1. Improving the School Nutrition Environment
Tanisha D. Belton, MPH student
Walden University
PUBH
Instructor: Dr. Rebecca Heick
Winter 2010
My presentation is aimed at parents and teachers of school districts. This presentation may be fit for a “home and school” meeting which they are both involved in. Good Evening, my name is Tanisha Belton and I plan to talk to you all about improving the school nutrition environment.

2. Learning Objectives
Understand the problems associated with lack of adequate school nutrition
Policies in place to address the issue
Current programs
Challenges faced
What role can you play?
In this presentation I plan to address the problem which is associated with the lack of an adequate school nutrition environment, the policies that are in place, current programs in several states, challenges faced, and steps that can be taken to combat the issue. Let’s begin:

3. Introduction Childhood obesity is a growing problem
15% of children and teens ages 6 to 19 are overweight
15% are at risk of becoming overweight
Reference:
Centers for Disease Control and Prevention (CDC) (2004). Overweight Among U.S. Children and Adolescents. National Health and Nutrition Examination Survey. Retrieved on January 20, 2010 from
Obesity in the United States has been labeled an epidemic by the Centers for Disease Control and Prevention (CDC) and the Surgeon General has said that overweight and obesity may soon cause as much preventable disease and death as cigarette smoking. Fifteen percent of children and teens ages 6 to 19 are overweight and another 15% are at risk of becoming overweight—triple the rate of only 20 years ago (CDC, 2004). School food policies have become a component of public health efforts to reduce the increasing rates of childhood obesity (Cullen & Watson, 2009).

4. Primary and Secondary School Nutrition
Time for developing dietary habits
Harder to change once in middle school
Children obtain about one-third of their total daily energy requirements at school
Should expend 50% of daily energy expenditure
References:
Eliassen, E.,Wilson, M. (2007) Selecting Appropriate Elementary Nutrition Education Resources. American Journal of Health Studies, Vol. 22, Issue 4
Metos, J., Nanney, M. (September 2007). The Strength of School Wellness Policies: One State’s Experience. Journal of School Health, Vol. 77, No. 7
The elementary school years are an ideal time to encourage the development of healthy food behaviors in children. These years are a key period for developing dietary habits and food preferences; habits and patterns of eating become more difficult to change once children enter middle school (Eliassen & Wilson, 2007). Children obtain about one-third of their total daily energy requirements from school lunch and should expend about 50% of their daily energy expenditure while at school (Metos and Nanney, 2007). The importance of establishing a comprehensive school nutrition environment that supports a good overall diet and adequate physical activity is recognized by several Healthy People 2010 objectives. Participation in the school lunch program has declined, while competing foods and beverages have emerged. In 2000, food and beverage items were sold to children from vending machines, school stores, and a la carte lines in 74% of middle schools, and 43% of elementary schools (Metos and Nanney, 2007).

5. Policy Implementation
The Child Nutrition Reauthorization Act (CNRA) of 2004
Mandated local education agencies to adopt and implement local wellness policies
Limited funding
Not made a priority
References :
Metos, J., Nanney, M. (September 2007). The Strength of School Wellness Policies: One State’s Experience. Journal of School Health, Vol. 77, No. 7
Stahlberg, A., Howley, N., Luscri, L. (October 2008). A National Snapshot of Local School Wellness Policies. Journal of School Health, Vol. 78, No. 10
In response to the growing awareness of the school environment’s influence on nutritional intake and physical activity of the majority of the nation’s students, the Child Nutrition Reauthorization Act (CNRA) of 2004 included a school wellness component requiring school districts to develop a wellness policy by July 1, 2006 (Metos and Nanney, 2007). CNRA addresses the growing obesity epidemic by mandating local education agencies to adopt and implement local wellness policies. This mandate has provided an extraordinary opportunity to benefit students’ health and learning by changing social practices regarding nutrition and physical activity (Stahlberg, Howley, and Luscri, 2008). Unfortunately, given that legislation did not provide funding to assist with development, implementation and monitoring of school wellness policies, institutionalizing the wellness policies faces a number of challenges (Stahlberg et al., 2008). School districts face budgetary challenges with pressure to devote scarce resources toward meeting academic performance goals, leaving limited time and funds to devote to improvements in student health, although progress has been made, it remains difficult to make wellness practices a school priority (Stahlberg et al., 2008). Let’s take a look at what some states already have in place to address school nutrition environment.

6. Current Programs Texas Public School Nutrition Policy
Changes in foods served to students
Utah School Districts
78% followed federal guidelines
22% did not follow guidelines for competitive foods
References:
Metos, J., Nanney, M. (September 2007). The Strength of School Wellness Policies: One State’s Experience. Journal of School Health, Vol. 77, No. 7
Cullen, K., Watson, K. (April 2009) The Impact of the Texas Public School Nutrition Policy on Student Food Selection and Sales in Texas. American Journal of Public Health, Vol. 99 No. 4
Examining several current programs shows the impact that improving the school nutrition environment has. The Texas Public School Nutrition Policy was implemented in fall 2004; the evaluation was done two years after this implementation. The policy did affect the foods served and sold to students during the first year of implementation; fewer portions of high-fat vegetables were served to students from the school lunch program line (Cullen and Watson, 2009). Further evaluation was done on the Utah school districts to examine the changes made as a result of the CNRA. It was found that 78% of Utah school districts complied with the federal guidelines; however, 22% of the school districts did not follow the guidelines for competitive foods (Metos and Nanney, 2007). A variety of state-level policies were chosen by school districts, but food guidelines such as altering pricing to encourage healthy food consumption or offering fruits and vegetables where all foods are sold were rarely incorporated. This shows that school districts are not able or ready to make this type of change even though it is shown to be effective (Metos and Nanney, 2007). This state’s experience indicates that compliance with the CNRA may be a positive step toward improving the school nutrition environment.

7. Challenges Lack of support Limited funding Board members
Administrators
Parents and Students
Limited funding
References:
Brown, K., McCormack, A., Tabia H., Pitt, S., McDermott, R., Berends, V., Agron, P., Purcell, A. (February 2004) California School Board Members' Perceptions of Factors Influencing School Nutrition Policy: Journal of School Health, Vol. 74, Issue 2
Greves, H.M., Rivara, F. (January 3, 2006). Report card on school snack food policies among the United States' largest school  districts in 2004–2005: Room for improvement. International Journal of Behavioral Nutrition and Physical Activity, 3:1
Let’s take a look at some of the barriers when it comes to a change in the school’s nutrition environment. One barrier was the lack of priority among school district administrators to address child nutrition. Respondents from nutrition services in some districts described their struggle to find support among administrators or school board members to champion the cause for improving nutrition, particularly given the burden of increasing requirements for achieving academic benchmarks (Greves and Rivara, 2006). Another barrier in some districts were parents and students who resisted changes to the school's food and drink offerings, wanting to protect students' "free will" in choosing what they eat, even if it is unhealthy. These aforementioned barriers are likely to remain an issue for school districts as they move forward to adopt and implement Wellness Policies (Greves and Rivara, 2006).
A study was conducted in California which assessed California school board members' attitudes, perceptions, and motivations related to enactment of policies that support healthy eating in schools; and barriers to adopting school policies that support healthy eating (Brown et al., 2004). Community, family, parent, school staff, food service, and school board factors all are salient when addressing school nutrition issues. Parents’ lack of knowledge about the policy-making process was reported as a "significant" factor for 43% of respondents; however, 26% did not consider this factor "significant." Board members believed lack of school staff most directly related to the health professions also were significant factors when addressing school nutrition issues (Brown et al., 2004). As mentioned earlier legislation did not provide funding to assist with the creation of wellness policies and budgets do not cover wellness policies.

8. Recommendations for action
Increase the amount of healthy alternatives
Make food accessible and attractive
Encourage increased consumption of fruits & vegetables
References:
O'Toole, T. P., Anderson, S., Miller, C., Guthrie, J. (October 2007).Nutrition Services and Foods and Beverages Available at School: Results From the School Health Policies and Programs Study Journal of School Health, Vol. 77, Issue 8
States, districts, and schools should examine their food-related policies and consider policies to decrease access to foods and beverages that are low in nutrients and high in fats and sugars, and they should also consider strategies for making healthier alternatives more accessible and attractive to students in terms of appearance, taste, and cost (O’Toole, Anderson, Miller, and Guthre, 2006). Given the wide availability of foods and beverages, schools should encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products whenever students have opportunities to eat and drink (O’Toole et al., 2006).

9. Summary Policies are in place Support is needed!
Make your voice count!
The information presented has shown that there is a growing problem in the United States. Its is important to note that there is a policy in place to address the issue and there are groups and organizations willing to help combat this issue. Further support is needed from the top to the bottom. The voices of parents, teachers, and board members are needed to be heard so that it is understood that it matters whether change occurs in schools today. To learn more about what some organizations are doing please visit (next slide).

10. Further Readings School Nutrition Association www.schoolnutrition.org
Action for Healthy Kids
US Department of Agriculture (USDA)
Pennsylvania School Food Service Association
The Food Trust
The above listed sites can give guidance on what you can do in your area to help with this issue.

11. Thank you!
Thank you for taking the time out to listen to this information. I hope that something presented in this presentation was useful to you and can be helpful to the children in our schools.

12. References
Brown, K., McCormack, A., Tabia H., Pitt, S., McDermott, R., Berends, V., Agron, P., Purcell, A. (February 2004) California School Board Members' Perceptions of Factors Influencing School Nutrition Policy: Journal of School Health, Vol. 74, Issue 2
Centers for Disease Control and Prevention (CDC) (2004). Overweight Among U.S. Children and Adolescents. National Health and Nutrition Examination Survey. Retrieved on January 20, 2010 from
Cullen, K., Watson, K. (April 2009) The Impact of the Texas Public School Nutrition Policy on Student Food Selection and Sales in Texas. American Journal of Public Health, Vol. 99 No. 4
Eliassen, E.,Wilson, M. (2007) Selecting Appropriate Elementary Nutrition Education Resources. American Journal of Health Studies, Vol. 22, Issue 4
Greves, H.M., Rivara, F. (January 3, 2006). Report card on school snack food policies among the United States' largest school  districts in 2004–2005: Room for improvement. International Journal of Behavioral Nutrition and Physical Activity, 3:1
Metos, J., Nanney, M. (September 2007). The Strength of School Wellness Policies: One State’s Experience. Journal of School Health, Vol. 77, No. 7
O'Toole, T. P., Anderson, S., Miller, C., Guthrie, J. (October 2007).Nutrition Services and Foods and Beverages Available at School: Results From the School Health Policies and Programs Study Journal of School Health, Vol. 77, Issue 8
Stahlberg, A., Howley, N., Luscri, L. (October 2008). A National Snapshot of Local School Wellness Policies. Journal of School Health, Vol. 78, No. 10