4
School Meal Policies

School is the one place where virtually all children assemble on a regular basis. It not only provides opportunities to learn about healthier living and engage in physical activity with peers, but also is the place where millions of children eat as many as two meals a day. In addition to lunch and breakfast, food available during the school day encompasses snacks, vending machines, à la carte cafeteria items, snack bars, and the stores and restaurants located near school buildings, where the offerings may be less healthy. School meals that are healthy and appealing can play a big role in providing nutrients and reducing the intake of unhealthy food. They also serve as a way to model good nutrition, perhaps leading children to choose a healthier diet at other times during the day. Although the national governments of the United Kingdom and the United States are not directly involved in the day-to-day preparation of school meals, they set policies and provide financial and other support that have an impact on what schools offer to children.

Judy Hargadon (Director, UK School Food Trust) and Julie Paradis (Administrator, Food and Nutrition Service, US Department of Agriculture [USDA]), focused on the role of school meals in addressing childhood obesity. Both agencies have revised guidelines in recent years to make these meals healthier.

HEALTHIER MEALS THROUGH THE UK SCHOOL FOOD TRUST

Hargadon reported on what she called detailed, practical, and feasible changes made to school meal programs. All schools in England are now



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4 School Meal Policies S chool is the one place where virtually all children assemble on a regu- lar basis. It not only provides opportunities to learn about healthier living and engage in physical activity with peers, but also is the place where millions of children eat as many as two meals a day. In addition to lunch and breakfast, food available during the school day encompasses snacks, vending machines, à la carte cafeteria items, snack bars, and the stores and restaurants located near school buildings, where the offerings may be less healthy. School meals that are healthy and appealing can play a big role in providing nutrients and reducing the intake of unhealthy food. They also serve as a way to model good nutrition, perhaps leading children to choose a healthier diet at other times during the day. Although the national governments of the United Kingdom and the United States are not directly involved in the day-to-day preparation of school meals, they set policies and provide financial and other support that have an impact on what schools offer to children. Judy Hargadon (Director, UK School Food Trust) and Julie Paradis (Administrator, Food and Nutrition Service, US Department of Agriculture [USDA]), focused on the role of school meals in addressing childhood obesity. Both agencies have revised guidelines in recent years to make these meals healthier. HEALTHIER MEALS THROUgH THE UK SCHOOL FOOD TRUST Hargadon reported on what she called detailed, practical, and feasible changes made to school meal programs. All schools in England are now 

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 PERSPECTIVES FROM UK AND US POLICY MAKERS required to ensure that the meals they provide support balanced nutritional intake. They are also encouraged to increase the number of children who are eating the food, as the impact of school meals on child health must be measured in terms of not only what schools offer, but also the number of children affected. While regulations govern what schools offer, no child is forced to eat school food. Thus, school meals are offered in a market envi- ronment and must also appeal to children’s palates. Schools in the United Kingdom choose how they provide food to stu- dents, from having small kitchen staffs to contracting with large catering companies and many variations in between. Food is offered as a commercial service: meals for those in need are covered by a government subsidy, but sales must cover most other costs. The School Food Trust was established in 2005 after Jamie Oliver, a noted celebrity chef in England, called attention to unhealthy school food in a popular television program. The Trust’s mission is to “transform school food and food skills, promote the education and health of children and young people and improve the quality of food in schools,” including that provided for lunch and breakfast, as well as that offered through vending machines, snacks, classes, and special events. The Trust works to dispel the myth that rules governing school food cannot result in food that appeals to children. Food-Based and Nutrient-Based Standards The School Food Trust revised the 1990s-era standards related to the provision of food in schools to include both food- and nutrient-based stan- dards. The food-based standards specify foods to include, limit, or exclude across the school day, but do not specify portion size, food balance, or overall nutrient balance. The nutrient-based standards set upper limits for fat, sugar, and salt and lower limits for protein, carbohydrates, fiber, vita- mins, and minerals. The time frame for issuing the new standards has been rapid: interim food-based standards were issued for lunches in September 2006 and for other meals and snacks in September 2007; final food- and nutrient-based standards were issued for primary schools in September 2008 and for all other schools in September 2009. Schools are responsible for implementing the standards, and they have developed appealing menus that comply. Hargadon provided examples of these menus (see Figure 4-1), as well as the calculations used to develop the nutrient-based standards for primary and secondary students. The Trust publishes a number of guides and training materials to assist in compliance. One concern regarding implementation of the new standards was their effect on the number of students eating the meals. Uptake of school lunch

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FIgURE 4-1 Menu in a secondary school using England’s new school meal standards. Figure 4-1.eps landscape, bitmap uneditable 

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 PERSPECTIVES FROM UK AND US POLICY MAKERS is now one of 200 national indicators used to monitor progress toward national goals related to health and other sectors, and is incorporated in local school inspections. Hargadon acknowledged, however, the need for a more consistent way to measure uptake, as well as for tools that would simplify data collection at the school level. Historically, school lunch uptake dipped in the 1980s, when school food was deregulated and schools started serving more fried and other unhealthy foods. An estimated 40 percent of children eat the meals in primary schools and 35 percent those in secondary schools, a slight increase since the standards were introduced. Preventing Obesity Hargadon discussed the challenges of preventing obesity in schools. When children are eating with their peers, schools can reinforce healthy eat- ing and support parents in this regard. Challenges include restaurants near school that offer unhealthy food; a physical environment that discourages energy expenditure; and the appeal and relatively lower prices of high-fat, high-sugar foods. Many parents pack lunch for their children thinking they are providing them a healthier meal, but analysis of a typical bag lunch shows this may not be the case. While not wanting to be too heavy-handed, the Trust encourages more parents to have their children eat school meals rather than a potentially less healthy packed lunch. FOOD AND NUTRITION SERVICE PROgRAMS IN US SCHOOLS Paradis said ending child hunger by 2015 and reducing obesity are both high priorities of the Obama Administration. School meals are one way to help meet these goals as they are a significant source of nutrition for many children during the school day. School meals must meet US Dietary Guidelines, which are currently being revised for release in late 2010 or early 2011. Lunches must provide one-third of nutrient needs and breakfast one-quarter. In response to a request from USDA, the IOM issued a report containing recommendations for improving school meals (IOM, 2009b; see Box 4-1). USDA’s Food and Nutrition Service will use these recommendations to improve the National School Lunch Program and the School Breakfast Program. The National School Lunch Program provides meals to more than 31 million children in 100,000 schools across the country every day. About half are children from low-income households, many of whom also eat breakfast at school. Regulations restrict the percentage of calories that can come from fat, as well as sodium and cholesterol content, and provide for a gradual increase in the amount of dietary fiber offered. Paradis said research shows that children who eat school lunches consume more milk,

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 SCHOOL MEAL POLICIES meat, and vegetables than children who do not. Thus these meals are an important tool to help children consume a nutritious diet and achieve a healthy weight. A number of strategies incorporated in the school meal programs address childhood overweight and obesity: • modeling healthy food choices that children can bring home; • prohibiting the sale of foods of minimal nutritional value in the school food service area during mealtimes, as well as discouraging their sale in vending machines on the school campus; • supporting schools through Team Nutrition, which provides train- ing and technical assistance for food service staff, nutrition educa- tion, and school and community support for healthy eating and physical activity; • providing training to food service staff through the National Food Service Management Institute in Oxford, Mississippi; and • changing the composition of foods provided to schools through the school meals programs (about 15 to 20 percent of what schools serve) so they are lower in sodium and sugar. Paradis also described USDA’s HealthierUS School Challenge, a volun- tary initiative that encourages schools to excel in providing nutritious food choices, nutrition education, and opportunities for physical activity. Schools become certified when they meet six criteria and then are recognized for achievements above this level. More than 600 schools are participating to date. Paradis ended by stressing that schools, parents, and communities share the responsibility for helping children develop healthy eating habits and active lifestyles. The obesity problem did not develop overnight and will not be solved overnight, but she is encouraged by the progress now under way. DISCUSSION During the question-and-answer session, Hargadon was asked about the role of Jamie Oliver’s television program in generating improvements in the school meals program in England. She replied that the program, which took place before the release of the Foresight report, was what she termed a “disruptive innovation” that resulted in change. Although Oliver is now in West Virginia working on a similar effort in the United States, it was suggested that someone who is more recognizable in the United States may be needed to have a similar impact.

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 PERSPECTIVES FROM UK AND US POLICY MAKERS BOX 4-1 School Meals: Building Blocks for Healthy Children At the request of the US Department of Agriculture, the IOM convened a com- mittee to provide recommendations for revising standards and requirements so school meals would be more healthful. The committee’s report was issued in Oc- tober 2009 and included eight recommendations for school lunches and breakfast programs: 1. The Food and Nutrition Service of USDA should adopt the Nutrient Targets as the scientific basis for setting standards for menu planning for school meals but should not adopt a nutrient-based standard for school meal plan- ning and monitoring. 2. To align school meals with the Dietary Guidelines for Americans and im- prove the healthfulness of school meals, the Food and Nutrition Service should adopt standards for menu planning that increase the amounts of fruits, vegetables, and whole grains; increase the focus on reducing the amounts of saturated fat and sodium provided; and set a minimum and maximum level of calories. 3. To achieve a reasonable balance between the goals of reducing waste and preserving the nutritional integrity of school meals, the Food and Nutrition Service, in conjunction with state and local educational agencies and stu- dents, should weigh the strengths and limitations of the committee’s two options when setting standards for the meals as selected by the student (these two options deal with how many items may be declined by the student). 4. The Food and Nutrition Service, working together with state agencies, professional organizations, and industry, should provide extensive support to enable food service operators to adapt to the many changes required by revised Meal Requirements. The types of support required include the following: • Technical assistance for developing and continuously improving menus, ordering appropriate foods (including the writing of specifications), and controlling costs while maintaining quality. • New procedures for monitoring the quality of school meals that (1) focus on meeting relevant Dietary Guidelines and (2) provide information for

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 SCHOOL MEAL POLICIES continuous quality improvement and for mentoring food service workers to assist in performance improvement. 5. USDA should work cooperatively with Health and Human Services, the food industry, professional organizations, state agencies, advocacy groups, and parents to develop strategies and incentives to reduce the sodium content of prepared foods and to increase the availability of whole grain-rich prod- ucts while maintaining acceptable palatability, cost, and safety. 6. The Food and Drug Administration should take action to require labeling for the whole grain content of food products. 7. Relevant agencies in USDA and other federal departments should provide support for the conduct of studies to evaluate the revised Meal Require- ments for the School Breakfast Program and the National School Lunch Program. 8. The committee recommends that agencies of USDA, of other federal de- partments, and relevant foundations fund research studies on topics related to the implementation of the new Meal Requirements, children’s acceptance of and participation in school meals, and children’s health—especially the following: • Effects of the recommended range of calorie levels on the adequacy of energy intakes for individual children within each of the age-grade categories. • Impacts of various approaches to reducing the sodium content of school meals and student acceptance of reduced-sodium foods. • Impacts of various approaches to increase the acceptance of whole grain-rich products. • Fruit and vegetable options and preparation methods that will increase consumption and decrease waste. • Effects on cost, waste, and food and nutrient intakes of various options to govern the number and types of foods students must accept for a reimbursable meal under the offer versus serve provision of the law. • Targeted approaches to decreasing the prevalence of nutrient inadequacy that do not require increasing the intakes of all children. • Changes in child health as a result of the new standards. SOURCE: IOM, 2009b.

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