NUTRITION STANDARDS FOR FOODS IN SCHOOLS
Virginia Stallings, M.D.
Jean A. Cortner Endowed Chair in Pediatric Gastroenterology
Director of the Nutrition Center
Children's Hospital of Philadelphia
University of Pennsylvania School of Medicine
Chair, Committee on Nutrition Standards for Foods in Schools
Food and Nutrition Board
Institute of Medicine
The National Academies
Subcommittee on Healthy Families and Communities
Committee on Education and Labor
U.S. House of Representatives
May 10, 2007
Good morning, Madame Chair and members of the Committee. My name is Dr. Virginia Stallings. I am a pediatrician, Director of the Nutrition Center at the Children’s Hospital of Philadelphia, and Professor of Pediatrics at the University of Pennsylvania, School of Medicine. I served as chair of the Committee on Nutrition Standards for Foods in Schools of the Institute of Medicine which produced the report, Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.
In FY 2005, Congress directed the Centers for Disease Control and Prevention to undertake a study with the Institute of Medicine to review evidence and make recommendations about appropriate nutrition standards for the availability, sale, content, and consumption of foods and beverages at school, with attention to those offered outside the federally reimbursable meals and snacks. The need for such standards is simple: While federal school meals meet some nutrition guidelines, these “competitive” foods and beverages are not necessarily required to conform to any nutritional or health standards except for the very limited USDA requirements that no foods of minimal nutritional value are allowed during meal periods.
To begin the process of developing recommendations, the committee established a set of Guiding Principles that would result in the creation of a healthful eating environment for children in U.S. schools and to guide deliberations and development of the standards. The Guiding Principles are listed in Annex 1 of my written testimony. The committee was guided by the 2005 Dietary Guidelines for Americans (DGA), and also reviewed pertinent scientific evidence.
Using the Dietary Guidelines for Americans and the scientific data describing the current dietary intake of school-age children, the committee identified fruits, vegetables, whole grains, and low-fat dairy as foods and beverages to be encouraged if competitive foods and beverages are allowed in the individual school.
In regard to the issue of calories and portion size, the committee considered the fact that once a healthful breakfast and lunch are consumed, for many children there are relatively few calories remaining for consumption as snacks. The committee also considered the efficiency and simplicity of a system with one maximum calorie portion size for the school setting, to encourage industry to develop a variety of healthful food and beverage products for the school setting.
Hierarchy of Foods
The committee organized competitive foods and beverages in schools into two Tiers, according to the extent of their consistency with the Guiding Principles. Tier 1 foods and beverages provide at least one serving of “foods to be encouraged” as defined in the Guidelines, and include fresh or minimally processed foods such as apples, carrot sticks, raisins, some multigrain tortilla chips, granola bars, and nonfat yogurt with limited added sugars. Tier 1 beverages are 1 percent or skim milk, 100 percent fruit or vegetable juices and plain water. Tier 2 foods and beverages are different from Tier 1 in that they do not necessarily offer a full serving of fruits, vegetables, whole grains, or low-fat or nonfat dairy, but they do meet certain nutrient criteria. Tier 2 includes foods such as baked potato chips, low-sodium whole-wheat crackers, animal cracker cookies, graham crackers, and low-salt pretzels. Tier 2 beverages are non-caffeinated, non-fortified beverages with less than 5 calories per serving and they may or may not be artificially sweetened, carbonated, or flavored. Tier 1 foods and beverages are offered at all grade levels at all times in the school day. Tier 2 foods and beverages are offered only at the high school level after the end of the school day.
The committee’s standards are intended to ensure that competitive snacks, foods, and beverages complement the school lunch and breakfast meals, and that they contribute to the development of lifelong healthy eating patterns. Together, the Guiding Principles and the two Tiers form the basis of the committee’s recommended nutrition standards for competitive foods and beverages in schools. These standards have two objectives: to encourage consumption of healthful foods and beverages and to limit consumption of dietary components that either fall outside the recommendations of the Dietary Guidelines or are not optimal for the diets or health of school-age children.
Standards for Nutritive Food Components
The standards contain specified ranges for fat, energy, added sugars, and sodium, and are the committee’s recommendation based on available scientific evidence: Snacks, foods, and beverages meet criteria for dietary fat per portion: no more than 35 percent of total calories from fat; less than 10 percent of total calories from saturated fat; and zero trans fat. Snacks, foods, and beverages provide no more than 35 percent of calories from total sugars per portion with the exception of: 100 percent fruits and juices and 100 percent vegetables and juices, with juice portions being 4-ounce servings for elementary and middle schools and 8-ounce servings for high schools; unflavored nonfat and low-fat milk and yogurt. Snack or a la carte side items are 200 calories or less per portion and a la carte entree items do not exceed calorie limits on comparable school meal program items. Snack items meet a sodium content limit of 200 mg or less per portion or 480 mg or less per entree portion as served a la carte.
Standards for Nonnutritive Food and Beverage Components
Beverages containing nonnutritive sweeteners (sugar substitutes) are only allowed in high schools after the end of the school day. Because of the uncertainties and limitations in evidence, especially concerning safety and benefits for weight control, the committee does not recommend a standard for sugar substitutes in foods. Foods and beverages are caffeine-free, with the exception of trace amounts of naturally occurring caffeine-related substances, such as may be present in chocolate.
Standards for the School Day
Foods and beverages offered during the school day are limited to those in Tier 1. Plain, potable water is available throughout the school day at no cost to students. Sport drinks are not available in the school setting except when provided by the school for student athletes participating in sport programs involving vigorous activity of more than one hour’s duration.
Foods and beverages are not used as rewards or discipline for academic performance or behavior. Marketing of Tier 2 snacks, foods, and beverages in the high school setting is minimized by locating Tier 2 distribution in low student traffic areas and ensuring that the exterior of vending machines does not depict commercial products or logos or suggest that consumption of items conveys a health or social benefit.
Standards for the After-School Setting
Tier 1 snack items are allowed after school for student activities for elementary and middle schools. Tier 1 and 2 snacks, foods, and beverages are allowed after school for high school. For on-campus fund-raising activities during the school day, Tier 1 foods and beverages are allowed for elementary, middle, and high schools; Tier 1 and 2 foods and beverages are allowed for high schools after school. For evening and community activities that include adults and students, Tier 1 and 2 foods and beverages are encouraged.
The committee also made recommendations for actions to implement the nutrition standards and these are discussed in chapter 6 of the report.
In conclusion, the traditional school nutrition programs ensure that students have access to healthful foods. These programs are the main source of nutrition provided at school. However, when an opportunity arises for students to select competitive snacks, foods, and beverages, it should encourage greater consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products. The recommendations from the committee ensure that competitive foods and beverages are consistent with the DGA and encourage children and adolescents to develop life-long healthful eating patterns.
Thank you for the opportunity to testify. I would be happy to address any questions the Committee might have.
Guiding Principles and Recommended Standards
The committee recognizes that:
1. The present and future health and well-being of school-age children are profoundly affected by dietary intake and the maintenance of a healthy weight.
2. Schools contribute to current and life-long health and dietary patterns and are uniquely positioned to model and reinforce healthful eating behaviors in partnership with parents, teachers, and the broader community.
3. Because all foods and beverages available on the school campus represent significant caloric intake, they should be designed to meet nutrition standards.
4. Foods and beverages have health effects beyond those related to vitamins, minerals, and other known individual components.
5. Implementation of nutrition standards for foods and beverages offered in schools will likely require clear policies; technical and financial support; a monitoring, enforcement, and evaluation program; and new food and beverage products.
The committee intends that:
6. The federally reimbursable school nutrition programs will be the primary source of foods and beverages offered at school.
7. All foods and beverages offered on the school campus will contribute to an overall healthful eating environment.
8. Nutrition standards will be established for foods and beverages offered outside the federally reimbursable school nutrition programs.
9. The recommended nutrition standards will be based on the Dietary Guidelines for Americans, with consideration given to other relevant science-based resources.
10. The nutrition standards will apply to foods and beverages offered to all school-age children (generally ages 4 through 18 years) with consideration given to the developmental differences between children in elementary, middle, and high schools.
Standards for Nutritive Food Components
Standard 1: Snacks, foods, and beverages meet the following criteria for dietary fat per portion as packaged:
• No more than 35 percent of total calories from fat;
• Less than 10 percent of total calories from saturated fats; and
• Zero trans fat.
Standard 2: Snacks, foods, and beverages provide no more than 35 percent of calories from total sugars per portion as packaged.
• 100-percent fruits and fruit juices in all forms without added sugars;
• 100-percent vegetables and vegetable juices without added sugars; and
• Unflavored nonfat and low-fat milk and yogurt; flavored nonfat and low-fat milk with no more than 22 grams of total sugars per 8-ounce serving; and flavored nonfat and low-fat yogurt with no more than 30 grams of total sugars per 8-ounce serving.
Standard 3: Snack items are 200 calories or less per portion as packaged and á la carte entrée items do not exceed calorie limits on comparable NSLP items.
Standard 4: Snack items meet a sodium content limit of 200 mg or less per portion as packaged or 480 mg or less per entrée portion as served for á la carte.
Standards for Nonnutritive Food Components
Standard 5: Beverages containing nonnutritive sweeteners are only allowed in high schools after the end of the school day.
Standard 6: Foods and beverages are caffeine free, with the exception of trace amounts of naturally occurring caffeine-related substances.
Standards for the School Day
Standard 7: Foods and beverages offered during the school day are limited to those in Tier 1.
Standard 8: Plain, potable water is available throughout the school day at no cost to students.
Standard 9: Sports drinks are not available in the school setting except when provided by the school for student athletes participating in sport programs involving vigorous activity of more than 1 hour’s duration.
Standard 10: Foods and beverages are not used as rewards or discipline for academic performance or behavior.
Standard 11: Minimize marketing of Tier 2 foods and beverages in the high school setting by:
• Locating Tier 2 food and beverage distribution in low student traffic areas; and
• Ensuring that the exterior of vending machines does not depict commercial products or logos or suggest that consumption of vended items conveys a health or social benefit.
Standards for the After-School Setting
Standard 12: Tier 1 snack items are allowed after school for student activities for elementary and middle schools. Tier 1 and 2 snacks are allowed after school for high school.
Standard 13: For on-campus fundraising activities during the school day, Tier 1 foods and beverages are allowed for elementary, middle, and high schools. Tier 2 foods and beverages are allowed for high schools after school. For evening and community activities that include adults, Tier 1 and 2 foods and beverages are encouraged.
Actions for the Implementation of Nutrition Standards in Schools
Action 1: Appropriate policy-making bodies ensure that recommendations are fully adopted by providing:
• Regulatory guidance to federal, state, and local authorities;
• Designated responsibility for overall coordination and oversight to federal, state, and local authorities; and
• Performance-based guidelines and technical and financial support to schools or school districts, as needed.
Action 2: Appropriate federal agencies engage with the food industry to:
• Establish a user-friendly identification system for Tier 1 and 2 snacks, foods, and beverages that meet the standards per portion as packaged; and
• Provide specific guidance for whole-grain products and combination products that contain fruits, vegetables, and whole grains.