4
Foods and Beverages Sold Outside the School Meal Program: Federal, State, Local, and Industry Initiatives

INTRODUCTION

The school food environment has a large impact on the dietary intake of children and adolescents because a substantial proportion of total daily energy is consumed at school. National data show that foods eaten at school comprise 19 to 50 percent of students’ total daily energy intake (Gleason and Suitor, 2001). Foods and beverages at school are available through the U.S. Department of Agriculture (USDA) federally reimbursable school nutrition programs, that is, school breakfast and lunch programs, and also through competitive foods and beverages from à la carte lines in cafeterias, vending machines, snack bars, and other venues. Although school breakfasts, school lunches, and federally funded after-school snack and meal programs must meet federal nutrition standards to receive federal subsidies, competitive foods and beverages are largely exempt from such requirements. However, state and local authorities can impose additional restrictions. In response to growing concerns about childhood obesity, there has been national attention for the need to establish school nutrition standards and to restrict access to high-calorie, nutrient-poor competitive foods and beverages. As a result, over the past few years, school nutrition policy initiatives are in place at the federal, state, and local levels and there have been positive industry responses. The following is a background on the history of federal legislation and regulation of competitive foods and beverages and examination of recent federal, state, local, and industry policy initiatives related to competitive foods and beverages in schools.



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4 Foods and Beverages Sold Outside the School Meal Program: Federal, State, Local, and Industry Initiatives INTRODUCTION The school food environment has a large impact on the dietary in- take of children and adolescents because a substantial proportion of total daily energy is consumed at school. National data show that foods eaten at school comprise 19 to 50 percent of students’ total daily energy intake (Gleason and Suitor, 2001). Foods and beverages at school are available through the U.S. Department of Agriculture (USDA) federally reimbursable school nutrition programs, that is, school breakfast and lunch programs, and also through competitive foods and beverages from à la carte lines in cafeterias, vending machines, snack bars, and other venues. Although school breakfasts, school lunches, and federally funded after-school snack and meal programs must meet federal nutrition standards to receive federal subsidies, competitive foods and beverages are largely exempt from such requirements. However, state and local authorities can impose additional restrictions. In response to growing concerns about childhood obesity, there has been national attention for the need to establish school nutrition stan- dards and to restrict access to high-calorie, nutrient-poor competitive foods and beverages. As a result, over the past few years, school nutrition policy initiatives are in place at the federal, state, and local levels and there have been positive industry responses. The following is a background on the history of federal legislation and regulation of competitive foods and bev- erages and examination of recent federal, state, local, and industry policy initiatives related to competitive foods and beverages in schools. 0

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0 NUTRITION STANDARDS FOR FOODS IN SCHOOLS History of Federal Legislation and Regulation of Competitive Foods Competitive foods have been a controversial issue for more than 35 years. The Child Nutrition Act of 1966 (Pub. L. No. 89–642) authorized the Secretary of Agriculture to promulgate regulations necessary to carry out the mission of the government for child nutrition programs. In 1970, out of concern for the growing trend of “junk foods” (foods of minimal nutritional value) being offered in the public schools, the Child Nutrition Act (Pub. L. No. 91–248) was amended to give the Secretary authority to issue a regulation concerning competitive foods (Griffith et al., 2000). The resulting regulation stipulated that (1) competitive foods and beverages available in cafeterias during meal periods had to contribute to reimburs- able meals; (2) the revenue from competitive food sales would accrue to the nonprofit food service account; and (3) food and beverage sales else- where in the school could not occur at times and places that competed with the federally reimbursable lunch program (Garnett et al., 2006). As a result of this amendment, many schools lost revenues on which they had come to depend. In 1972, in response to pressure from the school com- munity, student organizations, and companies selling foods and beverages to schools, Congress once again amended the Child Nutrition Act (Pub. L. No. 92–433) to permit revenue from competitive foods and beverages to accrue to the school, approved school organizations, or the school’s food service unit (Griffith et al., 2000). This change resulted in an increased pres- ence of vending machines and other competitive food and beverage venues in schools to gain revenue for school activities. The 1973 regulation also directed state agencies to establish regulations and instructions to control the sale of competitive foods and beverages. In 1977, due to concerns about the quality of children’s diets and incon- sistent state regulations, Congress amended Pub. L. No. 95–166 to stipulate that the sale of competitive foods and beverages was subject to approval by the U.S. Secretary of Agriculture (Garnett et al., 2006; Griffith et al., 2000). This statute gave the secretary authority to regulate which items would be allowed as competitive foods. In April 1978, USDA proposed a rule that established a definition for nutritious and non-nutritious foods. This pro- posed rule prohibited the sale of foods in four categories: all candy, soda water (soft drinks), frozen desserts, and chewing gum. However, there were no nutrition standards for these categories. Sales of these items were prohib- ited throughout the school until after the last lunch period (GAO, 2004). In response to this proposed rule, USDA received more than 2,100 comments, of which 80 percent were in favor of the proposed rule. Of these, 40 percent wanted the list of prohibited foods expanded or the time restrictions on sales extended (Garnett et al., 2006). In December 1978, USDA withdrew the rule to consider strengthening it and to provide additional opportunity

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0 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM for public participation in the rule-making process. USDA then held a series of public hearings responding to a series of questions disseminated through the Federal Register. In response, USDA received 4,200 comments; of these, roughly 40 percent recommended additional restrictions (Garnett et al., 2006). The final rule in January 1980 restricted the sale of foods of minimal nutritional value (FMNV) in the same four categories (candy, soda water, frozen desserts, and chewing gum) as the 1978 proposal. The final rule also provided specific nutrition criteria for FMNV, which were defined as providing less than 5 percent of the U.S. Recommended Dietary Allow- ance (RDA) per serving for seven key nutrients (protein, vitamin A, vitamin C, niacin, riboflavin, thiamin, and calcium). The final rule also prohibited the sale of FMNV from the beginning of the school day until after the last lunch period throughout the school (GAO, 2004). In January 1980, the Community and Nutrition Institute challenged the final regulations as not being restrictive enough. In May 1980, the National Soft Drink Association (NSDA) filed suit in the U.S. District Court against the Secretary of Agriculture on the grounds that the Secretary had exceeded the powers given to him by Congress (Griffith et al., 2000). NSDA chal- lenged the regulations as “arbitrary, capricious, an abuse of discretion, and otherwise not in accordance with law,” and requested the court issue a pre- liminary injunction on implementation of the rule. In June 1980, the U.S. District Court consolidated both cases, denied the request for a preliminary injunction, and dismissed both actions. NSDA appealed the decision to the District of Columbia Court of Appeals (Garnett et al., 2006). School districts also challenged the proposed rule. In August 1980, the Pulaski County School District in Little Rock, Arkansas “challenged the rule by offering free carbonated beverages, which students could choose instead of milk. USDA attempted to restrict the practice and the Pulaski County School District filed suit against USDA. The court ruled in the district’s favor” (Garnett et al., 2006). In 1983, NSDA won their appeal based on what has become known as the “time and place” rule. The Court of Appeals ruled that the congres- sional intent was to prohibit the restricted foods only in the food service areas during meal periods. In 1984, USDA proposed to revise the regula- tions to prohibit the sale of FMNV within food service areas during meal periods. The final rule in 1985: established four categories of FMNV (soft drinks, water ices, chewing gum, and certain candies); specified nutrition criteria as providing less than 5 percent of the U.S. RDA for the key nutri- ents identified above; prohibited the sale of FMNV within the food service areas during meal periods; and specified that states and local districts may impose additional restrictions (Garnett et al., 2006). The 1985 ruling re- mains in effect today.

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0 NUTRITION STANDARDS FOR FOODS IN SCHOOLS CONCERNS ABOUT COMPETITIVE FOODS As discussed in Chapter 2, competitive foods are widely available to students in multiple school venues. They have increased in availability in the past five years. Many of these foods and beverages are low in nutritional value and high in sugar, fat, and calories, with the most common being soft drinks, fruit drinks that are not 100 percent juice, salty snacks, high-fat baked goods, and french fries (GAO, 2004; Wechsler et al., 2001). Several concerns have been raised about competitive foods. Federally reimbursable school meals in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) are required to meet federal nutrition guidelines and comply with the Dietary Guidelines for Americans (DGA) (DHHS/USDA, 2005). School lunches must provide one-third of the RDA for protein, energy, and key vitamins and minerals, and school breakfasts must provide one-fourth of the same nutrients. School meals must also meet the DGA for fat and saturated fat (see Chapter 2). However, these nutri- tion standards do not apply to à la carte foods and beverages available in the school cafeteria, nor do they apply to other foods and beverages sold throughout the school in vending machines, school stores, snack bars, or fund-raising activities. The definition of FMNV is narrow and restricts only a small range of competitive foods from being sold during meal times in food service areas. The definition of prohibited foods has not been updated in more than 20 years, and omits many high-calorie foods low in nutrients. Organizations and advocacy groups have called on Congress and USDA to update nutri- tion standards for foods and beverages available outside the federally re- imbursable school nutrition programs (APHA, 2003; NANA, 2005; Trust for America’s Health, 2006). A further concern is that, although the federal school meal programs set appropriate portion sizes, competitive foods are offered without serving size guidelines (e.g., students have access to large portions of soft drinks, cookies, french fries, or chips). A major concern among school food authorities is that the wide avail- ability and promotion of competitive foods in schools diminishes the ability of school meals to deliver on the nation’s commitment to provide nutri- tious meals to children (Griffith et al., 2000; USDA, 2001). The amount of federal money contributed to the NSLP and SBP was $8.8 billion in the 2004–2005 school year and represents a significant investment in children’s nutritional health (FRAC, 2006). School meals can make an important contribution to the nutrition intake of school-age children. Gleason and Suitor (2001) examined intake data from the 1994–1996 Continuing Survey of Food Intakes by Individu- als (CSFII) for associations between participation in federally reimbursable school meal programs and dietary intake among school-age children. This

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0 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM study found that children who ate school lunches and breakfasts had higher intakes of nutrients, both at mealtime and as total daily intake, compared to those who did not eat school meals. The study also concluded that their findings were suggestive that participation in the school meal programs declined with increasing availability of competing food options such as à la carte service, vending machines, and school stores. Neumark-Sztainer et al. (2005) studied associations between consumption patterns among high school students and vending machine purchases, and how school policies affect the school food environment. This study found that school policies limiting the hours of operation of snack and soft drink vending machines were associated with a decline in purchases, thus limiting access to foods and beverages high in fat and sugar. In a Report to Congress (USDA, 2001), USDA highlighted four major concerns about competitive foods: 1. Diet-related health risks. Many competitive foods and beverages are low in nutrient density and high in fat, sugar, and calories, and can negatively affect children’s diets and increase risk of excess weight gain. 2. Stigmatization of school meal programs. Low-income children can receive free or reduced-priced school meals. However, only children with money can purchase competitive foods and beverages. Therefore, children may perceive that school meals are primarily for poor children rather than nutrition programs for all children. 3. Impact on school meal programs. The increase in the sale of com- petitive foods and beverages is associated with a decrease in student par- ticipation in the reimbursable school meal program, which may affect the viability of the program. Although à la carte sales bring additional revenues to school food service programs, declining participation results in decreased cash and commodity support. States with more restrictive competitive food and beverage policies have rates of school meal participation that are higher than the national average. 4. Mixed messages. When children are taught in the classroom about good nutrition and healthy food choices, but are surrounded by vending machines, school stores, and à la carte service offering primarily foods of low nutritional value, this sends an inconsistent message about the impor- tance of nutrition. FEDERAL INITIATIVES The widespread and unrestricted availability of competitive foods has led many nutrition and health organizations and advocacy groups to rec- ommend setting nutrition standards for foods and beverages offered in schools, and establishing tighter controls of competitive foods and bever-

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0 NUTRITION STANDARDS FOR FOODS IN SCHOOLS ages. USDA has urged Congress to take action to foster a healthier school environment by strengthening the statutory language to ensure that (1) all foods and beverages sold or served anywhere in school during the school day meet nutrition standards, and (2) revenue from all competitive food and beverage sales throughout the school accrue to the school food service account (USDA, 2001). In March 2007, the Child Nutrition Promotion and School Lunch Protection Act of 2007 was introduced in both houses of Congress to amend the Child Nutrition Act of 1966 to improve the nutrition and health of school-age children by having USDA update the definition of FMNV and applying those standards everywhere on school grounds, including in vending machines, à la carte or snack lines, snack bars, and school stores. School-sponsored fund-raisers are exempt in this bill. A recent federal policy initiative that has implications for competitive foods and beverages in schools emerged from the WIC (Child Nutrition and Women, Infants, and Children) Reauthorization Act of 2004. This Act con- tains a local school wellness policy provision, a new tool to address obesity and promote healthy eating and physical activity in the school environment. The wellness policy provision required every school district in the country that participates in the federal school meal program to enact a wellness policy by the first day of the 2006–2007 school year. The school district policies must address goals for nutrition guidelines for all foods available at school, nutrition education and physical activity goals, assurances that school meal guidelines are not less restrictive than federal requirements, and plans for evaluating implementation of the policy. The development of the local school wellness policy had to involve parents, students, school food service, and school administrators. Because the school wellness policies only recently went into effect, little is known at this time about implementation, compliance, or their impact. A preliminary analysis of local wellness policies collected from 112 school dis- tricts in 42 states found that only half of the newly approved policies met all of the minimum guidelines for nutrition and physical activity (Source: www. actionforhealthykids.org [Accessed October 10, 2006]). Compliance with the federal policy guidelines varied among school districts. Forty percent did not specify who was responsible for implementation, 19 percent did not address implementation or evaluation, and 14 percent did not specify goals for nutrition education. The School Nutrition Association assessed key characteristics of local wellness policies approved by the school districts with the 100 highest enrollments in the U.S. They found that 99 percent of the schools addressed school meal nutrition standards, and 92–93 percent addressed nutrition standards for foods and beverages in à la carte services and vending machines. The School Nutrition Association has made plans to evaluate the implementation phase of local wellness policies.

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0 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM STATE AND LOCAL SCHOOL INITIATIVES According to federal regulations, states and local districts may impose further restrictions on all foods and beverages on school grounds. In re- sponse to growing concerns over childhood obesity, there have been wide- spread efforts to regulate competitive foods and beverages at the state and local levels. Many states, local school districts, and individual schools have implemented competitive food policies that are more restrictive than USDA regulations, though they differ in the type and extent of restrictions. State and local policy initiatives related to competitive foods include the areas of establishing nutritional standards for foods and beverages in schools, restricting access to and sales of competitive foods and beverages, and ban- ning or limiting access to items in vending machines (HPTS, 2005a). State-Level Policies Detailed state-level analyses conducted by the Health Policy Tracking Service1 (HPTS) show that, as of February 2007, approximately half (27) of all states have adopted competitive school food and beverage policies, federal regulations through legislative bills, executive orders, rules, and regulations that are more restrictive than USDA. These include policies that limit the times or types of competitive foods available for sale in vending machines, cafeterias, school stores, and snack bars. Of these, 16 states cur- rently require nutritional standards for competitive foods and beverages at school (Alabama, Arizona, California, Connecticut, Hawaii, Illinois, Kentucky, Louisiana, Maine, New Jersey, New Mexico, North Carolina, Rhode Island, Tennessee, Texas, and West Virginia) (HPTS, 2007). Access to competitive foods is also prohibited by 25 states at certain times dur- ing the day or the entire school day, although the time restrictions, type of food/beverage prohibited, and grade level included vary widely. Portion size restrictions of competitive foods or beverages are specified in 14 states (Alabama, Alaska, Arkansas, California, Connecticut, Illinois, Kentucky, Louisiana, New Jersey, North Carolina, Rhode Island, Tennessee, Texas, and West Virginia) (HPTS, 2007). For a state-by-state profile, see Table C-1 in Appendix C. Over the past few years, state legislative activity in the area of school nutrition has been brisk. In 2004, HPTS noticed a considerable increase in the amount of legislation introduced related to improving the school food 1 The Health Policy Tracking Service (Thomson West, Inc.) identifies, analyzes, and reports on state and federal legislation and policies affecting health services. HPTS also conducts custom policy research and analysis projects, such as state legislation and policies affecting nutrition and physical activity of children and adolescents supported by the Robert Wood Johnson Foundation.

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0 NUTRITION STANDARDS FOR FOODS IN SCHOOLS environment, and this issue continues to receive attention in statehouses around the country (HPTS, 2005a). In 2004, 37 states introduced legisla- tion that provided some level of nutritional guidance or encouraged schools to set standards, and measures were enacted in 12 states (HPTS, 2004). In comparison, in 2005, 42 states introduced approximately 200 bills related to nutrition standards, and measures were enacted in 21 states (HPTS, 2005b). In 2006, 31 states introduced or carried over school nutrition leg- islation and 11 states adopted legislation (HPTS, 2007). Of the 31 states, at least 23 introduced or carried over legislation that would establish or amend school nutrition standards (HPTS, 2007). The Center for Science in the Public Interest (CSPI) issued a report in 2006 evaluating the policies for foods and beverages sold outside the NSLP for 50 states and the District of Columbia (CSPI, 2006). State policies were graded based on five areas: beverage nutrition standards; food nutrition standards; grade level(s) to which policies apply; time during the school day to which policies apply; and location(s) on campus to which policies apply. The report concluded that although changes are occurring at the state level, such changes are “fragmented, incremental, and not happening quickly enough to reach all schools in a timely way. The nation has a patchwork of policies addressing the nutritional quality of school foods and beverages and the majority of states have weak policies” (CSPI, 2006). Lawmakers and citizens tend to be divided on the role that states should have in setting nutrition requirements for elementary, middle, and high school students. Some argue that policies should be made at the local level with school administrators, school boards, and parents. Others main- tain that state governments, which incur a significant proportion of rising health care costs, should facilitate healthy school nutrition environments (HPTS, 2006). Financial pressures are reported to be the major obstacles to passing legislative mandates (HPTS, 2006). Competitive food sales generate revenue streams for schools, and school and state officials often express concern about legislative measures that would reduce additional sources of income (HPTS, 2006). However, as is evident from the flurry of activity, states continue to press forward. State policies for competitive foods tend to be most restrictive for el- ementary schools and least restrictive for high schools. High schools have many more vending machines and competitive food sales, thus more profits and revenues than elementary and middle schools. For example, the 2000 federal School Health Policies and Programs Study (SHPPS) found that 43 percent of elementary schools, 74 percent of middle schools, and 98 per- cent of high schools have vending machines, school snack bars, or other food sources outside the federally reimbursable school nutrition programs (Wechsler et al., 2001). A recent survey of 40 California secondary schools

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 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM found that high schools provided students with the greatest access to com- petitive foods. The survey also found that “nine times more high schools than middle schools had food vending machines, and three times more high schools had a school store compared to middle schools” (Samuels and As- sociates, 2006). In spite of greater access to competitive foods in middle and high schools, there has been a tendency for nutrition standards for competitive foods to be most restrictive in elementary schools and less so in middle and high schools. State departments of education have also been involved in initiatives to create healthy school environments. A number of measures have directed state departments of education or, in fewer cases, the U.S. Department of Agriculture to develop rules or recommendations for schools to follow. In 2004, the Texas Department of Agriculture issued a public school nutri- tion policy for all schools participating in the federal school meal pro- grams (HPTS, 2004). The policy restricted the availability of FMNV and set nutritional standards, as well as portion size restrictions. In addition, the policy limited availability of soft drinks in high schools to 30 percent of all beverages offered, and restricted access to such beverages in middle schools until the end of the last lunch period (HPTS, 2004). In 2005, seven states (Arizona, Kansas, Kentucky, Maine, New Mexico, North Carolina, and South Carolina) mandated that their departments of education develop minimum standards for all foods and beverages sold or served in elemen- tary, middle, or high schools. Kentucky is unique in that in its state school nutrition bills, penalties were established for schools that were not compli- ant with the new standards. Many of the state initiatives on competitive foods have been in place only for short periods of time, so their impact is unknown. The extent to which these changes may affect rates of childhood obesity, children’s diets, or academic performance has not been evaluated. Few systems are in place to evaluate the implementation or effectiveness of these programs. State policies vary widely in scope and requirements, thus representing a mix of policies implemented in isolation. It is therefore hard to get an overall picture of the similarities and differences among states and determine which initiatives are having the most positive effect. Furthermore, with so many different state nutrition standards, specifying differing amounts of fats, sugars, and portion sizes, it may be difficult for food companies to package and formulate products. Local-Level Policies In addition to action at the state level, several school districts have joined the growing movement to restrict competitive foods and beverages in schools. More than half of the 10 largest U.S. school districts have policies

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 NUTRITION STANDARDS FOR FOODS IN SCHOOLS that go beyond federal and state regulations in restricting competitive foods in schools. For example, starting in the fall of 2003, the New York City Public School District, the largest school district in the country, eliminated candy, soft drinks, and other snack foods from vending machines on school grounds. Vending machines are now limited to selling water, low-fat snacks, and 100 percent fruit juices (GAO, 2004). The Los Angeles Unified School District, the second-largest school district in the country, passed a ban on vending of soft drinks that went into effect in January 2004. In addition, a ban on fried chips, candy, and other snack foods in school vending ma- chines and school stores went into effect July 2004 (GAO, 2004). In 2004, The Chicago Public Schools, the nation’s third largest school district, an- nounced a plan to ban soft drinks, candy, and high-fat snacks from school vending machines and replace them with healthier offerings (Story et al., 2006). The Philadelphia School District has a comprehensive school nutri- tion policy that includes nutrition education components, guidelines for all foods and beverages sold in schools, family and community involvement, and program evaluation (Story et al., 2006). In 2004 Greves and Rivara (2006) interviewed representatives of school districts with the largest student enrollment in each state and the District of Columbia about nutrition policies concerning competitive foods. The 51 districts accounted for 5.9 million students, representing 11 percent of U.S. students. Of the 51 districts, 39 percent exceeded state or federal require- ments in their competitive food policies. Standards specific to grade level were set by 53 percent. Most districts reported having content criteria for competitive food and beverages and prohibited soft drinks. Approximately half of all district policies had restrictions on portion size of foods or bever- ages. These applied more often to vending machines, à la carte sales, and student stores than to fund-raising activities. Less than a third of policies addressed either monitoring or consequences for failing to monitor. Another recent survey also looked at competitive food policies in U.S. schools. At the request of Congress, the Government Accountability Of- fice (GAO) conducted a study in 2004–2005 using a random stratified sample of U.S. schools (GAO, 2005). Among the 317 school principals in the survey, 60 percent reported that they had policies in place restricting student access to competitive foods and beverages. The policies were most often developed and enacted at the school district level. Neumark-Sztainer et al. (2005) examined high school students’ lunch patterns and vending machine purchases in association with school food policies. In schools with established policies, students reported consuming fewer competitive foods than students in schools without policies. These findings provide evidence that school food policies that decrease access to less nutritious competitive foods are associated with less frequent consumption of these foods during the school day.

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 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM Barriers and Lessons Learned Barriers that have been examined in adopting and implementing school competitive food policies include the major obstacle cited among school nutrition representatives for school districts: the financial impact of limit- ing competitive foods, specifically soft drinks (Greves and Rivara, 2006). Little reliable data are available on how changes to competitive food sales affect revenues. Detailed revenue records are often not available, but limited data suggest that districts experience mixed revenue effects (GAO, 2005; USDA/CDC, 2005). Other barriers include a lack of priority among school district admin- istrators to address child nutrition compared to academic achievement benchmarks, and parents and students who resist changes in food choices (Greves and Rivara, 2006). The GAO report found that many people, including district and local officials as well as members of groups selling food in schools, have decision-making responsibility for competitive food and beverage sales and what to sell; but commonly, no one person had responsibility over all sales in a school, making implementation and policy decisions difficult (GAO, 2005). The new federally mandated school well- ness policies should facilitate efforts in this area. Another barrier faced by local school districts in making school food policies is that they typically do not determine nutrition criteria and they lack recommended nutrition standards for competitive foods (GAO, 2005). Many schools throughout the country have made changes to improve the school food environment. Making It Happen! School Nutrition Success Stories, a joint project of the Centers for Disease Control and Prevention (CDC) and the USDA Team Nutrition (USDA/CDC, 2005), tells the sto- ries of 32 schools and school districts that have implemented innovative strategies to improve the nutritional quality of foods and beverages sold in schools outside of the federally reimbursable meal programs. The docu- ment describes six key approaches for improving the nutritional quality of competitive foods: establish nutrition standards for competitive foods; influence food and beverage contracts; make more healthful foods and bev- erages available; adopt marketing techniques to promote healthful choices; limit student access to competitive foods; and use fund-raising activities and rewards that support student health. A major finding from Making It Happen! is that students will buy and consume healthy foods and beverages and that schools can make money from selling healthful options. Making It Happen! provides key lessons learned, including the follow- ing (1) a single “champion,” such as a parent, food service manager, or school principal, is usually the driving force behind the change; (2) because improving school nutrition involves multiple steps, teams with diverse skills and backgrounds are well positioned to undertake such change; (3) a useful

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 NUTRITION STANDARDS FOR FOODS IN SCHOOLS starting point is to assess the current nutrition environment of the school to identify strengths and weaknesses; (4) data are needed to document im- pact and change; and (5) change is a destination and a process. Adopting a nutrition policy does not guarantee it will be implemented; it will require ongoing attention. NONGOVERNMENTAL AND INDUSTRY INITIATIVES The Alliance for a Healthier Generation is a nongovernmental program jointly founded by the William J. Clinton Foundation and the American Heart Association and sponsored by the Robert Wood Johnson Foundation to help schools provide a healthful environment for school-age children by assisting schools in setting and meeting standards for improving the health of children in schools. Focus areas include 1. goals to improve the nutritional value of foods served; 2. goals to increase physical activity during the school day and after school; 3. goals for implementation of classroom lessons on healthy lifestyles; and 4. programs for staff wellness. The Alliance’s Guidelines for Competitive Foods for K–12 Schools, released in 2006, are shown in Appendix D. Industry Initiatives The food and beverage industries historically have opposed federal or state school nutrition legislation that restricts access to certain foods and beverages, emphasizing that a healthy diet can include all foods and bever- ages in moderation (HPTS, 2006). However, in the past year, the beverage industry has recognized that it has a role in preventing childhood obesity (HPTS, 2005b). The food and beverage industry has the opportunity to reformulate products and develop new ones to comply with standards. Steps Toward Improving the Nutritional Value of Foods In August 2005, in response to growing pressure from parents and pub- lic health advocates, the American Beverage Association (ABA) announced a new voluntary school vending policy. ABA asked the beverage industry and school districts to implement the following guidelines: (1) provide only water and 100-percent juice to elementary schools; (2) provide only nutri- tious and/or lower calorie beverages such as water, 100-percent juice, sports

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 FOODS AND BEVERAGES SOLD OUTSIDE THE SCHOOL MEAL PROGRAM drinks, nonnutritive sweetened soft drinks, and low-calorie juice drinks; sugar-sweetened soft drinks and juice drinks containing 5 percent or less juice would be provided only after school to middle schools; (3) provide a variety of beverage choices, with no more than 50 percent of the vending selections being soft drinks to high schools (ABA, 2005). The policy applied to new contracts, not existing ones. In May 2006, new school beverage guidelines were announced by the country’s top three soft drink companies, Coca-Cola, PepsiCo, Inc., and Cadbury Schweppes, which together control more than 90 percent of school beverage sales. These three companies and ABA established new voluntary guidelines to limit portion sizes and reduce the number of calories available to children during the school day (ABA, 2006). The agreement, assisted by the Alliance for a Healthier Generation, stated that students in elementary schools would be served only bottled water; low-fat and nonfat milk with up to 150 calories per 8 ounces; and 100-percent fruit juice up to 8 ounces. High schools would be allowed to sell bottled water; no or low- calorie beverages with up to 10 calories per 8 ounces; nonfat and low-fat regular and flavored milk with up to 150 calories per 8 ounces; 100-percent juice with no added sweeteners with up to 120 calories per 8 ounces; and light juice and sports drinks with no more than 66 calories per 8 ounces. At least 50 percent of beverages must be water and a no or low-calorie option. Fully implementing the agreement is anticipated to take 3 years, with 75 percent of schools participating by fall 2008 and all by 2009. The guidelines are voluntary, and the success of the program depends on the schools’ will- ingness to amend existing contracts (Burros and Warner, 2006). A progress report on the agreement will be provided at the end of each school year, beginning in 2007 (Burros and Warner, 2006). In October 2006, the Alliance for a Healthier Generation announced a collaboration with five of the nation’s leading food manufacturers to es- tablish voluntary guidelines for foods offered for sale in schools outside of the NSLP to students before, during, and after the school day. Kraft Foods Inc., Mars Inc., Campbell Soup Co., Dannon, and PepsiCo Inc., agreed to begin promoting snacks that meet nutrition guidelines backed by the American Heart Association. The guidelines provide nutrition criteria for total, saturated, and trans fats; sugar; and sodium. Because the guidelines are voluntary, the plan’s success will depend on participation of schools in implementing the guidelines (Alliance for a Healthier Generation, 2006). Appendix D shows the food and beverage criteria proposed by the Alliance for a Healthier Generation.

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