School Nutrition: Making the Grade?

New policies aim to reduce childhood obesity.

Reviewed by Louise Chang, MD on September 15, 2006
From the WebMD Archives

Nearly 50 million kids are back in school, ready for reading, writing, and arithmetic. Along with new teachers and lesson plans, they will also find new policies governing what they can eat and drink while at school.

Much has changed since the National School Lunch program was launched 60 years ago. Most notably, 17% of kids are now overweight, and children are increasingly developing “adult” diseases, such as high blood pressure, elevated cholesterol and diabetes. According to the CDC, up to 40% of today’s children will develop Type 2 diabetes during their lives if something doesn’t change.

Starting this school year, U.S. policy requires all school districts participating in federal meal programs to implement "wellness policies" -- detailed plans incorporating nutrition education, physical activity, and healthier food choices on campus. The policies also set nutrition guidelines for all foods sold at school, including those available in vending machines.

"Kids spend a great deal of time at school, which is why [schools have] been targeted with the huge task of educating kids about the importance of good nutrition and making healthy food choices; encouraging active lifestyles; and serving nutritious food and drinks at mealtime, in vending machines and during parties, celebrations, and fund-raising," says Alicia Moag-Stahlberg, MS, RD, executive director for the nonprofit Action for Healthier Kids organization.

Experts say schools are a logical place to start stemming the tide of obesity. Not only are school-aged children in the process of establishing lifetime eating habits, research has actually linked proper nutrition to better academic performance.

"We need to help kids make the right decisions, and we do that by serving healthy food and educating them in the classroom about the importance of diet and nutrition," says Connie Mueller, RD, spokeswoman for the School Nutrition Association.

Keeping It Local

Specific guidelines are left to the discretion of each state, district and local school board. But the policies must meet minimum federal guidelines, which specify, for example, that vending machines be locked during meals, and not be located in the cafeteria.

"What has worked so well is allowing each local school district to design their own policies because what works in one district may not work in another," says Mueller, a school food service director in Bloomington, Ill. "Having discretion at the local level is key to the success of the policies."

Foundations, cities, school boards, neighborhood organizations, food companies, and parents across the country were involved in developing the wellness policies.

"Six thousand volunteers -- including dietitians, principals, students, and parents -- are working together to help implement good nutrition and quality physical activity in our nation’s schools," says Moag-Stahlberg, whose organization helps create state teams that develop, implement, and monitor the school wellness policies.

Parties and Fund-Raisers

Some schools have gone so far as to ban cupcakes during class birthday parties, Moag-Stahlberg says. Parents and educators are being urged to consider healthier snack choices for homeroom celebrations.

"There is a groundswell of support for healthier items in the cafeteria, classroom, vending [machines] and … at fund-raisers," says Moag-Stahlbert. "It is up to the schools to establish their own nutrition policy with guidelines that foster healthy choices, and some have eliminated the classroom parties because it is one of the easier changes to implement."

Schools have taken a variety of approaches to the wellness policies. Some have focused on nutrients, calories, and/or portion sizes to determine which foods will be allowed to be sold.

In some schools, the only beverages allowed are water, non-carbonated calorie-free waters, sports drinks, 100% fruit juice, and 1% or skim milk (plain or flavored).

For example, the Alabama Department of Public Health has issued a "Guide to Healthy Vending Machines" for the state's school districts. The model policy allows snacks that contain less than 30 grams of carbohydrates and 360 milligrams of sodium, are low to moderate in fat, high in fiber, and high in at least one nutrient in each 1 to 1.5 ounce serving. Foods that qualify include fruit, nuts, sunflower seeds, certain cereals, granola and oatmeal bars, soft pretzels, certain simple crackers or cookies, and baked chips.

Profit-Making Foods

One point of contention has been the sale of "competitive foods" -- that is, foods sold separately from those available through the school meal programs, including snack bars, vending machines, and fund-raisers.

Experts say that when there are no competitive foods, kids are more likely to eat school meals and thus consume more nutritious foods.

"The problem is, schools are strapped for finances and often turn to selling competitive foods to generate income; yet there is growing concern that these calories contribute to obesity," says Moag-Stahlberg.

Some schools are foregoing federal funds so they can continue to sell the profit-making junk foods thought to be one of the many causes of childhood obesity, Moag-Stahlberg says.

Most states already prohibit the sale of foods with minimal nutritional value during meal service and certain other times. Such foods include soda water, water ices (not including those containing fruit or fruit juice), chewing gum, and certain candies.

The good news, experts say, is that schools can make money on healthier items, Mueller says. The food industry has responded to public interest in health by creating and packaging more nutritious snacks.

Mealtime at School

School meals are already required to be relatively low in fat and rich in vitamins and minerals. Later this year, they will also be required to adhere to the U.S. Department of Agriculture's 2005 Dietary Guidelines.

"Schools across the country are already adding more fruits, vegetables, whole grains, and low-fat dairy to meals," says Mueller. "The addition of fresh fruits and vegetables, delicious whole grains, and milk served cold in eye-appealing, easy-to-grasp bottles instead of antiquated, hard-to-open cartons, is teaching kids that healthy food tastes good.

"Let’s face it: if they don’t eat it, we have not done our jobs," she says.

Another perk of the school breakfast or lunch: "It teaches kids proper portion sizes," says Mueller.

Offering more healthy food may increase the cost of school meals somewhat, she says. But "these are great meals that are worth the money," she adds.

Can They Make a Difference?

The real question is whether these new policies can really make a difference in the waistlines of our nation’s children.

A preliminary analysis by Action for Healthy Kids recently found that only half of the 112 school districts in 42 states met even the federal government's minimum guidelines for nutrition and physical education.

"There are lots of challenges. The school wellness policies are an added requirement onto an already very full agenda” says Mueller.

But, she adds, "It is also exciting to see how each district is approaching the challenges and implementing policies that are working beautifully."

Show Sources

SOURCES: U.S. Census Bureau, October 2004: School Enrollment; National Health and Nutrition Survey, 1999-2002. CDC web site. 2005 United States Department of Agriculture Dietary Guidelines. School Nutrition Association web site. Alabama Department of Public Health web site. Alicia Moag-Stahlberg, MS, RD, executive director, Action for Healthy Kids. Connie Mueller, MS, RD, SFNS, director of food and nutrition services, Bloomington, Ill. public schools. Action for Healthy Kids web site, USDA web site

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