Building Blocks for Healthy Children
Virginia A. Stallings, Carol West Suitor, and Christine L. Taylor, 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 Contract No. AG-3198-C-08-0001 between the National Academy of Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Institute of Medicine (U.S.). Committee on Nutrition Standards for National School Lunch and Breakfast Programs.
School meals : building blocks for healthy children / Committee on Nutrition Standards for National School Lunch and Breakfast Programs, Food and Nutrition Board ; Virginia A. Stallings, Carol West Suitor, and Christine L. Taylor, editors.
Includes bibliographical references.
ISBN 978-0-309-14436-0 (pbk.)
1. School children—Food—United States. 2. School children—Nutrition—Government policy—United States. I. Stallings, Virginia A. II. Suitor, Carol West. III. Taylor, Christine Lewis. IV. Title.
[DNLM: 1. Food Services—standards—United States. 2. Nutrition Policy—United States. 3. Adolescent—United States. 4. Child—United States. 5. Schools—United States. WA 350 I59s 2009]
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Suggested citation: IOM (Institute of Medicine). 2010. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press.
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COMMITTEE ON NUTRITION STANDARDS FOR NATIONAL SCHOOL LUNCH AND BREAKFAST PROGRAMS
VIRGINIA A. STALLINGS (Chair),
The Children’s Hospital of Philadelphia, University of Pennsylvania
KAREN WEBER CULLEN,
Children’s Nutrition Research Center, Baylor College of Medicine, TX
Minneapolis Public Schools, Special School District No. 1, MN
MARY KAY FOX,
Mathematica Policy Research, Inc., Cambridge, MA
Division of Epidemiology and Community Health, University of Minnesota, MN
GAIL G. HARRISON,
School of Public Health, Center for Health Policy Research, University of California, Los Angeles
MARY ARLINDA HILL,
Jackson Public Schools, MS
HELEN H. JENSEN,
Department of Economics, Iowa State University, Ames
RONALD E. KLEINMAN,
Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
GEORGE P. McCABE,
College of Science, Purdue University, West Lafayette, IN
SUZANNE P. MURPHY,
Cancer Research Center of Hawaii, University of Hawaii, Honolulu
ANGELA M. ODOMS-YOUNG,
Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL
Department of Food Science, University of Massachusetts, Amherst
MARY JO TUCKWELL,
inTEAM Associates, Ashland, WI
CHRISTINE TAYLOR, Study Director
SHEILA MOATS, Associate Program Officer
JULIA HOGLUND, Research Associate
HEATHER BREINER, Program Associate
CAROL WEST SUITOR, Consultant Subject Matter Expert and Writer
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant,
Food and Nutrition Board
LINDA D. MEYERS, Director,
Food and Nutrition Board
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 National Research Council’s (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:
Cheryl A. M. Anderson, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Janet Currie, Economics Department, Columbia University, New York, NY
Barbara L. Devaney, Human Services Research, Research Division, Mathematica Policy Research, Inc., Boston, MA
Deanna M. Hoelscher, School of Public Health, University of Texas Health Sciences Center at Houston
Eileen T. Kennedy, Friedman School of Nutrition Sciences and Policy, Tufts University, Boston, MA
Daryl Lund, Cottage Grove, WI
Penny McConnell, Food and Nutrition Services, Fairfax County Public Schools, Vienna, VA
Barry Sackin, B. Sackin & Associates, L.L.C., Murrieta, CA
Sandra Schlicker, Wellness and Nutrition Services, Office of the State Superintendent of Education, Government of the District of Columbia, Washington, DC
Frances H. Seligson, Independent Consultant, Hershey, PA
Patricia Wahl, University of Washington School of Public Health and Community Medicine, Seattle
Walter C. Willett, Department of Nutrition, Harvard School of Public Health, Boston, MA
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 Elaine L. Larson, School of Nursing, Columbia University, and Joanna T. Dwyer, Tufts University School of Medicine & Friedman School of Nutrition Science & Policy, Frances Stern Nutrition Center, Tufts-New England Medical Centers. Appointed by the NRC 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 small southern town memories of food at school are many, starting with cafeteria lunch provided after we presented our green tokens and without discussion of choices or options except for the big decision of chocolate or plain milk. Everyone had a lunch token, so no one knew that there was a free or reduced-price lunch and no one went home or 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 machine foods and beverages were few, and most students did not come to school with money or plans to purchase foods other than school lunch. 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, sugar, or sodium in childhood diets, and when most meals were consumed at home with family members or at school. I now know that some children were hungry and the school lunch, and later school breakfast, 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 and quan-
tity, emerging food and health habits, and maintaining a healthy pattern of childhood growth. Today overweight children outnumber undernourished children, and childhood obesity is often referred to as an epidemic in both the medical and community settings. Nonetheless, 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 mainly to school lunch, now often include many choices in addition to the meals offered by 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.
It is within this scientific and social environment that our committee established criteria for nutrient targets and meal standards and made recommendations to revise the nutrition- and food-related standards and requirements for the National School Lunch Program and the School Breakfast Program. The recommended standards for menu planning lay out a school meal approach that results in the wide array of nutrients that children need and that reflect the Dietary Guidelines for Americans.
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 recommendations for nutrition and food standards for schools meals. We recognized that the standards will be effective only to the extent that standards are implemented effectively and thus made recommendations related to technical support, developing foods that are reduced in sodium content, and taking measures to help schools incorporate more products that are rich in whole grains.
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. This will require attention to many factors that go beyond the federally supported school meal programs: competitive foods (foods and beverages offered other than the meals provided under the National School Lunch and Breakfast programs), time and duration of meal periods, activity level of children, and evaluation and research that address interactions of such factors with the success of the school meal programs.
The involvement of students, parents, schools, and the food industry is important to the success of implementing the recommended revisions. Support from state and federal agencies and from professional organizations and child advocacy groups will help to promote the acceptance of the recommended meals. Finally, the level of federal reimbursement for school meals needs to be sufficient to cover the cost of improvements in the meals
such as increased amounts of fruits and vegetables and the substitution of whole grain-rich foods for some of the refined grains.
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 is the basis of our success.
Many individuals volunteered significant time and effort to address and educate our committee members during our two public workshops on July 8, 2008, and January 28, 2009. Workshop speakers included: Tom Baranowski, Kimberly Barnes-O’Connor, Jessica Donze Black, Helene Clark, Adalia Espinosa, Joanne F. Guthrie, Jeanne Harris, Geraldine Henchy, Fred Higgens, Jay Hirschman, Lynn Hoggard, Sue E. Holbert, Leonard Marquart, Cathie McCullough, Celeste Peggs, Matt Sharp, Ted Spitzer, Kimberly Stizel, Katie Wilson, and Margo Wootan.
In addition representatives from many entities provided oral testimony to the committee during the public workshops that were held on July 8, 2009, and January 28, 2009. They represented the Action for Healthy Kids, Alliance for a Healthier Generation, American Academy of Pediatrics, American Dietetic Association, Apple Processors Association, ARMARK Education, Baylor College of Medicine, Food Research and Action Center, California Food Policy Advocates, Charterwells School Dining Services, Economic Research Service, Food Distribution Program and Food and Nutrition Service of United States Department of Agriculture, General Mills, Grocery Manufacturers Association, International Dairy Foods Association, Local Matters, National Alliance for Nutrition and Activity, National Dairy Council, National Pork Board, Nemours Division of Health and Prevention Services, School Nutrition Association, Soyfoods Association of North America, Sunkist Taylor LLC, United Egg Producers, United Fresh Produce Association, University of Minnesota, U.S. Apple Association, and Wellness in American Schools.
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 extensive contributions of Carol West Suitor, ScD, as Consultant Subject Matter Expert and Writer to the project. Furthermore, it is important to recognize the efforts, skills, and grace that were provided in large measure by Christine L. Taylor, PhD, RD, Study Director for this project; Sheila Moats, BS, Associate Program Officer; Julia Hoglund, MPH, Research Associate; Heather Breiner, BS, Program Associate; and Linda Meyers, PhD, Director, Food and Nutrition Board. I also want to thank Todd Campbell from Iowa State University for developing the software used by the committee to analyze menus
for cost and nutrient analyses, and Mathematica Policy Research, Inc. for providing data analyses. 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 schoolchildren whose health and future we were asked to consider.
Virginia A. Stallings, Chair
Committee on Nutrition Standards for National School Lunch and Breakfast Programs