Evaluating Dietitians’ Perspectives on Expanding the 2025 Medicare Physician Fee Schedule to Include Nutrition-Related Caregiver Training Services

Objectives: To explore Food Service Directors' (FSDs) perspectives on barriers and facilitators to increasing scratch cooking (meals cooked with minimally processed ingredients) as a strategy for reducing ultra processed foods (UPF) in school meals.Methods: We conducted Zoom interviews with 20 FSDs in California's (CA) San Joaquin Valley, a largely Latinx agricultural area.FSDs were randomly sampled from rural/urban locale and receipt of a CA grant for freshly prepared meals.A Community Advisory Board consisting of the CA Department of Education, Department of Food and Agriculture, a school food cooperative, two non-profits, and FSDs provided input on the design and interpretation of the results.Interviews were recorded, transcribed, and double-coded.A hybrid thematic analysis was performed with emergent and a priori themes based on the socio-ecological model using NVivo.Results: Most participants were women (98.3%), White (50%), or Hispanic (37.5%), with a mean age of 50.9 years (SD 12).FSDs reported that federal and state funding supported the transition to scratch cooking, but future budget uncertainties limited their confidence to make permanent changes.Many FSDs lacked skills to calculate nutritional requirements and relied on packaged foods with Child Nutrition labels.Although US Department of Agriculture commodities provided minimally processed foods, districts often sent them to manufacturers that returned UPFs.Funding for Kitchen Infrastructure and Training facilitated equipment purchases, but limited space and outdated facilities hindered installation.Other barriers included concerns about foodborne illnesses, limited full-time staff, and training.While some FSDs noted students' preference for UPFs, others observed demand for fresh foods.Engaging students and offering familiar foods improves acceptability.Conclusions: School meals represent a promising population-level strategy for reducing UPFs and improving children's health.Given the National and California interests on policies to reduce UPF, this study offers valuable insights into opportunities for increasing scratch cooking to decrease UPF in school meals.