1. Improving School Nutrition in U.S.
Hello parents and teachers of California , my name is Cam-Thu Do and I would like to welcome you here today. Today’s focus will be on school nutrition. For this presentation, I will be presenting to you information about school nutrition in the U.S. and the health effects that it has on adolescents. First of, I would like to go over the topic itinerary.
School Nutrition
By: Cam-Thu Do

2. Topic Outline for School Nutrition in the U.S.
Adolescent Nutrition Needs & Benefits
Nutrition in Schools
Health Effects of Nutrition in Adolescents
Tools for Successful Implementation of School Nutrition Intervention
Barriers Associated with Nutritional Interventions
To start my presentation, I would like to go over some of the needs of adolescent nutrition and the benefits associated with good and poor food choices. Then, I will mention some nutritional statistics of adolescent food choices. Following that, I will present to you the negative health outcome of poor nutrition food choices, such as heart disease, type II diabetes and obesity. Then I will shift gears and move on to some interventions that schools can implement to improve the nutritional intake of adolescents. At the end of my presentation, I would like to address some of the barriers associated with implementing nutritional programs in school environments.

3. Adolescent Nutritional Needs and Benefits
Five or more servings of fruits and vegetables
Sufficient intake of water per day
Proper servings of grains, dairy, healthy fats and animal products
The nutritional needs of adolescents are based off of the food pyramid, which was established by the U.S. Department of Agriculture in The food pyramid offers a general nutritional guidance based on the 5 different food groups. One thing that is not mentioned on the food pyramid is that fat consumption should consist mainly of healthy fats such as monounsaturated fats compared to saturated and trans fat which can increase the risk for heart disease. According to an article titled “Adolescent Nutrition: Needs and Recommendations for Practice” by Marilyn Massey-Stokes, total fat consumption over several days should not exceed 30% of total calorie intake. We will see how this value changes compared to the School Lunch Program in the next few slides. Another fact that should be mentioned is that proper serving size of each food group is highly recommended for a healthy diet.
Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,
United States Department of Agriculture (2010). Retrieved on April 22, 2010 From

4. Adolescent Nutritional Needs and Benefits
Nutritional Benefits
Improve learning abilities
Improve problem solving abilities
Improve self-esteem and motivation
Improve self image
According to Marilyn Massey-Stokes, the nutritional benefits of a healthy diet can improve the learning abilities of students allowing them to focus in school and perform at their optimum level. Improvements in problem solving and critical-thinking abilities are crucial in adolescent development. Development of critical thinking skills will further be beneficial in adulthood. A healthy nutritional diet can also lead to a better self-image and also increased self esteem and motivation in adolescents. This will help prevent the onset of eating disorders, which we will discuss in the next few slides.
Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,

5. School Nutrition Statistics
23.9% of students eat five or more servings of fruits and vegetables
18% drink 3 or more glasses of water per day
42.7% of students were trying to lose weight
32.7% of elementary school, 71.3% of middle school and 89.4% of high school had vending machines, or school store to purchase food and beverage
4% of sates require schools to make fruits and vegetables available for purchase
The School Lunch Program nutritional guideline includes >=30% of the calories from fat and 1/3 RDA for Vitamin A, Vitamin C, iron, calcium and calories.
School Nutrition
Statistics on food consumption, school food options and school lunch program
The statistics of actual food consumption of adolescent is lacking in nutrition and could result in drastic health effects. According to the Centers of Disease Control and Prevention, the percentage of non-nutritious food options in schools are increasing from 32.7% in elementary school to 89.4% in high schools. The food options that are available through vending machines are usually high in sugar, low in nutritional value and high in calorie intake. As a result, the nutritional intake is decreased. The total calorie from fat intake from the School Lunch Program is greater than or equal to 30% per day. Comparing this statistic to Marilyn Massey-Stokes value of no more than 30% calorie intake from fat over several days differ drastically.
Centers for Disease Control and Prevention: School Health Policies and Programs Study (2006). Retrieved April 20, 2010 from
U.S. Department of Agriculture: National School Lunch Program (2010). Retrieved April 20, 2010 from
Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,

6. Health Effects of Poor School Nutrition
Chronic Disease Risk
Increased risk for heart disease
Increased risk for type II diabetes
Increased risk for cancer development
Overweight and Obesity
Increased risk for eating disorders
Increased risk for depression
Increased risk for adulthood obesity
Poor nutrition can lead to the development of chronic diseases such as heart disease, cancer and type II diabetes. Factors that increase the risk of developing chronic disease and obesity includes sedentary lifestyle, poor diet and genetics. According to Wechsler et al, in 2002, an estimated of 50% of new type II diabetes are among children or adolescents. As mentioned earlier, adolescent obesity increases the risk for adulthood obesity, which in turn can decrease the quality of life. Adolescent obesity has become an epidemic within the last few decades. An estimated of 11% of U.S. adolescents are categorized as being overweight and another 14% of U.S. adolescents are at risk for obesity Wechsler et al estimates that 25% of adult obesity cases are carried over cases from adolescent obesity. The medical cost of obesity in the United States is approximately $117 billion according to Wechsler et al.
Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,
Wechsler, H., McKenna, M., Lee, S., Dietz, W. (2004). Overweight among Children and Adolescents. National Association of State Boards of Education, 7, 4-12.
Story, M., Neumark-Stzainer, D., Sherwood, N., Holt, K., Sofka, D., Trowbridge, F., Barlow S. (2002). Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills and Training Needs Among Health Care Professionals. Pediatrics, 110,

7. Risk Factors Associated with Heart Disease
Age
Gender
Heredity
Tobacco Smoking
High Blood Pressure
High Cholesterol
Physical inactivity
Obesity
Diabetes
Risk Factors Associated with Heart Disease
As I have just mentioned in the previous slide, one of the negative health outcome of poor school nutrition is heart disease. According to the Centers for Disease Control and Prevention (CDC), smoking tobacco has a two times higher risk for heart disease than non-smokers. Nicotine raises blood pressure and carbon monoxide reduces the amount of oxygen the blood carries. There are a wide variety of risk factors for heart disease that includes genetic, behavior and also environment. Statistics from the CDC also indicate that males have a higher risk for heart disease than females. Some of the risk factors for heart disease can be prevented, while others are not. Age, gender, heredity are factors that cannot be control and behavioral choices such as tobacco smoking and exercise can be controlled. Blood pressure, cholesterol, obesity and diabetes are health conditions in which the environment and lifestyle choices can influence the onset.
Centers for Disease Control and Prevention: Heart Disease Conditions (2010). Retrieved on April 20, 2010 from

8. Risk Factors Associated with Adolescent Obesity
Behavioral
Physical activity
Food Preference
Cultural norms
Psychosocial
Educational Attainment
Socioeconomic status
Environmental
Availability of fast food chain
Food choices offered in educational institutions
Another health outcome associated with poor school nutrition is adolescent obesity. There are three main risk factors associated with obesity and they are behavioral, psychosocial and environmental. Behavioral factors that increase the risk of adolescent obesity is poor physical activity, poor choices in food selection and also cultural norms. Behavioral factors can be modified to decrease the risk of developing adolescent obesity. The next factor is psychosocial. According to Merten et al,adolescent obesity can affect adult life socioeconomic achievements that could result in low level of career and educational attainment. The third factor that can place adolescents at higher risk for development of obesity is the environment. The availability of fast food along with the low nutrient food offered in school can increase the risk for adolescent obesity. Brennan Davis and Christopher Carpenter, author of “Proximity of Fast-Food Restaurants to Schools and Adolescent Obesity” revealed that the risk for adolescent obesity is increased if there is a fast food restaurant located at least one half of a mile near an educational institution.
Merten, M., Wickrama, K., & Williams, A. (2008). Adolescent Obesity and Young Adult Psychosocial Outcomes: Gender and Racial Differences. J Youth Adolescence, 37,
Davis, B., Carpenter, C. (2009). Proximity of Fast-Food Restaurants to School and Adolescent Obesity. American Journal of Public Health, 99,

9. School Nutrition Interventions
Health Education
Physical Education
Health Services
Nutrition Services
Counseling, Psychological and Social Services
Healthy School Environment
Health promotion for staff
Family and community involvement
Interventions used for school nutrition will utilize a multifaceted approach. Educating individuals from student to staff to parents and the community about nutrition will increase the chances that the school nutrition requirements will be improved and implemented. Health education and physical education are included in the school nutritional intervention because over 95% of young people are enrolled in educational institutions, which makes it more necessary for schools to provide health education and physical education. Health and nutritional services will allow student to seek addition information about nutrition, while counseling, psychological and social services will help students cope with low self esteem, eating disorders and depression. Providing a healthy school environment by promoting educational nutrition for staff members of the educational institution will encourage staff members to motivate students about healthy nutritional choices. Nutrition is not limited to school institutions, but it carried over to home environments, that is why it is very important to include family and the community in school nutrition interventions. By doing so, school nutrition interventions are more likely to succeed and the healthy nutrition standard will be more likely to be accepted.
Wechsler, H., McKenna, M., Lee, S., Dietz, W. (2004). Overweight among Children and Adolescents. National Association of State Boards of Education, 7, 4-12.

10. Barriers to Implementing a School Nutrition Intervention
Defining Healthy Eating
Strengthen Environment
Simplify and clarify healthy eating habits
Modify messages in advertisement and food choices to encourage healthy eating
Educating staff, students, family and community on how to improve nutrition
Educating students on media literacy
Utilizing peer leaders and peer educators to motivate students to eat healthy
Educate students on the benefits of an active lifestyle
Defining healthy eating in terms that are easily understood by adolescents will improve their understanding of the importance of nutrition for their health and development. Financial strains will be a challenge that must be overcome in order to reallocate resources to educating staff, students, family and the community on the importance of school nutrition. Strengthening the environment to promote physical activity and maintaining a healthy lifestyle will require teachers to educate the students on media message fallacies in order to allow the students to be knowledgeable about their food choices. Providing peer leaders and peer educators the opportunity to motivate students to change their unhealthy behavior will reduce the risk of students from developing chronic diseases and obesity in adulthood.
Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,
Wechsler, H., McKenna, M., Lee, S., Dietz, W. (2004). Overweight among Children and Adolescents. National Association of State Boards of Education, 7, 4-12.

11. Tools for Successful Implementation of School Nutrition Intervention
Coordinate School Health Program (CSHP)
School Health Council (SHC)
School Health Index: A self- Assessment and Planning Guide (SHI)
Tools for Successful Implementation of School Nutrition Intervention
The Centers for Disease Control and Prevention (CDC) offers funding for the establishment of a new infrastructure to implement a Coordinated School Health Program (CSHP) to provide guidance on on school nutrition. According to Wechsler et al, an estimated of 23 states are currently receiving funding from the CDC to implement CSHP. The goal of CSHP is to promote physical exercise and healthy eating. Establishment of a School health Council (SHC) will allow key stake holders such as parents, teachers, students, school staff, health care providers, social service professionals and many others the opportunity to provide input into the discussion topic of school nutrition and what standards should be implemented. The last one, the School Health Index: A self-Assessment and Planning Guide (SHI) helps identify potential weaknesses and strengths associated with a change in policy or standard. It is an evaluation step that will instruct the members of the SHC in the right direction in order to lead to success of the health policy or practice.
Wechsler, H., McKenna, M., Lee, S., Dietz, W. (2004). Overweight among Children and Adolescents. National Association of State Boards of Education, 7, 4-12.

12. Overview of School Nutrition
Adolescent Nutrition Needs & Benefits
Adequate intake of the 5 food groups from the food pyramid
Improved school performance
Nutrition in Schools
Lack of nutrient rich food in educational institutions
Health Effects of Nutrition in Adolescents
Chronic diseases
Obesity and overweight
Tools for Successful Implementation of School Nutrition Intervention
Coordinate School Health Program (CSHP)
School Health Council (SHC)
School Health Index (SHI)
Barriers Associated with Nutritional Interventions
Defining healthy eating
Strengthen environment
School nutrition is an important factor for adolescent health and development. The food pyramid is used as a guide for daily food intake. The benefits associated with good school nutrition can result in improved school performance, decrease depression, improved self esteem as well as reduce risk for chronic diseases and obesity. The nutrition offered in schools today are lacking nutrient rich food choices. Several tools can be utilized for the implementation of school nutrition intervention. These tools include the Coordinate School Health Program, School Health Council and the School Health Index. Some of the barriers that are associated with the implementation of school nutritional interventions includes defining healthy eating in a simple way for adolescents to understand and also strengthening the environment through education and peer leaders. Again, we must keep in mind that in order to implement a school nutritional intervention, a multifaceted approach is needed which involved students, educational staff, parents, health care providers to work together to achieve the goal. At this point in time I would like to spend the next few minutes and open the floor up for any questions you may have in regards to school nutrition.

13. Reference List
[1] Massy-stokes, M. (2002). Adolescent Nutrition: Needs and Recommendations for Practice. The Clearing House, 75,
[2] United States Department of Agriculture (2010). Retrieved on April 22, 2010 From
[3] Centers for Disease Control and Prevention: School Health Policies and Programs Study (2006). Retrieved April 20, 2010 from
[4] U.S. Department of Agriculture: National School Lunch Program (2010). Retrieved April 20, from
[5] Wechsler, H., McKenna, M., Lee, S., Dietz, W. (2004). Overweight among Children and Adolescents. National Association of State Boards of Education, 7, 4-12.
[6] Story, M., Neumark-Stzainer, D., Sherwood, N., Holt, K., Sofka, D., Trowbridge, F., Barlow S. (2002). Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills and Training Needs Among Health Care Professionals. Pediatrics, 110,
[7] Centers for Disease Control and Prevention: Heart Disease Conditions (2010). Retrieved on April 20, 2010 from
[8] Merten, M., Wickrama, K., & Williams, A. (2008). Adolescent Obesity and Young Adult Psychosocial Outcomes: Gender and Racial Differences. J Youth Adolescence, 37,
[9] Davis, B., Carpenter, C. (2009). Proximity of Fast-Food Restaurants to School and Adolescent Obesity. American Journal of Public Health, 99,
I would like to thank everyone for attending my presentation. I have included on this a slide a complete reference list in chronological order to the slide in which I presented them. In addition, I would like to include additional resources in the next slide that I will present in which additional information can be obtained regarding the speech topic of school nutrition and its impact on adolescent health.

14. [1] Gordon, A. , Devaney, B. , Burghardt, J. (1995)
[1] Gordon, A., Devaney, B., Burghardt, J. (1995). Dietary Effects of the National School Lunch Program and the School Breakfast Program. American Journal of Clinical Nutrition, 61, 221S-231S.
[2] Pinhas-Hamiel, O., Standiford, D., Hamiel, D., Dolan, L., Cohen, R., Zeitler, S. (1999). The Type 2 Family: A Setting for Development and Treatment of Adolescent Type 2 Diabetes Mellitus. Arch Pediatr Adolesc Med., 153,
[3] Rosenbloom, A., Joe, J., Young, R., Winter, W. (1999). Emerging Epidemic of Type 2 Diabetes in Youth. Diabetes Care, 22,
[4] Schwimmer, J., Burwinkle, T., Varni, J. (2003). Health-Related Quality of Life of Severely Obese Children and Adolescents. JAMA, 289,
[5] Story, M., Neumark-Stzainer, D., Sherwood, N., Holt, K., Sofka, D., Trowbridge, F., Barlow S. (2002). Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills and Training Needs Among Health Care Professionals. Pediatrics, 110,
Additional Resources
Listed above are several additional research articles of health consequences of adolescent nutrition.

15. Questions
Once again, I would like to thank everyone for coming and have a wonderful day.