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Jenny Pompilio

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Jenny Pompilio ...

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Jenny Pompilio

    PHE 510-11 Public Health and Social Justice

    December 2008

    The National School Lunch Program and Children’s Health

    Introduction

    This paper was inspired by the volunteer work I do at my 2 year old son’s childcare center in

    Portland Oregon. Our committee is working to improve the menu so that it is more in line with

    sustainable practices for the long term health of the children. Since the center qualifies for the federal

    National School Lunch Program (NSLP), I thought it pertinent to learn more about the history of school

    lunches in the United States, especially since I suspected that federal policy was contributing to poor

    nutritional standards and the rising wave of obesity in children. With this in mind, I will briefly discuss

    the childhood obesity epidemic in the United States, then focus on the National School Lunch Program.

    I will discuss a few positive trends at the national, state and local levels to improve childhood nutrition

    and reduce the risk of obesity. An appendix at the end will provide readers with resources to learn more

    and hopefully become further engaged in this important topic.

    Obesity in Childhood

    thIn the United States, childhood obesity, defined as a body mass index (BMI) >95% for weight

    and height, has increased three-fold between 1980 and 2000 (Daniels, 2005). There are now 23 million

    children aged 2 to 19 who are overweight or obese, accounting for one-third of all our children (Robert

    Wood Johnson Foundation [RWJF], 2008). According to the Alliance for a Healthier Generation (AHG),

    overweight and obese children are 3 times more expensive on the healthcare system than their normal

    weight peers (2006). The direct and indirect costs of treating obesity are estimated at $117 billion

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dollars a year; “while children may not represent a large portion of current healthcare costs, overweight

    children who become obese adults represent a staggering burden in terms of future healthcare

    expenditures (AHG, 2006).” Much of this future burden will be attributable to diseases linked to obesity

    such as diabetes, high cholesterol, hypertension, certain cancers, and heart disease.

    A recent study has shown that “plaque buildup in the neck arteries of obese children or those

    with high cholesterol is similar to levels in middle-aged adults (Raghuveer, 2008).” Although this was a small study and might not be applicable to all obese children, the results are alarming. Another study

    has projected 100,000 additional cases of heart disease by 2035 that will be directly attributable to

    current childhood obesity (Goldman, 2007). For the first time since the Great Depression, life

    expectancy is projected to drop because of long term complications from the childhood obesity

    epidemic (Olshansky, 2005). Experts suspect that while genetic variables may play a role in obesity,

    social determinants such as class status and ethnicity are probably more important (Daniels, 2005). It is

    widely known that low-income children are “disproportionately affected by childhood obesity (RWJF,

    2008).” Despite ample food supplies, many youth in the United States are facing diet-related illnesses

    due to inadequate nutrition and overconsumption of non-nutritious foods. Nonprofit and child

    advocacy groups such as The Center for Ecoliteracy believe that “good nutrition has a vital role in promoting childhood growth, health, and learning, and in reducing the risk for chronic diseases of

    adulthood (2004).” We can, and must, advocate for children since they lack the political power to make

    policy changes themselves.

    National School Lunch Program: Background, Industry Ties and sub-par Nutrition

    The NSLP was established under the National School Lunch Act of 1946. The idea of federal

    assistance for improving the food supply and the children’s nutrition was established several decades before that, by the U.S. School Garden Army during World War 1 and the Victory Gardens of World War

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II (Kane, 2008). When World War II ended, the NSLP was a way to permanently embed school nutrition

    programs in federal legislation; in fact, the Act itself states that this was a “measure of national security… (and intended to) safeguard the health and well-being of the Nation’s children (Kane, 2008).” Today, the NSLP is no longer inherently tied to national security, and critics purport that it is more

    inherently tied to the interests of agribusiness. The United States Department of Agriculture’s (USDA)

    Food & Nutrition Service (USDA FNS, ND) states that the NSLP’s mission provides nutritious lunches [and snacks] to more than 30 million children in >100,000 public schools, nonprofit private schools, and

    childcare institutions. More than 94% of all schools in the United States participate in the program. In

    2006, cafeterias served more than 5 billion lunches-28 million lunches daily-most of them free or at

    reduced prices. Free lunches are available to any child whose household income is at or below 130

    percent of poverty, while reduced-price lunches are available if the child’s household income is at or below 185 percent of poverty (USDA Economic Research Service [ERS], 2007). At institutions that

    participate, 60% of the children buy or receive a reduced-price or free lunch. While the NSLP’s goal is to help low income children, up to 40% of participating students do not qualify for free or reduced-price

    lunch and therefore pay the full price ($2.40 in 2006). If an institution has a fixed tuition that includes

    food (such as my son’s childcare center), then NSLP participation is 100% of children.

    The NSLP is administered nationally by the USDA FNS, but at the state level it is administered by

    the education agencies which form agreements with local school food authorities (SFA). These

    agreements mandate that the participating school meet the 2005 Dietary Guidelines for Americans

    (DGA), and provide free and reduced-price lunches to eligible children. “Decisions about what specific

    foods to serve and how they are prepared are made by local SFA (USDA FNS, 2008).” Despite this disclaimer that local SFAs are in control of what to serve, it is difficult to provide healthy meals given the

    USDA’s conflicting goals of safeguarding children’s health versus subsidizing agribusiness and “shoring

    up demand for beef and milk even as the public’s taste for these foods declines (Yeoman, 2003).” For

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    participating in NSLP, institutions receive cash subsidies for every lunch served, and “entitlement” commodities purchased by the USDA. The goal of the commodities program is to “provide students

    with nutritious food while removing surplus production from the marketplace to improve and maintain

    farm income (USDA Economic Research Service [USDA ERS], 2008).” The average commodities subsidy was 16.75 cents per subsidized free meal in 2006 (USDA ERS). Although this seems small, studies have

    shown that the commodities often set the tone for the menu (RWJF, 2008).

    TheDGA forms the backbone for all federal nutrition programs, including the NSLP. In 2000, the

    Physician’s Committee for Responsible Medicine won a lawsuit against the USDA, arguing that “…at least six of the 11 members of the Dietary Guidelines Advisory Committee, which formulates the [guidelines],

    had financial ties to the meat, dairy, or egg industries that may have made it more likely that unhealthy

    foods would remain in the government’s diet plan (Chaitowitz, 2000). Despite this lawsuit, nothing has

    changed. In 2004, the Committee released new recommendations further tainted by industries such as

    the American Council on Science and Health; Campbell Soup Company; Procter & Gamble; the American

    Egg Board; the American Cocoa Research Institute; the Sugar Association; the Kellogg Company;

    National Dairy Council; National Dairy Board; Kraft (Bushgreenwatch.org, 2004); the National

    Cattlemen’s Beef Association (NCBA) and Mars, Inc. (American Academy of Pediatrics, 2006).

    From a lay point of view the nine major messages of the 2005 DGA seem appropriate, but there

    are several important differences from the 2000 DGA. For the first time, any direct reference to limiting

    sugar intake has been omitted from the key themes of the document; the committee defends this in the

    executive summary by saying they “make this point clearly under the new topic "Choose Carbohydrates

    Wisely for Good Health" and also under the first and second topics, which address energy needs and

    controlling calorie intake, respectively (US Department of Health and Human Services [USDHHS], 2005).” Also, dairy still retains a central spot in the key themes, while legumes are omitted entirely. And, the

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newest recommendation for dietary fat is a range of 20-35% of total calories, depending on age group,

    instead of the previously recommended <30% of total calories (USDHHS, 2005).

    As of 2004, there were at least nine USDA employees with former direct ties to the meat

    industry; these included USDA Press Secretary Alisa Harrison (NCBA); USDA Senior Advisor on Food and

    Nutrition Elizabeth Johnson (NCBA); and USDA Chief Information Officer Scott Charbo (ConAgra Foods)

    (Bushgreenwatch.org, 2004). The current Secretary of Agriculture, Ed Schafer, was appointed in

    January 2008. According to the USDA’s biography on Mr. Schafer, his accomplishments have included

    encouraging North Dakota to embrace corn sweetener manufacturing when he was Governor, and co-

    founding the Governor’s Biotechnology Partnership to promote biotech companies (USDA, 2008).

    While the 2005 DGA is supposed to reflect the most up to date science regarding diet and

    nutrition, it is easy to see that nutrition might be a secondary goal given the conflicting commodities

    program. According to the Robert Wood Johnson Foundation (RWJF, 2008), the Meat and Dairy

    industries received 82% of the estimated $1 Billion dollars spent yearly by the NSLP commodities

    program. This is in direct conflict with the USDA food pyramid, based on the 2000 DGA, which prioritizes

    grains, fruits and vegetables while limiting dairy and meat. Studies have found that although NSLP

    participants tend to consume more vegetables and fiber, this is due to processed potato foods such as

    french fries; as a correlate to this, sodium intake exceeds the upper recommended limit for 95% of

    participants (Ralston, 2008). RWJF also found that “nationally, more than 50 percent of commodity

    foods are sent to processors… before they are sent to schools. Processing is not regulated for nutritional quality and often involves adding fat, sugar and sodium to commodity products

    (2008).” Although the DGA 2000 recommends <30 percent of calories should come from fat, and <10

    percent from saturated fat, several studies show that of participating elementary schools, less than 1 in

    4 meet the former requirement and less than 1 in 3 meet the saturated fat requirement (Ralston, 2008).

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Perhaps this data, coupled with influence from industry, prompted the DGA 2005 to change the fat

    recommendation to a range of 20-35%, rather than <30%. This is a subtle yet profound difference in

    policy that will make the percent of schools in compliance with DGA guidelines rise artificially, i.e.

    without having to modify the actual fat content of served meals. Finally, the USDA acknowledges

    studies suggest a link between the NSLP and obesity, especially in low-income children, but temper this

    with “the worst-case verdict would appear to be that the program is making children a little overweight

    while contributing a little support for agriculture (Ralston, 2008).” Interesting that an epidemic is “a little overweight,” and $1 Billion dollars a year is just “a little support for agriculture.”

    Recent trends

    Despite the poor recommendations of the USDA’s DGA 2005 and the commodities based nutrition for the NSLP, there are threads of hope for the future. One of these is local wellness policies,

    which were mandated by the Child Nutrition and WIC Reauthorization Act of 2004. This mandate

    requires “each local education agency (LEA) or school district participating in the National School Lunch

    Program and/or School Breakfast Program to develop a local wellness policy that promotes the health of

    students and addresses the growing problem of childhood obesity (USDA FNS, ND).” Although most districts have been slow in adopting wellness policies, there is a trend in that direction. The Portland

    Public Schools has been honored nationally for creating one of the most aggressive wellness policies

    including elimination of sugary drinks and minimally-nutritious snacks, along with implementing a farm-

    to-school program, prioritizing purchasing from local farmers, and featuring seasonal produce in the

    menus (Kane, 2008). Recently, an amendment to the NSLA requires that the USDA Secretary of

    Agriculture encourage (but not require) institutions participating in federal nutrition programs to

    “purchase unprocessed locally grown and locally raised agricultural products (Long, 2008).” This also applies to pasteurized milk, but not to other dairy products. Overall, wellness policies bring hope for

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piecemeal change on a local or regional level, but still lack the power of a coordinated national program

    or a revamping of the NSLP. Increased funding is needed for the national Farm to School program, to

    support local wellness policies, and for procuring fresh produce. To remove or minimize conflicts of

    interest, the commodities program needs to be eliminated entirely from the USDA FNS division. A new

    Secretary of Agriculture appointed by the president-elect might have the power to make sweeping

    changes like this.

    In addition to the positive changes in Portland Public Schools, Oregon has been an innovator in

    other ways. In an October Oregonian article Leslie Cole praises the recent addition of “Cory Schreiber in

    the Department of Agriculture and Joan Ottinger in the Department of Education (who) are charged

    with connecting farmers with school cafeterias, encouraging students to eat more local fruits and

    vegetables, seeding a statewide school garden program and getting lessons about food into classrooms

    (2008).” These two positions were required by House Bill 3601, which establishes the Oregon Farm to

    School and the School Garden Programs within the Department of Education. Funding for the program

    will be via public and private donations and assistance (Fogel, 2008) and is the first of its kind in the

    United States.

    Finally, the American Academy of Pediatrics (AAP, 2006) made several recommendations for

    how schools could improve nutrition. These include identifying a champion to coordinate healthy

    nutrition programs (this is the role I am playing at my son’s childcare center), identify specific nutrition

    issues within the school (this is the role of the sustainability committee at the center), developing

    policies that promote student health (an example of this would be a wellness policy), and lobbying for

    regulatory changes that improve access to nutritious foods (such as House Bill 3601). The AAP notes

    that “given the widening discrepancy between recommended dietary guidelines and current dietary

    intake, a reevaluation of federal agricultural policies may be warranted. Strategies for food subsidies

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and taxation should reflect health goals. Foods made available and served through public nutrition

    programs must be consistent with current recommendations.” It is interesting to note that their 2006

    recommendations for children and adolescents focused heavily on dairy and meat; one author was an

    American Dairy Association consultant, another was a Dairy management Inc. grantee, and one

    endorsement reviewer was on the speaker’s bureau for the National Dairy council and the NCBA, and

    was on the 2005 Dietary Guidelines Advisory Committee (AAP, 2006). So, although the AAP’s general recommendations are laudable, the specific dietary recommendations need to be viewed more critically

    given possible industry influence.

    Conclusions

     Although there is no definitive proof that the National School Lunch Program has directly

    influenced this epidemic, there is reason to believe that it plays an important role in defining childhood

    nutrition. The goals of the program to feed children healthy meals while promoting certain industries

    through a commodities program, coupled with subpar nutrition standards, support the assertion that

    the NSLP has at least indirectly contributed to the epidemic. With over 28 million meals served daily,

    and 94% of all schools participating, the food served by the NSLP sets the tone for children’s lifelong

    eating habits. Although children in lower income households represent 60% of NSLP participants, it

    affects millions of children across all socioeconomic, racial and cultural lines. The USDA acknowledges

    that “the program could influence children’s preferences for particular foods-healthful or unhealthful (Ralston, 2008).” It is with this in mind that national nonprofits, farm to school programs, individual

    states, and local wellness policies (under the leadership of schools and parents) have taken the initiative

    to try to improve children’s health. Please see the appendix for resources to learn more and advocate

    for children’s health.

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    References

    American Academy of Pediatricians & American Heart Association [AAP/AHA]. 2006. Dietary

     recommendations for children and adolescents: A guide for practitioners. Pediatrics 117(2).

    Alliance for a Healthier Generation. 2006. Engaging the healthcare system. Retrieved October 31, 2008

     from http://healthiergeneration.org/healthcareprofessionals.aspx.

    Bibbins-Domingo K., Coxson P., Pletcher M.J., Lightwood J, & Goldman L. 2007. Adolescent overweight

    and future adult coronary heart disease. New England Journal of Medicine 357 (23):2371-2379.

     Retrieved November 21, 2008 from http://content.nejm.org/cgi/content/ short/357/23/2371.

    Bushgreenwatch.org. 2004a. National dietary guidelines rewritten to favor industry. Retrieved

     November 14, 2008 from www.bushgreenwatch.org/mt_archives/000217.php.

    Bushgreenwatch.org. 2004b. Agency guarding U.S. food supply has close ties to beef industry. Retrieved

     November 14, 2008 from www.bushgreenwatch.org/mt_archives/000037.php.

    Center for Ecoliteracy [CEL]. ND. Programs: Rethinking school lunch guide. Retrieved October 31, 2008

     from www.ecoliteracy.org/programs/rsl-guide.html.

    Chaitowitz S. 2000. Oct 2000. Court rules against USDA’s secrecy and failure to disclose conflict of

    interest in setting nutrition policies. Physicians Committee for Responsible Medicine:

    Washington, DC. Retrieved November 14, 2008 from www.pcrm.org/news/health001002.html.

    Cole L. October 2008. Growing lunch: Schools embrace healthier kids with locally grown foods. Portland,

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    OR: The Oregonian. Retrieved November 21, 2008 from www.oregonlive.com/foodday/index.

    ssf/2008/10/the_localfood_movement_moves_i.html.

    Daniels S.R., Arnett D.K., Eckel R.H., Gidding S., & Hayman L. 2005. Overweight in children and

    adolescents: Pathophysiology, consequences, prevention, and treatment. Circulation111: 1999-

    2012. Retrieved October 31, 2008 from http://circ.ahajournals.org/cgi/content/full/111/15/

    1999?ck=nck.

    Fogel, G. 2008. Farm to school legislation: A state by state listing. Community Food Security Coalition:

    Washington, D.C. Retrieved December 1, 2008 from http://www.foodsecurity.org/policy/

    StateByStateFarmtoSchoolLegislation.pdf.

    Kane, D. 2008. What’s for lunch? A review of school food and garden-based education in the United

     States using Portland public schools as a model for change. Ecotrust: Portland, OR. Available at

     http://www.ecotrust.org/farmtoschool/.

    Long, C. 2008. Memo SP 30-2008: Applying geographic preferences in procurements for the child

    nutrition programs. USDA Food and Nutrition Service: Washington, D.C. Retrieved December 1,

    2008 from http://www.fns.usda.gov/cnd/Governance/Policy-Memos/2008/SP_30-2008.pdf#xml

    =http://65.216.150.153/texis/search/pdfhi.txt?query=memo+applying+geographic+preferences

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