Is the Balanced School Day truly balanced? A review of the impacts on children, families, and school food environments.

Background: The Balanced School Day (BSD) is a scheduling policy that has the potential to impact children's food behaviors because students are provided with two 20-minute eating opportunities versus the traditional 20-minute lunch.

Methods: We aim to raise awareness of this grassroots academic policy and its potential consequences to inform future decision making and minimize potential unintended negative health consequences.

Results: While there is limited research on this schedule, it has been shown that there is less time lost in transition from classroom to recess. Perception surveys have shown that principals and custodians are the most satisfied, followed by parents, teachers, and secretaries, with students being the least satisfied. The BSD is also perceived to improve organization of instructional time, playground cleanliness, and student concentration. Despite these purported benefits, there is limited data on the impact of the BSD on children's eating habits, physical activity, and body mass index (BMI). While 1 study reported fewer pedometer-measured step counts during breaks in the BSD, more research is needed on the impact of this alternative schedule on children's food intake and BMI.

Conclusions: School and public health professionals must advocate for "health impact assessments" to assess the health effects of this policy.