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Appendix D
January 2009 Workshop Agenda and Summary of Public Comments

Food and Nutrition Board

Committee on Nutrition Standards for National School Lunch and Breakfast Programs



January 28, 2009 9:00 am–1:00 pm

The National Academy of Sciences


2100 C Street NW

Washington, DC

9:00–9:10 am

Welcome and Goals


Virginia Stallings, MD, Chair





USDA Food and Nutrition Service

Jay Hirschman, MPH, CNS, Director, Special Nutrition Staff, Office of Research

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

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Appendix D January 2009 Workshop Agenda and Summary of Public Comments Food and Nutrition Board Committee on Nutrition Standards for National School Lunch and Breakfast Programs OPEN PUBLIC FORUM ON PHASE I REPORT AGENDA January 28, 2009 9:00 am–1:00 pm The National Academy of Sciences THE LECTURE ROOM 2100 C Street NW Washington, DC 9:00–9:10 am Welcome and Goals Virginia Stallings, MD, Chair 9:10–10:30 SESSION 1: PERSPECTIVES ON PROPOSED APPROACH 9:10–9:20 USDA Food and Nutrition Service Jay Hirschman, MPH, CNS, Director, Special Nutrition Staff, Office of Research 

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 SCHOOL MEALS and Analysis, Food and Nutrition Serice, USDA PANEL 9:20–9:30 National Alliance for Nutrition and Activity Margo G. Wootan, DSc, Director, Nutrition Policy, Center for Science in the Public Interest 9:30–9:40 Alliance for a Healthier Generation Jessica Donze Black, RD, MPH, National Director of the Healthy Schools Program 9:40–9:50 School Nutrition Association Katie Wilson, PhD, SNS, School Nutrition Director, Onalaska School District, Wisconsin 9:50–10:00 California Food Policy Advocates Matt Sharp, Senior Adocate, California Food Policy Adocates 10:00–10:15 Discussion 10:15–10:30 Break 10:30 am– SESSION 2: UPDATES ON SPECIAL TOPICS 12:15 pm 10:30–10:45 10:45–11:00 Commodities in the School Meal Programs Cathie McCullough, Director, Food Distribution Program, Food and Nutrition Serice, USDA Discussion PANEL DISCUSSION: Research Perspective on School Children’s Acceptance of Food as It Relates to Nutrition Standards 11:00–11:15 Fruits and Vegetables Tom Baranowski, PhD,USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine

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 APPENDIX D 11:15–11:30 Whole Grains Leonard Marquart, PhD, RD, Department of Food Science and Nutrition, Uniersity of Minnesota 11:30–11:45 Plate Waste Joanne F. Guthrie, PhD, MPH, RD, Assistant Deputy Director, Food Assistance & Nutrition Research Program, Economic Research Serice, USDA 11:45 am–12:15 pm Discussion (approx.) 12:15–1:00 pm SESSION 3: PUBLIC COMMENTS on PHASE I REPORT (5 minutes each) To be determined ia registration Action for Healthy Kids (Rob Bisceglie) National Pork Board (Ceci Snyder) Nemours, Division of Health and Prevention Services (Karyl Thomas Rattay) National Dairy Council (Ann Marie Krautheim) Soyfoods Association of North America (Julie Obbagy) United Fresh Produce Association (Lorelei DiSogra) General Mills (Kathy Wiemer)—Unable to attend due to weather International Dairy Foods Association (Michelle Matto) Local Matters (Noreen Warnock)—Unable to attend due to weather American Dietetic Association (Gloria Stables)—Un- able to attend due to weather Wellness in American Schools (Tazima Dais) Grocery Manufacturers Association (Robert Earl) Food Research and Action Center (Geraldine Henchy) SUMMARY OF PUBLIC COMMENTS ON THE PHASE I REPORT The committee invited comments from the public through the Institute of Medicine project website ( SchoolMeals.aspx). More than 50 comments were received. The following is a list that summarizes those comments, organized by topic area.

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 SCHOOL MEALS Energy Levels • Calorie levels should not compromise other nutrient standards. • The RDA/DRI for energy needs to be addressed (some children obtain all their calories from school meals). • When establishing calorie levels (maximums and/or minimums), consider the interrelationship between the fax maximum level and the calories provided by fat. • Consider body size and activity level of children (a safety net is needed for students who are active/need additional calories). • Additional calories from non-school meal items should be considered. • Consider calorie requirements relative to addressing the obesity epidemic. • Assuming the EER is the mean and school meals don’t exceed the standard, half of the students automatically receive inadequate calories. • Maintain the current minimum daily calorie levels and establish a range. • Do not reduce the calorie requirements for breakfast and lunch since there is no evidence that school meals are contributing to obesity. • Energy levels are too high (especially kindergarten through grade 3). • Twenty percent and 30 percent of calories may be too low. • Decrease minimum calories requirements at breakfast and lunch by 100 calories. Meal Patterns • Simpler approaches, based on operational problems and financial limitations. • Flexibility with requirements per grade level. • Expand the number of age-grade groupings. • Change the age-grade groups for meal planning to match those in DRIs. • Grades 5–8 should have their own meal pattern requirements. • Provide recommendations for all menu planning options (food- and nutrient-based). • Discontinue the Enhanced Food-Based Menu Planning option. • Discontinue the “serve” system. • Consider changes to the offer ersus sere rule. • Base reimbursable meals on menu items, not components (same standards for FBMP and NBMP).

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 APPENDIX D • Increase the number of items in the FBMP to six (three of which are fruits and/or vegetables). • Offer more items to encourage children to select more fruits and vegetables. • Reducing the amount of food at breakfast as a way to offset snacks later in the day fails to recognize the importance of meeting the immediate nutritional needs of children. • Decrease meat and meat alternate servings to 1 oz (2 oz is too much for cheese). • Require an entrée at lunch and at least three (or two?) additional menu items, no matter how many are offered; at breakfast, require three (or two?) menu items. • Children should not have the option of purchasing a second meal (even if their parents allow it). • Allow double servings or “seconds” of fruits and vegetables and whole grains. • Maintain the 25 and 33 percent goals for the percentage of the day’s MyPyramid food intake pattern. Fruits and Vegetables • Require offering three different servings of fruits and vegetables instead of two. • Offer two fresh fruits per meal; serve two fresh vegetables per meal. • Continue setting minimum fruit and/or vegetable portion sizes at each grade level (count minimum sizes as “servings” toward the required number of menu items and allow students to select the full number of serv- ings recommended by MyPyramid). • Offer five different fruits and five different nonfried vegetables per week. • Serve raw fruits and vegetables daily. • Include canned fruits and vegetables in menus. • Require two dark green, one yellow, three fresh, two legumes per week. • Require fruits and vegetables for NBMP. • Keep serving size at one-quarter cup. • Fruit juice should be limited to 8 oz and have a low sugar content. • Consider the most popular vegetables (corn and green beans) when developing vegetable requirements. • Extra servings of fruits and vegetables are contingent on additional reimbursement.

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0 SCHOOL MEALS • Consider financial assistance for states without access to inexpen- sive fresh fruits and vegetables. • Serve organic and buy local when possible. • Require that 50 percent of all fruits and vegetables must be ac- quired by fresh local sources (move to 75 percent in the future; offer incentive). Meal Components/Foods • Increase the number of components to six (that would make the meal pattern half fruits and vegetables). • Keep OVS at three components. • Do not allow student choice regarding portion size or seconds (for entrées, desserts, condiments). • Schools cannot control the amount of food consumed by children (whether less than offered, or more). • Menus developed by the committee must include choices. • Providing age-appropriate choices is important. • More healthy, ethnic foods. • Serve local, organic foods when possible. • Breading should not count toward grain and bread servings. • Promote 2 cups of low-fat or fat-free dairy foods for 2–8-year-olds and 3 cups for children 9 years and older. • Reduce dairy items (especially cheese); causes too many allergies. • Use soy/rice milk. • Low-fat dairy products contain a lot of nutrients (some of which are nutrients of concern) and are acceptable to children. • Flavored milk is acceptable to children and contains important nutrients. • Offer only 1 percent and skim milk (not to exceed 28 g of sugar per 8 oz serving). • Serve lean, unbreaded proteins. • Include more pork products. • There are no reasonably priced, acceptable meat/bean entrees on the market that meet the FDA definition of “lean.” • Encourage consumption of nonfried fish, especially oily fish. • Serve less red meat. • Serve one lean (based on FDA definition) entrée per week, move toward one per day (lean entrées would be very expensive). • Address large amount of sugary foods (cereal, pastries); sweets should not be credited as bread. • No donuts, sweet rolls for breakfast; promote cereal, milk, and fruit.

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 APPENDIX D • Breakfast/cereal items should have less than 5 g of sugar. • Cookies and sweets should not count as breads and grains in the FBMP. • Recognize the value of added sugars for palatability of nutrient- dense foods, such as dairy foods and RTE cereal. • No fried breaded foods, gravies, cheesy condiments. • Desserts other than fruit should be a reasonable serving size and served only once per week. • Access to plant-based protein smoothies, not soy. • USDA commodity food purchases should focus on fruits, veg- etables, whole grains, and beans, and eliminate purchases of foods high in saturated fats (beef, pork, chicken, cheese, eggs). • Eliminate, substitute health alternatives, and/or strictly control amounts and quantities of cheese, sunflower seeds, salad dressing, meats, and salads made with mayonnaise-type dressings on salad bars. • Offer at least one low-fat entrée at lunch. Nutrient Standards • The current standards (based on RDAs) are outdated. • Nutrient standards should be the same for all menu planning op- tions (NBMP and FBMP). • Meals based on gender-based nutrient targets may be unrealistic and result in food waste. • Nutrient standards should be consistent with all areas of the Di- etary Guidelines. • Nutrient standards should be evaluated across a week, not applied to individual food products. • If there are weekly/monthly goals, why have daily meal goals for nutrients? • Monitoring meal compliance based on weighted menus should be discontinued since weighted menu analysis is weighted based on items served, not items offered. • Require NBMP schools to publish analyzed meals. • Provide nutrition information. • Recommend nutrition information on foodservice and commodity products. • Very high nutrient standards encourage schools to serve fortified foods rather than improved food offerings. • If nutrition standards become more strict, more children will leave campus for foods or purchase more snacks from vending machines because they are hungry (especially high school students).

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 SCHOOL MEALS • Keeping sodium at an acceptable level has been a challenge in most food planning efforts. • A TMI for sodium based on the UL is too high. • If sodium level is too low, foods will not be acceptable. • Sodium-level reductions continue to be voluntary; eliminate salt packets. • Recommend that individual foods contain less than 0.5 g of trans fat. • Differentiate between naturally occurring and artificial trans fat. • Implementing a standard for added sugars is not practical since added sugar content is not on labels; there should not be a standard for individual food products. • Require labeling for added sugars. • Fiber goal should be realistic and accomplished using a variety of fiber-containing foods, without having to use “special” high-fiber foods that may not be acceptable to children. Special Diets/Needs • Address overweight/undernourished paradox. • Improve labeling (regarding allergies). • Consider special needs children. • Offer vegetarian meals once a week. • Some children are sensitive to food texture. • Consider a diverse population of schoolchildren. • If a beverage nutritionally equivalent to cow’s milk is not available, the committee should provide product specifications. Acceptance • Meals need to be appetizing. • Taste and nutrition need to coexist; sodium restriction is extreme (look at health issues). • Consider palatability of foods that meet recommendations. • Consider marketplace availability and acceptability (student taste test). • Nutrition requirements should ensure foods are appealing and ac- ceptable to children. • Recommend including more nutrition education, student involve- ment in planning meals, and students taste tests.

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 APPENDIX D Cost/Administrative Concerns • Use the most current food price levels. • Cost analysis of menus for all grade levels. • Cost analysis should consider regional/local expenses incurred by districts for foods and services. • Consider the costs involved in training state/local school district staff to implement and monitor nutrition standards and meal requirements. • The cashier, manager, and outside monitor need to be able to quickly look at a tray and determine if it is a reimbursable meal. • Consider marketplace availability. • Assess the availability and affordability of the food products through the local markets traditionally used by school districts. • High-quality products will be more acceptable, but cost more. • Consideration needs to be given to the constraints of school admin- istrative issues. • Different school sizes should have different requirements; smaller schools should be required to have a certain percent of the foods prepared in the school kitchen (not shipped in frozen). • Incremental changes are necessary for students, schools, and manufacturers. • Provide some “how to” guidance for implementation. • It is unrealistic to expect districts to implement a new program without additional funds; without adequate funding, the program will fail. Processed Foods • Limit/eliminate the amount of high-fructose corn syrup, artificial colors and partially hydrogenated oils, and refined sugar and grain. • Make sure recommendations don’t encourage schools to use more processed foods. • Reflect on the accessibility of foods that meet recommendations. • Fewer processed, frozen foods; more whole foods and fruits. • Embrace all forms of food equally; fresh, packaged, canned, bot- tled, frozen, and dried. • Do not serve foods that are shipped to the schools cold and sit in lukewarm cabinets. • Do not adopt food enhancement techniques used by the fast food industry.

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 SCHOOL MEALS Whole Grains • Most grains should be whole grains. • Half of the grains served should be whole grains. • A whole grain should be the primary ingredient and there needs to be a minimum gram level of whole grain per FDA reference amount customarily consumed. • Whole grain requirements need to be phased in. • Offering a choice between whole grain and non-whole grain may result in infrequent selection of whole grains, but offering 100 percent whole grains may affect participation. • School meal standards should be based on the percent whole grains, not ounces/grams of whole grains: • Grain servings are often larger than 1 oz. • The food industry has inappropriately translated the 3 oz advice in the DGAs into an 8 g minimum. • Food with 8 g of whole grains could be 85 percent of more refined grain. • Labels do not disclose gram amount of whole grains. • Use percent whole grain.