Regulations for Nutrition
Standards for Competitive
Foods in Schools
February 9, 2011
Childhood Obesity in Massachusetts
• Children 2-5 years old
– 18.4% “at risk of overweight” and 15.4% “overweight” (WIC Program 2007)
• Middle School Students
– 17% overweight and 10% obese (2009 MA YHS)
• High School Students
– 15% overweight and 11% obese (2009 YRBS)
• Low-income Black and Hispanic youth/adolescents
– Black 18%, Hispanic 15% and White 9% (obesity only, 2009 YRBS)
• BMI screening data on 109,674 students in grades 1, 4, 7 and 10
– 16.9% overweight and 17.3% obese (2008-2009)
2
MA Students with BMI for Age in
Overweight/Obese Category by Grade & Gender,
2008-2009
39.7
40
37.7
35.5
32.9
33.5
31.0
28.6
30
Percent
32.3
20
10
0
Grade 1
Grade 4
Male
Grade 7
Female
Grade 10
3
Source: MDPH, Bureau of Community Health, Access and Prevention, Division of Primary Care and Health Access, School Health Unit
4
Childhood Obesity is Not
Randomly Distributed
Childhood Obesity and Median Household Income
50
45
% Overweight or Obese Children
40
35
30
25
20
15
10
5
0
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
Median Household Income (2000 Census Data)
$140,000
$160,000
$180,000
5
Health Impact Pyramid
Increasing Population
Impact
Increasing Individual
Effort Needed
Counseling &
Education
Clinical
Interventions
Lasting Protective
Interventions
Changing Context to Support
Healthy Default Decision Making
Socioeconomic Factors
6
Adapted from T. Frieden, AJPH, April 2010
Policy, Systems and Environmental Change
Strategies to Support
Healthy Eating in Schools
Policy Changes
•
School Nutrition Regulations
System Change
•
School policies and practices that support healthy
eating campus-wide 24/7
Environmental Changes
•
Healthy foods available in vending machines, school
stores or served in cafeterias
7
School Nutrition Bill Provisions
Overview of Key Elements of Bill
• Requires nutritional standards for “competitive
foods” in public schools
• Requires regulations to promote school wellness
advisory committees
• Requires training of public school nurses in
screening and referral for obesity, diabetes and
eating disorders
• Establishes Commission on School Nutrition and
Childhood Obesity
9
Definition of Competitive Foods
• All food/beverages not part of school
breakfast, lunch and CACFP programs
–
–
–
–
–
–
A la carte lines
School stores
Snack bars
Vending machines
Fundraising activities
School sponsored events
• Excludes non-sweetened carbonated water
10
Establish Nutritional Standards
• DPH to issue regulations establishing
standards for competitive food/beverages
– Based on dietary recommendations from HHS,
USDA, AHA, IOM, School Nutrition Association of
MA, American Dietetic Association
• Apply to competitive foods sold 30 minutes
before through 30 minutes after the school
day
• Update standards every 5 years in
consultation with ESE
11
Possible Exceptions
• Food/beverages sold up to 30 minutes before
or 30 minutes after school day
– School district may choose to apply standards
beyond this time frame
• DPH may make exceptions for
– Booster sales
– Concession stands
– School-sponsored or school-related fundraisers
and events
12
Nutrition Standards for Competitive
Foods and Beverages
Standards Development
• Interagency workgroup
–
–
–
–
–
DPH obesity prevention and school health staff
DESE health and nutrition staff
John Stalker Institute at Framingham State
Boston Public Health Commission
Harvard School of Public Health
• Multiple sources of information
– Institute of Medicine Nutrition Standards for Foods in
Schools
– MA Action for Healthy Kids
– Alliance for a Healthier Generation
– MA Public Health Association
– MA School Nutrition Association
– MA Executive Order 509
– Other states – CA, CT, MI, WV, PA, RI
14
General Nutrition Standards –
Specified in Statute
1. Plain water readily available during school day at no
cost
2. Offer fresh fruits/non-fried vegetables wherever
food is sold (except vending machines)
3. Make nutrition info available for non-prepackaged
foods by August 2013 (except fresh
fruits/vegetables, food/beverages sold at booster
sales and other school sponsored events)
4. Prohibit use of fryolators in preparing competitive
foods
5. Ensure food preparation and all foods/beverages
meet state and federal food safety guidelines
15
Competitive Food Standards - Beverages
Proposed Massachusetts Standard
Institute of Medicine
Juice
100 % fruit or vegetable juice with no added sugar
Elem and middle – 4 oz serving; High – 8 oz serving
Same
Milk and Milk Substitutes
All milk/milk substitutes (incl. lactose free and soy milk) shall
be low fat (1%) or fat-free
8 oz serving
Meet USDA standards for fluid milk and milk substitutes
Flavored milk ≤ 22 g sugar/8 oz
Same
Water
Water without added sugars, sweeteners, artificial sweeteners,
but can contain natural flavoring and/or carbonation
Same except no
carbonation or natural
flavors
16
Competitive Food Standards - Beverages
Proposed Massachusetts Standard
Institute of Medicine
Other Beverages
No beverages other than juice, milk, milk substitutes and water
shall be sold or provided
For High School after
school: allows noncaffeinated, non-fortified
beverages with less than 5
calories per portion, with or
without non-nutritive
sweeteners
Beverages with added sugar or sweeteners
These will be phased out by August 2013, except for flavored
milk or milk substitutes that contain same amount or less sugar
than plain fat-free or low-fat milk.
17
Competitive Food Standards - Food
Proposed Massachusetts Standard
Institute of Medicine
Calories
Limit 200 calories per item, except for a la carte entrees, which
shall not exceed calories in comparable National School Lunch
Program entrees
Same
Fat, Saturated Fat, Trans Fat
No more than 35% of total calories from fat
No more than 10% of total calories from saturated fat
All foods shall be trans fat free
Exception – 1 oz of nuts, nut butters, seeds or reduced fat
cheese
Same except for the
nut/cheese exception
Sugar
No more than 35% of total calories from total sugars, except
•Non-fat or low-fat yogurt with maximum of 30g sugar/8 oz
•100% added fruit with no added sugar
Same
18
Competitive Food Standards - Food
Proposed Massachusetts Standard
Institute of Medicine
Sodium
No more than 200 mg per item
Exception: no more than 480 mg per item for a la carte entrees
Same
Grains
All bread and other grain-based products shall be whole grain
Same for snack items but
no guideline for a la carte
entrees
Artificial sweeteners
No artificial sweeteners allowed.
Not mentioned
Caffeine
No more than trace amounts of caffeine allowed.
Same
19
Proposed Guideline Topics
• Easy-to-read chart of the guidelines with examples
for each category
• List of foods and beverages that meet the guidelines
(similar to the MA Action for Healthy Kids “A List” of
approved foods and beverages)
• Alternatives for school fund raising activities
• Recommendations to create and support a healthy
school environment, e.g., lunch duration
• Alternatives for healthy celebrations
• Rationale for selected nutrition standards
20
Implementation Assistance
• DPH to work with DESE in implementation of
nutritional standards
– Training in nutrition and diet for food/
nutrition service directors
– Assessment of school’s capacity,
resources, equipment to prepare
recommended foods
21
Possible Financial Implications of
Nutrition Standards
What do we know?
• The majority of studies and reports
have found that schools implementing
healthier competitive foods have not
had decreases in overall revenue
• Profitable healthy fundraising
alternatives abound
– Events such as car washes, fun
runs, walk-a-thons, raffles
– Sales of non-food items such as
calendars, greeting cards,
flowers/plants, personal care
products, wrapping paper
23
On the Horizon
• National efforts
– USDA school lunch nutrition standards
– USDA competitive food nutrition standards
– First Lady’s Let’s Move Cities and Towns
• Other state wide initiatives
– Mass in Motion Municipal grants
– Act FRESH Campaign
– Healthy People, Healthy Economy
24
Timeline
Activity
Schedule
Public Health Council
February 9, 2011
Public Hearings and public
comment period
March 2011
Public Health Council for final
vote
Late spring
Implementation
August 1, 2012
25
Acknowledgements
• Internal DPH work group
– Laura York
– Chris Nordstrom
– Cynthia Bayerl
– Diana Hoek
– Paula Dobrow
– Howard Saxner
– Lauren Smith
• John Stalker Institute
– Karen McGrail
• Boston Public Health
Commission
– Kathy Cunningham
• DESE staff
– John Bynoe
– Katie Millett
– Carol Goodenow
– Linda Fischer
– Mary Anne Gilbert
– Rita Brennan Olson
• Harvard School of Public
Health
– Eric Rimm
– Juliana Cohen
– Jessica Garcia
26
27
Commission Membership
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Commissioner of DMH
Commissioner of Agricultural Resources
MA Association of School Superintendents
MA Secondary School Administrators Association
MA Nutrition Board
MA Association for Health, Physical Education, Recreation
American Heart Association
American Diabetes Association
MA Parent Teachers Association
Chair, Student Advisory Council
MA American Academy of Pediatrics
MA School Nutrition Association
Representative of food/beverage industry
6 members appointed by Senate President & House Speaker
28