Regulations for Nutrition Standards for Competitive Foods in Schools

February 9, 2011

Childhood Obesity in Massachusetts

•

Children 2-5 years old

– 18.4% “at risk of overweight” and 15.4% “overweight” (WIC Program 2007) •

Middle School Students

– 17% overweight and 10% obese (2009 MA YHS) •

High School Students

– 15% overweight and 11% obese (2009 YRBS) •

Low-income Black and Hispanic youth/adolescents

– Black 18%, Hispanic 15% and White 9% (obesity only, 2009 YRBS) •

BMI screening data

on 109,674 students in grades 1, 4, 7 and 10 – 16.9% overweight and 17.3% obese (2008-2009) 2

MA Students with BMI for Age in Overweight/Obese Category by Grade & Gender, 2008-2009

40 30 20 10

32.9

31.0

39.7

35.5

37.7

33.5

32.3

28.6

0

Grade 1 Grade 4 Grade 7 Grade 10 Male Female

3 Source: MDPH, Bureau of Community Health, Access and Prevention, Division of Primary Care and Health Access, School Health Unit

4

Childhood Obesity is Not Randomly Distributed

Childhood Obesity and Median Household Income

50 45 40 35 30 25 20 15 10 5 0 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000

Median Household Income (2000 Census Data)

$140,000 $160,000 $180,000 5

Health Impact Pyramid

Increasing Population Impact Increasing Individual Effort Needed

Counseling & Education Clinical Interventions Lasting Protective Interventions

Changing Context to Support Healthy Default Decision Making

Socioeconomic Factors Adapted from T. Frieden, AJPH, April 2010 6

Policy, Systems and Environmental Change Strategies to Support Healthy Eating in Schools

•

Policy Changes

School Nutrition Regulations •

System Change

School policies and practices that support healthy eating campus-wide 24/7 •

Environmental Changes

Healthy foods available in vending machines, school stores or served in cafeterias 7

School Nutrition Bill Provisions

Overview of Key Elements of Bill

• Requires

nutritional standards

foods” in public schools for “competitive • Requires regulations to promote school

wellness advisory committees

• Requires

training of public school nurses

in screening and referral for obesity, diabetes and eating disorders • Establishes

Commission on School Nutrition and Childhood Obesity

9

Definition of Competitive Foods

• All food/beverages not part of school breakfast, lunch and CACFP programs – A la carte lines – School stores – Snack bars – Vending machines – Fundraising activities – School sponsored events • Excludes non-sweetened carbonated water 10

Establish Nutritional Standards

• DPH to issue regulations establishing standards for competitive food/beverages – Based on dietary recommendations from HHS, USDA, AHA, IOM, School Nutrition Association of MA, American Dietetic Association • Apply to competitive foods sold 30 minutes before through 30 minutes after the school day • Update standards every 5 years in consultation with ESE 11

Possible Exceptions

• Food/beverages sold up to 30 minutes before or 30 minutes after school day – School district may choose to apply standards beyond this time frame • DPH may make exceptions for – Booster sales – Concession stands – School-sponsored or school-related fundraisers and events 12

Nutrition Standards for Competitive Foods and Beverages

Standards Development

• Interagency workgroup – DPH obesity prevention and school health staff – DESE health and nutrition staff – John Stalker Institute at Framingham State – Boston Public Health Commission – Harvard School of Public Health • Multiple sources of information – Institute of Medicine Nutrition Standards for Foods in Schools – MA Action for Healthy Kids – Alliance for a Healthier Generation – MA Public Health Association – MA School Nutrition Association – MA Executive Order 509 – Other states – CA, CT, MI, WV, PA, RI 14

General Nutrition Standards – Specified in Statute

1. Plain

water

cost readily available during school day at no 2. Offer

fresh fruits/non-fried vegetables

food is sold

(except vending machines)

wherever 3. Make

nutrition info available

for non-prepackaged foods by August 2013

(except fresh fruits/vegetables, food/beverages sold at booster sales and other school sponsored events)

4. Prohibit use of fryolators

foods in preparing competitive 5. Ensure food preparation and all foods/beverages meet state and federal

food safety guidelines

15

Competitive Food Standards - Beverages

Proposed Massachusetts Standard Institute of Medicine Juice

100 % fruit or vegetable juice with no added sugar Elem and middle – 4 oz serving; High – 8 oz serving

Milk and Milk Substitutes

Same All milk/milk substitutes (incl. lactose free and soy milk) shall be low fat (1%) or fat-free 8 oz serving Meet USDA standards for fluid milk and milk substitutes Flavored milk ≤ 22 g sugar/8 oz

Water

Water without added sugars, sweeteners, artificial sweeteners, but can contain natural flavoring and/or carbonation Same Same except no carbonation or natural flavors 16

Competitive Food Standards - Beverages

Proposed Massachusetts Standard Institute of Medicine Other Beverages

No beverages other than juice, milk, milk substitutes and water shall be sold or provided For High School after school: allows non caffeinated, non-fortified beverages with less than 5 calories per portion, with or without non-nutritive sweeteners

Beverages with added sugar or sweeteners

These will be phased out by August 2013, except for flavored milk or milk substitutes that contain same amount or less sugar than plain fat-free or low-fat milk.

17

Competitive Food Standards - Food

Proposed Massachusetts Standard Institute of Medicine Calories

Limit 200 calories per item, except for a la carte entrees, which shall not exceed calories in comparable National School Lunch Program entrees

Fat, Saturated Fat, Trans Fat

No more than 35% of total calories from fat No more than 10% of total calories from saturated fat All foods shall be trans fat free Exception – 1 oz of nuts, nut butters, seeds or reduced fat cheese

Sugar

No more than 35% of total calories from total sugars, except •Non-fat or low-fat yogurt with maximum of 30g sugar/8 oz •100% added fruit with no added sugar Same Same except for the nut/cheese exception Same 18

Competitive Food Standards - Food

Proposed Massachusetts Standard Institute of Medicine Sodium

No more than 200 mg per item Exception: no more than 480 mg per item for a la carte entrees

Grains

All bread and other grain-based products shall be whole grain Same Same for snack items but no guideline for a la carte entrees

Artificial sweeteners

No artificial sweeteners allowed.

Not mentioned

Caffeine

No more than trace amounts of caffeine allowed.

Same 19

Proposed Guideline Topics

• Easy-to-read chart of the guidelines with examples for each category • List of foods and beverages that meet the guidelines (

similar to the MA Action for Healthy Kids “A List” of approved foods and beverages

) • Alternatives for school fund raising activities • Recommendations to create and support a healthy school environment, e.g., lunch duration • Alternatives for healthy celebrations • Rationale for selected nutrition standards 20

Implementation Assistance

• DPH to work with DESE in implementation of nutritional standards – Training in nutrition and diet for food/ nutrition service directors – Assessment of school’s capacity, resources, equipment to prepare recommended foods 21

Possible Financial Implications of Nutrition Standards

What do we know?

• The majority of studies and reports have found that schools implementing healthier competitive foods have not had decreases in overall revenue • Profitable healthy fundraising alternatives abound – Events such as car washes, fun runs, walk-a-thons, raffles – Sales of non-food items such as calendars, greeting cards, flowers/plants, personal care products, wrapping paper 23

On the Horizon

• National efforts – USDA school lunch nutrition standards – USDA competitive food nutrition standards – First Lady’s

Let’s Move Cities and Towns

• Other state wide initiatives – Mass in Motion Municipal grants – Act FRESH Campaign – Healthy People, Healthy Economy 24

Timeline

Activity

Public Health Council

Schedule

February 9, 2011 Public Hearings and public comment period Public Health Council for final vote Implementation March 2011 Late spring August 1, 2012 25

Acknowledgements

•

Internal DPH work group

– Laura York – Chris Nordstrom – Cynthia Bayerl – Diana Hoek – Paula Dobrow – Howard Saxner – Lauren Smith •

John Stalker Institute

– Karen McGrail •

Boston Public Health Commission

– Kathy Cunningham •

DESE staff

– John Bynoe – Katie Millett – Carol Goodenow – Linda Fischer – Mary Anne Gilbert – Rita Brennan Olson •

Harvard School of Public Health

– Eric Rimm – Juliana Cohen – Jessica Garcia 26

27

Commission Membership

– Commissioner of DMH – Commissioner of Agricultural Resources – MA Association of School Superintendents – MA Secondary School Administrators Association – MA Nutrition Board – MA Association for Health, Physical Education, Recreation – American Heart Association – American Diabetes Association – MA Parent Teachers Association – Chair, Student Advisory Council – MA American Academy of Pediatrics –

MA School Nutrition Association

– Representative of food/beverage industry – 6 members appointed by Senate President & House Speaker 28