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Background  School recess before lunch (e.g., reverse recess) has been suggested as a means to improve dietary intake and classroom behavior but limited research explores this school-based policy. This pilot study tests the impact of recess scheduling on dietary intake at school lunch.    Methods  A mixed methods approach included assessment of dietary intake assessed by measured plate waste on five non-consecutive days at Madras Elementary School, Madras, Oregon, United States (n = 104 intervention; 157 controls). Subjects included primary school children in grades kindergarten, first and second. Logistic regression was used to test associations between recess timing and dietary intake. Four focus groups involving teachers and staff explored reactions to the intervention. Qualitative data was transcribed verbatim and assessed for key themes.    Results  Milk consumption was 1.3 oz greater in the intervention group (5.7 oz vs. 4.4 oz); and 20% more of the intervention participants drank the entire carton of milk (42% vs. 25%, p < 0.0001). Intervention participants were 1.5 times more likely to meet the nutritional guidelines for calcium (≥267 mg, p = 0.01) and fat (≤30% of total energy, p = 0.02). Consumption of entrees, vegetables, and fruits did not differ between groups. Teachers perceived recess before lunch beneficial to classroom behavior and readiness to concentrate following lunch.    Conclusions  The recess before lunch intervention yielded increased milk consumption; the nutritional and social benefits observed warrant policy change consideration. Future research should assess the impact of recess before lunch in larger districts.

Elementary school children’s recess schedule and dietary intake at lunch: a community-based participatory research partnership pilot study