There’s a good reason why America is home to a large population of poorly-nourished people despite the fact that America is one of the wealthiest countries in the world. The problem isn’t a lack of food; it’s the food choices people tend to make when they visit the abundance of food sources available to them.

Too many people are filling their empty stomachs with food that is of poor nutritional quality — whether it’s a meal bought at a supermarket, a work site cafeteria, a restaurant, entertainment venue or food truck — according to a new study.

“Our results suggest substantial nutritional harms for millions of kids who have not been consistently receiving meals at school and must rely on other sources.”

The study of diet quality looked at the meals, snacks and beverages consumed from a variety of possible food sources by about 40,000 adults and 21,000 children over the age of 16. Researchers at the Friedman School of Nutrition Science and Policy at Tufts University collected the data from eight National Health and Nutrition Examination Surveys (2003-2018).

Meals with the least nutritional value came from restaurants. Sixty-five percent of the adult meals and 80 percent of children’s meals purchased at restaurants were nutritionally inadequate. Next lowest on the list were meals eaten at entertainment venues and food trucks, where roughly half of meals eaten by both adults and kids were of poor nutritional quality. About half of the meals eaten at work sites did not meet nutritional standards.

Surprisingly, meals from grocery stores and school cafeterias ranked better. About a third of adult meals and just under half of children’s meals from foods obtained at grocery stores were poor quality, but schools ranked the best with just under 25% of meals considered nutritionally poor.

The highest quality foods for kids came from schools, not home.

The numbers sound pretty discouraging, but modest improvements were seen for foods consumed from grocery stores and small improvements were noted for restaurant meals over the 15 years data analyzed. Other sources of meals showed stable or worse food quality.

The fact that schools provided the highest quality foods is likely a result of the Healthy, Hunger-Free Kids Act of 2010 that mandated more stringent nutrition standards for schools and early child care. As a result, kids ate more of the foods that were good for them like whole grains, fruits and vegetables and less refined grains, sugary foods and beverages.

It is also concerning that the highest quality foods for kids came from schools, rather than their homes. “Schools are now the single healthiest place Americans are eating. This finding is particularly timely given widespread school closures over the last year from COVID-19, and current efforts to safely and fully reopen schools,” Dariush Mozaffarian, Dean and Jean Mayer Professor at the Tufts Friedman School and Professor of Medicine at Tufts Medical School, explained in a statement.

“Our results suggest substantial nutritional harms for millions of kids who have not been consistently receiving meals at school and must rely on other sources. These harms also disproportionately affect low-income, Black and Latinx children.”

Children only get about nine percent of their calories from school meals, however, which means parents and caregivers have a lot of work to do to make sure their children are being fed nutritious food when they aren’t at school.

With the end of the pandemic in sight, now is a good time to reconsider where we get our food, as well as the food choices we make. Before the COVID-19 pandemic, grocery stores were already the primary source of food, but since then even more people are purchasing food from grocery stores, even if it’s online, giving these stores important opportunities for improving the quality of the diets of Americans.

The study is published in JAMA Network Open.