Regulations for Nutrition Standards for Competitive

Foods in Schools

February 9, 2011

2

Childhood Obesity in Massachusetts

• Children 2-5 years old – 18.4% “at risk of overweight” and 15.4% “overweight” (WIC Program 2007)

• Middle School Students– 17% overweight and 10% obese (2009 MA YHS)

• High School Students– 15% overweight and 11% obese (2009 YRBS)

• Low-income Black and Hispanic youth/adolescents – Black 18%, Hispanic 15% and White 9% (obesity only, 2009 YRBS)

• BMI screening data on 109,674 students in grades 1, 4, 7 and 10– 16.9% overweight and 17.3% obese (2008-2009)

3

MA Students with BMI for Age in Overweight/Obese Category by Grade & Gender,

2008-2009

32.9

39.737.7

32.331.0

35.533.5

28.6

0

10

20

30

40

Grade 1 Grade 4 Grade 7 Grade 10

Per

cen

t

Male FemaleSource: MDPH, Bureau of Community Health, Access and Prevention, Division of Primary Care and Health Access, School Health Unit

4

5

Childhood Obesity and Median Household Income

0

5

10

15

20

25

30

35

40

45

50

$0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $180,000

Median Household Income (2000 Census Data)

% O

verw

eigh

t or O

bese

Chi

ldre

nChildhood Obesity is Not

Randomly Distributed

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Increasing Population Impact

Increasing IndividualEffort Needed

Lasting Protective Interventions

Clinical Interventions

Counseling &Education

Changing Context to Support Healthy Default Decision Making

Socioeconomic Factors

Health Impact Pyramid

Adapted from T. Frieden, AJPH, April 2010

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Policy, Systems and Environmental Change Strategies to Support

Healthy Eating in Schools

Policy Changes• School Nutrition Regulations

System Change• School policies and practices that support healthy

eating campus-wide 24/7

Environmental Changes• Healthy foods available in vending machines, school

stores or served in cafeterias

School Nutrition Bill Provisions

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Overview of Key Elements of Bill

• Requires nutritional standards for “competitive foods” in public schools

• Requires regulations to promote school wellness advisory committees

• Requires training of public school nurses in screening and referral for obesity, diabetes and eating disorders

• Establishes Commission on School Nutrition and Childhood Obesity

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Definition of Competitive Foods

• All food/beverages not part of school breakfast, lunch and CACFP programs– A la carte lines– School stores– Snack bars– Vending machines– Fundraising activities– School sponsored events

• Excludes non-sweetened carbonated water

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Establish Nutritional Standards

• DPH to issue regulations establishing standards for competitive food/beverages– Based on dietary recommendations from HHS,

USDA, AHA, IOM, School Nutrition Association of MA, American Dietetic Association

• Apply to competitive foods sold 30 minutes before through 30 minutes after the school day

• Update standards every 5 years in consultation with ESE

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Possible Exceptions

• Food/beverages sold up to 30 minutes before or 30 minutes after school day– School district may choose to apply standards

beyond this time frame

• DPH may make exceptions for– Booster sales– Concession stands– School-sponsored or school-related fundraisers

and events

Nutrition Standards for Competitive Foods and Beverages

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Standards Development

• Interagency workgroup– DPH obesity prevention and school health staff– DESE health and nutrition staff– John Stalker Institute at Framingham State– Boston Public Health Commission– Harvard School of Public Health

• Multiple sources of information– Institute of Medicine Nutrition Standards for Foods in

Schools– MA Action for Healthy Kids– Alliance for a Healthier Generation– MA Public Health Association– MA School Nutrition Association– MA Executive Order 509 – Other states – CA, CT, MI, WV, PA, RI

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General Nutrition Standards – Specified in Statute

1. Plain water readily available during school day at no cost

2. Offer fresh fruits/non-fried vegetables wherever food is sold (except vending machines)

3. Make nutrition info available for non-prepackaged foods by August 2013 (except fresh fruits/vegetables, food/beverages sold at booster sales and other school sponsored events)

4. Prohibit use of fryolators in preparing competitive foods

5. Ensure food preparation and all foods/beverages meet state and federal food safety guidelines

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Competitive Food Standards - Beverages

Proposed Massachusetts Standard Institute of Medicine

Juice

100 % fruit or vegetable juice with no added sugar

Elem and middle – 4 oz serving; High – 8 oz serving

Same

Milk and Milk Substitutes

All milk/milk substitutes (incl. lactose free and soy milk) shall be low fat (1%) or fat-free

8 oz serving

Meet USDA standards for fluid milk and milk substitutes

Flavored milk ≤ 22 g sugar/8 oz

Same

Water

Water without added sugars, sweeteners, artificial sweeteners, but can contain natural flavoring and/or carbonation

Same except no carbonation or natural flavors

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Competitive Food Standards - Beverages

Proposed Massachusetts Standard Institute of Medicine

Other Beverages

No beverages other than juice, milk, milk substitutes and water shall be sold or provided

For High School after school: allows non-caffeinated, non-fortified beverages with less than 5 calories per portion, with or without non-nutritive sweeteners

Beverages with added sugar or sweeteners

These will be phased out by August 2013, except for flavored milk or milk substitutes that contain same amount or less sugar than plain fat-free or low-fat milk.

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Competitive Food Standards - Food

Proposed Massachusetts Standard Institute of Medicine

Calories

Limit 200 calories per item, except for a la carte entrees, which shall not exceed calories in comparable National School Lunch Program entrees

Same

Fat, Saturated Fat, Trans Fat

No more than 35% of total calories from fat

No more than 10% of total calories from saturated fat

All foods shall be trans fat free

Exception – 1 oz of nuts, nut butters, seeds or reduced fat cheese

Same except for the nut/cheese exception

Sugar

No more than 35% of total calories from total sugars, except•Non-fat or low-fat yogurt with maximum of 30g sugar/8 oz•100% added fruit with no added sugar

Same

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Competitive Food Standards - Food

Proposed Massachusetts Standard Institute of Medicine

Sodium

No more than 200 mg per item

Exception: no more than 480 mg per item for a la carte entrees

Same

Grains

All bread and other grain-based products shall be whole grain Same for snack items but no guideline for a la carte entrees

Artificial sweeteners

No artificial sweeteners allowed. Not mentioned

Caffeine

No more than trace amounts of caffeine allowed. Same

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Proposed Guideline Topics

• Easy-to-read chart of the guidelines with examples for each category

• List of foods and beverages that meet the guidelines (similar to the MA Action for Healthy Kids “A List” of approved foods and beverages)

• Alternatives for school fund raising activities• Recommendations to create and support a healthy

school environment, e.g., lunch duration• Alternatives for healthy celebrations • Rationale for selected nutrition standards

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Implementation Assistance

• DPH to work with DESE in implementation of nutritional standards

– Training in nutrition and diet for food/ nutrition service directors

– Assessment of school’s capacity, resources, equipment to prepare recommended foods

Possible Financial Implications of Nutrition Standards

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What do we know?

• The majority of studies and reports have found that schools implementing healthier competitive foods have not had decreases in overall revenue

• Profitable healthy fundraising alternatives abound– Events such as car washes, fun

runs, walk-a-thons, raffles– Sales of non-food items such as

calendars, greeting cards, flowers/plants, personal care products, wrapping paper

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On the Horizon

• National efforts– USDA school lunch nutrition standards– USDA competitive food nutrition standards– First Lady’s Let’s Move Cities and Towns

• Other state wide initiatives– Mass in Motion Municipal grants– Act FRESH Campaign– Healthy People, Healthy Economy

25

Timeline

Activity Schedule

Public Health Council February 9, 2011

Public Hearings and public comment period

March 2011

Public Health Council for final vote

Late spring

Implementation August 1, 2012

26

Acknowledgements

• Internal DPH work group– Laura York– Chris Nordstrom– Cynthia Bayerl– Diana Hoek– Paula Dobrow– Howard Saxner– Lauren Smith

• John Stalker Institute– Karen McGrail

• Boston Public Health Commission– Kathy Cunningham

• DESE staff – John Bynoe– Katie Millett– Carol Goodenow– Linda Fischer– Mary Anne Gilbert– Rita Brennan Olson

• Harvard School of Public Health– Eric Rimm– Juliana Cohen– Jessica Garcia

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Commission Membership

– Commissioner of DMH– Commissioner of Agricultural Resources– MA Association of School Superintendents– MA Secondary School Administrators Association– MA Nutrition Board– MA Association for Health, Physical Education, Recreation– American Heart Association– American Diabetes Association– MA Parent Teachers Association– Chair, Student Advisory Council – MA American Academy of Pediatrics– MA School Nutrition Association– Representative of food/beverage industry– 6 members appointed by Senate President & House Speaker