Weighing healthier options
by Linda Dawson
Illinois School Board Journal, March/April 2004

Linda Dawson is IASB director of editorial services and Journal editor.

When lunchtime rolls around, Jimmy and Eric usually opt for pizza from the a la carte line. Sometimes, Jimmy says, he buys a cheeseburger, and he usually adds an order of curly fries.

Neither of these two seventh-grade friends likes vegetables, although corn on the cob is a summer favorite and both will eat fruit — if it’s grapes, an apple or a banana.

Jimmy buys a soft drink "occasionally" when he’s at school, but Eric’s drink of choice is usually 1 percent chocolate milk, as opposed to 2 percent regular milk.

At home, both like to snack on Doritos and Chex Mix and drink at least one can of soda a day. Jimmy drinks regular; Eric usually has diet, because that’s what his mom buys for the family.

Which student is overweight?

From eating patterns you might have guessed Jimmy … and you would be wrong. Jimmy is 5 feet 2 inches tall and weighs 90 pounds. Eric, on the other hand, is 5 feet 7 inches tall and weighs 160. Calculating their body mass index (BMI), Jimmy registers at 16.5, which means he’s underweight. Eric, on the other hand, has a BMI of 25.1 — slightly overweight. A BMI of 18-24 is considered "normal." A BMI of 25-29.9 is "overweight," and anything above that is classified as "obese."

But with their penchant for pizza, chips and carbonated beverages, these boys are prime examples of the eating patterns and statistics that health care professionals say will lead to more overweight adults and compound the U.S. health problems of diabetes and heart disease.

The U.S. Department of Health and Human Services estimates that 310,000 to 580,000 deaths each year in the United States can be attributed to unhealthy eating and inactivity, very similar to the 430,700 deaths attributed to tobacco each year. And, according to a recent study by the Research Triangle Institute, a North Carolina-based educational research organization, and the U.S. Centers for Disease Control and Prevention, unhealthy eating and resultant diseases also translated to about $75 billion in extra medical costs in 2003, about half of which had to be paid through Medicare and Medicaid programs.

The numbers are staggering. The Center for Science in the Public Interest, a nutrition advocacy organization, now estimates that approximately 61 percent of Americans are overweight or obese. The number of obese children ages 6 to 11 has nearly doubled from 7.6 percent to 13.7 percent in the past 20 years, as has the number of obese teenagers, which rose from 5.7 percent to 11.5 percent.

In his call to action that led to a national Healthy Schools Summit in 2002, former Surgeon General David Satcher labeled the number of overweight adolescents at "epidemic" proportions.

While a May 2002 article in the Journal of the American Dietetic Association called for "Family-based interventions for the treatment of childhood obesity," the authors readily admitted that day-care providers as well as schools have assumed a bigger role in what was once the sole purview of mothers: making sure children eat what they should.

"Schools are a structured environment where it is possible to have a powerful influence on children’s eating and activity patterns," said a report from Satcher’s 2002 Healthy Schools Summit. Additionally, "School is where children develop many lifelong habits and preferences," the report said.

The report went on to praise existing school intervention programs such as "Know Your Body," "Planet Health" and "Eat Well and Keep Moving" as having demonstrated effectiveness in changing children’s patterns of eating and activity.

Across the nation, 93 percent of public schools, about 85,000 of them, offer meals through the National School Lunch Program. And 71 percent of all public schools also offer a breakfast program.

While these meal programs operate under nutritional guidelines from the U.S. Department of Agriculture (USDA) as well as some state regulations (See page 16), their effectiveness can be weakened or strengthened by local board policy. For example, boards must give final approval to curriculum choices, closed or open campuses and physical education requirements. But by asserting their influence through policy, boards literally are able to shape student choices and prepare them for lifelong habits and lifestyles — either good or bad.

Reshaping national policy

Because news of rising obesity rates has been flooding the media in recent months, school board members may already be giving some thought to helping students make better nutritional choices. But even preliminary thoughts now are getting more insistent prodding since the beginning of the year.

In January, the American Academy of Pediatrics called on school officials to adopt "a clearly defined, district-wide policy that restricts the sale of soft drinks" as a way to curb consumption. The AAP cited statistics showing soft drink consumption has risen 300 percent in the past 20 years, paralleling the rise in overweight children.

This spring, House Republican Leader Tom Cross (R-Oswego), with encouragement from Governor Rod Blagojevich, introduced a bill in the Illinois House that would ban all junk food and sodas from school vending machines, beginning in January 2005.

Currently, state law in Illinois only requires that districts adopt a food service policy to restrict "the sale of foods of minimal nutritional value as defined by the U.S. Department of Agriculture in the food service areas during the meal periods." But the loopholes are many.

Often, schools place vending machines filled with sodas, candy bars and chips in corridors separate from the lunch program, but still accessible to students. Others, legally, sell "competitive foods" — those defined as confections, candy, potato chips, carbonated beverages, fruit drinks containing less than 50 percent pure fruit juice, tea, coffee and any other foods or beverages designated as such by the State Board of Education — by letting the income accrue in the non-profit school lunch fund.

Why would districts want to sell foods that have questionable nutritional value? Because funds from vending machines subsidize many programs and purchases that would not exist without them. Besides, it’s what the students will buy. (See "By the numbers, soft drinks pack a hard punch," http://www.iasb.com/.)

"If I thought there were alternate ways to get revenue for schools, I’d take those machines out," said Jason Leahy, principal at Illini Central High School in Mason City, Illinois. But the profits from the school’s vending machines support school athletic activities and the prom, in addition to providing incentives for literary programs like "Drop Everything and Read" and service learning.

However, reliance on vending machine money doesn’t mean districts can’t provide some healthier options. This year, Leahy said, his high school added a milk vending machine "to give the kids a choice."

Although they have no hard data on whether students are spending more on milk than they would have on sodas and candy, Leahy said he sees many students walking around with milk … especially in the morning.

One district that does have hard data on consumption also is one jump ahead of vending machine ban legislation. Mundelein CHSD 120 took all carbonated soft drinks and junk food out of its vending machines at the beginning of the year, according to district spokesperson Kelley Happ.

The school’s nine vending machines now only carry Gatorade, water and flavored juices, as well as healthier snack items, such as baked chips, Happ said. The same vendor — Pepsi Cola — has served the machines both before and after the junk food ban, she said, but the district has seen a $5,000 decline, or about 30 percent, in vending revenues since September.

For this district, however, it’s not just about the money. It’s also about student health. The district tries to prepare all of its cafeteria food in the healthiest way — baking, not frying, if possible, and serving healthy, not super-sized portions. "We’re really trying to educate the students, to teach the students good health," Happ said.

The changes in vending machine options in both Illini Central and Mundelein were made by the administration without input from the board. But growing concerns over childhood obesity are tailor-made opportunities for school boards to connect with their communities to determine what role the school district should play in student health — and what options are available.

Current board policy

Policies around student nutrition and physical activity are based on what is required by law in regards to food service, curriculum, exemptions from physical activity and advertising by non-school related entities, which govern vending machine and pouring-rights contracts. These initial policies, however, can be a starting point rather than the end of the discussion.

Cathy Talbert, IASB senior director of policy services, sees this as an opportunity for boards to open a discussion to learn just what the community wants for its children … and what it expects from the school board. But rather than jumping on an obesity prevention, soda-banning bandwagon, boards should first step back and analyze the "why" for their actions.

"So many of us always want to start with what we should do," Talbert said, "when we need to start with a question: ‘Why are we doing this?’"

For boards, this means asking questions of themselves and their community:

• Why would we want a new nutrition policy?
• What do we hope to achieve with this policy?
• What do we want children to know and be able to do when it comes to nutrition?
• What is the purpose for our school lunch program? Nutrition education? Physical education?

Only when those types of questions have been answered is the board ready to move into decisions on how new policies might be written and then adopted.

If the board is looking for examples of new policy areas that others have considered, a growing body of reports is beginning to surface on the subject.

In December 2003, the Robert Woods Johnson Foundation (an arm of the health and medical giant Johnson & Johnson) released its latest report: "Healthy Schools for Healthy Kids." The report is based on a national opinion poll of teachers and parents, as well as a nutrition and physical activity policy analysis on federal, state and local levels. It also includes a review of in-school and after-school physical activity and nutrition programs.

Among its key finds:

• "USDA regulations, by which all schools participating in the National School Lunch Program must abide, limit some but not all unhealthy foods in schools."
• "The definition of foods of minimal nutritional value (FMNV) is outdated and incomplete."
• "The USDA relies on state education agencies to enforce federal nutrition policies, but most enforcement responsibility for school policy is at the local level."
• "More schools and districts are trying to improve their policies on vending machines and school lunches, one step at a time."

However, in terms of relevance to school boards, the most important finding from the report may be this one: "The district and school levels are where policy decisions governing schools are most effective, but most current school board policies are out of date and demonstrate little initiative to make healthy foods or daily physical activity a priority."

Creating new policy

So if a district were to update its school nutrition policies, what might they look like? According to the RWJ Foundation report, such policies would have clarity, strong wording, seek to foster healthy eating in the school and, above all, be enforceable.

The following nutrition policy, which meets those criteria, recently went into effect in Los Angeles Unified School District to eliminate all unhealthy beverages:

" … effective January 2004, the only beverages authorized for sale at the Los Angeles Unified School District, before, during and until one half hour after the end of the school day at all sites accessible to students shall be: fruit-based drinks that are composed of no less than 50 percent fruit juices and have no added sweeteners; drinking water; milk, including, but not limited to, chocolate milk, soy milk, rice milk and other similar dairy or nondairy milk; and electrolyte replacement beverages and vitamin waters that do not contain more than 42 grams of added sweetener per 20 ounce serving."

In May 2001, Richland One School District in South Carolina adopted the following nutrition policy:

" … the district will prohibit the sale of foods of minimal nutritional value in vending machines, snack bars, school stores, concession stores and a la carte offerings in the food service program which students will have access to during the school day. Elementary schools are prohibited from having vending machines which students can access … . Student access to the sale and service of carbonated beverages will be prohibited."

Richland One also further defined foods with minimal nutritional value as "chewing gum, flavored ice bars and candy bars" and specified that other foods offered for sale "may contain no more than 40 percent, by weight, of sugar or artificial sweeteners."

In Alabama, Opelika City Schools has been working for more than 10 years to improve student nutrition. They have not allowed vending machines for more than 16 years, the report said, and their cafeterias quit frying food in the early 1990s. Menus are analyzed "to ensure nutritional appropriateness" both for the age and grade level being served. The district also has a closed-campus policy at lunch.

All of the policies mentioned here have been undertaken at the school level beyond what is required by their state boards. But by considering a state ban on junk foods in schools, Illinois would join a growing number of states that have, in effect, severely limited how much control local boards can exercise.

How does Illinois’ proposed ban on junk food stack up against other states?

According to "State Policies on the Sale of Food and Beverages at School" by Jim Bogden, which appeared in the Spring 2001 issue of The State Education Standard, Maine has the most stringent prohibition by banning "all food sales and vending machines on school campuses during the school hours that are not a part of the school meals program."

Other examples cited by Bogden include:

• A prohibition in Florida and West Virginia for the sale "of all foods and beverages at elementary schools."
• The sale of only "approved cafeteria supplementary food items" at schools in Hawaii.
• California’s requirement that "50 percent of all food items offered for sale by any entity at school during regular school hours must be from a specified list of approved nutritious foods," such as nuts, yogurt, pretzels and beverages that contain at least 35 percent full-strength fruit juice.

Seeing these examples of policies may help school boards narrow their focus and come up with their own plan to encourage better nutrition at school. But once the policies are enacted, how successful will they be? Doesn’t much of the success still rest with what the kids are willing to eat?

Turning to some experts

While school boards and administrators can make policy and procedural changes, they are not in the cafeteria every day to see how those policies play out in real life. That falls to food service workers, many of whom in Illinois belong to the state’s School Food Service Association (ISFSA).

"In reality, kids are not eating what they should," said ISFSA president Jeannine Wheeler, who is employed by Quincy SD 172. "Sometimes schools do not have the proper equipment to serve healthier, attractive meals. And at home, parents are not following the USDA recommended guidelines."

Through seminars and an annual conference, ISFSA and its national counterpart (American School Food Service Association) try to educate food service personnel as to how to maintain a healthy program, Wheeler said. The two organizations also offer access to healthy Web sites, a quarterly magazine and "endless educational and networking opportunities."

But the bottom line, she said, still is: "What will kids eat?"

Their preferences run to pizza, tacos, hot dogs and French fries, Wheeler said, or anything that is served in a fast-food restaurant.

"And they’re very picky," she added. "It has to taste like their favorite restaurant, too."

When she hears students talking about nutrition or diets in the lunch lines, she realizes how much confusion and misinformation abounds. "Girls feel that being ‘on a diet’ constitutes eating French fries and a diet pop, or nothing at all," Wheeler said. "The nutrition message is not getting through."

And, the question of economic feasibility also comes into play. If the cafeteria doesn’t serve what the students will buy, then it won’t make ends meet, she said. She finds offering choices and marketing are the best ways to keep participation as high as possible in the lunch program.

"Ideally," Wheeler said, "students would be taught how and why to make healthy choices and actually be exposed at an early age to different healthy food choices. Unfortunately, some kids do not know what fresh spinach tastes like."

In a position paper issued January 14, ISFSA recommended the following ways for the education community to combat the growing problem of childhood obesity:

• Increased support of the National School Breakfast Program, because studies show that children consume fewer empty calories throughout the day after a balanced breakfast.
• Increased financial support of nutrition programs to help schools become less reliant on a la carte sales.
• Improved funding and expansion of education programs to help schools meet a goal of educating "the whole child."

While ISFSA sees elimination or limitation of certain vending machine offerings as one approach, they do not see it as the solution. Instead, the organization concurs with the American Dietetic Association that there are no "good" or "bad" foods. "All foods can be a part of a healthy, balanced diet when consumed in moderation and combined with an active lifestyle."

So, if Jimmy, Eric and their friends want to eat pizza for lunch occasionally and have a can of soda, they should go ahead. But if they don’t want to continue as part of the growing statistics for overweight Americans, they should start eating more vegetables. And they might want to run a few extra laps in gym class or spend time shooting hoops at home instead of playing their favorite video game.

Sources

Action for Healthy Kids, www.actionforhealthykids.org

Center for Science in the Public Interest, www.cspinet.org/nutritionpolicy/index.html

"Healthy Schools for Healthy Kids," a report of The Robert Woods John-son Foundation, December 2003, www.rwjf.org/files/publications/other/HealthySchools.pdf

"Policy Statement," American Academy of Pediatrics, Pediatrics, January 2004

Sachiko T. St. Jeor, Suzanne Perumean-Chaney, Madeleine Sigman-Grant, Christine Williams and John P. Foreyt, "Family-based interventions for the treatment of childhood obesity," Journal of the American Dietetic Association, May 2002

Weighing Healthier Options

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