National Nutrition Standards In the Schools

School Nutrition Association-USDA State Agency Conference

November 27, 2007

Virginia A Stallings, MDChildren’s Hospital of Philadelphia

University of Pennsylvania School of Medicine

The most pressing challenge to nutritional health in this first decade of the 21st century is obesity.

Competitive Foods are Widely Available in Schools

Percentage of Schools Offering Competitive Foods

Food Venue Elementary Middle High

A la carte 67 88 91

Vending Machines

46 87 91

Snack Bars 15 25 54

School-Related Health Policy

• 2004 Child Nutrition and WIC Reauthorization Act

• Wellness Policy Required by 2006– Nutrition education goals– Physical activity goals– Nutrition guidelines– Other school-based activities

Nutrition Guidelines• All foods available on campus with

objective of promoting health and reducing obesity

• FY 2005 Congress directed CDC to initiate an IOM study to review the evidence and make recommendations

Institute of Medicine• National Academies chartered in 1863 to

advise the government on scientific and technical matters

• National Research Council, 1916National Academy of Engineering, 1964Institute of Medicine, 1970

• IOM for evidence-based info to support policies related to the health of the public

Committee’s Task• Review evidence and make nutrition

standard recommendations:– for availability of sale, content and

consumption of foods and beverages at schools;

– with attention to foods and beverages in competition with federally reimbursable meals and snacks.

Task

• Consider lessons learned– National School Lunch and Breakfast

Program– State- and local-based standards

• One standard for all ages, or not?

Task• Develop standards based upon

nutrition and health science• Ensure that foods and beverages

offered in schools contribute to an overall healthful environment

• Develop benchmarks to guide evaluations of the standards

Committee on Nutrition Standards for Foods in Schools

• Virginia A. Stallings (chair)Children’s Hospital of Philadelphia, PA

• Dennis M. BierBaylor College of Medicine, TX

• Margie Tudor Bradford, Bardstown Independent School Dist., KY

• Carlos A. Camargo, Jr.Massachusetts General Hospital, MA

• Isobel R. ContentoColumbia University, NY

• Thomas H. CookVanderbilt University, TN

• Eric A. DeckerUniv. of Massachusetts, Amherst, MA

• Rosemary DederichsMinneapolis Public School District, MN

• Jay T. EngelnNational Association of Secondary School Principals, VA

• Barbara N. FishWest Virginia Board of Educ., WV

• Tracy A. FoxFood, Nutrition & Policy Consultants, VA

• James C. OhlsMathematica Policy Research Inc., NJ

• Lynn ParkerFood, Research, and Action Center, Washington, DC

• David L. PelletierCornell University, NY

• Mary T. StoryUniversity of Minnesota, MN

Institute of Medicine Staff

• Ann Yaktine, Study Director (from July, 2006)• Janice Rice Okita, Study Director (until July,

2006)• Amin Akhlaghi, Research Associate (until

Oct., 2006)• Alice Vorosmarti, Research Associate• Heather Del Valle, Senior Program Assistant

Process and Approach• Ten Guiding Principles• Tier 1: All students all day “F, V, WG, D”

Tier 2: High school students after school• Includes recommendations for:

– Non-nutritive sweeteners– Caffeine– Water availability– Sport drinks– Food for student reward and punishment– Fund raising

The committee recognizes that:1. The present and future health and well-

being of school-age children are profoundly affected by dietary intake and the maintenance of a healthy weight.

2. Schools contribute to current and life-long health and dietary patterns and are uniquely positioned to model and reinforce healthful eating behaviors in partnership with parents, teachers, and the broader community.

The Guiding Principles

3. Because all foods and beverages available on the school campus represent significant caloric intake, they should be designed to meet nutritional standards.

4. Foods and beverages have health effects beyond those related to vitamins, minerals, and other known individual components.

5. Implementation of nutrition standards for foods and beverages offered in schools will likely require clear policies; technical and financial support; a monitoring, enforcement, and evaluation program; and new food and beverage products.

The committee intends that:6. The federally reimbursable school nutrition programs will be the primary source of foods and beverages offered at school.7. All foods and beverages offered on the school campus will contribute to an overall healthful eating environment.8. Nutrition standards will be established for foods and beverages offered outside the federally reimbursable school nutrition

programs.

9. The recommended nutrition standards will bebased on the Dietary Guidelines for Americans, with consideration given to other relevant science-based resources.

10. The nutrition standards will apply to foodsand beverages offered to all school-age children (generally ages 4 through 18 yrs) with consideration given to the developmental differences between children in elementary, middle, and high schools.

CaloriesWeight managementPhysical activity

Food groups to encourageFatsCarbohydratesSodium, potassiumAlcoholic beveragesFood safety

U.S. Department of Health and Human ServicesU.S. Department of Agriculture

www.healthierus.gov/dietaryguidelines

Dietary Intake Data

• <2% meet the Food Guide Pyramid recommendations

• 16% did not meet any of the Pyramid food group recommendations

• Too few fruits, vegetables, whole grains; not enough fiber- or calcium-rich foods

• Too much fat, sodium, added sugar

Are children’s diets meeting theDietary Guidelines for Americans?

Tier 1 for All Students All School Day: Foods

Tier 1 foods are fruits, vegetables, whole grains, and related combination products and nonfat and low-fat dairy that are limited to 200 calories or less per portion as packaged and: No more than 35% of total calories from fat Less than 10% of total calories from saturated fats Zero trans fat (≤0.5 g per serving) 35% or less of calories from total sugars, except for yogurt w/ no more than 30 g of total sugars, per 8-oz. portion as packaged Sodium content of 200 mg or less per portion as packaged

Tier 1 for All Students: Foods

Á la carte entrée items meet fat and sugar limits as listed above and: o are National School Lunch Program (NSLP) menu items o have a sodium content of 480 mg or less

Tier 1 for All Students All School Day: Beverages

Tier 1 beverages are: Water without flavoring, additives, or carbonation. Low-fat (1%) and nonfat milk (in 8 oz. portions): o Lactose-free and soy beverages are included o Flavored milk with no more than 22 g of total sugars per 8-oz. serving 100-percent fruit juice in 4-oz. portion for elementary/

middle school and 8 oz. for high school. Caffeine-free, with the exception of trace amounts of

naturally occurring caffeine substances

Tier 1 Foods and Tier 1 Foods and BeveragesBeverages

• Individual fruits: apples, pears, fruit cups packed in juice • Vegetables - baby carrots • Dried or dehydrated fruit - raisins, apricots, apples • 100 percent fruit juice or low-salt vegetable juice • Low-fat, low-salt whole-grain crackers or chips • Whole-grain, low-sugar cereals • 100 percent whole-grain mini bagels• Whole grain granola bars w/ or w/out fruit (Total = 1 serving)• 4, 6, or 8-oz low-fat fruit-flavored yogurt with no more than

15, 22.5, or 30 gm sugar accordingly • 4, 6, or 8-ounce servings low-fat chocolate milk with no more

than 11, 16.5 or 22 gm sugar accordingly

Tier 2 for High School Students After School

Tier 2 snack foods are: those that do not exceed 200 calories per portion as packaged and: No more than 35% of total calories from fat<10% of total calories from saturated fats Zero trans fat (≤0.5 g/portion) 35% or less of calories from total sugars Sodium content, 200 mg or less per portion as packaged

Tier 2 beverages are:Non-caffeinated, non-fortified beverages with less than 5 calories per portion as packaged: with or without:- nonnutritive sweeteners,- carbonation,- flavoring

Tier 2 Foods and BeveragesTier 2 Foods and Beverages

• Low-salt baked potato chips, crackers, and pretzels

• Animal crackers with no more than 35% of calories from sugar

• Graham crackers with no more than 35% of calories from sugar

• Caffeine-free, calorie-free, non-fortified soft drinks

• Frozen ice cream products that meet the standards for sugar and fat

Items that Items that Do NotDo Not Meet the Standards Meet the Standards

• Potato chips and pretzels with too much fat or sodium

• Cheese crackers with too much fat or sodium

• Breakfast or granola bars with too much fat or sugar

• Ice cream products with too much fat

• Cake, cupcakes, cookies with too much sugar or salt

• Fortified sports drinks or fortified water

• Gum, licorice, candy

• Fruit smoothies with too much added sugar

• Regular colas or sodas with sugar or caffeine

Nutritive Food and Beverages

1. Fat: < 35/10 / 02. Total sugars < 35%

kcal3. <200 kcal/portion4. <200 mg

sodium/portion

STANDARDS:

Non-nutritive Food and Beverages

5. Nonnutritive sweetener in beverages in high school after school

6. Caffeine-free

STANDARDS:

All Students During the School Day

7. Tier 1 foods and beverages8. Water available and free 9. Sport drink limited to student

athletes with >1 hr vigorous activity via coach

10.Not for reward or punishment for behavior or academic achievement

11.Minimize marketing of Tier 2 foods and beverages

STANDARDS:

After-School Setting12.Tier 1 for elementary and

middle schoolTier 1 and Tier 2 for high school

STANDARDS:

Fund Raising13. Tier 1 on campus during school day for

all students

Tier 1 and Tier 2 on campus after school for high school students

Encourage Tier 1 and Tier 2 for evening and community events that include adults and students

Action for Implementation1. Policy making bodies providing:

•Regulatory guidance•Designate responsibility•Performance guidelines•Technical and financial support

2. Federal agencies and food and beverage industry•Identification system for Tier 1 and Tier 2

•Whole grain and combination products guidance

Key Elements for Success

Awareness and understanding of the standards by schools, parents, students, and federal, state, and local as well as other private stakeholders.

CDC Implementation Guide – under development

Concluding RemarksFederal school nutrition programs are

the main source of nutrition provided at school. However, if opportunities for students to select competitive foods and beverages arise, they should be used to encourage greater consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy foods.

The recommendations in this report ensure that competitive foods and beverages are consistent with the DGA and will help encourage students to develop healthful life-long eating patterns.

““Remember when we Remember when we used to have to fatten used to have to fatten

the kids up first?”the kids up first?”