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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions Summary Nutrition Standards and Meal Requirements provide the foundation for the National School Lunch Program and the School Breakfast Program, but much has happened since the standards and requirements were last set in 1995. Substantial changes have been made in Dietary Guidelines for Americans and in nutrient reference values, and the prevalence of childhood obesity has increased dramatically. This report focuses on how to determine what can be done to help make the meals provided through the National School Lunch Program and the School Breakfast Program more consistent with the current understandings about the diet and health of the children of the United States. The National School Lunch Program alone now serves more than 30 million children per day. Thus, improvements to the program offer great potential to improve the ability to serve its purpose “as a measure of national security, to safeguard the health and well-being of the Nation’s children and to encourage the domestic consumption of nutritious agricultural commodities and other food” (P.L. 79-396). Improvements to the School Breakfast Program would contribute to meeting the same purpose. Together, the two school meal programs can make a great impact because they may provide more than 50 percent of a student’s food and nutrient intake on school days. Furthermore, depending on household income, a child may receive program meals at no cost, reduced cost, or full (but a partially subsidized) price. Thus, the programs serve as a safety net for children in need. When the U.S. Department of Agriculture (USDA) began its school meal programs, nutritional concerns in the United States centered on nutrient deficiencies and underconsumption, and the programs were designed to address those concerns. Although many of the overt nutritional deficiencies in children’s diets have largely been eliminated, other nutrition-related concerns have emerged, most notably, a high prevalence of childhood obesity. Although program standards were updated in 1980 and 1995, further revision is needed. The revision of program standards would enable the programs to incorporate public health recommendations and current knowledge about the nutritional needs of children and adolescents. Among the specific reasons for revising the standards are substantial changes in the Dietary Guidelines for Americans (which, by law, the school meal programs are required to follow), major changes in nutrient reference values and ways to apply them, and an alarming increase in the prevalence of childhood obesity.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions The Nutrition Standards and Meal Requirements provide the foundation for the school meals programs. If the meals offered meet the Nutrition Standards and Meal Requirements in USDA regulations, the USDA subsidizes the cost of the school meals through cash reimbursements. In fiscal year 2007, the value of the cash reimbursements was nearly $10 billion total for both programs. In the same year, USDA also provided the programs with commodity foods valued at approximately $1 billion. The commodity foods available to schools have changed over the years, and states may now choose from a list of more than 180 agricultural commodities, including more foods that are encouraged by Dietary Guidelines for Americans, such as fruits and vegetables. The committee’s work has been divided into two phases. This report reflects the outcomes of the Phase I activities. The goal of Phase I was to describe the approach that the Institute of Medicine Committee on Nutrition Standards for National School Lunch and School Breakfast Programs proposes to use in making recommendations for revisions to the Nutrition Standards and Meal Requirements of the school meal programs. During Phase I the committee identified and reviewed available data and information, formulated working principles and criteria, reviewed and assessed the reported food and nutrient intakes by schoolchildren, and described its planning model and analytic methods for developing recommendations for revising the standards. At the time this Phase I report is released, comments from interested parties will be accepted. The report will be discussed during a public forum carried out as part of the next scheduled committee meeting.1 The input received will be taken into account during the Phase II activities, which will specify the recommendations for revisions. This Phase I report provides an overview of the school meal programs and the participants; an overview of reasons for updating program standards; the Nutrition Standards and Meal Requirements currently in use; topics relevant to updating the Nutrition Standards and Meal Requirements; the working principles and criteria that the committee will use to guide its efforts; and descriptions of the methods that the committee proposes that it will use to develop recommendations for revisions, including an assessment of the nutrient and food needs of schoolchildren, a planning model that addresses nutrients and foods and the assumptions on which the model is based, and methods for incorporating sensitivity analyses and addressing cost implications and market effects. Topics related to the competitive foods offered in schools (e.g., foods available in vending machines, at snack bars, and á la carte) are outside the scope of this report. 1 More information about committee meetings can be found by visiting the IOM website: http://www.iom.edu/fnb/schoolmeals.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions CURRENT STANDARDS FOR SCHOOL MEALS Laws and regulations establish the current Nutrition Standards and Meal Requirements that programs must meet to qualify for cash reimbursement and the receipt of commodity foods from the federal government. Figure S-1 illustrates the steps involved in providing a school lunch or breakfast to a child under the USDA provisions for a reimbursable school meal. The existing planning model is based on the application of the 1995 Dietary Guidelines for Americans and the 1989 Recommended Dietary Allowances for selected nutrients averaged over 5 school days. As shown in Figure S-1, the Nutrition Standards set the goals for school meals and the quantitative amounts of foods and nutrients that the meals must provide. Currently, the Meal Requirements allow schools to choose to use either a set of standards associated with a food-based menu planning approach or a set of standards associated with a nutrient-based menu planning2 approach. Each of these standards encompasses specifications for the amounts of food items or nutrients to be included in the menu planning approach and for the components of a reimbursable meal as offered on the cafeteria line and as served to the student (based on allowable student selections). THE COMMITTEE’S TASK USDA requested that the committee provide recommendations for the updating and revision of the Nutrition Standards and Meal Requirements for the school lunch and breakfast programs. For the phase of the work reported here (Phase I), the committee was asked to (1) outline the proposed criteria and process to be used to develop recommended revisions to the Nutrition Standards and Meal Requirements for both meal programs, (2) discuss how the concepts presented in Institute of Medicine reports and focused on the application of Dietary Reference Intakes to planning and assessment will be applied to school meals in Phase II, and (3) propose plans for undertaking a sensitivity analysis and for considering cost implications and market effects. WORKING PRINCIPLES AND CRITERIA The committee developed a set of working principles to focus the committee’s deliberations and to guide the committee on the data to be selected and the types of analyses and reviews to be conducted. The committee’s working principles are described in Box S-1. 2 USDA often refers to this set of meal standards as nutrient standard menu planning
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions FIGURE S-1 Current path to a nutritious school lunch and breakfast.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions BOX S-1 Working Principles for Determining Recommendations for Revisions to the Nutrition Standards and Meal Requirements for School Meals The present and future health and well-being of schoolchildren are profoundly affected by their food and nutrient intakes and the maintenance of healthy body weight. School meals, when they are consumed, should improve food and nutrient intakes, and those intakes that are inadequate or excessive in schoolchildren should specifically be targeted. School meals are targeted to children ages 4 through 17 years, but younger children and children of all ages with special needs may be affected by the standards set for the general population. Recognition will be given to health effects of foods (including beverages) that go beyond those related to their nutrient content. School lunch and breakfast programs, which may contribute to more than 50 percent of the caloric intake by children on school days, offer opportunities to promote the health and well-being of children. School meals can contribute to beneficial health and dietary patterns and are uniquely positioned to provide a model for healthy meals and to provide opportunities to model and reinforce healthy eating behaviors. School meals can provide a platform for education in nutrition, environmental responsibility, and food safety. School meals can be a positive environment for pleasant social interactions. For children in families characterized by limited resources and food insecurity, school meals provide a critical safety net in meeting their nutritional needs and reducing the adverse effects of food insecurity. School lunch and breakfast programs operate in a challenging and changing environment. School food service environments (such as facilities, equipment, labor, and skills) are complex and highly varied across the nation as well as from school to school within school districts. Challenges include the need to meet food safety standards, offer appetizing foods to an increasingly diverse population, adjust to the changes in the available food supply, improve the image and appeal of the program, and achieve a sound financial operation. Food costs, other direct costs, and indirect costs related to program operation are outpacing the available resources. In addition to promoting the health and well-being of children, high rates of participation may support the financial stability of school meal programs. Efforts to change the current school nutrition environments vary, with some districts already making significant strides and others just starting the process of change. Because scientific findings and authoritative recommendations related to the nutrition of children evolve over time, the process of developing recommendations for revisions should be transparent and designed to take into account new evidence-based findings and recommendations.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions The committee also developed a proposed set of criteria to be applied during the development of the committee’s recommendations for revision of the Nutrition Standards and Meal Requirements. The proposed criteria appear in Box S-2. The committee plans to use iterative processes to derive the recommendations that best meet all four criteria. BOX S-2 Proposed Criteria for the Nutrition Standards and Meal Requirements for the National School Lunch Program and the School Breakfast Program Criterion 1. The Nutrition Standards and Meal Requirements are consistent with current dietary guidance and nutrition recommendations to promote health—as exemplified by the Dietary Guidelines for Americans and the Dietary Reference Intakes—with the ultimate goal of improving children’s diets by reducing the apparent prevalence of inadequate and excessive intakes of food, nutrients, and calories. Criterion 2. The Nutrition Standards and Meal Requirements will be considered on the basis of age-grade groups that are consistent with the current age-gender categories used for specifying reference values and with widely used school grade configurations. Criterion 3. The Nutrition Standards and Meal Requirements will result in the simplification of the menu planning and monitoring processes, and they will be compatible with the development of menus that are practical to prepare and serve and that offer nutritious foods and beverages that appeal to students. Criterion 4. The Nutrition Standards and Meal Requirements will be sensitive to program costs.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions APPROACH FOR RECOMMENDING REVISIONS TO THE NUTRITION STANDARDS AND MEAL REQUIREMENTS The committee’s proposed approach to developing recommendations for revisions to the Nutrition Standards and Meal Requirements for the National School Lunch Program and the School Breakfast Program includes the following four steps: applying the working principles to guide the selection of data and the types of analyses and reviews to be conducted and to focus committee deliberations; assessing the dietary intakes of food groups, food subgroups, and nutrients by schoolchildren to identify the food and nutrient intakes of concern for selected age groups; examining various approaches to planning the nutritional aspects of school meals so that the recommendations for revisions to the Nutrition Standards and the Meal Requirements may be effectively incorporated into the requirements for the meals; and applying the criteria shown in Box S-2 in the development of the committee’s recommendations for revision of the Nutrition Standards and Meal Requirements. This will include incorporating sensitivity analysis to study the nutritional impact of the recommended revisions, and addressing the cost implications and market effects of the recommended revisions. Therefore, the Phase I work has included an initial assessment of food and nutrient intakes, the development of a proposed planning model, and proposals for incorporating sensitivity analyses and addressing cost implications and market effects. Review and Assessment of Food and Nutrient Intakes The committee reviewed and assessed food and nutrient intakes by schoolchildren using national data from USDA sources. Two recently released reports, The School Nutrition Dietary Assessment Study–III (SNDA-III) and Diet Quality of American School-Age Children by School Lunch Participation Status, which used data from the National Health and Nutrition Examination Survey (1999–2004), provide a comprehensive picture of the diets of U.S. schoolchildren ages 5–18 years. In particular, the committee used data on the mean intakes of foods from each of seven MyPyramid food groups plus added fat and sugar (the MyPyramid food guidance system translates the Dietary Guidelines for Americans into specific food-based dietary guidance) and the distribution of usual intake of calories and of 18 nutrients. It should be noted, however, that data on dietary supplement intake was not considered since it was not available in the reports used.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions Food Group Intakes The mean daily food group intakes were compared with MyPyramid recommendations for selected calorie levels. The 24-hour usual nutrient intakes were assessed by using the appropriate Dietary Reference Intakes. Mean food group intakes that are below MyPyramid recommendations do not necessarily indicate inadequate nutrient intake, but they do suggest that improvements to the diet would be consistent with current Dietary Guidelines for Americans and with relevant Dietary Reference Intakes. For all children ages 5–18 years, the mean intakes of total vegetables, fruit, whole grains, total meat and beans, and milk were found to be less than the MyPyramid recommendations. The mean vegetable and whole grain intakes were much less than the recommended amounts for all ages, and the mean fruit intake was 50 percent or less than the recommended amounts for children ages 9–18 years. Children consumed larger than recommended amounts of calories from solid fats and added sugars. Nutrient Intakes The committee used methods recommended by earlier Institute of Medicine reports to (1) estimate the prevalence of inadequacy of usual nutrient intake or, if applicable, the nutrients with mean and median intake below the Adequate Intake (AI) and (2) identify indications of excessive intake and of usual dietary intakes that exceed the Tolerable Upper Intake Level (UL). The nutrients whose intakes were apparently inadequate varied considerably by age-gender group. Inadequate intakes were the most prevalent among the older children. Among those aged 9 years and older, a high prevalence of inadequate intake was most common for magnesium, vitamin A, phosphorus, zinc, and vitamin C. For adolescent females, the data suggest that the prevalence of inadequate intakes was high for virtually all vitamins and minerals. The prevalence of inadequate intakes may be overestimated for adolescent females, however. In particular, estimated usual nutrient intakes may be substantially lower than actual intakes because studies suggest that underreporting of food intake is common among this group. Because supplement data were unavailable, it generally was not possible to determine whether nutrients were consumed in amounts that were higher than the UL. For all age groups, however, the prevalence was high for intakes of sodium that exceeded the UL and of intakes of saturated fat that exceeded recommendations in Dietary Guidelines for Americans. Zinc intake of more than 25 percent of the children aged 6–8 years exceeded the UL. The mean and median calcium intakes by older children were less than the AI, and the gap was the highest for adolescents (ages 14–18 years), particularly females. The mean and median intakes of potassium and fiber were substantially less than the AIs for all groups of children. This suggests the potential for inadequate intakes of these nutrients. Intakes of saturated fat were a major concern. More than three-quarters of the children in all age-gender groups had usual saturated fat intakes that exceeded the recommendation of the Dietary Guidelines for Americans of less than 10 percent of total energy. Total fat intake was of less concern: more than 60 percent of the children in all age groups had usual fat intakes that were within the acceptable range. Nonetheless, the usual fat intakes by some children were excessive. More than 90 percent of schoolchildren had usual sodium intakes that exceeded the UL.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions Foods and Nutrients Meriting Considerations As a result of this review and assessment, the foods and nutrients to be given special consideration during Phase II of the study were identified and are listed in Table S-1. The foods and nutrients in this table are those for which a notable proportion of children had intake levels inconsistent with recommended intake levels. The committee will consider them carefully when identifying priority foods and nutrients for the Nutrition Standards and Meal Requirements. In addition, the committee will give special consideration to energy intake for schoolchildren of all ages. Even though reported energy intakes did not appear to be higher than energy requirements, the high prevalence of overweight and obesity (a prevalence of obesity of 17 percent or more, depending on the age and the gender) indicate reason for concern. The Proposed Planning Model for School Meals The intent of the planning model is to provide the basis and rationale for developing recommendations for revisions to the Nutrition Standards and Meal Requirements. During Phase I of this study, the committee explored the use of target median intakes (TMIs) to set school meal nutrient targets and the use of USDA MyPyramid food group recommendations as food intake targets. The term target is used here to represent a major but preliminary part of the process of setting Nutrition Standards and Meal Requirements for the school meal programs. A TMI is the median of the usual nutrient intake distribution that would meet the needs of most people in a group. Because the prevalence of inadequate nutrient intakes can be estimated from the percentage of people with usual nutrient intakes that are below the Estimated Average Requirement (EAR), the method of calculating the TMI involves (1) setting a (low) goal for the prevalence of inadequate intakes and (2) calculating how much the current median intake needs to change so that the percentage of people with intakes below the EAR is equal to that goal. The elements of the proposed planning model (setting school meal nutrient targets and food intake targets and combining them) are outlined below. Proposed Method for Setting Nutrient Intake Targets for School Meals On the basis of earlier guidance from the Institute of Medicine (IOM, 2003), the committee has proposed seven steps for the setting of nutrient intake targets for school meals. For each age-gender group, determine the target daily energy intake and the goals for the percentages of energy to be provided by breakfast and lunch. For nutrients with an EAR: Determine the acceptable prevalence of inadequacy and the acceptable prevalence of excessive intakes. Determine a target nutrient intake distribution to achieve these goals. The median of this distribution is the target median intake (TMI) for the age-gender group. If necessary, adjust the target nutrient intake distribution so that the prevalence of inadequacy and the prevalence of intakes above the UL are acceptably balanced. For nutrients (other than sodium) with an AI: Set the TMI equal to the AI for the age-gender group. If necessary, adjust the TMI to reduce the prevalence of intakes above the UL. For sodium, set the TMI equal to the UL for the age-gender group.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions TABLE S-1 Foods and Nutrients Under Consideration in Children’s Diets Age Category Foods for Which Intakes Are Inadequate, Male and Female Nutrients for Which Intakes Are Inadequate Nutrients for Which Intakes Are Excessivea Male Female Male Female Ages 6–8b Fruit Total vegetables Dark green and orange vegetables and legumes Whole grains Total meat and beans Milk Potassium Fiber Potassium Fiber Sodium Saturated fat Total fat Energyc Sodium Saturated fat Total fat Energyc Age 9–13 Fruit Total vegetables Dark green and orange vegetables and legumes Whole grains Total meat and beans Milk Magnesium Potassium Vitamins A, E Fiber Calcium Magnesium Phosphorus Potassium Zinc Vitamins A, C, E Fiber Sodium Cholesterol Saturated fat Sodium Energyc Total fat Saturated fat Age 14–18 Fruit Total vegetables Dark green and orange vegetables and legumes Whole grains Total meat and beans Milk Magnesium Potassium Vitamins A, C, E Energyc Fiber Calcium Iron Magnesium Phosphorus Potassium Zinc Vitamins A, C, E, B6, B12 Folate Thiamin Energyc Fiber Sodium Cholesterol Saturated fat Total fat Sodium Cholesterol Saturated fat Total fat NOTE: Excessive energy intakes for some age-gender groups may not have been identified because of underreporting. aExcessive amounts of discretionary calories were consumed from solid fat and added sugars; this also constitutes concern relative to recommendations to be made by the committee. Usual intakes of added sugars could not be estimated because relevant data were not available in SNDA-III. The committee notes the quantitative amounts of added sugars in Table 4-5. Furthermore, while intakes of trans fatty acids also could not be measured, trans fatty acids will be considered as appropriate by the committee during Phase II. bData for children age 5 years were included in the food intake data. cIt is difficult to accurately estimate energy intakes because of under- and overreporting of food intake and a lack of accurate information about customary levels of physical activity.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions For each nutrient, apply the age-gender TMIs to develop a TMI for each grade category using either a weighted average or a nutrient-density approach. For each nutrient, determine the goal for the percentage of a day’s intake to be provided by school breakfast and school lunch, and apply the percentage to the TMI to obtain the school meal nutrient target. Evaluate the proposed school meal nutrient targets in terms of feasibility, cost, and acceptability. Revise the targets as needed to provide an acceptable balance of adequacy, avoidance of excess, feasibility, cost, and acceptability. The resulting school meal nutrient targets would be consistent with the goals of planning school meals to reduce the prevalence of inadequacy and to reduce the risk of excessive intakes assessed among schoolchildren as described above. However, the impact of changes in the Nutrition Standards and Meal Requirements on children’s daily intakes cannot be completely predicted. An intake assessment performed after changes are implemented by USDA would be needed to determine the impact. Proposed Method for Setting Food Intake Targets for School Meals The following three steps outline a potentially useful general approach for applying current dietary guidance to the planning of school meals: Select appropriate energy levels. Apply the goal for the percentage of the day’s intake (e.g., 20 and 30 percent for breakfast and lunch, respectively) to the MyPyramid food intake pattern for the energy level to obtain amounts of each food group to recommend, that is, the school meal food targets. Consider the recommendations for discretionary calories, which are calories from any source that can be used flexibly (these calories are often from added sugars or solid fats or fat from foods that are not in their lowest-fat form, such as 2 percent fat milk). Staying within these recommendations may require greatly decreasing or eliminating the use of foods that are high in fats and added sugars. Combining the School Meal Nutrient Targets and Food Targets Although the committee recognizes the need for nutrient intake targets, the process described above involves many assumptions. Thus, there are many uncertainties about the accuracy of the estimated TMIs. A comparison of the TMIs with the nutrients provided by the MyPyramid food intake patterns shows that adherence to MyPyramid results in diets whose nutrient contents almost always meet or exceed the TMIs. Moreover, adherence to MyPyramid results in diets that are consistent with the Dietary Guidelines for Americans. To achieve the planning objectives, the committee will consider recommending that school meal food targets be emphasized in the development of the Nutrition Standards and Meal Requirements for school meals. In particular, the committee may begin by using the MyPyramid food plans as the basis for the school meal targets and then assess projected nutrient intake distributions (using information about the shape of current intake distributions) to determine if the desired objectives are likely to be achieved. As with any method of planning school meals, it would be necessary to assess the children’s actual nutrient intakes after changes are implemented to determine if the planning objectives have been achieved.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions The school meal food targets would be supplemented with selected school meal nutrient targets for nutrients such as sodium, fat, saturated fat, and cholesterol, and a target for added sugars. If this is workable, this approach may offer an additional advantage: the simplification of meal planning and monitoring. Proposed Approach for Sensitivity Analysis, Cost Implications, and Market Effects Sensitivity Analysis The sensitivity analysis will critically examine each recommendation with respect to likely benefits and consequences. Specifically, the committee will examine the following factors: food intake sample menus with respect to improved adherence to the 2005 Dietary Guidelines for Americans, possible effects of nutrient intake contributions from school meals with respect to the prevalence of inadequacy and excessive intake as defined by the Dietary Reference Intakes (DRIs), cost and administrative impacts on food service operations, menu characteristics that influence acceptance by students, and participation rates. The committee will explicitly state its assumptions and will examine the recommendations relative to each of the factors separately. It will also consider, in a qualitative sense, the net effect of combined benefits and consequences. The committee will examine the recommendations relative to each of the factors separately and consider qualitatively the net effect of the combined benefits and consequences. Cost Implications Because USDA does not anticipate that additional funding will be available to schools for implementation of the revised requirements, the committee will aim to design changes in requirements in a manner that keeps program costs economical and as close as possible to current levels (adjusted for inflation). The objective of maintaining program costs at current levels is particularly challenging during a period of rapidly rising food and other costs, as was the case in 2008. The key sources of information used for examination of the cost implications will be national-level studies of meal and food costs and available publications on the experiences of school districts that have implemented these or similar changes. Assessment of the impacts of revisions on the costs of reimbursable lunch and reimbursable breakfast meals requires data on the relative amounts of foods used in a representative (typical or average) meal and the relative prices of the individual food items used. The committee proposes to (1) select a representative menu for the lunch and breakfast meals by drawing from menus for each type of meal from frequently observed menus (and food items) from data for elementary schools from the School Nutrition Dietary Assessment Study-III; (2) estimate the cost of the representative menu; and (3) use the representative menu to examine the cost implications of offering the base menu versus those of offering the menus that include the proposed revisions to the school meals offered.
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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions Baseline cost data derived from available food cost data, adjusted to the 2005–2006 school year or more current price levels, will be developed. The adjusted food cost data can be evaluated and calibrated, if necessary, to more recent estimates of the meal costs that are available from the USDA. Although this approach has limitations, it is useful for estimating the cost implications of possible adjustments to the types and amounts of foods needed to meet the recommended revisions to the Nutrition Standards. Market Effects The committee will also analyze the economic impacts of its recommendations on school food authorities and on commodity markets. The impact of each of the proposed changes will be included and assessed on the basis of available information. For estimation of the economic effects of its recommendations on commodity markets, the committee will consider the impacts on markets under assumptions of full substitution and full supplementation and the expected levels of substitution and supplementation. NEXT STEPS The committee intends to receive input on its proposed approach as described in this Phase I report during a public forum scheduled for January 2009 in Washington, DC (go to http://www.iom.edu/fnb/schoolmeals for details). In addition, interested parties may submit written comments electronically through January 31, 2009, using the following e-mail address: FNBSchoolMeals@nas.edu. If needed and as appropriate in response to the comments that it receives, the committee will consider the need to adjust its approach to developing recommendations for revision of the Nutrition Standards and Menu Requirements for the school meal programs. This report completes the Phase I activities for this study. The committee’s Phase II work will address the development of the recommendations for revision of the Nutrition Standards and Menu Requirements for the School Breakfast Program and the National School Lunch Program. Phase II will culminate in a final report that will also document the scientific information, methods, and assumptions underlying the recommendations. Sensitivity analyses and considerations of cost implications will be integrated with the development of its recommendations. In other words, by applying the four criteria to potential Nutrition Standards and Meal Requirements and then finding a balance among those criteria, the committee will be using a holistic approach to its task. Finally, the Phase II report will include a discussion of the market effects of implementing the revisions that the committee recommends.
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