Food Service Directors' Knowledge and Beliefs About Ultraprocessed Foods in California's San Joaquin Valley Schools.

Introduction: Ultraprocessed foods (UPFs) are industrial formulations of ingredients typically not used in home cooking and often high in added sugars, saturated fat, or sodium. UPF intake is associated with obesity, type 2 diabetes, hypertension, and other chronic diseases. Although the National School Lunch Program and School Breakfast Program must meet US Department of Agriculture nutrition standards, federal standards do not specifically address food processing. However, reducing UPFs in schools is gaining momentum. As food service directors (FSDs) are key implementers of school nutrition policies, we sought to characterize their knowledge and beliefs about UPFs in school meals. Methods: In this qualitative study, we conducted 20 semistructured interviews with FSDs in California's low-income, largely rural San Joaquin Valley from January through June 2024. Two analysts double-coded transcripts and used inductive thematic analysis to identify key themes. Results: Of 20 FSDs, 16 completed the demographic survey. Participants' mean age was 49.5 years (IQR, 41.0-59.5), 15 were women, 8 identified as White, and 6 identified as Hispanic or Latino. Seven FSDs reported that they had never heard of UPFs. After receiving a definition, FSDs generally described UPFs as less healthy than scratch-cooked foods, although several perceived UPFs served in schools as healthier than UPFs sold elsewhere. FSDs cited student food insecurity, food safety concerns, and student acceptance as reasons for serving UPFs; others worried that serving UPFs at school could reinforce unhealthy eating habits. Conclusion: Training that is free of conflicts of interest and food labeling systems that are clearer may improve FSDs' ability to identify UPFs and implement policies to reduce UPFs in school meals.