Obesity is a major chronic care condition proven to affect more than 12 million children and adolescents, age 2 to 19; which categorizes approximately 17% of America's youth as obese or overweight. Congress has established federal mandates targeting obesity by enforcing nutritional policies for cafeteria and competitive foods to enhance learning environments. Establishing federal nutritional guidelines in education allows more than 31 million children to receive meals at a free and low cost in more than 96,000 public and nonprofit private schools. The purpose of this quality improvement project is to compare individual food choices with the National School Lunch Program (NSLP) and physical activity following an educational program on food choices and physical activity to high school students.

The John Hopkins Nursing Evidence-Based 18-step research model was utilized to establish practice change, search evidence, and translate action plans in a NSLP environment. Opportunities to improve current practice was established by recruiting Wellness Committee members to monitor and evaluate the nutritional and physical activity behaviors while conducting an internal and external search for evidence.

An extensive review of the literature was conducted to identify evidence-based practices that effect body mass index (BMI), dietary patterns and food choices, and physical activity levels to assist the researcher to establish strategies to improve nutrition and physical fitness. The intervention includes the implementation of an educational program; using the USDA SuperTracker, journaling, and accurate recording of nutrition logs; to determine adherence and identify barriers.

The 4-week cross-sectional study is comprised of sample data that reveals participant's demographic information, BMI, food choices, physical activity level, and adherence to recording nutritional information during pre-and post-intervention. The sample population included a total of 84 adolescents, age 14-17; comprised of 92.86% female (n = 78) and 7.14% male (n = 6); who were assessed during the pre-and post-intervention phase of the study. The data shows that 55.95 % of participants prefer to eat in the Cafeteria (n = 47) rather than the 44.05% in the Canteen (n = 37). There was no change in the pre-and post-intervention population and the dietary preferences remained the same. Comparable to the pre-intervention group, Week 4 data shows BMI and physical activity for total step decreased 32% over time; totaling 27 participants not adhering to the recording requirements.