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Preventing Childhood Obesity: Health in the Balance
more, consistency of the messages and opportunities across the school environment is vital—from the cafeteria, to the playground, to the classroom, to the gymnasium.
Increasingly, schools and school districts across the country are implementing innovative programs focused on improving student nutrition and increasing their physical activity levels. Parents, students, teachers, school administrators, and others play important roles in initiating these changes, and it is important to evaluate these efforts to determine whether they should be expanded, refined, or replaced and whether they should be further disseminated.
It is acknowledged that the school environment is complex, and schools face many economic and time constraints on their ability to address a broad array of student needs. Further, many food- and physical activity-related policies and practices are linked at multiple levels. A change in one practice may impact other areas of the school environment, either related directly to food or physical activity or indirectly to other areas (such as academic, extracurricular, financial, or administrative). The recommended actions, described below, therefore, were developed with the goal of being implemented concurrently and not as stand-alone strategies. Moreover, these actions should reinforce and support each other not only in the schools but in other settings, including the community and home environments (Chapters 6 and 8). Recommendations regarding schools also must acknowledge the diverse ways in which public schools are governed and funded throughout the United States. Although public school governance is primarily local (school boards that oversee school districts), there is variability in the additional role that states play (NRC, 1999).
The recommended actions in this chapter are intended to apply, as relevant, to all the settings where children and youth spend a majority of their organized time outside the home. For most children and youth over the age of 5 years, this will be a school setting (i.e., elementary school, middle school, or high school). For children below the age of 5 years, this may be kindergarten, formal preschool, early childhood education program, child development center, child-care center, or family or other informal child-care setting.
FOOD AND BEVERAGES IN SCHOOLS
The school food environment has undergone a rapid transition from a fairly simple to a highly complex environment, particularly in high schools. Traditionally, school cafeterias offered only the U.S. Department of Agriculture (USDA) federally subsidized school meal, which is required to meet defined nutritional standards. Recently there have been increases, however, in the amount of “à la carte” foods and beverages—items offered individu-