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Committee on Nutrition Standards for National School Lunch and
Breakfast Programs
Food and Nutrition Board
Virginia A. Stallings, Carol West Suitor, and Christine L. Taylor, Editors
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance.
This study was supported by Contract No. AG-3198-C-08-0001 between the National Academy of
Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or
recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the
view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2009. School Meals: Building Blocks for Healthy
Children. Washington, DC: The National Academies Press.
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COMMITTEE ON NUTRITION STANDARDS FOR NATIONAL SCHOOL LUNCH
AND BREAKFAST PROGRAMS
VIRGINIA A. STALLINGS (Chair), The Children’s Hospital of Philadelphia, University of
Pennsylvania
KAREN WEBER CULLEN, Children’s Nutrition Research Center, Baylor College of
Medicine, TX
ROSEMARY DEDERICHS, Minneapolis Public Schools, Special School District No. 1, MN
MARY KAY FOX, Mathematica Policy Research, Inc., Cambridge, MA
LISA HARNACK, Division of Epidemiology and Community Health, University of Minnesota,
MN
GAIL HARRISON, School of Public Health, Center for Health Policy Research, University of
California, Los Angeles
MARY ARLINDA HILL, Jackson Public Schools, MS
HELEN H. JENSEN, Department of Economics, Iowa State University, Ames
RONALD E. KLEINMAN, Massachusetts General Hospital for Children, Harvard Medical
School, Boston, MA
GEORGE P. McCABE, College of Science, Purdue University, West Lafayette, IN
SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu
ANGELA ODOMS-YOUNG, Department of Kinesiology and Nutrition, University of Illinois
at Chicago, IL
YEONHWA PARK, Department of Food Science, University of Massachusetts, Amherst
MARY JO TUCKWELL, inTEAM Associates, Ashland, WI
Study Staff
CHRISTINE TAYLOR, Study Director
SHEILA MOATS, Associate Program Officer
JULIA HOGLUND, Research Associate
HEATHER BREINER, Program Associate
CAROL WEST SUITOR, Consultant Subject Matter Expert and Writer
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant, Food and Nutrition Board
LINDA D. MEYERS, Director, Food and Nutrition Board
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REVIEWERS
This report has been reviewed in draft form by individuals chosen for their diverse
perspectives and technical expertise, in accordance with procedures approved by the National
Research Council's (NRC’s) Report Review Committee. The purpose of this independent review
is to provide candid and critical comments that will assist the institution in making its published
report as sound as possible and to ensure that the report meets institutional standards for
objectivity, evidence, and responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the deliberative process. We wish to
thank the following individuals for their review of this report:
Cheryl A. M. Anderson, Department of Epidemiology, The Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
Janet Currie, Economics Department, Columbia University, New York, NY
Barbara L. Devaney, Human Services Research, Research Division, Mathematica Policy
Research, Inc., Boston, MA
Deanna M. Hoelscher, School of Public Health, University of Texas Health Sciences Center at
Houston
Eileen T. Kennedy, Friedman School of Nutrition Sciences and Policy, Tufts University,
Boston, MA
Daryl Lund, Cottage Grove, WI
Penny McConnell, Food and Nutrition Services, Fairfax County Public Schools, Vienna, VA
Barry Sackin, B. Sackin & Associates, L.L.C., Murrieta, CA
Sandra Schlicker, Wellness and Nutrition Services, Office of the State Superintendent of
Education, Government of the District of Columbia, Washington, DC
Frances H. Seligson, Independent Consultant, Hershey, PA
Patricia Wahl, University of Washington School of Public Health and Community Medicine,
Seattle
Walter C. Willett, Department of Nutrition, Harvard School of Public Health, Boston, MA
Although the reviewers listed above have provided many constructive comments and
suggestions, they were not asked to endorse the conclusions or recommendations nor did they
see the final draft of the report before its release. The review of this report was overseen by
Elaine L. Larson, School of Nursing, Columbia University, and Joanna T. Dwyer, Tufts
University School of Medicine & Friedman School of Nutrition Science & Policy, Frances Stern
Nutrition Center, Tufts-New England Medical Centers. Appointed by the National Research
Council and Institute of Medicine, they were responsible for making certain that an independent
examination of this report was carried out in accordance with institutional procedures and that all
review comments were carefully considered. Responsibility for the final content of this report
rests entirely with the authoring committee and the institution.
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Preface
My small southern town memories of food at school are many, starting with cafeteria lunch
provided after we presented our green tokens and without discussion of choices or options except
for the big decision of chocolate or plain milk. Everyone had a lunch token, so no one knew that
there was a free or reduced-price lunch and no one went home or off campus for lunch unless
you lived in the neighborhood. Bigger or maybe hungrier students got larger portions. A few
students brought lunch in cool lunch boxes, and we envied what was assumed to be a better
lunch. There were no vending machines until high school, and then the machine foods and
beverages were few, and most students did not come to school with money or plans to purchase
foods other than school lunch. We did not want to spend our allowance on food.
This was a time when childhood nutrition issues were iron deficiency and undernutrition,
when few were concerned about fat, sugar or sodium in childhood diets, and when most meals
were consumed at home with family members or at school. I now know that some children were
hungry and the school lunch, and later school breakfast, was an important source of food.
Interestingly, the key stakeholders have not changed—the children, families, school
administrators, teachers, nurses, coaches, food service team, and food industry. The local and
state school authorities implement federal policy and make many food and health decisions at
their levels. In the background, nutritionists, health-care providers, and other child advocates
influence both policy and implementation. We now clearly recognize the importance of food and
nutrient intake on child health and on lifelong adult health. All stakeholders are concerned about
diet quality and quantity, emerging food and health habits, and maintaining a healthy pattern of
childhood growth. Today overweight children outnumber undernourished children, and
childhood obesity is often referred to as an epidemic in both the medical and community settings.
Nonetheless, normal or overweight status does not guarantee food security and a healthful diet
for many children. Our inexpensive, abundant food supply and innovative food industry provide
highly palatable foods and beverages for children. School foods and beverages, once almost
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limited mainly to school lunch, now often include many choices in addition to the meals offered
by federally supported school breakfast and lunch programs. The calories and nutrients
consumed at school and school-related activities are an important component of dietary intake of
all school-age children.
It is within this scientific and social environment that our committee established criteria for
nutrient targets and meal standards and made recommendations to revise the nutrition- and food-
related standards and requirements for the National School Lunch Program and the School
Breakfast Program. The recommended standards for menu planning lay out a school meal
approach that results in the wide array of nutrients that children need and that reflect the Dietary
Guidelines for Americans.
Our committee is a dedicated group of remarkable people from diverse backgrounds and
experiences. We quickly recognized that this was not an easy task. Over nearly 2 years, we
learned and debated together, and developed this set of recommendations for nutrition and food
standards for schools meals. We recognized that the standards will be effective only to the extent
that standards are implemented effectively and thus made recommendations related to technical
support, developing foods that are reduced in sodium content, and taking measures to help
schools incorporate more products that are rich in whole grains.
The goal is for schools to employ their unique, long-term relationship with children and their
families to support child health and provide a healthful school eating environment. This will
require attention to many factors that go beyond the federally supported school meal programs:
competitive foods (foods and beverages offered other than the meals provided under the National
School Lunch and Breakfast programs), time and duration of meal periods, activity level of
children, and evaluation and research that address interactions of such factors with the success of
the school meal programs.
The involvement of students, parents, schools, food industry is important to the success of
implementing the recommended revisions. Support from state and federal agencies and from
professional organizations and child advocacy groups will help to promote the acceptance of the
recommended meals. Finally, the level of federal reimbursement for school meals needs to be
sufficient to cover the cost of improvements in the meals such as increased amounts of fruits and
vegetables and the substitution of whole grain-rich foods for some of the refined grains.
Sincere appreciation is extended to the many individuals and groups who were instrumental
in the development of this report. First and foremost, many thanks are due to the committee
members, who volunteered countless hours to the research, deliberations, and preparation of the
report. Their dedication to this project was outstanding and is the basis of our success.
Many individuals volunteered significant time and effort to address and educate our
committee members during our two public workshops on July 8, 2008 and January 28, 2009.
Workshop speakers included: Tom Baranowski, Kimberly Barnes-O’Connor, Jessica Donze
Black, Helene Clark, Adalia Espinosa, Joanne F. Guthrie, Geraldine Henchy, Jeanne Harris, Fred
Higgens, Jay Hirschman, Sue E. Holbert, Lynn Hoggard, Cathie McCullough, Leonard
Marquart, Matt Sharp, Kimberly Stizel, Ted Spitzer, Celeste Peggs, Katie Wilson, and Margo
Wootan.
In addition representatives from many entities provided oral testimony to the committee
during the public workshops that were held on July 8, 2009 and January 28, 2009. They
represented the Action for Healthy Kids, Alliance for a Healthier Generation, American
Academy of Pediatrics, American Dietetic Association, Apple Processors Association,
ARMARK Education, Baylor College of Medicine, Food Research and Action Center, California
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Food Policy Advocates, Charterwells School Dining Services, Economic Research Service, Food
Distribution Program and Food and Nutrition Service of United States Department of
Agriculture, General Mills, Grocery Manufacturers Association, International Dairy Foods
Association, Local Matters, National Alliance for Nutrition and Activity, National Dairy
Council, National Pork Board, Nemours Division of Health and Prevention Services, School
Nutrition Association, Soyfoods Association of North America, Sunkist Taylor LLC, United Egg
Producers, United Fresh Produce Association, University of Minnesota, U.S. Apple Association,
and Wellness in American Schools.
It is apparent that many organizations and individuals from a variety of school and scientific
backgrounds provided timely and essential support for this project. Yet we would have never
succeeded without the extensive contributions of Carol West Suitor, Sc.D., as Consultant Subject
Matter Expert and Writer to the project. Furthermore, it is important to recognize the efforts,
skills, and grace that were provided in large measure by Christine L. Taylor, PhD, RD, Study
Director for this project; Sheila Moats, BS, Associate Program Officer, Julia Hoglund, MPH;
Research Associate; Heather Breiner, BS, Program Associate; and Linda Meyers, PhD, Director,
Food and Nutrition Board. I also want to thank Todd Campbell from Iowa State University for
developing the software used by the committee to analyze menus for cost and nutrient analyses,
and Mathematica Policy Research, Inc. for providing data analyses. Last, as chair, I express my
sincere appreciation to each member of this committee for their extraordinary commitment to the
project and the wonderful opportunity to work with them on this important task for the nutrition
and school communities and for the school children whose health and future we were asked to
consider.
Virginia A. Stallings, Chair
Committee on Nutrition Standards for National
School Lunch and Breakfast Programs
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Contents
SUMMARY S-1
1 Introduction and Background 1-1
2 Foundation for Revising Nutrition Standards and Meal Requirements 2-1
3 Schoolchildren’s Food and Nutrient Intakes and Related Health Concerns 3-1
4 Process for Developing the Nutrient Targets 4-1
5 Process for Developing Meal Requirements 5-1
6 Iterations–Achieving the Best Balance of Nutrition, Student Acceptance, Practicality, and 6-1
Cost
7 Recommendations for Nutrient Targets and Meal Requirements for School
Meals 7-1
8 Food Cost Implications and Market Effects 8-1
9 Projected Impact of the Recommended Nutrient Targets and Meal
Requirements 9-1
10 Implementation, Evaluation, and Research 10-1
11 References 11-1
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APPENDIXES
A Acronyms, Abbreviations, and Glossary A-1
B Biographical Sketches of Committee Members B-1
C Critical Issues for Consideration by the Committee on Nutrition Standards for National C-1
School Lunch and Breakfast Programs, as Submitted by the U.S. Department of
Agriculture
D January 2009 Workshop Agenda and Summary of Public Comments D-1
E Current Standards for the Current Food- and Nutrient-Based Menu Planning Approaches E-1
F Data Used to Calculate Estimated Energy Requirements F-1
G Data Tables Containing Examples of New SNDA-III Analyses G-1
H Estimated Average Requirements Compared to Reported Usual Intakes H-1
I Target Median Intake (TMI) Tables I-1
J Use of MyPyramid Food Groups, Recommendations and the MyPyramid Spreadsheet J-1
K Use of the School Meals Menu Analysis Program K-1
L Baseline Menus L-1
M Evidence Considered Related to the Definition for Whole Grain-Rich Foods M-1
N Comparison of Recommended Nutrition Targets to Other Existing Nutrition Standards for N-1
School-Age Children
O Sample Menus O-1
P Regulations Related to the Sodium Content of Foods Labeled “Healthy” P-1
Q Comparison of Dietary Guidelines for Americans with Recommended Meal Q-1
Requirements
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