considering nutrient intake outside of the cafeteria. This study also included a limited geographic area and time span of two weeks. Finally, the observational nature of this study cannot determine causal impacts of milk choice on overall nutrition; additional research is needed to understand how milk consumption affects nutrition intakes.

What this means for your practice: The 2015-2020 Dietary Guidelines for Americans recommends limiting added sugar to less than 10% of calories per day. Findings from this study showed that participants who chose low-fat chocolate milk did consume more total sugar, but also more nutrients such as protein, calcium, magnesium and vitamin A. Additional research is needed to examine whether the benefit of the additional nutrients outweighs the risk associated with the added sugar. At Rethink Your Drink, we teach families that flavored milk is a SLOW drink and is only recommended for kids in small amounts. Refer your families to to learn more about WHOA, SLOW, and GO drinks

Original citation: Peckham, J. G., Kropp, J. D., Mroz, T. A., Haley-Zitlin, V., & Granberg, E. (2021). Students choosing fat-free chocolate milk during school lunch consume more calories, total sugar, protein, minerals and vitamins at lunch. Public Health Nutrition, 24(7), 1818-1827.

About the Author:  Chenin Treftz, Ph.D., R.D.N., is a member of the research faculty at the University of Nevada, Reno.  Dr. Treftz has expertise in research, community nutrition, and higher education. Dr. Treftz has been a member of the Rethink Your Drink team since 2012.

The goal of Rethink Your Drink Nevada is to promote healthy beverages and reduce sugary drinks. To support this goal, free educational resources are available to eligible medical and dental care practices in Nevada.  For more information, please visit or e-mail

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