Improving Primary and Secondary Schools Nutrition Environment

1. Improving Primary and Secondary Schools Nutrition Environment Elena Chiru – MPH Student Environmental Health Walden University, April, 2009

2. Background • Children are the most vulnerable and the most easily influenced and manipulated demographic for fast-food advertising • Fast-food companies constitute one of many reasons for obesity rates skyrocketing • By making low-cost high-calorie-intake food seem “cool”, fast food companies are targeting children • Research indicates that an individual’s dietary and physical activity habits are primary contributors to an individual being overweight and/or obese • Research states that banning fast-food advertising on television in the United States could reduce the number of overweight children by as much as 18 percent” (Fox, 2008) 

3. Why Better Nutrition in Children is Important? • Poor nutritional habits along with a decline in physical activity contribute to childhood and adult obesity • Overweight adolescents have a 70% chance of becoming overweight adults, which increases to 80% if one or both parents are obese • There has been an increase in the number of children with health problems that typically were adult-onset due to overweight: - Type II diabetes - Cardiovascular disease risk factor • These children also encounter psychosocial difficulties: - Increased risk for discrimination - Low self esteem - Poor body image Source: Surgeon General of the United States, The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, available at http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm

4. Why Better Nutrition in Children is Important (continue)? • Obesity most commonly starts before adulthood and obesity related health problems are now epidemic • Interventions during primary and secondary school years must become a high national priority (Vieweg V, 2007)

5. Why should we Care? • This generation of children is on track to experience: • Shorter life expectancies that their parents • Higher rates of disabilities (resulting in lack of participation in the workforce) • Increasingly complex and expensive medical costs • Today “1 out of 3 kids are considered overweight or obese” (Gavin, 2008) • “Obese children and adolescents are more likely to be obese as adults” (CDC, 2008)

6. Obesity among adolescents has tripled since 1980. 15% of children ages 6 to 11 were overweight in 2000, up 11% from 1994. The number of overweight teens aged 12 to 19 grew from 10.5 to 15.5% over the same period. Sources: National Center for Health Statistics, Prevalence of Overweight Among Children and Adolescents:United States, 1999-2000 (2000); Centers for Disease Control and Prevention & National Center for Health Statistics, National Health and Nutrition Examination Survey at http://www.cdc.gov/nchs/data/hus/tables/2002 /02hus071.pdf. Total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in 2000.* *Source: U.S. Dept. of Health and Human Services, Press Release, Overweight and Obesity Threaten U.S. Health Gains: Communities Can Help Address the Problem, Surgeon General Says, available at: http://www.surgeongeneral.gov/news/pressreleases/pr_obesity.htm Statistics in US

7. Percentage of Overweight and Obese Virginians 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Statistics in VA • Since 1990 the prevalence of obesity in Virginia has increased 154% • ~39.2% of children in Virginia are overweight or at risk of becoming overweight • ~60% of adults are overweight or obese • Obesity is now classified as a disease and contributes to other ailments including diabetes, cancer, heart disease, and infant mortality.

8. Only 2% of school-aged children meet the Food Guide Pyramid serving recommendations for all 5 food groups. 51% of children eat less than one serving of fruit a day.** Overall, the percentages of children meeting the recommended number of food group servings are: 14% for fruit 17% for meat 20% for vegetables 23% for grains 30% for milk Added sugars (used as ingredients in processed foods or added to foods as they are consumed) contribute an average of 20% of total food energy.* Overall, 56 to 85% of children (depending on age and gender) consume soda on any given day.* More than 84% of children and adolescents eat too much fat, and more than 91% eat too much saturated fat.** Poor Nutritional Habits *Source: USDA, Food, Nutrition, and Consumer Services, Foods Sold in Competition with USDA School Meal Programs (2001). **Source: Centers for Disease Control (1999).

9. Objectives • Identify and influence key stakeholders, such as parents, teachers and, communities to support opportunities for better nutrition in school children • Better nutrition by: - Increasing children consumption of fruits and vegetables - Decreasing children consumption of sugar- sweetened beverages - Reducing children consumption of high-energy- dense foods.

10. What Kind of Interventions are Need? • A Social-Ecological Model (theory) to tacle better nutrition in children would look at interventions at all levels of influence: individulas, interpersonal-groups, organizations, community and society. (Adapted from the CDC website)

11. School Importance Because young people spend the majority of their time in schools, educational institutions have a unique opportunity to encourage, motivate, and promote healthy choices among school-age children. Proper nutrition enhances academic performance – breakfast has been found to be particularly important to school performance and reductions in absenteeism and tardiness. Family Importance Most parents of overweight children are predominately overweight and obese (31% overweight, 58% obese). Both parents and children can be regular consumers of high fat foods (average: 10.6 and 11.3 times per week for adults and children, respectively). Students prefer fast foods, sweetened beverages, and salty snacks when they are available (54% of children’s snacks are high in fat and sugar) Stakeholders Virginia Department of Health, Office of Family Health Services, Cool Kids Program, available at http://www.vahealth.org/nutrition/execsumm.htm.

12. School Challenges • Sixty-nine percent of schools obtain additional funds through business partnerships with food and beverage companies.* • Nutrition is often overlooked when schools seek additional revenue. Competitive foods represent a source of income that can be spent for discretionary purposes not necessarily related to food service. • The USDA has found that the greatest challenge to the nutrition in schools are foods made available in competition with meals. • Competitive foods have diet-related health risks. • Lack of education standards for school food service managers and directors • Preparation and serving spacesare frequently inadequate for preparing and serving appealing school meals to all students and with insufficient time to eat, many students turn to less nutritious foods that are readily accessible in vending machines and snack bars. *Source: National Conference of State Legislatures, Junk Food in Schools (Summer 2001), available at http:///www.ncsl.org/programs/health/junkfood.htm U.S. Department of Agriculture; Food, Nutrition, and Consumer Services, Foods Sold in Competition with USDA School Meal Programs (2001)

13. Recommendations

14. Initiatives • States Boards of Education should establish standards for food sales in schools to prohibit the sale of foods of minimal nutritional value anywhere in a school from 6:00 a.m. until the end of the scheduled breakfast period, and from the beginning of the first scheduled lunch period to the end of the last scheduled lunch period. The revenue from the sale of all foods and beverages during the protected periods must be credited to the school nutrition program account. • Create regulations that are more restrictive than the USDA in the sale of competitive foods.

15. Pubic Campaigns and/or School Programs to teach children to make their own healthful lunches and snacks and pay attention to portion size; incorporate color, music, and the senses to teach children that healthy food and physical activity are fun. Hold “taste-test fairs” of nutritious foods. Activities to encourage parents (especially for primary-school-age children) to get involved in free school activities with their kids and offer tips for recipes, purchasing and preparing fruits and vegetables at home. Public service advertising and promotion of healthier food choices on public TV. Educating Teachers and Families

16. Other Initiatives Team Nutrition Training Grants These can be used to finance training for school food service personnel, the creation of informational materials for students, the creation of training curricula for teachers, and more. • Limit the number of times student organizations can sell food items on campus and on the number of different types of food items they can sell. For more information regarding Team Nutrition Grants, see the Website at http://www.fns.usda.gov/tn/Grants/index.htm.

17. Other References • DeVol R, Bedroussian A, Charuworn A, et al. An unhealthy America: the economic burden of chronic disease—charting a new course to save lives and increase productivity and economic growth. Oct.07. On-line: http://www.milkeninstitute.org/publications/publications.taf?function=detail&ID=38801018&cat=ResRep • State Nutrition, Physical Activity and Obesity (NPAO) Program Technical Assistance Manual. Jan. 08. On-line: http://www.cdc.gov/. • Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future Child 2006;16:109-142. • Larson, N, Story, M. Food and Beverage Marketing to Children and Adolescents Research Brief Oct.08. • Fox, M. (2008). Fast-food Ad Ban Could Cut Child Obesity: US Study. Reuters. Retrieved from: http://www.commondreams.org/headline/2008/11/20-4 • CDC Youth Media Campaign. (2007). Retrieved from: http://www.cdc.gov/youthcampaign/index.htm • Kraft C. 2007. Virginia Youth Overweight Collaborative. VA department of Health website accessed at: www.vdh.state.va.us. • Hilbert J. (2007). Virginia Department of Health – Obesity Prevention Efforts and, Kraft C. Virginia Youth Overweight Collaborative. Retrieved from VA department of Health website: www.vdh.state.va.us