Healthy Choices at School:
Nutrition Guidelines that Can
Make a Difference
Action for Healthy Kids Minnesota
Pamela Van Zyl York, MPH, PhD, RD, LN
Teresa Rondeau-Ambroz, RD, LD
January 13, 2005
Minnesota
Minnesota
Action for Healthy Kids Minnesota
works to improve nutrition and physical
activity of children and teens through
collaboration with diverse stakeholders.
HEALTHY SCHOOLS SUMMIT: TAKING ACTION FOR
CHILDREN’S NUTRITION & FITNESS
October 7-8, 2002
The Ronald Reagan Building and
International Trade Center
Washington, DC
MN State Team Members
Educators
Student leaders
School
administrators
Concerned
parents
Health and
nutrition
professionals
Government
leaders
Community
and business
leaders
Child and Adolescent Overweight by Race:
1988-94 to 1999-2000
2010 Target
1988-94
Total
White
Black
Mexican
American
Female
Male
0
10
20
30
Percent
Note: Overweight is defined for ages 6-19 years as BMI >= gender- and weight-specific 95th percentile
from the 2000 CDC Growth Charts for the United States Black and white exclude persons of Hispanic
origin. Persons of Mexican-American origin may be any race.
Source: National Health and Nutrition Examination Survey, NCHS, CDC.
Obj. 19-3c
Caution: Beyond Calories
Healthy eating
and physical
activity are
important to
health – not just
body weight
Healthy growth and
development




Calcium, Iron and other minerals
Vitamins
Protein
Other disease protective factors
Chronic disease prevention
Academic achievement
Enjoyment
Did you know?
Kids with high added-sugar diets eat
fewer fruits and vegetables and drink
less milk
Poor nutrition can compromise cognitive
development and school performance
Poor nutrition can increase the chances
of getting a cold or the flu and lead to
missed days at school
Environment of abundance and
convenience: The Toxic Environment
Cheap, mass-produced, good-tasting food
that is packed with calories is available 24/7
at very little effort.
Supersizing portion sizes at all levels
Incessant advertising
Physical activity increasingly unneeded

Modern conveniences, auto-based
transportation, communities are not walkable
and have no destinations
Increased Introduction of Large
Portion Sizes in the US
Young and Nestle, JADA 2003
Soda
20 Years ago
Today
??? calories
12 fluid ounces 110
calories
Twenty years ago, 12 fluid ounces was the popular size for soft
drinks and provided 110 calories. How many calories do you think
are in today’s popular soft drink portion?
125
250
500
Environment
Availability
Promotion
Annual NCI budget for 5-a-day
nutrition education
$ 1 million
McDonald’s “we love to see
you smile” campaign
$ 500 million
U.S. government’s entire budget
for nutrition education
Is one-fifth the advertising
budget for…
Altoids mints
Nestle, 2002
Revenue Concerns
“For decades, soft drink companies
have had an important presence
in our nation’s schools”
“The revenue generated from the sale of
beverages in schools is an important
part of the education funding equation
in the United States”
Web Site, 5/18/02
Change the Person versus
Change the Environment
Change the Person
- Education alone is not enough
Change the Environment
- Supportive environment makes
healthy food choices easier
What can we do to change the
environment?
Recreation opportunities – schools,
worksites, rec centers, other community
spaces

Availability, accessibility, acceptability
Support healthy food environment

Promote availability of healthy foods and
decrease availability of unhealthy foods

Vending machines, cafeterias, other sales venues
Support healthful messages and counter
advertising campaigns
What does your school food
environment look like?
Strategies that Support
Healthy Eating …
Allow adequate time to eat
Provide adequate space and
comfortable seating
Restrict availability of vending machines
during school
Only allow water in classrooms
Use non-food items for fundraising
More Healthy Strategies…
Close the campus so students don’t get
fast food
Serve lunch after recess
Integrate nutrition education into
curriculum (and food service)
Provide nutrition-related in-service to
staff
More Healthy Strategies…
Encourage staff to model healthy eating
Educate parents and staff about a
healthy school environment in
newsletters, etc.
Make healthier foods more price
appealing
Involve students
Strategies for Improving
Vending
Improve the offerings…healthy
options are available (involve kids)
Adjust the pricing to encourage
the healthy choice
Research shows profits can be
maintained
Source: French, et al. Am J Public Health 2001;91:112-117.
Success Stories
North Community High School – Mpls
Limited soft drinks to just 1 machine,
added water, juice, sports drinks.
Vending profit increased $4,000
Whitefish Central School in Montana
replaced junk foods and pop with fruits,
bagels, 100% juice, milk and water.
Profits remained the same
2003, Action for Healthy Kids
Choices must be available,
accessible and affordable for
individuals to make choices
Question assumptions about what
is needed, what is possible and
what can be changed
Why the “Guidelines for Good
Nutrition at School”?
Kids are not meeting their nutritional
needs and often get too many calories
Meals and snacks at school can provide
one-third to one-half of a child’s daily
nutritional needs
More children are selecting a la carte
and vending items…which are not
regulated for nutritional value
JADA – April, 2003
Fruit and Vegetable Intake
Among MN Youth
(MN Student Survey, 2001 and 2004)
Students eating 5 or more servings of fruit and
vegetables on the previous day
6th grade
9th grade
12th grade
2001
2001
2001
2004
2004
2004
Boys
21% 20% 17% 16% 15% 13%
Girls
22% 22% 13% 14% 11% 12%
25% of all
vegetables eaten
in the U.S. are
French Fries
Krebs-Smith, Cancer, 1998
On average, adolescents
aged 12-17, get 11% of
their calories from soft
drinks*:
15 teaspoons
of sugar per day
*Soft drinks = carbonated beverages, fruit-flavored and part juice drinks, and sports drinks
Source: USDA, Continuing Survey of Food Intake by Individuals, 1994-96
Beverages Consumed by MN Youth
(MN Student Survey, 2001 and 2004)
Three or more glasses of milk
6th grade
9th grade
12th grade
Boys
46% to 42% 44% to 42% 37% to 35%
Girls
37% to 34% 27% to 25% 19% to 18%
One or More Glasses of Pop or Soda
Boys
70% to 64% 76% to 71% 77% to 72%
Girls
60% to 55% 60% to 54% 62% to 56%
One or More Glasses of Sports Drinks
Boys
Girls
33% to 40% 32% to 41% 27% to 38%
21% to 27% 14% to 22% 8% to 15%
Beverages Consumed by MN Youth
(MN Student Survey, 2001 and 2004)
One or more glasses of Fruit Drinks
6th grade
9th grade
12th grade
Boys
61% to 60% 57% to 55% 59% to 48%
Girls
60% to 58% 52% to 51% 43% to 40%
One or more glasses of 100% Fruit Juices
Boys
64% to 61% 64% to 60% 62% to 61%
Girls
63% to 59% 59% to 54% 56% to 52%
Five or more glasses of Water
Boys
46% to 47% 38% to 39% 32% to 34%
Girls
42% to 44% 32% to 35% 27% to 31%
Schools are Taking Action
Proactive schools have taken positive
steps to make improvements in school
foods, however, definitions of “healthier
choices” are not consistent
No simple nutrition guidelines existed
for competitive foods in schools
New Requirement for
Local Wellness Policy
Local Wellness policies must be in place
by July 1, 2006
Must include goals for nutrition education
and nutrition guidelines for ALL foods
available on each school campus
Must form a task force or work group as
defined by the law
(Child Nutrition Reauthorization, 2004)
P.L. 108-265
AFHK MN Goal
Develop statewide nutrition guidelines
with the support of students, families,
community and school to ensure a
healthy school nutrition environment
Guidelines vs Policy
With the Guidelines for Good Nutrition
at School as a standard from with to
base local discussions individual
schools or districts can make local
policies
Guidelines are for Non-Regulated
Foods
Vending machines
A la carte in
cafeteria
School stores
Concession stands
Snack bars
Fund-raising events
Classroom parties
School-related
meetings
Other foods in
schools not
regulated by USDA
Priorities Set
Kids health is first and foremost
Keep it simple
Foods kids will eat!
Recognize local fiscal constraints and
needs
Nutrition Goals
To provide healthier food choices for
students (and staff!)
To reduce the availability of high-sugar,
high-fat candy and beverages
To work with the school to help the
students reach their full potential having
had healthier food choices for breakfast
and lunch
Three Nutrition
Criteria
Serving size
2. Dietary fat
3. Added sugars
1.
Serving Size
People eat more food and calories
when they are served larger portions
Larger portions can lead to weight
problems
Guideline: Defines sensible serving
sizes except for water, fruits and
vegetables
Wanted: Fruits and Vegetables
Half of children eat
less than one serving
of fruit a day
One-third don’t even
get a serving of
vegetables that have
not been fried
Most miss out on the
health benefits
Fats
High fat diets increase the risk for heart
disease, stroke, some types of cancer and
other chronic conditions in adulthood and
can add excess calories
Some fats may reduce the risk for heart
disease and some types of cancer
Guideline: Limit total fats to about less than
35% total calories except for nuts and seeds
Added Sugars
Kids get 20% of their
calories from added
sugars!
Sweetened beverages
are the biggest source of
added sugars
Extra calories may
contribute to obesity
Added Sugars
Some sugars found naturally in food
- Whole fruits
- 100% fruit juice
- Milk
Labels don’t indicate the source of sugars
Guideline: “Sugar is not the first ingredient”
except “no added sugar” in most beverages
Wanted: More Calcium
Half of adult bone
mass is built during
adolescent years
By age 13, 95% of
girls and 75% of
boys are not getting
adequate calcium
Wanted: Whole Grains
Most kids missing out
Less risk of heart
disease, certain cancers,
type-2 diabetes
Three are key!
Cereals, tortilla chips,
popcorn, whole-grain
breads
Promote Healthier Choices
Whole-grain cereals
and breakfast bars
Baked chips
Nuts and seeds
Fruits and
vegetables
Skim, 1% milks and
yogurt
100% juices
Limit Amounts
Most candy bars
Sweetened
beverages
Most cookies
High-fat chips
High-fat milks,
meats and other
high-fat foods
Guideline Pilot Test: Apple Valley
Allowed flavored milks
Allowed for 1 oz. cookies
Allowed cereal bars & granola bars within
the guidelines
Allowed small muffins, bagels
Allowed for small bags of snacks
Allowed for ice creams, frozen yogurts
Key Learnings
Food industry still needs to improve on
availability and sizing of healthier snacks
Pricing is still a big factor
With increase market share, hopefully
pricing will become more attractive
Manufacturers are responding to needs
Students will choose healthy options if
provided
Support Better Nutrition in
Schools for…
Better learning
Better behavior
Better life-long
habits
Better health
Better futures
Healthy foods for kids
Guidelines for good nutrition at
schools
Action for Healthy Kids MN
www.actionforhealthykids.org,
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Visit the AFHK Website
www.ActionForHealthyKids.org
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