NUTRITION STANDARDS FOR FOODS IN SCHOOLS
Leading the Way Toward Healthier Youth
Virginia A. Stallings and Ann L. Yaktine, Editors
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by grant number H75/CCH324857-01 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsoring agency that provided support for the project.
Library of Congress Cataloging-in-Publication Data
Nutrition standards for foods in schools : leading the way toward healthier youth / Committee on Nutrition Standards for Foods in Schools, Food and Nutrition Board ; Virginia A. Stallings and Ann L. Yaktine, editors.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-309-10383-1 (hardbound : alk. paper)
ISBN-10: 0-309-10383-5 (hardbound : alk. paper)
1. School children—Nutrition—Government policy—United States. 2. School lunchrooms, cafeterias, etc.—Management—United States. 3. Nutrition policy—United States. I. Stallings, Virginia A. II. Yaktine, Ann L. III. Institute of Medicine (U.S.). Committee on Nutrition Standards for Foods in Schools.
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Suggested citation: IOM (Institute of Medicine). 2007. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington, DC: The National Academies Press.
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COMMITTEE ON NUTRITION STANDARDS FOR FOODS IN SCHOOLS
VIRGINIA A. STALLINGS (Chair),
Joseph Stokes Jr. Research Institute, Children’s Hospital, University of Pennsylvania School of Medicine, Philadelphia
DENNIS M. BIER,
Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
MARGIE TUDOR BRADFORD,
School Board, Bardstown Independent School District, Bardstown, KY
CARLOS A. CAMARGO, JR.,
Massachusetts General Hospital and Brigham & Women’s Hospital, Harvard Medical School, Boston
ISOBEL R. CONTENTO,
Teachers College, Columbia University, New York
THOMAS H. COOK,
Vanderbilt University’s School of Nursing, The Monroe Carroll Children’s Hospital, Vanderbilt University, Nashville, TN
ERIC A. DECKER,
Department of Food Science, University of Massachusetts, Amherst
Food Services Department, Minneapolis Public School District, MN
JAY T. ENGELN,
National Association of Secondary School Principals, Reston, VA
BARBARA N. FISH,
West Virginia Board of Education, Parkersburg, WV
TRACY A. FOX,
Food, Nutrition, and
LLC, Bethesda, MD
JAMES C. OHLS,
Mathematica Policy Research, Inc., Princeton, NJ (retired)
Food Research and Action Center, Washington, DC
DAVID L. PELLETIER,
Division of Nutritional Sciences, Cornell University, Ithaca, NY
MARY T. STORY,
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
ANN L. YAKTINE, Senior Program Officer (from July 2006)
JANICE RICE OKITA, Study Director (until July 2006)
AMIN AKHLAGHI, Research Associate (until October 2006)
ALICE VOROSMARTI, Research Associate
HEATHER B. DEL VALLE, Senior Program Assistant
FOOD AND NUTRITION BOARD*
DENNIS M. BIER (Chair),
Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
MICHAEL P. DOYLE (Vice Chair),
Center for Food Safety, University of Georgia, Griffin
Center for Research on Dietary Botanical Supplements, Iowa State University, Ames
School of Public Health and Policy, Morgan State University, Baltimore, MD
Chemical Producers and Distributors Association, Alexandria, VA
NANCY F. KREBS,
Department of Pediatrics, University of Colorado Health Sciences Center, Denver
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
J. GLENN MORRIS, JR.,
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
SUZANNE P. MURPHY,
Cancer Research Center of Hawaii, University of Hawaii, Honolulu
JOSE M. ORDOVAS,
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
JIM E. RIVIERE,
College of Veterinary Medicine, North Carolina State University, Raleigh
NICHOLAS J. SCHORK,
Scripps Genomic Medicine and The Scripps Research Institute, LaJolla, CA
REBECCA J. STOLTZFUS,
Division of Nutritional Sciences, Cornell University, Ithaca, NY
JOHN W. SUTTIE,
Department of Biochemistry, University of Wisconsin, Madison
WALTER C. WILLETT,
Department of Nutrition, Harvard School of Public Health, Boston, MA
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ANTON BANDY, Financial Associate
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Dorothy R. Caldwell, School Health Consultant, Raleigh, North Carolina
Susan Crockett, General Mills, James Ford Bell Technical Center
Barbara Devaney, Human Services Research, Mathematica Policy Research
Adam Drewnowski, Center for Public Health Nutrition, Professor of Epidemiology and Medicine, University of Washington
Deanna Hoelscher, School of Public Health, University of Texas Health Science Center, Houston
Francine R. Kaufman, The Keck School of Medicine, University of Southern California, Center of Endocrinology, Diabetes and Metabolism, Children’s Hospital, Los Angeles
Ronald E. Kleinman, Pediatric Gastroenterology and Nutrition Unit, Massachusetts General Hospital, Boston
Michael I. McBurney, Department of Nutrition and Food Science, Texas Agricultural Experiment Station, Texas Cooperative Extension, Texas A&M University
Theresa A. Nicklas, Baylor College of Medicine
Connie M. Weaver, Department of Foods and Nutrition, Purdue University
Margo G. Wootan, Nutrition Policy, Center for Science in the Public Interest
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Johanna T. Dwyer, Tufts University School of Medicine and Tufts–New England Medical Center and Neal A. Vanselow, Tulane University, Professor Emeritus. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
My memories of food at school are many, starting with cafeteria lunch provided after we presented our green lunch token and without discussion of choices or options. Everyone had a lunch token, so no one knew that there was a free or reduced-price lunch and no one went off campus for lunch unless you lived in the neighborhood. Bigger or maybe hungrier students got larger portions. A few students brought lunch in cool lunch boxes, and we envied what was assumed to be a better lunch. There were no vending machines until high school, and then the beverages were milk (full-fat chocolate and regular), orange juice, and a few candy and cracker snacks. I think the only soda machine was in the gym lobby.
Hallway or homeroom bake sales provided great homemade cookies, cupcakes, fudge, and brownies. I recall that the school band had the rights to the chocolate bar sale, complete with our school colors and mascot on the label. Birthdays were not celebrated in school. The Halloween carnival was all about food, fun, and homeroom pride for all, from first graders to seniors. Dedicated parents and friends were the band and sport team boosters, and loyally staffed the concession stand for the football and basketball games. I don’t remember many students taking time from the action of the game to eat, and we did not want to spend our allowance on food.
This was a time when childhood nutrition issues were iron deficiency and undernutrition, when few were concerned about fat or sugar in childhood diets, and when most meals were consumed at home or school. I now know that some children were hungry and the school lunch was an important source of food. Interestingly, the key stakeholders have not
changed—the children, families, school administrators, teachers, nurses, coaches, food service team, and food industry. The local and state school authorities implement federal policy and make many food and health decisions at their levels. In the background, nutritionists, health-care providers, and other child advocates influence both policy and implementation. We now clearly recognize the importance of food and nutrient intake on child health and on lifelong adult health. All stakeholders are concerned about diet quality, emerging food and health habits, and maintaining a pattern of healthy childhood growth. Today overweight children outnumber undernourished children, and yet normal or overweight status does not guarantee food security and a healthful diet for many children. Our inexpensive, abundant food supply, and innovative food industry provide highly palatable foods and beverages for children. School foods and beverages, once almost limited to school lunch, now often include many choices in addition to the federally supported school breakfast and lunch programs. The calories and nutrients consumed at school and school-related activities are an important component of dietary intake of all school-age children. Childhood obesity is often referred to as an epidemic in both the medical and community settings.
It is within this scientific and social environment that our committee established our guiding principles and made recommendations for competitive foods and beverages provided outside of the federally funded school programs. The goal is for schools to employ their unique, long-term relationship with children and their families to support child health and provide a healthful school eating environment. Our committee is a dedicated group of remarkable people from diverse backgrounds and experiences. We quickly recognized that this was not an easy task. Over nearly 2 years, we learned and debated together, and developed this set of food and beverage standards for competitive foods and beverages, if they are offered.
Sincere appreciation is extended to the many individuals and groups who were instrumental in the development of this report. First and foremost, many thanks are due to the committee members, who volunteered countless hours to the research, deliberations, and preparation of the report. Their dedication to this project was outstanding and the basis of our success.
Many individuals volunteered significant time and effort to address and educate our committee members during the workshops and public meetings. Workshop speakers included Richard Black, Karen Cullen, Robert Eadie, Stanley Garnet, Harold Goldstein, Nancy Green, Hope Hale, Mary Kay Harrison, Jay Hirschman, Mary McKenna, Clare Miller, Derek Miller, Alicia Moag-Stahlberg, Susan Neely, John Perkins, Michael Rosenberger, Barbara O. Schneeman, Jonathan Shenkin, Susan Waltman, Shirley Watkins,
Marilyn Wells, Melanie White, Kathy Wiemer, Gail Woodward-Lopez, and Margo Wootan.
In addition, representatives from many entities provided oral testimony to the committee during public meetings that were held on October 26, 2005, December 5, 2005, February 13, 2006, and April 21, 2006. They represented the Action for Healthy Kids, Albert Einstein College of Medicine, American Academy of Pediatrics, American Beverage Association, American Dietetic Association, American Heart Association, Baylor College of Medicine, Boston University, The California Center for Public Health Advocacy, The Centers for Disease Control and Prevention, The Center for Science in the Public Interest, Coca-Cola North America, ConAgra Foods, Inc., The Food and Drug Administration, Food Products Association, General Mills Bell Institute of Health and Nutrition, Grocery Manufacturers Association, International Dairy Foods Association, Irving Independent School District, Kraft Foods Inc., Los Angeles Unified School District, The National Association of State Boards of Education, National Dairy Council, National Medical Association, PepsiCo, The Physician’s Committee for Responsible Medicine, School Nutrition Association, Schwan Food Company, The Texas Department of Agriculture, University of California–Berkeley, The United States Department of Agriculture, Westchester Coalition, and the West Virginia Department of Education.
It is apparent that many organizations and individuals from a variety of school and scientific backgrounds provided timely and essential support for this project. Yet we would have never succeeded without the efforts, skills, and grace that were provided in large measure by Janice Okita, Ph.D., R.D. (8/05–7/06) and Ann Yaktine, Ph.D. (7/06–8/07), our Senior Program Officers and Study Directors for this project; Amin Akhlaghi, Research Associate (09/05–10/06); Alice Vorosmarti, M.S.P.H., Research Associate; Heather Del Valle, B.S., B.A., Senior Program Assistant; and Linda Meyers, Ph.D., Food and Nutrition Board Director. Thanks also to Hilary Ray for technical editing.
Last, as chair, I express my sincere appreciation to each member of this committee for their extraordinary commitment to the project and the wonderful opportunity to work with them on this important task for the nutrition and school communities and for the school children whose health and future we were asked to consider.
Virginia A. Stallings, Chair
Committee on Nutrition Standards for Foods in Schools