Nutrition Education in the K-12 Curriculum: The Role of National Standards: Workshop Summary (2013)

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Perspectives from Educators

Implementing nutrition education curriculum standards may depend on the policy makers, administrators, and teachers in individual districts and schools across the nation. Four representatives of these groups spoke at the workshop: a school board member, a superintendent, a principal, and a teacher. Each pointed to the potential of nutrition education even as they described the obstacles that must be overcome to deliver that education.

PERSPECTIVE OF A SCHOOL BOARD MEMBER

Elaine Gantz Berman has been a member of both the Denver Board of Education and the Colorado State Board of Education. In Colorado, State Board of Education members are elected by party affiliations. “I find that terribly unfortunate,” she said, because “politics enter into many of our very important policy decisions. You would think that nutrition education is nonpartisan. It is not.” The Colorado State Board currently has four Republicans and three Democrats. Thus, for votes pertaining to nutrition education, that means “it’s never quite smooth sailing.”

Starting in 2009, Colorado added comprehensive health education standards to its preexisting academic standards. Health education includes sex education, which “was definitely a little tricky, but we [managed to reach consensus],” in part through artful compromises. Health education also includes physical education, which is staffed in a different department than nutrition education. One way to coordinate the two, which Berman believes is important, would be to establish a team that brings together representatives of these departments to coordinate their work, but such teams also need to have the ear of the commissioner of education so that they do not end up talking just among themselves.

In the area of “apply knowledge and skills to engage in lifelong healthy eating,” Colorado established the following expectations:

Elementary school expectations

1. Demonstrate the ability to engage in healthy eating behaviors.
2. Demonstrate the ability to set a goal in order to enhance personal nutrition status.
3. Examine the connection between food intake and physical health.
4. Demonstrate the ability to make and communicate appropriate food choices.
5. Identify eating and drinking behaviors that contribute to maintaining good health.
6. Know that eating a variety of foods from the different food groups is vital to promote good health.
7. Identify the major food groups and the benefits of eating a variety of foods.

Middle school expectations

1. Analyze factors that influence healthy eating behaviors.
2. Demonstrate the ability to make healthy food choices in a variety of settings.

3.  Access valid and reliable information, products, and services to enhance healthy eating behaviors.

High school expectations

1. Analyze the benefits of a healthy diet and the consequences of an unhealthy diet.
2. Analyze how family, peers, media, culture, and technology influence healthy eating choices.
3. Demonstrate ways to take responsibility for healthy eating.

School districts in Colorado are required to implement all 10 of the Academic Standards, beginning in school year 2013-2014. However, if these standards are to be implemented then there must be a way to hold them accountable for the implementation, Berman stated. Every school in Colorado has a wellness policy, but are those policies actually being put to use? This “is a problem in policy making in general,” said Berman. “We have a lot of policies but, in many cases, we have no way of knowing if they get implemented.”

In Colorado, the State Board of Education has the authority to adopt academic content standards, but the curriculum is left up to the local school district. Nevertheless, many districts, and especially small rural districts, are eager to use model curricula made available by the state or other entity. In some cases, the provision of model curricula has generated “extraordinary pushback.” For this reason, the state generally refers to “guidelines for implementing standards” rather than model curricula.

Despite the difficulties encountered in developing and implementing standards in Colorado, the attention given to childhood obesity has made the process politically possible, said Berman. Support from philanthropy also has been critical. The Colorado Health Foundation has made reducing obesity its number one priority, and other foundations, including the Colorado Legacy Foundation, the Bill & Melinda Gates Foundation, and the Kaiser Foundation, also have been involved in school health and wellness in the state. In addition, Berman called attention to the potential for local school foundations to raise money for special initiatives. In Colorado, this can be done at the state level, and it enables action to be taken more quickly than through the state department of education.

Colorado has the lowest rates of adult obesity in the country, though the rate is still above 20 percent and has been increasing. But the state is 23rd in the nation in childhood obesity, which means that adult obesity is likely to increase in the future. Colorado has been implementing new meal pattern standards and nutritional standards for competitive foods. It also has made free water available whenever meals are served during mealtimes

and is adjusting the prices of school lunches for students who pay the full amount in order for this amount to become more equitable with the reimbursement rate. And a bill called Breakfast after the Bell being discussed at the time of the workshop would enable the delivery of breakfast during instructional hours.

In closing, Berman raised several issues that still require attention. At the time of the workshop, 39 states had policies for competitive foods, but none were consistent with the standards recommended by the IOM. She also expressed concern about students opting out of school lunches if they are dissatisfied with the lunches provided. “What we hear a lot is high school students are still hungry after they’ve had their meal, [although] maybe that’s because they’re overeating to begin with.” And having sufficient time and money are always considerations in making and certifying changes in education.

PERSPECTIVE OF A SUPERINTENDENT

The Elk Grove Unified School District in southern Sacramento County, California, is not only the “face of California,” according to its superintendent Steven Ladd, but the “face of the world.” Its 62,000 students spread across 320 square miles are 26 percent Latino, 25 percent white, 22 percent Asian American, and 18 percent African American, with a wide range of other ancestral backgrounds included. “We have a rich and wonderfully diverse population,” said Ladd.

Elk Grove has had the opportunity to combine many different elements into a health and nutrition program. In 2006 the district’s board, which has been very supportive of the district’s emphasis on health, adopted a wellness policy with a coordinated school health program. The district has used the Shaping Health as Partners in Education (SHAPE) model, which includes a variety of initiatives (discussed below). It also is part of Network for a Healthy California, has a Harvest of the Month Club that brings local healthy foods into the classroom, and has a farm-to-school program.

The district began participating in SHAPE 18 years ago with 27 K-6 teachers. It now has 500 teachers participating—one-seventh of its teaching force. SHAPE includes field trips to food processing centers, farmers’ markets, and local grocery stores. These trips are supplemented by a wide variety of other activities and programs, including Nutrition Olympics, Professor Mimo kindergarten nutrition lessons (in which a consultant dressed as a clown delivers a message to elementary students about colorful vegetables and fruits), junior chef cooking assemblies, school gardens, student-run health fairs, and parent communications. Partnerships with Kaiser Permanente, the Dairy Council, Future Farmers of America, Power Play!, community service clubs, and nonprofit organizations support

and diversify the offerings. “It’s going to take everybody to be involved, and thankfully we have a community and our partnerships that are very strong,” said Ladd.

The district has breakfast programs in every one of its 64 schools. It participates in the USDA’s HealthierUS School Challenge and in 2011 all 39 elementary schools in the Elk Grove district received an award.

Nutrition education is taught in some seventh grade physical education or science classes through nutrition laboratories. A nutrition unit in ninth-grade health class is mandatory for graduation, and high schools offer electives for advanced nutrition studies. The district also has a culinary arts academy and regional occupational program courses focused on food. Ladd also pointed to the potential of online education to create blended classrooms in which a diverse array of materials can be introduced into the classroom in a variety of ways.

Ladd briefly reviewed the nutrition standards adopted in California in 2008. Nutrition is one of six California health content standards and has eight overarching standards. Within each of these eight are a set of skills-based standards that focus on students making healthy choices and avoiding risky behaviors regarding nutrition. All of the curricula in the district are aligned to these state standards, with instruction linked to core content areas and the mandated family life education curriculum. More than 475 district elementary teachers receive nutrition education professional development annually, and they are provided with and use free curricula from the Dairy Council, Agriculture in the Classroom, Power Play!, and USDA’s MyPlate. Teachers are adept at adapting the curriculum material that is available to making the points they need to make, Ladd said.

Children need to be able to apply what they learn to their own lives if nutrition education is to improve health. In that regard, Ladd urged the use of SHAPE as a national model for offering healthy meals in child nutrition programs, providing nutrition education, building and maintaining partnerships, and applying nutrition policies and practices. He also urged the development of a nutritional framework that provides competencies as opposed to standards alone. Assessments could help determine whether students have mastered these competencies, he added during the discussion session, though assessments inevitably will focus more on literacy and mathematics, with food literacy as part of the content across the curriculum.

Making changes such as those his district have adopted is not necessarily easy. He recalled pairs of students buying three lunches to split between themselves. Removing junk food from his schools cost the district between $250,000 and $350,000 in money earned to support school activities. Many students move not just within a state but among states. California is 49th out of the 50 states in per-pupil expenditures, and the Elk Grove district is now in danger of losing part of the SNAP-Ed funding it has used for

nutrition education, which would mean that much of the work the district has been doing could not continue. Finally, Ladd and several other speakers in the session emphasized the potential disruption of sequestration, which had just gone into effect at the time of the workshop and was reducing funds for staff, professional development, and other essential activities. “We’re bracing to figure out what will be the next steps.”

The Common Core standards will be a sea change for public education, Ladd said. The development of the Common Core provides an opportunity to reexamine what is occurring in districts, but it also is anxiety producing. “The biggest challenge, I believe, will come out of the assessments portion. How are we going to measure academic achievement?” California is a member of one of the two consortia that are developing Common Core standards and assessments, and the state plans to impose additional requirements beyond those of the Common Core. This process will provide an opportunity to incorporate nutrition content and assessments into other subjects, whether science, the language arts, or mathematics. For example, “genetically modified foods is a conversation that allows people to go back and forth,” said Ladd. “You can talk about crop yields, you can talk about percentages, and you can talk about how much that will help feed the world.” The problem, from the perspective of a superintendent, comes if the Common Core standards are added on to what already exists. In addition, professional development, curricula, and technology all add costs. These costs are not insurmountable, Ladd said, but they are important considerations.

Public education has many competing interests. For nutrition education to be sustainable in the curriculum, students need to understand why nutrition is important and how to apply it to their lives. Students, teachers, and parents need to understand the relevance and value of nutrition education. Districts need flexibility because of the great differences in their sizes and capacities. Districts often lack support for curriculum, and not every district has career academies¹ or culinary programs, as Elk Grove does. But changes going on in education provide opportunities for nutrition education that did not exist in the past.

PERSPECTIVE OF A PRINCIPAL

Fred Storti, executive director of the Minnesota Elementary School Principals’ Association and an elementary school principal for 27 years before that, offered a ground-level perspective on nutrition education. Borrowing from a presentation by education analyst, speaker, and writer Jamie

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¹ A specialized high school program that provides college preparatory curriculum based on a career theme (http://www.aypf.org/documents/092409CareerAcademiesPolicyPaper.pdf).

Robert Vollmer, he noted that schools have assumed an ever-growing list of responsibilities over the course of the 20th and 21st centuries. In the initial decades of the 20th century, they accepted responsibility for nutrition, immunization, and health, which “we’re still trying to get right,” said Storti. That was followed by physical education, home economics, vocational education, and mandated school transportation. The middle of the century brought such varied offerings as business education, art, music, speech, drama, half-day kindergarten, school lunch programs, expanded mathematics and science education, driver’s education, stronger foreign language requirements, sex education, Advanced Placement programs, Head Start, Title I, consumer education, and career education.

In the 1970s, during which the rate of breakups of American families grew substantially, schools added drug and alcohol abuse education, parenting education, behavior adjustment classes, character education, special education, Title IX programs, environmental education, women’s studies, African American heritage education, and school breakfast programs. In the 1980s, “the floodgates opened,” said Storti, and schools became responsible for keyboarding and computer education, global education, multicultural education, nonsexist education, English as a second language and bilingual education, teen pregnancy awareness, Hispanic heritage education, early childhood education, full-day kindergarten, various preschool and after-school programs, alternative education, antismoking education, expanded health and psychological services, and child abuse monitoring.

The 1990s and 2000s brought conflict resolution and peer mediation, HIV/AIDS education, distance learning, concurrent enrollment options, dropout prevention, wellness programs, and many other topics and programs. “The school curriculum is kind of full, isn’t it?” said Storti. “There is a lot we are asked to do.”

The problem, Storti continued, is that the time available for education is strictly limited. In a typical Minnesota elementary school, 50 percent of the day is devoted to literacy, writing, and mathematics. Specialists in art, music, physical education, and media technology take up about 17 percent of the day, with health, science, social studies, and other subjects taking up another 17 percent. Lunch, recess, and opening and closing the day take up much of the remaining 16 percent. The result is that it is very difficult to find 75 minutes per week for health instruction, said Storti.

From Storti’s perspective, national nutrition education standards are important. “If we don’t have them, they’re not going to happen.” However, they should not be mandatory. Rather, they should provide a framework for school districts to develop comprehensive K-12 nutrition programs. These programs should equip students with the lifelong critical thinking skills they need to judge the reliability of information. Students should understand key concepts such as healthy eating behaviors, food safety, and nutrition

for growth, health, and energy. They need to be actively engaged in their education so that they make healthier choices.

The purpose of nutrition education, said Storti, should be to empower student consumers and ensure health literacy, which are key 21st-century skills. Nutrition education standards give teachers the framework to develop age-appropriate lessons consistent in scope and sequence. Content standards should specify the skills and knowledge that students should have by the end of the fourth, eighth, and twelfth grades, while performance standards should demonstrate that students are achieving the content standards. In this way, nutrition education can provide students with important life skills taught through a comprehensive approach.

The curriculum should be devised at the local level to focus instruction from prekindergarten through twelfth grade to prepare students to meet the standards, Storti said. The curriculum specifies the details of day-to-day learning at the local level. Elementary school teachers have to prepare for seven different subjects in a day, and they need help to do so, especially in the area of health and nutrition.

Storti advocated for tight content and performance standards but a loose approach to the curriculum and teaching. Teachers need the flexibility to figure out how to achieve the standards. The integration of subjects “is one of the beautiful things about the elementary school day,” said Storti. “Yes, the teacher is responsible for all those things, but they do a great job of integrating these skills with the other subject areas.” Thematic units also can be a useful way of integrating skills on a grade-level or schoolwide basis.

As in many other states, funding for professional development has been decreasing, “but that doesn’t mean that we can’t move forward,” said Storti. A key step will be to involve national organizations in the conversation, such as the National Association of Elementary School Principals, the National Education Association, and national superintendents’ organizations. “Getting the right stakeholders to the table can leverage this.”

Principals are critical to the process and need to do five things, according to Storti:

1. Be instructional leaders and not just managers;
2. Be teachers of instruction;
3. Be in classrooms as much as possible;
4. Guide the mission, vision, and goals of the school; and
5. Help establish and model the tone for the school.

“If I believe that nutrition is important—and I demonstrate and I work with my teachers and my kids—then they are going to believe it and see the benefits,” Storti said.

PERSPECTIVE OF A TEACHER

For 15 years, Jason Dane, the 2013 Midwest District Health K-12 Teacher of the Year, has been a lunchroom supervisor at New Trier High School, where he teaches health. “If you really want to know what’s going on in the school, spend some time in the lunchrooms, really seeing what students are doing and talking about and putting theory into practice,” he said.

Dane said that of course he could not speak for every teacher, but much of what he heard at the workshop sounded very familiar. Nutrition education is very different than it was even 10 years ago. Adolescents have far more choices than in the past. Modern American supermarkets can confront consumers with something like 50,000 choices—an overwhelming number for adults as well as students. Eating at restaurants introduces even more choices. “How do we get students to make educated decisions, to make good choices, to take what they’re learning in the classroom and apply that outside the classroom?”

The number of shows on television devoted to foods and cooking has skyrocketed. Some are good, and some are “probably misleading,” said Dane. Advertisements add to the onslaught of information and confound the process of making healthy choices.

The brains of adolescents are still developing, and they think about risks and rewards in different ways than do adults. Thus, teaching students to make good choices extends beyond foods to other types of behavior, such as the use of drugs or alcohol or personal safety measures, such as wearing a helmet while biking. Dane’s goal is to give his students the strategies and techniques they need to make good decisions.

One approach Dane has taken is to educate students about the choices they make every day. For example, he will show his students four ice cream sandwiches that together contain 68 grams of sugar and a 20-ounce soda that contains 70 grams of sugar. Students know that they should not eat four ice cream sandwiches, but they do not realize that they are getting even more sugar from the soda. “Students have trouble making that connection, because they could easily drink a 20-ounce soda.” This kind of comparison can introduce a lesson in obesity and type 2 diabetes that would not make as much sense to students without the comparison.

Similarly, Dane pointed out, an individual deep-dish pizza can contain more salt than three 10-ounce bags of potato chips—and more than twice the recommended daily consumption of sodium. Students need to understand what they are putting into their bodies if they are to make good decisions, he said.

New Trier High School is a very high-performing school, and Dane emphasizes to his students the benefits of good nutrition to performance

and coping with stress and fatigue. “What you’re putting into your body might have an effect when you get to that last period of the day. You’re tired now—well, what did you eat beforehand?” He asks his students whether they are making good choices when they buy meals or snacks. He also tries to take advantage of the ability of computers and cell phones to deliver information from reliable sources to his students almost instantaneously. “That’s the world we live in now.” Not all students have cell phones, and they typically cannot use them in class, but most have access to cell phones after school, and many apps exist that can help students plan their eating and physical activity. “If I give the first person in here a dollar to tell me the saturated fat content in a Big Mac, we’d have 50 phones out and you’d have it in 30 seconds. Our students should be able to access that information and understand what it means.”

The health curriculum contains a lot of material and a lot to get done, Dane emphasized. Nutrition education needs to be integrated into other parts of the curriculum, including the Common Core standards, to be effective. His school has one classroom unit devoted to nutrition, covering 13 or 14 days, and Dane covers nutrition education during his weight-lifting unit and mental health unit, but many schools spend less time on nutrition education. Dane is part of a professional learning cohort at his school that is focused on fitness and nutrition and includes about 25 members, including teachers, librarians, and special education instructors. The group has looked at issues such as vending machines, the school lunch program, special events, and bake sales. “We’re taking a lot of research that is out there and bringing it back to the students.”

Other health issues at schools also require attention, such as special initiatives at Dane’s school on binge drinking and mental health, which a school risk behavior survey revealed to be problems. Socioeconomic issues are also “huge,” said Dane. Inexpensive foods may not be healthy, but many students rely on them. In addition, students come from many different cultures, some of which have an emphasis on foods that can contribute to obesity.

Progress will require collaboration among many different groups, Dane concluded, including national groups like the American Alliance for Health, Physical Education, Recreation and Dance. “There has to be a partnership among schools, among families, and certainly among various agencies that will have a say in whatever might be done.”