1. Menu Planning – Nutrition Best Practices ODE CNP June 2011

2. GOAL CACFP menus can be enhanced – Institute of Medicine Recommendations – 2010 Dietary Guidelines “Best Practices” in menu planning

3. Change in Obesity Rates* Sources: Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among U.S. adults, 1999–2008. JAMA. 2010;303(3): 235-241. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among U.S. children and adolescents, 1999– 2000. JAMA. 2002;288 (4):1728-1732. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007–2008. JAMA. 2010;303(3):242-249. Centers for Disease Control and Prevention. U.S. Obesity Trends. Available at: http://www.cdc.gov/obesity/data/trends.html. Accessed August 12, 2010. [Note: State prevalence data based on self-report.]http://www.cdc.gov/obesity/data/trends.html Dietary Guidelines for Americans, 2010, Chapter 2, page 10, Table 2.1 OBESITY THENOBESITY NOW In the early 1970s, the prevalence of obesity was 5% for children ages 2 to 5 years, 4% for children ages 6 to 11 years, and 6% for adolescents ages 12 to 19 years. In 2007–2008, the prevalence of obesity reached 10% for children ages 2 to 5 years, 20% for children ages 6 to 11 years, and 18% for adolescents ages 12 to 19 years. In the late 1970s, 15% of adults were obese.In 2008, 34% of adults were obese In the early 1990s, zero States had an adult obesity prevalence rate of more than 25%. In 2008, 32 States had an adult obesity prevalence rate ofmore than 25%.

4. CACFP SPONSORS AND FAMILY DAY CARE HOME PROVIDERS SERVING MENUS IN ALIGNMENT WITH 2010 DIETARY GUIDELINES AND THE INSTITUTE OF MEDICINE RECOMMENDATIONS OFFER MORE NUTRITIOUS FOOD CHOICES TO CHILDREN IN CARE Key Message:

5. Institute of Medicine (IOM) Recommendations Dietary Guidelines for Americans, 2010 Child Nutrition Reauthorization

6. Child Nutrition Reauthorization (Healthy, Hunger-Free Kids Act of 2010) Spring 2012Proposed rule published Fall 2013Final rule published

7. Effective Immediately and no later that October 1, 2011 Implement these changes: – 1% or non-fat milk for children ages 2 and older May be flavored or unflavored Meet State and local standards – Whole milk should be served to children under the age of 2 (no change in requirements) – Potable water readily available Is not part of the reimbursable meal and may not be served in lieu of milk Encourage to serve water when no other beverage is being served

8. Achieving “Best Practices” in Menu Planning Minimum Required Practice: Menus meet CACFP meal pattern requirements.

9. Good Practice: Menus meet CACFP meal pattern requirements and include basic menu planning principles such as: 1.Strive for balance 2. Emphasize variety 3. Add contrast 4. Think about color 5. Consider eye appeal

10. Achieving “Best Practices” in Menu Planning Best Practice: Menus meet CACFP meal pattern requirements, Menus include basic menu planning principles and, Menus include recommendations from the Institute of Medicine and 2010 Dietary Guidelines.

11. Six Key Recommendations Increase the variety of fruits and vegetables Increase the proportion of whole grains Decrease the amount of solid fats and trans fats Decrease the amount of added sugars Decrease the amount of sodium Increase the variety of foods offered for snack

12. Recommendation #1 Increase the variety of fruits and vegetables: – Offer dark green vegetables weekly – Offer deep orange vegetables weekly – Offer legumes (dried beans & peas) weekly – Limit starchy vegetables weekly – Offer other vegetables weekly (include additional vegetables at lunch & supper) – Offer unsweetened 100% juice < 1 time per day

13. Recommendation #2 Increase the proportion of whole grains: – ½ grains/breads offered are whole grain The product ingredient listing lists whole grains first, specifically: – Non-mixed dishes (i.e. breads, cereals): “whole grain” must be the primary ingredient by weight – Mixed dishes(i.e. pizza, corn dogs): Whole grains must be the primary grain ingredient by weight (a “whole grain” is listed is the first grain ingredient in the list).

14. Recommendation #3 Decrease solid fats and trans fats: Choose non-fat or 1% dairy products Choose lean meats Reduce the amount of grain-based desserts, pizza, processed meats, fried foods and regular fat cheeses. Choose foods with nutrition labels that are labeled as containing 0 trans fat.

15. Recommendation #4 Decrease added sugars: Choose fruits and juices free of added sugar Serve ready-to-eat breakfast cereals with < 6 gm sugar/dry oz of cereal Limit to < 1 serving per week baked or fried grain products (donuts, sweet rolls) that are high in added sugars.

16. Recommendation #5 Limit the amount of sodium: Limit highly salted meat, poultry, and fish and breaded fried products to <1 time per week Prepare foods with less salt Use no salt at the table

17. Recommendation #6 Increase the variety of foods offered for snack: – Vary throughout the week the components offered for snack. – Provide water as a beverage when milk is not one of the components for snack

18. Adapted from Child and Adult Care Food Program, Aligning Dietary Guidance For All, Institute of Medicine of the National Academies, The National Academies Press, Chapter 7, page 122, table 7-5 Regular Snack Menu Sample template Food GroupMondayTuesdayWednesdayThursdayFriday Fruit1 serving fruit0 00 Vegetable01 serving orange vegetable 001 serving non- starchy vegetable Cereals/grains/breads01 serving refined grain 01 serving whole grain 0 Lean meat or meat alternate001 serving0 Non-fat or 1% milk1 serving00 0 WaterOffer/Make Available One Idea for a Weekly Snack Menu Template

19. Menu Evaluation Take out the Menu Activity Handout: Compare week 1 lunch and snack menus with week 2 lunch and snack menus.  Which snack menu would meet “best practices”?  Which lunch menu would meet “best practices”?

20. Six Key Recommendations  Increase the variety of fruits and vegetables  Increase the proportion of whole grains  Decrease the amount of solid fats and trans fats  Decrease the amount of added sugars  Decrease the amount of sodium  Increase the variety of foods offered for snack

21. Revising Menus to Meet Nutrition Best Practices Take out the “Nutrition Best Practices Menu Activity” #2. Using the 6 key recommendations to guide you, make as many revisions as you can in 5 minutes. In your packet is a list of fruits, vegetables, and whole grains for menu ideas. Remember that the menu must meet CACFP meal pattern requirements.

22. Revising Menus to Meet Nutrition Best Practices Using the 5 Basic Menu Planning Principles listed in the next slide and on your Nutrition Best Practices checklist take 5 minutes to evaluate the menus you have planned to determine that you have included the Menu Planning Principles in your menu.

23. Meal Pattern Menu Planning 5 Basic Menu Planning Principles 1. Strive for balance 2. Emphasize variety 3. Add contrast 4. Think about color 5. Consider eye appeal

24. Other Suggestions for Best Practices in Menu Planning Use cycle menus – Generally 4-6 weeks – Accommodates seasonal foods – Encourages variety Use new USDA recipes (June 2009) – Lower in fat, sugar and sodium

25. SUMMARY What is required for menus to be reimbursable for USDA CACFP? Menus ( Minimum Required Practice) –m–must meet CACFP Meal Pattern Requirements for the meal served (including non-fat or 1% milk) –w–working menu shows specific foods that were served –m–minimum portions served according to the age group served –s–supporting documentation available

26. How Might Menus Be Improved? Menus (Good Practice) –m–meet CACFP Meal Pattern Requirements – include the 5 Basic Menu Planning Principles Menus (Best Practice) –m–meet CACFP Meal Pattern Requirements –i–include the 5 Basic Menu Planning Principles –I–Include the 6 Key Recommendations from the IOM and 2010 Dietary Guidelines

27. Remember Effective immediately and no later than October 1, 2011, Sponsors must serve non-fat or 1% milk to children ages 2 and older. Potable water must be available and Sponsors are encouraged to serve water for snack when no other beverage is served.

28. Except for the requirements regarding non-fat and 1% milk, the “Best Practices” recommendations are not required. When new guidance comes out from USDA regarding meal pattern changes, you will be notified with a memo from ODE.

29. Links To Recommendations Institute of Medicine CACFP Meal Pattern Recommendations http://iom.edu/Reports/2010/Child-and-Adult-Care- Food-Program-Aligning-Dietary-Guidance-for- All/Report-Brief.aspx Dietary Guidelines for Americans, 2010 http://www.cnpp.usda.gov/dietaryguidelines.htm USDA Recipes for Child Care http://teamnutrition.usda.gov/Resources/childcar e_recipes.html

30. SUMMARY Effective immediately and no later than October 1, 2011, Sponsors must serve non-fat or 1% milk to children ages 2 and older. Potable water must be available and Sponsors are encouraged to serve water for snack when no other beverage is served. Spring 2012 – Proposed rule on CACFP meal pattern Fall 2013 – Final rule on CACFP meal pattern

31. THE END