1. Increasing plant-based menu items within Lee County Public Schools
PUBH Service-based learning activity
Rosemarie Hemmings, PhD student
Walden University
Environmental Health
PUBH
Dr. Howard E. Rubin
November 5, 2010
Lee County Public Schools offer some plant-based menu items but due to the obesity and overweight issues which face our children, it is the goal of this presentation to evoke a thought provoking discussion among school board members regarding whether or not more could be done as it relates to what is offered on the menu within our schools.

2. Objectives Understand why poor nutrition is a problem.
Understand why the problem exist.
Identify where schools fit in.
Identify benefits of increasing plant-based-menu options.
Identify barriers to increasing plant-based menu options.
Identify opportunities.
As school board members it is important for you to understand why the nutrition of the students for whom you are concerned about matters. Making a change to the current menu of the schools will not be an easy task and it is my hope that despite the barriers presented, that you will discover through the opportunities presented that change is feasible and worth the health of our children.

3. Why is poor nutrition a problem?
Almost 34 percent of children and adolescents are considered overweight or at risk of being overweight (Musher-Eizenman et al., 2010, p. 186).
Sixty percent of children who are overweight have at least one cardiovascular risk factor (Musher-Eizenman et al., 2010, p. 186).
Musher-Eizenman, D. R., Young, K. M., Laurene, K., Galliger, C., Hauser, J., & Wagner Oehlof, M. (2010). Children’s sensitivity to external food cues: How distance to serving bowl influences children’s consumption. Health Education and Behavior, 37, 186. doi: 10:1177/
It has been mentioned in the media regarding childhood obesity so I am sure most of you may not be surprised at the numbers. It is important to have a good understanding of what the numbers mean for the future of our children. Many health risk are associated with obesity and these risk are not reserved for adults only.

4. Why is poor nutrition a problem continued
Childhood obesity has more than doubled over the past three decades for ages 2 to 5 and 12 to 19(Mathematica Policy Research, Inc, 2010).
Childhood obesity has more than tripled for children aged 6 to 11(Mathematica Policy Research, Inc, 2010).
In 2005 more than one-fourth of Florida’s children were overweight or obese (Florida House of Representative, 2006).
Florida House of Representative. (2006). HR Retrieved from Florida House of Representative website:
Mathematica Policy Research, Inc. (2010). Nutrition policy research. Retrieved from Mathematica Policy Research, Inc website:
If you take a look at the numbers, you see that ages 6 to 11 has had the most significant increase which correlates with the elementary school years. We must ask ourselves what is taking place during this period both environmentally, physically, and socially, This could be a crucial period for schools to target their efforts to address nutritional needs.

5. Why is poor nutrition a problem continued
Obesity in childhood contributes to physical, social and emotional wellbeing of children (Mayo Clinic, 2010).
Type 2 diabetes, high cholesterol, high blood pressure, sleeps disorders, early puberty or menstruation are physical complications of childhood obesity (Mayo Clinic, 2010).
Low self-esteem, bullying, depression, behavior and learning problems are social and emotional complications as a result of childhood obesity (Mayo Clinic, 2010).
Mayo Clinic. (2010). Childhood obesity. Retrieved from Mayo Clinic website:
There are many factors of a child’s wellbeing that is affected by being overweight and obese and I have included a few on the slide. The effects of obesity fall in the categories of physical, social, and or emotional. Keep in mind that all of these categories may occur at the same time. The reality is that children who are overweight or obese have a harder time moving physically, are more likely to be teased/bullied and therefore will have emotional difficulties. Add to these, medical complications and we have a generation of children who may have difficulties fitting into a learning environment.

6. Why does the problem exist?
Not enough exercise and increase calorie intake
Consuming diets high in fat and sugar
Childhood obesity is a complex issue which involves genetic and hormonal causes but as per the Mayo Clinic (2010), the main cause relates to eating too much and not getting enough exercise. The reduction and or removal of physical education within our schools, increase time spent watching television and playing video games has limited the opportunities for our children to participate in physical activities.
Reference
Mayo Clinic. (2010). Childhood obesity. Retrieved from Mayo Clinic website:

7. Why does the problem exist continued
Most children do not eat the recommended daily 3 ½ to 5 cups of fruits and vegetables (Produce for Better Health Foundation([PBHF], 2005).
Produce for Better Health Foundation. (2005). Promoting fruits and vegetables in schools: Wellness policy opportunities ( ). Retrieved from Produce for Better Health Foundation website:
A diet which contains more fruits and vegetables is less likely to contribute to being overweight or obese. We have heard many times that eating healthy can be more expensive than eating unhealthy foods. As a result of this, our children may not have the benefit within their home environments to consume the recommended daily intake of these healthy alternatives.

8. Where do schools fit in?
Approximately 2.2 million breakfast and 7.2 million lunches are served in Lee County public schools each year (The School District of Lee County, 2010).
Seventy percent of students were enrolled in the free and/or reduced lunch program in 2009/10 school year (The School District of Lee County, 2010).
The School District of Lee County. (2010). Factoids. Retrieved from The School District of Lee County website:
Lee County public school is a an environment where most students consume one to two meals per day five days per week. As a result, the schools play a crucial role in meeting the nutritional needs of students.

9. Where do schools fit in continued
Food consumption in the school setting contributes significantly to student’s diet (Condon, Crepinsek, & Fox, 2009).
Access to fruits and vegetables is positively associated to adolescences consumptions of these items (Di Noia & Contento, 2010).
Condon, E. M., Crepinsek, M. K., & Fox, M. K. (2009, February). School meals: Types of foods offered to and consumed by children at lunch and breakfast. Journal of American Dietetic Association, 2suppl,
Di Noia, J., & Contento, I. R. (2010, June). Fruit and vegetable availability enables adolescent consumption that exceeds national average. Nutrition Research, 30(6), doi: 10:1016/j.nutres
Studies have shown that environment and access play a role in what children eat and therefore if schools offered healthier foods such as plant-based menu items, children are more likely to consume these items as part of their overall nutritional intake( Brownell et al., 2010).
Reference
Brownell, K. D., Kersh, R., Ludwig, D. S., Post, R. C., Puhl, R. M., Schwartz, M. B., & Willett, W. C. (2010, March). Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs, 29(3), doi: 10:1377/hlthaff

10. Benefits of increasing plant-based menu items
Fruits and vegetable contributes to decreased risk of chronic disease such as cardiovascular disease and type 2 diabetes (PBHF, 2005).
Fruits and vegetables can help with achieving a healthy weight as these items are lower in calorie content than high fat/sugar/sodium foods and drinks (PBHF, 2005).
Provides the option of eating something different from the norm.
Produce for Better Health Foundation. (2005). Promoting fruits and vegetables in schools: Wellness policy opportunities ( ). Retrieved from Produce for Better Health Foundation website:
I am sure many of you if not all at some point or another have been told of the benefits of increasing plant-based foods into your diet. We have even heard President Bill Clinton talk about how he lost weight by switching to a plant-based diet in order to undo some of the damage done to his cardiovascular health. Many of our children may not have access to plant-based foods in their home environment for various reasons and therefore having access to these items in the school setting would expose them to something new and healthy options.

11. Benefits of increasing plant-based menu items continued
Helps provide low fat and cholesterol free foods (Physicians Committee for Responsible Medicine (PCRM, 2008).
Incorporates taste for foods that are nutritious at an early age which can carry into adulthood (PCRM, 2008).
Including one plant-based meal a week can be the start to correcting poor nutrient intake (Physicians Committee for Responsible Medicine (PCRM, 2008).
Physicians Committee for Responsible Medicine. (2008). Health school lunches. Retrieved from Healthy school lunches.org website: healthyschoolluches.org
By increasing plant-based menu items within our schools we help in creating a learning environment within the lunch room. When children are exposed to foods that are different from what they are used to consuming, it allows for an opportunity for them to learn that plant-based foods can taste good and is good for them. Such learning can translate into permanent changes to their eating habits as they share their learning with their families.

12. Barriers More expensive.
Vegetarian food/alternative protein are not part of the commodity program.
Location and presentation of plant-based menu items may deter students from consuming these items.
The Farm to School program offers fruits and vegetables to schools thereby helping student’s nutrition by offering low cost locally grown fruit and vegetables. Some plant-based options are cheaper than others and I will discuss these items later. Location of plant-based foods may influence choice. A study conducted by Musher-Eizenman et al. (2010) demonstrated that when nutrient dense foods were placed in closer proximity to children it decrease the intake of energy dense foods. How we market and present plant-based menu items is equally important as the location of these items in the cafeteria.
Reference
Musher-Eizenman, D. R., Young, K. M., Laurene, K., Galliger, C., Hauser, J., & Wagner Oehlof, M. (2010). Children’s sensitivity to external food cues: How distance to serving bowl influences children’s consumption. Health Education and Behavior, 37, 186. doi: 10:1177/

13. Opportunities
Congress has expanded commodity food. purchases to include increase whole grains (PCRM, 2008).
Congress authorized increase in funding for purchases of fruits and vegetables (PCRM, 2008).
Physicians Committee for Responsible Medicine. (2008). Health school lunches. Retrieved from Healthy school lunches.org website: healthyschoolluches.org
There are several changes that have occurred on the federal level in an attempt to improve the nutrition of students who participate in school meals. These changes are as a result of the increasing problem of childhood obesity. As school board members you have an opportunity to make changes to the nutritional options by examining how changes on the federal level could be of benefit.

14. Opportunities continued
National School Lunch Program [NSLP] approved alternative protein products [APPs] which means schools can offer meatless foods such as vegetarian burgers (PCRM, 2008).
Physicians Committee for Responsible Medicine. (2008). Health school lunches. Retrieved from Healthy school lunches.org website: healthyschoolluches.org
Although NSLP now allows these items, they are not covered under the commodities market where the schools obtain subsided meals.

15. Opportunities continued
The Healthy School Meal Act of 2010 (HR.4870) if approved aims to include plant-based options in schools lunches and breakfast, increase access and make it affordable by providing incentives to schools who offer plant-based options. Provisions include purchasing of plant-based alternative protein products by USDA which schools could purchase through the commodities program as they do other foods (PCRM, 2008).
Physicians Committee for Responsible Medicine. (2008). Health school lunches. Retrieved from Healthy school lunches.org website: healthyschoolluches.org
This act could help to revolutionize options offered within our schools. It would help to decrease the barrier related to cost of providing more plant-based options. This is a great time to call your local congress person to ask them to vote for Healthy School Meal Act of 2010.

16. Suggested plant-based menu items
Veggie burger
Bean chili
Black beans and rice
Rice burritos
Veggie chili
Nuts, seeds, and dried fruits for snack machines are a healthy alternative to chips and cookies
Soy milk
Earlier I stated that I would give some recommendations for plant-based menu items because I think it is important for you to see some examples of what would be constituted as plant- based options. Items such as veggie burger may pose more difficulties due to cost but bean chili and black beans and rice are relatively inexpensive plant-based meals to prepare.

17. Conclusion
Recognizing that one fourth of Florida’s children were either obese or overweight, the Florida House of Representatives passed a resolution designating “Healthy Schools Lunch Year”. The resolution was designed to promote healthy foods such as vegetarian options into the school lunch programs (Florida House of Representative, 2006). We must ask ourselves, did we and are we maximizing the 2006 resolution to the full benefit of our students and if the answer is no, then it is time to step up our efforts and make the nutritional wellbeing of Lee County public school children a priority so that we do not contribute to a future generation of overweight and obese adults.
Florida House of Representative. (2006). HR Retrieved from Florida House of Representative website:
As school board members I hope you have developed new knowledge regarding the benefits of increasing plant-based menu items within our schools but more importantly I hope that a conversation will begin as to how you can help to improve the nutritional health of children who attend our schools. Thank you attending this presentation.

18. References
Brownell, K. D., Kersh, R., Ludwig, D. S., Post, R. C., Puhl, R. M., Schwartz, M. B., & Willett, W. C. (2010, March). Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs, 29(3), doi: 10:1377/hlthaff
Condon, E. M., Crepinsek, M. K., & Fox, M. K. (2009, February). School meals: Types of foods offered to and consumed by children at lunch and breakfast. Journal of American Dietetic Association, 2suppl,
Di Noia, J., & Contento, I. R. (2010, June). Fruit and vegetable availability enables adolescent consumption that exceeds national average. Nutrition Research, 30(6), doi: 10:1016/j.nutres
Florida House of Representative. (2006). HR Retrieved from Florida House of Representative website:
Mathematica Policy Research, Inc. (2010). Nutrition policy research. Retrieved from Mathematica Policy Research, Inc website:

19. References
Mayo Clinic. (2010). Childhood obesity. Retrieved from Mayo Clinic website:
Musher-Eizenman, D. R., Young, K. M., Laurene, K., Galliger, C., Hauser, J., & Wagner Oehlof, M. (2010). Children’s sensitivity to external food cues: How distance to serving bowl influences children’s consumption. Health Education and Behavior, 37, 186. doi: 10:1177/
Physicians Committee for Responsible Medicine. (2008). Health school lunches. Retrieved from Healthy school lunches.org website: healthyschoolluches.org
Produce for Better Health Foundation. (2005). Promoting fruits and vegetables in schools: Wellness policy opportunities ( ). Retrieved from Produce for Better Health Foundation website:
The School District of Lee County. (2010). Factoids. Retrieved from The School District of Lee County website:

20. Additional resources
Finkelstein, D. M., Hill, E. L., & Whitaker, R. C. (2008, July). School food environments and policies in U.S. public schools. American Academy of Pediatrics, 122(1), doi: 10:1542/peds
Fox, M., Hedley Dodd, A., Wilson, A., & Gleason, P. M. (2009, February). Association between school food environment and practice and body mass index of U.S. public school children. Journal of American Diabetic Association, 109(2), doi: 10:1016/j.jada
Schultz, C. R. (2010). Removing junk food and beverages from school vending machines. Retrieved from

21. Additional resources continued
United States Department of Agriculture. (2010). List of vegetarian USDA commodity foods. Retrieved from USDA website:
Wallinger, D. (2010, March). Agricultural policy and childhood obesity: A food systems and public health commentary. Health Affairs; Chevy Chase, 29(3),