Why do you think today’s children are at a higher risk for chronic diseases that were once thought to only affect older adults?
I. Introduction
A. Rates of childhood morbidity and mortality due to infectious diseases have dramatically decreased, but new perils have arisen in the past few decades.
B. There has been an alarming increase in the prevalence of overweight and obese children and adolescents.
C. Children are generally categorized as ages 1 to 11 years, while adolescents are ages 12 to 19 years.
II. Healthy People 2010 National Nutrition Objectives
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Physical activity and fitness, nutrition, and dental health were among the priority concerns for children and adolescents in Healthy People 2010.
A. Healthy People 2010 Progress Review. The progress review of Healthy People 2010 suggests that significant steps be made in order to bring about further progress toward achievement of the objectives that promote healthy weights and food choices in children and adolescents.
III. What Are Children and Adolescents Eating?
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Children’s eating habits have changed over the past two decades.
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The Healthy Eating Index (HEI), used as an indicator of diet quality, provides an overall picture of the variety and quantity of foods people choose to eat, and their compliance with specific dietary recommendations.
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Children ages 7 to 9 have a lower diet quality than younger children.
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Most children do not meet recommended intakes of vegetables or meat.
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The Continuing Survey of Food Intakes by Individuals (CSFII) results indicate that children of all ages, races, and ethnic groups were at risk of inadequate intakes of magnesium, zinc, and vitamins A and E.
A. Influences on Child and Adolescent Eating Patterns and Behaviors
B. Weighing In on the Problem of Childhood Obesity
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Over the past two decades, the percentage of children who are overweight has nearly doubled and the percentage of adolescents who are overweight has almost tripled.
1. Childhood Obesity and the Early Development of Chronic Diseases. a. Childhood obesity is associated with hyperinsulinemia, hypertriglyceridemia, and reduced HDL-cholesterol concentrations.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University

b. Several factors contribute to overweight and obesity in this population including genetic susceptibility to obesity, lifestyle, family eating patterns, lack of positive role models, and inactivity.
C. Other Nutrition-Related Problems of Children and Adolescents. The nutritional health of U.S. teenagers is better today than ever before, although there are some specific nutrition-related problems that still exist, such as undernutrition, iron-deficiency anemia, high blood cholesterol levels, dental caries, eating disorders, and overweight and obesity.
1. Undernutrition. a. Undernutrition is a problem for children from low-income families and those who have run away from home or abuse alcohol or drugs. b. The common and widespread practice of dieting among adolescents, especially girls, makes them at risk for undernutrition.
2. Iron Deficiency and Iron-Deficiency Anemia. Iron deficiency is one of the most common nutritional deficiencies, not only in the United States, but in the world.
3. Blood Lead Level. Overall, the percentage of children aged 1 to 5 years with elevated blood lead levels decreased more than 80% between 1976 and 1994.
4. Dental Caries. Although dental caries are largely preventable, it remains the most common chronic disease of children aged 5 to 17 years.
5. High Blood Cholesterol. When compared with children in other countries, children and adolescents in the United States have higher blood cholesterol levels and higher dietary intake of saturated fat and cholesterol.
6. Eating Disorders. Anorexia nervosa and bulimia nervosa may affect about 3% of all teenage girls in the U.S.
D. Children with Special Health Care Needs. Children with special health care needs include those with developmental disabilities, developmental social needs, handicapping conditions, chronic disorders, and chronic illnesses.
1. These children are at increased nutritional risk because of factors such as feeding problems, metabolic aberrations, decreased mobility, and alternations in growth patterns.
2. Despite the importance of healthful eating habits, unhealthful eating patterns are becoming more pronounced due to increased independence from parents, eating away from home, concern with physical appearance and body weight, the need for peer acceptance and busy schedules.
IV. The History of Child Nutrition Programs in Schools
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Federal programs addressing the nutritional needs of children and adolescents have existed for more than 150 years.
A. Nutrition Programs of the U.S. Department of Agriculture. Nutrition programs of the U.S.
Department of Agriculture include:
1. The National School Lunch Program. The National School Lunch Program helps states make lunches available to children and encourages consumption of domestic agricultural commodities; lunches must include the following: a. 8 ounces fluid milk. b. 2 ounces protein. c. ¾ cup serving consisting of two or more vegetables or fruits or both. d. 8 servings of bread, pasta, or grains per week.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University

2. The School Breakfast Program. School Breakfast Program helps states provide a nutritious, nonprofit breakfast for children. a. Breakfast must provide one-fourth of the daily recommended levels of protein, calcium, iron, vitamin A, vitamin C, and calories. b. Breakfast can be either hot or cold. c. Breakfast is served free or at a reduced price to eligible students.
3. The After School Snack Program. The After School Snack Program, an expansion of the
NSLP, provides reimbursement for snacks served to children, through the age of 18, in after school educational and enrichment programs.
4. The Summer Food Service Program for Children. Summer Food Service Program for
Children provides funds for eligible sponsoring organizations such as residential camps, youth sports camps, and units of local, county, tribal, or state government for the purpose of serving nutritious meals to needy children when school is not in session.
5. The Food Distribution Program. The Food Distribution Program provides commodities to public and private nonprofit schools that serve meals to students. School districts are given an entitlement dollar value based on the number of lunches served during the previous year.
B. Nutrition Programs of the U.S. Department of Health and Human Services. Nutrition programs of the U.S. Department of Health and Human Services include the Head Start Program.
1. Head Start provides children form low-income families with comprehensive social, education, health, and nutrition services.
2. Eligible children range in age from birth to the age at which they begin school.
3. It provides meals and snacks as well as nutrition assessment and education for children and their parents.
V. Impact of Child Nutrition Programs on Children’s Diets
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Despite progress that has enhanced the nutrition quality of school meals, results of research conducted in the 1990s indicated that school meals were failing to meet certain key nutritional goals.
A. Factors Discouraging Participation in Child Nutrition Programs. The environment in some schools discourages students from eating meals provided by the NSLP and SBP, and encourages food choices and eating habits that are not consistent with the Dietary Guidelines for Americans, such as purchase from competitive foods from vending machines.
B. Building Healthful School Environments. Many states and school districts are developing policies that limit the sale of competitive foods and less healthy food choices.
VI. Nutrition Education Programs
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Nutrition education strategies aimed at children or their caregivers are found in both the public and private sectors, and strive to improve eating patterns among children.
A. Nutrition Education in the Public Sector
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Three nutrition education programming agencies have been the USDA’s Nutrition Education and Training program (NET), Expanded Food and Nutrition Education Program (EFNEP), and TEAM Nutrition.
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The CDC Coordinated School Health Program (CSHP) combines health education and promotion, disease prevention, and access to health and social services in an integrated,
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University

comprehensive manner. Examples of programs include: YourSELF; Eat Smart. Play Hard.; 5
A Day the Color Way; VERB. Its What You Do; and Powerful Bones, Powerful Girls.
1. YourSELF
2. Eat Smart. Play Hard.
3. 5 a Day the Color Way
4. VERB. It’s What You Do
5. Powerful Bones, Powerful Girls
B. Nutrition Education in the Private Sector
C. Keeping Children and Adolescents Healthy
1. Programs and services designed to keep children and adolescents healthy can have a lasting effect on the nation’s public health.
2. Programming for children and adolescents succeeds when it is fun and informative and when it is geared toward a specific health or nutritional objective, such as weight loss or increased physical activity.
3. Involving children and adolescents in the planning and implementation of a program increases its effectiveness, as does using peer support.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University