Eating at School - Patterns, Challenges and Opportunities

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1 Eating at School - Patterns, Challenges and Opportunities Presented by: Allison Karpyn, PhD November 17,

2 Overview Brief introduction to The Food Trust Overview of Eating at School Summary of the many opportunities and challenges in making changes Brief discussion of other community based efforts of the Trust Corner Store Initiative

3 The Food Trust Mission - Ensuring everyone has access to affordable, nutritious food Increasing access - Supermarket Campaign, Corner Store Initiative, Farmers Markets Nutrition Education - School Nutrition Education, Kindergarten Campaign, Farm to School Policy/Advocacy: Menu Labeling, Trans fat ban, school beverage policy etc. Research: Internal and external Consulting TA related to core programming and evaluation.

4 Eating at School: The Critical, Fundamental Question Are our children, especially those at risk for hunger, eating the right amount of the right kinds of foods to maintain a healthy diet?

5 47% Eating at School : Where are the opportunities? REIMBURSABLE SCHOOL MEALS COMPETITIVE FOODS FOOD BROUGHT IN FROM OUTSIDE 35% Breakfast Lunch Snack Twilight meals A la carte items School stores Teacher rewards Vending Class parties Fundraisers Etc. Corner Store Food Food Prepared at Home Fast Food 17% 26% daily energy obtained and consumed at school, for average child R.R. Briefel, A. Wilson and P.M. Gleason, Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants, J Am Diet Assoc 109 (suppl 1) (2009), pp. S79 S90.

Corner Store Youth Purchasing to/from School 53% shop once a day 42% shop 2 times/day 356.6 kcal per purchase from snacks/beverages Students spent $1.

6 Corner Store Youth Purchasing to/from School 53% shop once a day 42% shop 2 times/day kcal per purchase from snacks/beverages Students spent $1.07 on 2 items per purchase from corner stores Borradaile KE, Sherman S, Vander Veur S. et al. Snacking In Children: The Role of Urban Corner Stores. Pediatrics. 2009; 124 (5).

7 Reimbursable School Meals Over 40 percent of children who are certified for free meals come from families earning under $10,000 a year.

8 Philadelphia Public School Breakfast Menu Monday Tuesday Wednesday Thursday Friday 15 Rice Krispies Graham Crackers Grape Juice 1% Milk 16 Cinnamon Raisin Bagel Assorted Jelly Orange Juice 1% Milk 17 Blueberry Muffin Pineapple Juice 1% Milk 18 Cherry Yogurt Graham Crackers Apple Juice 1% Milk 19 Breakfast Round Blended Fruit Juice 1% Milk CALORIES PROTEIN(GM) 14.4 CALCIUM(MG) IRON(MG) 2.3 VITAMIN A(RE) VITAMIN C(MG) 47.5 SAT FAT OF % 7.4 TOTAL FAT OF % 20.7

9 Philadelphia Public School Lunch Menu Monday Tuesday Wednesday Thursday Friday Cheese Ravioli Chicken Nuggets w/creamy Tomato Sauce Potato Rounds Peach Cup Milk BBQ Sauce Applesauce Cup Milk 17 Meatballs & Sauce or Beef Hot Dog w/tri Tators Hot Dog Bun Mixed Fruit Cup Milk 18 Toasted Ham & Cheese on White Bread or Turkey on a Seeded Bun Pear Blended Fruit Juice Milk 19 5" Round Pizza or Beef Patty on a Bun Baby Carrots Ranch Dressing Blended Fruit Juice Milk CALORIES: PROTEIN:27.5g CALCIUM: IRON:3.2 VITAMIN A: VITAMIN C: 11.8 SAT FAT OF CAL % 11.2 TOTAL FAT OF CAL % 27.3

What s in the bag? Top 10 items 10. Bottled Water 9.

10 What s in the bag? Top 10 items 10. Bottled Water 9. Doritos, Nacho Cheese (1oz) 8. Charms Blow Pops 7. Bubbaloo Gum 6. Andy Capps, Cheddar Fries (1oz) 5. Water Ice, small 4. Sour Patch Kids 3. Peanut Chews 2. Cheetos, Flamn Hot, crunchy (1oz) 1. Hug (8oz) Borradaile KE, Sherman S, Vander Veur S. et al. Snacking In Children: The Role of Urban Corner Stores. Pediatrics. 2009; 124 (5).

11 To Promote the Health and Wellbeing of our Nations Children Lunch Breakfast Number participants mil 11.1 mil 79% free, 71% * 45% of those Participation rate (free/red) reduced ADP eating lunch Federal Reimbursement Free $2.74 $1.76 Reduced $2.34 $1.46 Paid $0.28 $0.26 National Cost (2009) 9.8 Billion 2.9 Billion * Most Needy Districts, >60% Free/reduced lunch prior year, 40% Breakfast

12 School Lunch Participation Trends The Pressure Cooker: School Meals Face rising Costs and participation, Oct 2009, School Nutrition Association,

13 School Breakfast Participation Trends The Pressure Cooker: School Meals Face rising Costs and participation, Oct 2009, School Nutrition Association,

$in Americas Big Cities, FRAC, 2007 http://www.frac.org/pdf/urbanbreakfast07.$

14 To Promote the Health and Wellbeing of our Nations Children School Breakfast in Americas Big Cities, FRAC,

15 School meal participation and BMI

16 Do school meals contribute to, or protect from, overweight? School Breakfast participation: - Associated with lower BMI, but small effect (.75), (Gleason et al.) - Others (Millimet, 2010) found null or modestly beneficial effects, selection bias a problem. - Effect despite increased consumption of baked goods. - BMI change likely due to more even distribution of daily energy intake. -. Philip Gleason, Ronette Briefel, Ander Wilson, and Allison Hedley Dodd. School Meal Program Participation and Its Association with Dietary Patterns and Childhood Obesity. Princeton, NJ: Mathematica Policy Research, July Document No. PR09-41, 170 Pages. Millimet D, Briefel RR, Tchernis R., Husain M. School Nutrition Programs and the Incidence of Childhood Obesity. J of Human Resources, Vol 45 (3), 2010,

17 Do school meals contribute to, or protect from, overweight? Lunch participation associated with: No or detrimental connection to BMI the NSLP is contributing to the [obesity] problem (Millimet, p. 653) But some find modest positive influences on dietary intake Reduced intake of sugar sweetened beverages (Elem. and Sec.), Increased F & V intake in elem schools that offer it daily ; NOT french fries. (Briefel et al) Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of US public school children. J Am Diet Assoc.2009;109(suppl 1):S91-S107. (2009a) Millimet D, Briefel RR, Tchernis R., Husain M. School Nutrition Programs and the Incidence of Childhood Obesity. J of Human Resources, Vol 45 (3), 2010,

18 Do school meals contribute to, or protect from, overweight? Cole and Fox (2008) NHANES analysis: NSLP participants ate more nutrient-dense lunches. More milk, fruits, and vegetables and less salty snacks and sweetened beverages at lunch. Cole B, Fox MK. Diet quality of American school-age children by school lunch participation status: Data from the National Health and Nutrition Examination Survey, Alexandria, VA: Food and Nutrition Service. July 2008.

19 Competitive Foods

20 Competitive foods Evidence that limiting access to competitive foods improves diets 99% of high schools, 97% of middle schools and 83% of elementary schools have vending machines, school stores or snack bars (FRAC) Largely exempt from federal standards now School wellness policies may regulate, but No Enforcement Competing priorities, cost contained operation and food sales = revenue Larson N, Story M. Are Competitive Foods Sold at School Making Our children Fat?. Health Affairs 29, No 3 (2010):

School Nutrition Policy Initiative Establishing School Health/Wellness Councils Completing School Health Index and School Health Action Plan Initiating social marketing, Insuring that all foods meet

21 School Nutrition Policy Initiative Establishing School Health/Wellness Councils Completing School Health Index and School Health Action Plan Initiating social marketing, Insuring that all foods meet guidelines, Integrating 50 hours of nutrition education, Conducting 10 hours of teacher nutrition training, and Involving family members and the community. Tool Kit Available online at:

22 School Nutrition Policy Findings 50% decrease in the incidence of overweight 15% became overweight in control schools vs. 7.5% in intervention No effect on obesity incidence, prevalence Intervention funded by SNAP Ed Unadjusted Incidence Remission and Prevalence of Overweight (85 th -95 th ) at 2yrs Foster GD, Sherman S, Borradaile KE, et al. A policybased school intervention to prevent overweight and obesity. Pediatrics. 2008; 121(4). Available at:

23 Healthy Corner Store Initiative Youth leadership, education Mini-Corner Store Conversions Training and Technical Assistance for Corner Store Owners Local Distribution Systems

24 Promising Practices & Recommendations 1. Enforce wellness policies 2. Breakfast as part of the school day 3. Meal participation rates on school report cards 4. Increase reimbursement 5. Universal free 6. Re-evaluate procurement practices (School Food Focus) 7. School Nutrition Policy Initiative Integrated nutrition education School wellness councils Standards and accountability for competitive foods 8. Farm to School Programming 9. Corner Store Campaign

25 Research Recommendations 1. What strategies are most effective in upgrading the food consumed from the line? $, strategic procurement support, educational approaches, farm to school (and community engagement), taste testing 2. In what ways can marketing/merchandizing/placement influence consumption/participation in schools, and at stores? 3. Cross Disciplinary Studies diet, educational achievement, behavioral outcomes 4. How do we engage the taxpayer?

26 Allison Karpyn, PhD

The Grocery Excursion

Transparency/Blackline Master Grade 5 Day 38 Standard 5.NBT.7 The Grocery Excursion Name: Date: You are visiting your grandparents for one week and have been given $200 to purchase groceries for the three