THE POWER OF SCHOOL BREAKFAST. Keith T. Ayoob, EdD, RDN, FADN Albert Einstein College of Medicine March 4, 2018

Transcription

1 THE POWER OF SCHOOL BREAKFAST Keith T. Ayoob, EdD, RDN, FADN Albert Einstein College of Medicine March 4, 2018

2 Disclosures General Mills Bell Institute of Health & Nutrition Pure Circle Stevia Institute Chobani Monsanto Calorie Control Council The Glutamate Society

3 Past clients Want Disney Corporation Dannon United Soybean Board Unilever Cranberry Marketing Commission Florida Citrus Commission Haas Avocado Board Dairy Boards of: New England Alaska Idaho Midwest, and lots of others Council for Responsible Nutrition Tchotchke recipient: pens, pads, keyrings, tote bags, refrigerator magnets, wooden spoons, spatulas, recipe cards, cook books, cell phone & laptop chargers, an apple wedger

4 EATING BREAKFAST DAILY So why do we care?

5 Skipping Breakfast: It starts young 9-year-old white students 23% 77% 9-year-old Af-Am students 43% 57% Skipping breakfast: common in young children Disproportionately common among minority children Ate BKFST Skipped BKFST Basch VCE Skipped BKFST Basch CE. J School Health, 2011

6 2011 REVIEW: Breakfast Consumption Among Urban Minority Youth Over ½ of high school students skipped breakfast the day of the survey 1 in 5 4 th -graders skipped breakfast a/o lunch >3x/week Urban students: TWICE as likely to skip breakfast Basch CE J of School Health 2011

7 Skipping Breakfast: A bad habit gets worse with age 19-yr-old White students 68% Ate BKFST 32% Skipped BKFST 9-yr-old Afr-Am girls 78% Ate BKFST 22% Skipped BKFST Breakfast consumption declines as students age Even worse for minority youth NOTE: Absolute disparities decreased with age, but relative disparities increased Basch CE. J School Health, 2011

8 Building a Culture of WELLNESS Starts with BREAKFAST

9 GOAL: Ensuring That Every Child Is Ready to Learn

10 Children s DIETS lack enough: Fruits & vegetables Low-fat dairy Whole grains

11 BREAKFAST: A UNIQUELY NUTRITIOUS MEAL Tends to be the most nutrient-rich meal. Ideal time for filling dietary gaps: Fruit Low-fat dairy Whole grains Nutrients lost when breakfast is skipped: These nutrients are usually NOT made up the rest of the day.

12 How Breakfast Helps Learning It s Food for Thought!

13 SKIPPING BREAKFAST IMPAIRS LEARNING

14 Hungry kids can t learn NOT just a factor of income Among low-income families, hungry kids are more likely to: Repeat a grade Receive special ed services Show objectively measurable emotional, behavioral, academic problems Kleinman et al, Pediatrics 101(1) 1998

15 GOT HUNGER? GOT TROUBLE. BREAKFAST SKIPPERS AND BEHAVIOR

16 Breakfast & grades Odds of below average grades Boys Girls Controlled for: parental education level, family structure, dieting, smoking, soft drink intake DIRECT relationship between SKIPPING breakfast & poor grades Lien L. Public Health Nutrition, 2006

17 Breakfast & mental distress Odds ratios 95% CI Boys Girls Controlled for: parental education level, family structure, dieting, smoking, soft drink intake DIRECT relationship between SKIPPING breakfast & higher mental distress Lien L. Public Health Nutrition, 2006

18 Breakfast & behavior problems BK skippers Behavioral problems BK eaters 9 th & 10th graders Self-reported diet & behavior 70% decrease in likelihood of behavioral problems in students who ate breakfast regularly Or: 250% GREATER likelihood in breakfast skippers Not true for any other meal Overby & Hoigaard Food & Nutr Research, 2012

19 Breakfast & cognitive function 2.4 points* Regularly-eaten breakfast associated with improved cognitive function by 2.4 points Regularly-eaten breakfast predicted improved cognitive function *on LOTCA Almomani et al, Scand J Occ Ther 2013

20 Breakfast eaters score higher Standardized test scores Spelling Reading Math Day-of-the-test breakfast eaters vs. skippers SIGNIFICANTLY higher scores in spelling, reading, math when breakfast was eaten (WIAT) BK skippers BK eaters Ptomey, et al. JACN, 2016

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22 2013 review: The impact of habitual breakfast Better on-task classroom behavior. Habitual breakfast & school breakfast programs: POSITIVE effect on academic performance Best results: math/arithmetic scores Poorly nourished children Adolphus et al, Front Hum Neurosci (2013)

23 2013 review: The impact of habitual breakfast habitual breakfast (frequency and quality) and SBPs have a positive effect on children s academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. The evidence indicated a mainly positive effect of breakfast on ontask behavior in the classroom. Adolphus et al, Front Hum Neurosci (2013)

24 2009 review: Breakfast & cognitive performance children & adolescents 45 studies, Overall conclusions: Habitual breakfast is best May be linked to improved attendance and reduced absenteeism Nutritionally vulnerable students benefit the most Hoyland et al Nutr. Research Rev. 2009

25 SCHOOL breakfast works better Especially better MATH scores when schools offer the SBP Kids eating breakfast at school, CLOSER TO CLASS AND TEST- TAKING TIME produced better standardized test scores than when kids skipped breakfast or ate breakfast at home Frisvold, Public Economics 2015; Ptomey et al. J Am Coll Nutr 2016; Vaisman et al. Arch of Ped Adol Med 1996

26 The impact of habitual SCHOOL breakfast Reduces marginal food insecurity Reduces nutritional impact of poor home diets Reduced reports of hunger Khan, et al J of School Health (2009); Nalty, et al. J of Nutr (2013); Kleinman et al, Nutr & Metab (2002)

27 Students felt breakfast helps them Math/Rdng & Std test scores Mem/Attn & Prob slvg Healthy habits Rch/Mntn Healthy Wt Get better math scores Have better memory retention & problem solving Get & keep healthier habits Reach/maintain healthier weight Bkfst Eaters Bkfst skippers Hearst MO et al. J Sch Health 2016

28 Students say breakfast helps with getting along better with my peers Agree/strongly agree BK eaters BK skippers Overall, nearly 3 in 5 students felt eating breakfast together helped with peer relationships True even for HALF of students who typically skipped breakfast Hearst, et al. J School Health, 2017

29 Anyone Can be Too Hungry to Learn No breakfast offered at meeting No food until lunchtime Nurse at the front of the room Allowed participants to feel what skipping breakfast feels like

30 The VALUE ADDED of SCHOOL BREAKFAST Better nutrition, better health

31 SCHOOL breakfast = better health SBP participation is associated with: LOWER BMI LOWER risk of overweight LOWER probability of obesity Wang, et al. Pediatric Obesity (2016); Gleason & Dodd, JADA, (2009)

32 SCHOOL breakfast = better nutrition FACT: School breakfast is more balanced & more complete than most home breakfasts SBP eaters: Get more nutrients of concern : calcium, fiber, vitamin D, potassium Get more vitamins C & A More likely to meet or exceed recommended nutrient standards Clark & Fox. J Am Acad Diet. (2009); Bhattacharya et al. J Hum Resources (2006)

33 MAIN BARRIERS TO SBP PARTICIPATION Stigma associated with eating breakfast at school Getting to school in time to eat. Basch CE J of School Health 2011

34 Students WANT breakfast in the classroom I m uncomfortable eating in my classroom Strongly disagree Disagree Agree Sterongly agree Eaters and skippers say: They don t mind eating breakfast in class! BK eaters BK skippers Hearst, et al. J School Health, 2017

35 Breakfast in the classroom Associated with IMPROVED math & reading scores Improvement was best among LOW-performing students LOW BMI NOT associated with increases on obesity Imberman & Kugler, J of Policy Anal & Mgmt (2014); Corcoran et al, J of Policy Anal & Mgmt (2016)

36 But what kind of breakfast?

37 Breakfast: Whole lot of good More servings of whole grains associated with higher scores in: Reading comprehension Fluency Mathematics Ptomey, et al. JACN, 2016

38 Meal composition & Alertness 3 meal types: High protein: 21% CHO, 52% Pro, 27% fat Super high carb: 72% CHO, 27% fat Regular: 18% pro: 55% CHO, 27% fat Paz & Berry, Annals of Nutr & Metab; 1997

39 Meal composition & alertness Regular diet: best with performance 55% CHO, 18% pro, 27% fat CHO:PRO ratio of 3:1 was suggested as optimal balance between mood & performance Typical breakfast: WG Cereal, 1% milk, 4 oz. juice: CHO: 208 cal; PRO: 40 cal; Fat: 27 cal CHO:PRO ratio: 5:1 Need protein? Paz & Berry, Annals of Nutr & Metab; 1997

40 THE POWER OF PROTEIN Most children (and adults!) get enough May not get enough, early enough Most calories obtained after school through evening hours

41 WHAT DOESN T WORK

42 BLOCK GRANTS CBO says block grants could eliminate access to nutrition programs for some children and reduce it for others. Can t respond to changes in enrollment, need, number of eligible students Don t address annual cost increases: food/commodity prices are historically among the most volatile & variable

43 BLOCK GRANTS In poor economic times, school meal programs are even more critically important. Block grant funding caps would reduce the ability of school meal programs to reach vulnerable children. REALITY: SCHOOL NUTRITION PROGRAMS HAVE NO GUARANTEE OF RECEIVING BLOCK GRANTS!

44 BLOCK GRANTS One more thing SCHOOL NUTRITION PROGRAMS HAVE NO GUARANTEE OF RECEIVING BLOCK GRANTS! Diversion away from school meal programs is easy for states to do. To effect positive change in school nutrition, BLOCK GRANTS ARE UNACCEPTABLE. PERIOD.

45 A LITTLE MATH 6 extra per breakfast to provide commodities 11,667 breakfasts subsidized for the price of 1 TOILET SEAT

46 Bureaucrat salaries Private sector: $70,000/year Federal sector: $127,000/year Excess: $57,000 $57,000 could subsidize 950,000 breakfasts!

47 And some words about the elephant in the room

48 Child obesity & Low SES % Obese by education College Grad 19% % Obese based on income >350% 11% HS Grad or less 44% >130% to 350% 25% 130% 64% Some College 37% Source: CDC.gov; MMWR Feb 16, (6);

49 Child obesity: An ethnic issue Obesity by ethnicity Hispanic 34% Asian 13% White 23% Multifactorial VERY complicated School breakfast: part of the SOLUTION Black 30% White Black Hispanic Asian

50 CHILDHOOD OBESITY: WHAT LEGISLATORS NEED TO KNOW School meals: part of the SOLUTION to child obesity. School meals: Have strict calorie guidelines Guided by US Dietary Guidelines for Americans Strict portion control Must be varied Possibly the MOST BALANCED MEALS children receive during the day.

51 CHILDHOOD OBESITY: WHAT LEGISLATORS NEED TO KNOW School breakfast MUST meet nutrient requirements Possibly the MOST BALANCED MEALS children receive during the day. Skipped breakfast = nutrients lost These nutrients and FOOD GROUPS are NOT made up the rest of the day Likely the MOST BALANCED MEALS children receive consistently.

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53 Food Sources of Added Sugars Ages 2 Years and Older, 2015 Dietary Guidelines Dairy 4% Data Source: What We Eat in America (WWEIA) Food Category analyses for the 2015 Dietary Guidelines Advisory Committee

54 Empty-calorie Drinks Where Do They Get Them-Where Do They Drink Them Drink at Home (53%) Drink Away from Home (47%) School/ day care Source: NCHS Data Brief No. 71, Figure 6. August 2011

55 And some parting words CONFIDENCE IN YOUR MESSAGE IT S JUSTIFIED BE GENUINE: THEY NEED TO KNOW THAT YOU CARE BEFORE THEY LL CARE ABOUT WHAT YOU KNOW KNOW YOUR GOALS: INFORM & EDUCATE SPEAK FROM EVIDENCE & FACTS MOTIVATE LEGISLATORS TO TAKE ACTION

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