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Introduction and Themes of the Workshop1

The childhood obesity epidemic and related health consequences are urgent public health problems. Approximately one-third of America’s young people are overweight or obese (Ogden et al., 2012). Health problems once seen overwhelmingly in adults, such as type 2 diabetes, cardiovascular disease, and hypertension, are increasingly appearing in youth (Jago et al., 2006; Nelson and Bremer, 2010). Though the health of Americans has improved in many broad areas for decades, increases in obesity could erode these and future improvements (Stewart et al., 2009).

The IOM report Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation recognized the importance of the school environment in addressing the epidemic and recommended making schools a focal point for obesity prevention (IOM, 2012). The development and implementation of K-12 nutrition benchmarks, guides, or standards (for a discussion of these terms, see the next section of this chapter) would constitute a critical step in achieving this recommendation. National nutrition education curriculum standards could have a variety of benefits, including the following:

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1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs, with the assistance of Institute of Medicine (IOM) staff, as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the IOM, and they should not be construed as reflecting any group consensus.



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1 Introduction and Themes of the Workshop1 The childhood obesity epidemic and related health consequences are ur- gent public health problems. Approximately one-third of America’s young people are overweight or obese (Ogden et al., 2012). Health problems once seen overwhelmingly in adults, such as type 2 diabetes, cardiovascular disease, and hypertension, are increasingly appearing in youth (Jago et al., 2006; Nelson and Bremer, 2010). Though the health of Americans has im- proved in many broad areas for decades, increases in obesity could erode these and future improvements (Stewart et al., 2009). The IOM report Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation recognized the importance of the school envi- ronment in addressing the epidemic and recommended making schools a focal point for obesity prevention (IOM, 2012). The development and implementation of K-12 nutrition benchmarks, guides, or standards (for a discussion of these terms, see the next section of this chapter) would con- stitute a critical step in achieving this recommendation. National nutrition education curriculum standards could have a variety of benefits, including the following: 1  he T planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs, with the assistance of Institute of Medicine (IOM) staff, as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the IOM, and they should not be construed as reflecting any group consensus. 1

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2 NUTRITION EDUCATION IN THE K-12 CURRICULUM • Improving the consistency and effectiveness of nutrition education in schools; • Preparing and training teachers and other education staff to help them provide effective nutrition education; • Assisting colleges and universities in the development of courses in nutrition as part of teacher certification and in updating methods courses on how to integrate nutrition education in subject-matter areas in the classroom and in materials; and • Establishing a framework for future collaborative efforts and part- nerships to improve nutrition education. Given the widespread and growing interest in nutrition education, the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) asked the IOM to conduct a workshop on the merits and potential uses of a set of national nutrition education curriculum standards and learning objectives for elementary and secondary school children. Held in Washing- ton, DC, on March 11-12, 2013, the workshop brought together more than 100 registered participants to identify current promising practices, consider the most important attributes of such standards, and suggest approaches to build acceptance and use among educators (see Appendix A for the State- ment of Task). Box 1-1 lists some of the key questions derived from the statement of work to be addressed at the workshop. The workshop was organized by a planning committee chaired by Karen Weber Cullen, professor of pediatrics at the Children’s Nutrition Research Center, Baylor College of Medicine. The members of the planning committee played key roles in moderating sessions at the workshop and in synthesizing the observations made by breakout groups on the workshop’s second day. This report is a summary of the workshop’s presentations and discus- sions prepared from the workshop transcript and slides. This summary presents recommendations made by individual speakers. However, none of these recommendations, including those summarized below from the clos- ing session, should be seen as consensus recommendations of the workshop. Following this introductory chapter, which provides background and introduces the main themes of the workshop, Chapter 2 describes the cur- rent opportunity to move forward on the development and implementation of national nutrition education curriculum standards. Chapter 3 provides an overview of past research on school-based nutrition education and a statistical summary of the extent of curriculum education occurring today. Chapter 4 looks at the lessons that can be learned from several major fed- eral nutrition programs that include educational components. Chapter 5 recounts the experiences from California, Wisconsin, and Washington, DC, in instituting nutrition education in schools. Chapter 6 offers perspectives

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INTRODUCTION AND THEMES OF THE WORKSHOP 3 BOX 1-1 Workshop Questions Key questions to be addressed during the workshop included the following: •  hat are the most important skills, tools, and knowledge for children to W learn to support healthful diets? How adequate are the current nutrition education-related materials available to teachers in the K-12 setting in ad- dressing these areas? •  o teachers and administrators have adequate training to provide class- D room instruction in the areas of nutrition education and/or nutrition educa- tion integration into core curriculum courses? •  hat models, benchmarks, or promising practices should be used in de- W veloping the standards? •  hat challenges could impact development and implementation of na- W tional nutrition education standards? What forces or barriers should be considered in developing these standards? How do age, gender, culture, community, and ethnicity need to be factored into the standards? •  ow will the standards be used? Who will be a champion for the develop- H ment and use of the standards? •  hat are the potential positive outcomes resulting from the implementation W of national nutrition education standards in core curriculum courses? on nutrition education from a school board member, a superintendent, a principal, and a teacher. Chapter 7 examines the training and professional development of teachers that could enable them to deliver standards-based nutrition education effectively. And Chapter 8 provides the steering com- mittee’s synthesis of the observations made by six breakout groups that met for 2 hours to discuss several critical questions on the morning of the work- shop’s second day. Appendix A contains the Statement of Task and work- shop agenda; Appendix B presents biographical sketches of the moderators and speakers; Appendix C provides the names and affiliations of workshop attendees; and Appendix D identifies abbreviations and acronyms. THE USE OF THE TERM “STANDARDS” The United States has been pursuing a standards-based vision of edu- cation reform for almost three decades. The 1994 reauthorization of the Elementary and Secondary Education Act mandated the establishment of rigorous content standards for all students and assessments to measure stu- dents’ progress in meeting the standards (Improving America’s Schools Act of 1994, P.L. 103-382). However, this approach to education reform has

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4 NUTRITION EDUCATION IN THE K-12 CURRICULUM encountered many practical difficulties. As a white paper from the National Academy of Education (2009) asks, “Exactly what should the standards be, how should they be set and by whom, and how should they be applied to ensure rigorous and high-quality education for American students?” Even the word “standards” can generate concern over the procedures used to determine and assess what students should know and be able to do. The planning committee for the workshop decided to use the word stan- dards to signify expectations for student learning in the area of nutrition. But on the first day of the workshop, all of the participants were given slips of paper on which they were invited to jot down alternatives to the word standards. Some of the suggested alternatives include • competencies, • guidelines, • benchmarks, • standards, • expectations, • goals, • guidance, • objectives, • framework, • touchstone, • roadmap, and • indicators. This summary of the workshop generally uses the word “standards” to denote the complex of ideas captured by the terms listed by participants. However, the term should be interpreted broadly and does not imply a specific approach to nutrition education. SUMMARY OF WORKSHOP THEMES In the final session of the workshop, Katie Wilson, executive director of the National Food Service Management Institute at the University of Mississippi, reviewed some of the most important points made during the workshop. Her summary is presented here as an introduction to several of the workshop’s major themes. Nutrition education is a life skill that provides the appropriate knowl- edge and skills to eat healthfully, which affects both quality of life and longevity. Furthermore, research has shown that nutrition education can change behaviors. Many questions remain regarding what should be taught, how it should be taught, and how much time needs to be devoted to nutri- tion education. But enough evidence exists to convince people that nutrition

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INTRODUCTION AND THEMES OF THE WORKSHOP 5 education is effective, Wilson observed, so long as that evidence can be presented to others in a convincing manner. Nutrition education needs to be factual. Changes to the school meal patterns should be explained to students and staff. For example, if meal pat- terns are changed to add more vegetables, students and staff need to learn the health benefits of eating vegetables in engaging ways. “Children want to know why,” Wilson said. “Why can’t I do what you’re telling me not to do?” Teachers should not be espousing the latest fad read in a magazine or their own personal views on nutrition. Wilson particularly emphasized the need to teach nutrition every year so that knowledge builds sequentially and cumulatively. Participants at the workshop spoke about both nutrition education and food literacy, and Wilson urged continued attention to the latter term. For example, encouraging people to eat foods from the produce aisle that have a variety of colors is food education. Scientific information focused on nutrients can be too far removed from the choices that students and parents make every day. People need simple and consistent messages that they can understand. Nutrition education is designed to achieve a change in lifestyle, which will not happen overnight. Teachers, administrators, students, and parents all need time to incorporate new information and change their behaviors accordingly, and some will change more readily than others. Also, nutri- tion education “takes a village,” Wilson said. The issue belongs to every- one, whether teacher educators in universities, new dietitians, the general public, or school nutrition staff. Moreover, the issue is international, with conversations about childhood nutrition, obesity, and education occurring in countries around the world. Nutrition education is for teachers as well as students. Teachers can benefit greatly from better eating and health, which in turn will benefit their students. And as teachers learn more about nutrition, they are better able to convey that information—and their enthusiasm over better health—to their students. Nutrition education needs champions. For example, Wilson referred to the organization Action for Healthy Kids, which is a grassroots organi- zation devoted to changing the school environment. The people involved in that organization and similar organizations are “already doing it, and they’re doing it in their districts with their district culture.” Nutrition ex- pertise also needs to be leveraged, given the scope of the changes that are necessary. For example, the National Food Service Management Institute, which provides education, training, technical assistance, and research in school nutrition, uses a train-the-trainer model to multiply impact, which Wilson recommended. National nutrition education curriculum standards would need to be

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6 NUTRITION EDUCATION IN THE K-12 CURRICULUM aligned with state standards. They also would need support from multiple stakeholders, such as school boards, principals, and legislators. And they would need to be flexible to accommodate the great differences among schools. Nutrition education can take advantage of the skills and enthusiasms of young people. They are the ones who are experts at social media and would know how to use new technologies and platforms to foster change. Students “are more than willing to tell you what they think, how they feel, and how you should do it right, so they’ll help us.” Many nutrition education curricula already exist. These could be com- piled, compared, and mined for valuable information and approaches, with the National Agricultural Library serving as a portal for wide dissemination. More science-based evidence from studies on the effectiveness of various nutrition education curricula is needed to know how best to move forward. Strategic planning can help ensure that initiatives are taken thoughtfully and carefully. And education and practice need to reinforce each other— “they go hand in hand.” “The time is now,” said Wilson. “Never before has the conversation been as loud.” Support from the Obama administration is very strong. Even the advocates of ideas that seem implausible, such as radical changes in food preparation in schools, have something to contribute to the dialogue. “Everybody is talking about ‘childhood wellness,’” Wilson said—a term she prefers to “obesity” because of the stigmatizing effect of that term. The workshop was not designed to produce definitive answers, Wilson observed. Rather, it was organized as a conversation, and the conversation needs to continue. “We have a responsibility,” she said. “We are the ones who are passionate. We must keep the pendulum moving.” As Wilson concluded, quoting the entrepreneur and speaker Jim Rohn, “You can- not change your destination overnight, but you can change your direction immediately.”