Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth

296 Pages·2007·1.42 MB·English

by  Committee on Nutrition Standards for Foods in Schools, Virginia A. Stallings, Ann L. Yaktine

Committee on Nutrition Standards for Foods in Schools
Food and Nutrition Board
Virginia A. Stallings and Ann L. Yaktine, Editors
THE NATIoNAl ACADEmIES PrESS
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NOTICE: The project that is the subject of this report was approved by the
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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 Preven-
tion. Any opinions, fndings, conclusions, or recommendations expressed in this
publication are those of the authors and do not necessarily refect 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.
LB3479.U6N88 2007
371.7´160973—dc22
2007023350
Additional copies of this report are available from the National Academies
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Copyright 2007 by the National Academy of Sciences. All rights reserved.
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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.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.
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
ROSEMARY DEDERICHS, 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 Policy Consultants, LLC,
Bethesda, MD
JAMES C. OHLS, Mathematica Policy Research, Inc., Princeton, NJ
(retired)
LYNN PARKER, 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
Staff
ANN L. YAKTINE, Senior Program Offcer (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, Griffn
DIANE BIRT, Center for Research on Dietary Botanical Supplements,
Iowa State University, Ames
YVONNE BRONNER, School of Public Health and Policy, Morgan State
University, Baltimore, MD
SUSAN FERENC, Chemical Producers and Distributors Association,
Alexandria, VA
NANCY F. KREBS, Department of Pediatrics, University of Colorado
Health Sciences Center, Denver
REYNALDO MARTORELL, 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
Staff
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ANTON BANDY, Financial Associate

*IOM boards do not review or approve individual reports and are not asked to endorse
conclusions and recommendations. The responsibility for the content of the report rests with
the authoring committee and the institution.
i
Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures 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 confdential 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
ii
iii REVIEWERS
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 fnal 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 fnal content of
this report rests entirely with the authoring committee and the institution.
Preface
My memories of food at school are many, starting with cafeteria lunch
provided after we presented our green lunch token and without discus-
sion 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 frst graders to
seniors. Dedicated parents and friends were the band and sport team boost-
ers, 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 defciency
and undernutrition, when few were concerned about fat or sugar in child-
hood 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
ix
x PREFACE
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 deci-
sions at their levels. In the background, nutritionists, health-care provid-
ers, and other child advocates infuence 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 pat-
tern 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 inex-
pensive, 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 scientifc and social environment that our committee
established our guiding principles and made recommendations for competi-
tive foods and beverages provided outside of the federally funded school
programs. The goal is for schools to employ their unique, long-term rela-
tionship with children and their families to support child health and pro-
vide 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 fore-
most, many thanks are due to the committee members, who volunteered
countless hours to the research, deliberations, and preparation of the re-
port. Their dedication to this project was outstanding and the basis of our
success.
Many individuals volunteered signifcant time and effort to address and
educate our committee members during the workshops and public meet-
ings. 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,