1. Understanding Obesity & Childhood Nutrition Panel Perspectives: Schools February 17, 2008 Virginia A Stallings, MD Childrens Hospital of Philadelphia University of Pennsylvania School of Medicine

2. The most pressing challenge to nutritional health in this first decade of the 21 st century is obesity.

3. Competitive Foods are Widely Available in Schools Percentage of Schools Offering Competitive Foods Food VenueElementaryMiddleHigh A la carte678891 Vending Machines 468791 Snack Bars152554

4. Competitive Foods are Widely Available in Schools Percentage of Schools Offering Low Fat a la carte foods Bread Products Lettuce, Veggies, Beans Salads Salty Snacks YogurtsVeggies other than potatoes 20005153383651 20066773535071

5. School-Related Health Policy 2004 Child Nutrition and WIC Reauthorization Act Wellness Policy Required by 2006 –Nutrition education goals –Physical activity goals –Nutrition guidelines –Other school-based activities

6. Nutrition Guidelines All foods available on campus with objective of promoting health and reducing obesity FY 2005 Congress directed CDC to initiate an IOM study to review the evidence and make recommendations

7. Committees Task Review evidence and make nutrition standard recommendations: –for availability of sale, content and consumption of foods and beverages at schools; –with attention to foods and beverages in competition with federally reimbursable meals and snacks.

8. Process and Approach Ten Guiding Principles Tier 1: All students all day F, V, WG, D Tier 2: High school students after school Includes recommendations for: – Non-nutritive sweeteners – Caffeine – Water availability – Sport drinks – Food for student reward and punishment – Fund raising

9. Calories Weight management Physical activity Food groups to encourage Fats Carbohydrates Sodium, potassium Alcoholic beverages Food safety U.S. Department of Health and Human Services U.S. Department of Agriculture www.healthierus.gov/dietaryguidelines

11. Dietary Intake Data <2% meet the Food Guide Pyramid recommendations 16% did not meet any of the Pyramid food group recommendations Too few fruits, vegetables, whole grains; not enough fiber- or calcium-rich foods Too much fat, sodium, added sugar Are childrens diets meeting the Dietary Guidelines for Americans?

12. Key Messages Federal school nutrition programs are the main source of nutrition provided at school. However, if opportunities for students to select competitive foods and beverages arise, they should be used to encourage greater consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy foods. The IOM recommendations ensure that competitive foods and beverages are consistent with the DGA and will promote healthful life-long eating patterns.

13. Recommended Standards for Competitive Foods Two Tiers –Tier 1 are foods to be encouraged based on the Dietary Guidelines for American (F, V, WG, LFD) –Tier 2 foods are consistent with the Dietary Guidelines but offer more choice and flexibility for high school students

14. Examples of Tier 1 Foods Fresh, pureed, or dried fruits (apples, pears, applesauce, raisins) Fresh vegetables (baby carrots, celery sticks) Whole grain low sugar cereals Low-fat fruit flavored yogurt Low-fat flavored milk

15. Examples of Tier 2 Foods Low salt baked potato chips crackers, or pretzels Graham crackers with no more than 35% calories from sugar Low-fat, low sugar ice cream products

16. Foods that do not Meet the Standards Potato chips and pretzels with too much fat or sodium Cheese crackers with too much fat or sodium Breakfast for granola bars with too much fat or sugar Ice cream products with too much fat Cake, cupcakes, cookies with too much sugar or salt Fortified sports drinks or fortified water Gum, licorice, candy Fruit smoothies with too much added sugar Regular colas or sodas with sugar or caffeine

17. Key Elements for Success Awareness and understanding of the standards by schools, parents, students, and federal, state, and local as well as other private stakeholders.

18. Impact CDC Implementation Guide for Nutrition Standards for Foods in Schools – under development West Virginia schools – new legislation to implement IOM recommended standards House bill (January, 2008) to require food served in schools to meet federal nutrition guidelines and IOM recommended standards

19. Web Information Nutrition Standards in Schools report http://www.nap.edu/catalog.php?record_id=11899 National Academics Press http://www.nap.edu