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Indiana Public Schools: A Model for the USDA
"Better Nutrition, Fitness and Wellness Policy"*©
On June 30, 2004, Congress passed the Child Nutrition and WIC Reauthorization Act of 2004 (Section 204 of Public Law 108-265 [PDF]). This law requires local education agencies participating in a program authorized by the National School Lunch Act or the Child Nutrition Act of 1966 to develop a wellness policy with the objectives of promoting student health and reducing childhood obesity.
Historically, "if it takes a village to raise a child", in today’s environment, it may take an entire state to raise a healthy child. Clearly, we have a moral obligation to raise healthy children, but because of today’s health care costs, we also have a fiduciary responsibility to all Hoosiers to raise a well child. Thus, the purpose of this model policy is to provide a template and sample language for school/district policy writers. It is intended for schools/districts to use as a tool in drafting a local policy that addresses the individual wellness needs of their school/district and entire community.
Schools/districts may choose to use sections of this document or alter the language in any way. However, we believe that the model policy is reasonable and exhibits "best practices" in building a school environment that promotes student wellness.
BACKGROUND INFORMATION:
Per the CDC, national health care costs are currently estimated at $1.5 Trillion per year. These costs are projected to explode to $3.6 Trillion by 2014. At this rate of growth, health care costs outpace the GDP and become 19% of the entire U.S. economy. This rate of growth is not sustainable.
Per the American Academy of Pediatrics, 2004, "overweight is now the most common medical condition of childhood, with the prevalence having doubled over the past twenty years".
Per JAMA 2002, "a small but increasing body of evidence shows that poor nutrition and obesity affect student behavior and even academics".
Per the Clarian Community Plunge, 2003, "80% of all diseases are chronic and respond positively to better nutrition." Better nutrition offers significant financial relief from today’s health care costs.
Therefore, the primary goal of this template is to provide Indiana’s public schools with a community-based wellness, fitness and better nutrition model that is based upon solid science, actual daily consumption and positive cash flow.
QUANTIFYING THE COST-BENEFIT OF BETTER NUTRITION WITH CALCIUM:
If "80% of all diseases are chronic and respond positively to better nutrition," then this Policy recommends that we, as a community, must learn how to not only affect all nutritionally based diseases, but also quantify the cost-benefit of better fitness and nutrition. Thus, this Policy recommends that calcium offers a unique scientific and nutritional opportunity when creating a community infrastructure that improves both daily nutrition and wellness that also quantifies the tremendous cost-benefit of better nutrition. If we can learn to successfully affect the daily nutritive intake of a single nutrient, then we can use that same infrastructure to affect a broad base of nutritionally based diseases; i.e., let’s first we learn to crawl, walk, and then run.
Per the National Institutes of Child Health and Human Development (NICHD), calcium is the single most important nutrient deficiency today (Duane Alexander, NICHD Director, 2002). Calcium will be used to demonstrate the cost-benefit of better nutrition because the science of calcium is solid, the consumption need is real, while the financial returns are significant; particularly for women, children and minorities.
A normal daily calcium intake is an executable example that immediately lowers Indiana’s health care costs and risks – without any cost to the State of Indiana.
o It is well-established that a normal daily calcium intake lowers the incidence and costs, in varying degrees, of osteoporosis, obesity, insulin resistance syndrome, high blood pressure, pre-eclampsia, kidney stone formation, polycystic ovary disease, colon cancer, and more.
o The USDA Childhood Nutrition Reauthorization Act recognizes broad calcium deficiencies within the male and female student populations; thus, giving a preference to healthy foods and beverages that are naturally or artificially fortified with calcium.
o Indiana PL209 (2001) mandates a purchasing preference to higher calcium items at same cost or less within all state and local public institutions, including all public schools. This Law works because it is based upon actual consumption and Corporate America competes to provide healthier foods and beverages without raising cost of goods.
o A very broad National Calcium Initiative (an Indiana 501(c)4) coalition is established that includes product manufacturers, facility managers, food service distributors, vending operators, grocery retailers, academia, health care providers, health insurers, corporations and consumer bases (schools, hospitals and corporations). The above groups will proactively support the execution of this wellness policy within schools.
o Extrapolation of the McCarron-Heaney (AJH, 2004; 17: 88-93) meta-analysis of the direct medical costs associated with dairy/calcium deficient diets projects Indiana’s population annual potential health care cost risk reductions as follows:
§ State-wide: 6.1 million people = >$500 Million per year
§ Medicaid recipients: 800K people = $123.7 Million per year
§ K – 12 population: 1 Million students = >$154 Million per year
§ Indianapolis Public Schools: 40K Students = $6.2 Million per year
o With the support of the membership of the National Calcium Initiative (a 501(c)4), and in order to quantify the cost-benefit of better nutrition and fitness, pilot public school systems will participate in the collection of calcium intake nutritional surveys coupled with bone density, body mass index and blood pressure studies.
FOOD AND BEVERAGE SALES:
Per the USDA School Breakfast and Lunch Guidelines, the sale of all foods and beverages on school grounds shall be under the management of the school food service program, except foods sold as part of an approved fundraising activity.
The food service and vending RFP’s (request for purchase) shall be offered/awarded as separate contracts within each school district.
Per USDA School Breakfast and Lunch Guidelines, the majority of profits generated from sales of foods or beverages in vending machines or school stores will accrue to the food service department. In order to improve physical fitness and reduce health care costs, a significant portion of the vending commission cash flow should be used to purchase fitness equipment for use by the general student and staff populations. Of these generated dollars, a discretionary percentage shall remain within the food service department for wellness and continuing education programs.
Foods, beverages, snacks and ice creams sold within vending machines must be USDA compliant. Any and all "foods of minimal nutritional value" (FMNV) as defined by 7 CFR 210.11(2) are prohibited from being served or sold anywhere a reimbursable meal is served, sold, and/or eaten. Foods of minimal nutritional value as defined by USDA include carbonated beverages, water ices, chewing gum, hard candies, jellies and gums, marshmallow candies, fondant, licorice, spun candy, and candy coated popcorn.
Elementary school students shall not have access to any foods or beverages of minimal nutritional value sold in vending machines and/or school stores.
Food and beverages sold or served on school grounds or at school-sponsored events during the normal school day shall meet the Dietary Guidelines for Americans and other nutrition standard guidelines as set forth by the Indiana Department of Health Child Nutrition Programs. This includes:
a la carte offerings in the food service program;
food and beverage choices in vending machines, snack bars, meal-period kiosks, and school stores;
food and beverages sold as part of school-sponsored fundraising activities; and
refreshments served at student parties, celebrations, and meetings.
FMNV will not be sold to junior high and high school student populations anywhere on the school campus from 30 minutes prior to the beginning of the school day and until 30 minutes after the school day has ended. USDA compliant foods, beverages, snacks and ice creams sold in vending machines may remain on throughout the school day. Attachment A serves as a guide for USDA approved foods, beverages, snacks and ice creams.
All foods and beverages sold in Indiana public schools must comply with the Indiana Calcium Purchasing Preference Law Code IC 5-22-15-24.
For foods and beverages, Indiana public schools are encouraged to apply the Governor’s 2005 "Buy Indiana" Provision as long as these items are of the same cost or less of non-Indiana products/distributors/operators.
FITNESS PHYSICAL ACTIVITY AND A HEALTHY SCHOOL ENVIRONMENT:
A. Recommendations for Physical Activity
1. Physical education courses should be the environment in which students learn, practice and are assessed on developmentally appropriate motor skills, social skills, and knowledge.
2. Physical activity involves bodily movement that results in an expenditure of energy of at least a moderate intensity level and for duration sufficient to provide a significant health benefit for students.
3. Children should accumulate at least 30 minutes of physical activity on all or most days of the week. This can be accomplished through several bouts of physical activity lasting 15 minutes or more each day.
4. Extended periods of inactivity (periods of two or more hours) are discouraged.
B. Recommendations for Physical Education for Children During the Normal School Day
1. Ensure that state-certified physical education teachers teach all physical education classes.
2. Provide an adequate amount of time for physical education classes. Schools should provide at least 150 minutes per week for elementary students and at least 225 minutes per week for middle and high school students for the entire school year.
3. Ensure that physical education classes have a teacher/student ratio comparable with those of other classes
4. Implement a sequential physical education course of study consistent with national standards for physical education and with a focus on students’ development of motor skills, movement forms, and health-related fitness.
5. Ensure that students are moderately to vigorously active at least 50% of the time while participating in physical education classes.
6. Provide a physical and social environment that encourages safe and enjoyable activity for all students, including those who are not athletically gifted.
7. Prohibit the use of physical activity as punishment, the withholding of participation in physical education class as punishment, or the use of physical education class time to complete assignments from other classes.
C. Encouraging Lifetime Physical Activity
1. Schools should provide daily recess periods of at least 20 minutes for all elementary school students.
2. Schools should provide physical activity breaks during classroom hours.
3. Schools shall offer after-school intramural programs and/or physical activity clubs that meet the needs and interests of all students, including those who are not athletically gifted and those with special health care needs.
4. Schools will be encouraged to provide community access to and encourage students and community members to use the school’s physical activity facilities outside of the normal school day.
5. Schools should encourage parents and community members to institute programs that support physical activity, such as a walk to school program.
6. Schools should encourage after-school childcare programs to provide developmentally appropriate physical activity for participating children and reduce or eliminate the time spent in sedentary activities such as watching television or videos.
D. Funding for the Physical Fitness Equipment
1. The net vending machine income appropriations are ultimately determined by each local Nutrition & Physical Activity Advisory Council. For that decision process, this Policy strongly encourages that a minimum of 25% percent of all vending machine income is used to purchase the fitness equipment, including but not limited to heart rate monitors, pedometers, treadmills, jump ropes, stationary bicycles, free weights and resistance training machines, needed to improve the daily activity of our Hoosier students.
PROMOTION OF HEALTHY CHOICES:
Schools shall take efforts to encourage students to make nutritious choices, such as fruits, vegetables, low-fat dairy foods/beverages, bottled water and low-fat whole grain products. Foods and beverages of good nutritional value shall be available wherever and whenever food is sold or otherwise offered at school during the normal school day.
FUNDRAISING:
Only approved student organizations and legally constituted, nonsectarian, nonpartisan organizations are permitted to engage in fundraising on school grounds at any time.
These organizations are encouraged to raise funds through the sale of items other than food.
Foods sold for fundraising purposes shall not be sold while school food service meals are being served or eaten.
All fundraising projects with food and beverages sold for consumption during the school day will follow the nutrition standards (Attachment A).
Each organization raising funds by selling foods is limited to one event per month during school hours.
CLOSED CAMPUS:
Students are not permitted to leave school grounds during the school day to purchase food or beverages.
COMMERCIAL ADVERTISING:
Long-term wellness requires significant public-private participation; therefore, partnerships between schools and businesses are encouraged and appropriate business sponsorship of educational activities and materials shall be duly acknowledged. However, such partnerships shall be designed to meet identified educational, nutritional, fitness and wellness needs of the student population, not commercial motives, and shall be evaluated for educational effectiveness by the school/district on an ongoing basis.
PARTIES/CELEBRATIONS/MEETINGS:
Students, parents, teachers and community members bringing food to school, will be encouraged to provide healthful options and will be provided with a list of recommended foods (Attachment B).
STUDENT INCENTIVES:
The use of food items as part of a student incentive program is strongly discouraged. If food items are used as an incentive, they will adhere to nutrition standards (Attachment A).
IMPLEMENTATION:
Educators, administrators, parents, health practitioners and communities must consider the critical role student health plays in academic stamina and performance and adapt the school environment to ensure students’ basic nourishment and activity needs are met. To ensure widespread understanding of the benefits to school environments where nutritious foods are provided and where students have an opportunity for physical activity, a public awareness campaign that highlights research demonstrating the positive relationship between good nutrition, physical activity, and capacity of students to develop and learn should be conducted.
A. Establish and maintain a district-wide Nutrition & Physical Activity Advisory Council with the purposes of:
developing guidance to explicate this policy
monitoring the implementation of this policy
evaluating policy progress
serving as a resource to school sites, (e.g. providing lists of healthy incentives, snacks, birthdays, etc.), and
revising policy as necessary
It is recommended that a district-wide Nutrition & Physical Activity Advisory Council be established. (This Council could be an augmentation of an existing Nutrition Advisory Council.) The Council would meet a minimum of two times annually with Council membership including, but not limited to:
District Food Service Director/Manager
Dietitian
Local Health Department
Local Health Practitioner (e.g., pediatrician, chiropractor, or other appropriate certified medical professional)
School Nurse-Teacher
A parent representative from each school
A student representative from each school
Staff member representative from each school
A School Committee/Board member
District Administrative Representative, Co-Chair
Physical Education and Health Program Leader, Co-Chair
Family & Consumer Sciences Teacher
Local Community Partners (e.g. Boys & Girls Club, YMCA)
Responsibilities of the Nutrition & Physical Activity Advisory Council may include, but not be limited to, oversight of the following:
Implementation of district nutrition and physical activity standards
Integration of nutrition and physical activity in the overall curriculum
Assurance that staff professional development includes nutrition and physical activity issues
Assurance that students receive nutrition education and engage in vigorous physical activity
Pursuance of contracts with outside vendors that encourage healthful eating and reduction of school/district dependence on profits from foods of minimal nutritional value.
Consistent healthful choices among all school venues that involve the sale of food.
Annual Reporting: The Nutrition & Physical Activity Advisory Council will be responsible for preparing an Annual Report by June 15 of each year that includes, but may not be limited to, the following information:
Monthly district menus and meal counts
Listing of all a la carte, vending, and competitive foods sold by school food service
Listing of all other sales of foods throughout the district including vending machines, school stores, culinary and special education programs, in-school and in-class fundraisers, etc.
Listing of physical activity programs and opportunities for students throughout the school year.
OUTCOME ASSESSMENT - QUANTIFYING THE EFFECTIVENESS OF THIS POLICY MODEL:
What makes this Policy a success and how can we quantify its effectiveness? Simply put, this Policy is successful when all of its programs are executed. The following are suggested measures of success:
o Are we truly executing this Policy? The leading goal of this Policy is to organize and execute a community-based, proactive, highly effective, public-private partnership made up of, but not limited to nutrition directors, dietitians, Indiana School Nutrition Association, school administrators, food and beverage manufacturers, food service distributors, vending operators, local public health professionals, local health care providers, health insurers, physical education directors, and other objective community leaders. For any level of success, this infrastructure must execute the one common goal – help our school-aged children become healthy, well and fit citizens.
o Timing is everything: The current health care costs and USDA policies have forced this public change! The USDA is mandating the execution of a "Wellness, Fitness and Better Nutrition Policy" by July 2006. Thus, at the minimum, Policy success is found only when every Indiana public school is executing, on or before July 2006, the USDA mandates of:
§ The removal of "Foods of Minimal Nutritional Value" from the entire school campus from 30 minutes before student enter and 30 minutes after students leave the campus, and
§ To ensure healthy choices for all students, the school food service department controls the sale of all foods and beverages sold on campus.
o This Policy is successful if 100% of Indiana’s public schools are immediately adhering to Indiana’s Calcium Purchasing Preference Law:
§ Apply Indiana’s Calcium Purchasing Preference Law to all school food service and vending sales in order to improve and/or normalize the student’s population daily calcium consumption,
o Additionally, this Policy is successful if 50% or more of Indiana’s public schools are also executing the National Calcium Initiative Model, on or before July 2006, to:
§ Per this Policy, calcium has been chosen as the nutrient that will deliver a legitimate working infrastructure, as well as quantifiable reductions in health care risks/costs through improvements in wellness, fitness and better nutrition. As previously stated, a normal daily calcium intake within Indiana’s entire K – 12 population offers over $154 million in potential annual risk reductions! Therefore, the participating National Calcium Initiative Pilot Schools, with the assistance of the National Calcium Initiative’s Membership, will provide the following pre and post-Policy application data:
· Daily dietary calcium intake surveys that include consumption from the school breakfast and lunch program and "healthy choices" vending machines,
· Bone density, blood pressure and body mass index data of randomized student, administrative, teaching and food service staff populations, and
· Extrapolation of the pilot population’s annual risk reductions to Indiana’s one million K – 12 population.
§ Execute this Policy Model to ensure a long-term cash flow stream for the acquisition and replenishment of fitness equipment for the student, teaching and administrative populations through the "healthy choices vending model".
§ A long-term goal of this Model is to drive a percentage of the state dollars saved from these quantifiable health care risk reductions back to the public schools. This will take time, as this requires Legislative action, but the reward to the public school system is significant and worth the long-term effort.
ATTACHMENT A:
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Food or
Beverage |
Nutrition Standards
These criteria focus on decreasing fat and added sugar, increasing nutrient density , and moderating portion size |
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Fruits and Non-fried vegetables |
Fruits and vegetables may be fresh, frozen, canned or dried, and they must be found in the Food Buying Guide for Child Nutrition Programs.
http://schoolmeals.nal.usda.gov/FBG/2003FBG/%20Section%202.pdf
Examples of products that cannot be sold/served as a fruit or vegetable include:
·1 Snack-type foods made from vegetables or fruits, such as potato chips, and banana chips
·2 Pickle relish, jam, jelly and
·3 Tomato catsup and chili sauce
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Approved
Beverages |
·1 Flavored or plain reduced fat (2%), low-fat (1%), skim/nonfat fluid milk meeting state and local standards for pasteurized fluid milk and/or USDA approved alternative dairy beverages4;
·2 100% full-strength fruit and vegetable juices artificially fortified with calcium; and
·3 Water (non-flavored, non-sweetened, and non-carbonated) naturally fortified with calcium and fluoride
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Any Other Individual
Food
Sales/Service |
·4 Calories from total fat must be at or below 35%, excluding nuts, seeds, and nut butters. This is determined by dividing the calories from total fat by the total calories and multiplying by 100. If calories from fat are not available, multiply the grams of fat by 9 to equal calories from fat.
·5 Calories from saturated fat must be at or below 10%. This determined by dividing the calories from saturated fat by the total calories and multiplying by 100. If calories from saturated fat are not available, multiply grams of saturated fat by 9 to equal calories from saturated fat.
·6 Total sugar must be at or below 35% by weight. This is determined by dividing the grams of total sugar by the gram weight of the product and multiplying by 100. This includes both naturally occurring and added sugars. This limit does not include fruits and vegetables or flavored milk as defined above.
·7 Portion size for a la carte sales in the school cafeteria are not to exceed the serving size of the food served in the National School Lunch Program/School Breakfast Program; for vending sales the item package or container is not to exceed 200 calories.
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4 There are no USDA approved alternative dairy beverages at this time. Public Law 108-265 (Child Nutrition Program Reauthorization) authorizes the Secretary of Agriculture to establish nutritionally equivalent non-dairy beverages by July 1, 2005.
ATTACHMENT B – RECOMMENDED HEALTHFUL FOOD AND BEVERAGES FOR SCHOOL FUNCTIONS:
At any school function (parties, celebrations, meetings, etc.) healthful food options should be made available to promote student, staff and community wellness. The following are recommended foods:
Raw vegetable sticks/slices with low-fat dressing or yogurt dip
Fresh fruit wedges – cantaloupe, honey dew, watermelon, pineapple, oranges, tangelos, etc.
Sliced fruit – nectarines, peaches, kiwi, star fruit, plums, pears, mangos, apples, etc.
Fruit salad
Cereal and low-fat milk
100% fruit or vegetable juice artificially fortified with calcium
Frozen fruit pops with fruit juice or fruit as the first ingredient
Dried fruits – raisins, cranberries, apples, apricots
Single serving applesauce or canned fruit in juice
Peanut butter with apple wedges or celery sticks
Fruit smoothies made with fat-free or low-fat milk
Trail mix (dried fruits and nuts)
Dry roasted peanuts, tree nuts and soy nuts (not coconut or palm nuts)
Lean meats and reduced fat cheese sandwiches (use light or reduced fat mayonnaise in chicken/tuna salads)
Party mix (variety of cereals, nuts, pretzels, etc.)
Pretzels or reduced fat crackers
Baked chips with salsa or low-fat dips (Ranch, onion, bean, etc.)
Low-fat muffins (small or mini), granola bars and cookies (graham crackers, fig bars)
Mini bagels with whipped light or fat-free cream cheese
Pasta salad
Bread sticks with marinara
Fat-free or low-fat flavored yogurt & fruit parfaits.
Fat-free or low-fat pudding cups
Fat-free or low-fat milk and milk products (string cheese, single-serving cottage cheese, cheese cubes)
Flavored soy milk fortified with calcium
Bottled water naturally fortified with calcium
C. GUIDELINIES FOR NUTRITIOUS CHOICES IN VENDING MACHINES:
Foods and beverages sold through school vending machines that meet acceptable nutritional standards shall consist of the following:
Plain, unflavored, noncarbonated bottled water naturally fortified with calcium and fluoride;
Milk, as that term is defined in C.R.S. 25-5.5-101 and shall include but not necessarily be limited to chocolate milk, soy beverage, rice beverage and other similar dairy or nondairy beverage;
One hundred percent fruit juices or fruit-based drinks composed of no less than fifty percent juice, without additional sweeteners and artificially fortified with calcium;
Nuts, seeds, dairy products, fresh fruits or vegetables, dried fruits or vegetables, and packaged fruits in their own juice; and
Any other food item containing:
· not more than thirty-five percent of total calories from fat and not more than ten percent of those calories from saturated fat; and
· not more than thirty-five percent of its total weight in sugar.
NOTE: For purposes of this exhibit, "additional sweetener" means an additive that enhances the sweetness of a food or beverage, including but not limited to sugar. "Additional sweetener" does not include the natural sugar or sugars that are contained in any fruit juice that is a component of the food or beverage .
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*The draft wellness policy language is adapted from the following resources:
Fit, Healthy and Ready to Learn, National Association of State Boards of Education. 2000. www.nasbe.org/HealthySchools/index.html
Healthier US School Challenge, United States Department of Agriculture www.fns.usda.gov/tn/HealthierUS/criteria_instructions.pdf
USDA, Food and Nutrition Service, (n.d.) Local Wellness Policy, http://www.fns/usda.gov/tn/Healthy/wellnesspolicy.html
Mercedes Independent School District Student Nutrition/Wellness Plan. 2004. www.mercedes.k12.tx.us/menus/Nutrition%20PolicyR10-8-04.pdf
The Rhode Island Healthy Schools Coalition, August 2004.
Illinois Draft Wellness Nutrition Policy, 2005.
Colorado – Guidelines for Nutritious Choices in Vending Machines, 2004.
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