The Healthy Hunger Free Kids Act (HHFKA) went into effect for the 2013-2013 school year. HHFKA is legislation authorizing funding and establishing the policy for the USDA’s core child nutrition programs-The National School Lunch Program (NSLP) and The School Breakfast Program (SBP). NSLP and SBP provides federal funded to schools for breakfast and lunch meals for America’s school children. Through this program over 30 million school children receive either free or reduced meals at school. To qualify for funding schools must serve a nutritionally balanced meal based on a USDA established meal pattern. The meal pattern followed prior to enactment of the HHFKA was last updated in 1975. HHFKA is the first major overhaul in 30 years of NSLP and SBP.
HHFKA is part of Michelle Obama’s Let’s Move! campaign. An effort to reduce childhood obesity and improve the health of America’s school aged children. The changes are a well thought out attempt to introduce a variety of healthy items to our children’s diet and change their palate in favor of healthier foods. The changes replace high fat, high sodium, empty calorie foods with fresh fruits and vegetables, whole grains, and lean proteins. As a Registered Dietitian and Health Law Attorney, I applauded the changes. Some key elements of HHFKA include:
•Established required meal components based on the age of the child and rooted in evidence based nutrition science.
•Set calorie limits per meal based on the age on the child.
•Set sodium limits per meal based on the age of the child.
•A requirement that fruits and vegetables be served at each meal. Vegetable sub groups to ensure appropriate nutrients over a weekly spread based on the age of the child.
•Whole grains with caps per meal.
•Fat free flavored milk or low fat white milk at each meal.
•100% fruit juice with limits.
•Limits on saturated fat and trans fats.
The School Nutrition Association (SNA), the national organization for school lunch professionals, first supported the changes and assisted in their design but now oppose the changes and are fighting to have them eliminated. SNA has joined forces with House Republicans and are receiving corporate lobbying help from Schwan’s Food Service, ConAgra, Domino’s Pizza, Coca-Cola, and American Frozen Food Institute. SNA’s complaint is lack of profits since implementation of the new meal pattern. SNA issued a position statement largely claiming we do not want to “gut” the program, we want help and request the following:
•Schools operating at a loss of 6+ months the opportunity to waive the improved nutrition standards.
•Eliminate the requirement for 100% whole grains and cap the whole grain requirement at 50%. This is to accommodate the palate for refined white flour, the difficulty finding certain whole grain items, and to decrease plate waste.
•Eliminate sodium restrictions. As SNA states-“there is no scientific evidence that supports reduced sodium diets for children.” The sodium restriction makes it difficult to find an appropriate pizza, mac & cheese, and deli sandwich.
•Eliminate the fruit and vegetable requirement because children should not be forced to eat what they do not want to eat.
•Eliminate the requirement for healthy foods (competitive food) in vending machines because this has reduced their sales.
I do not know where to begin with this position statement!
SNA’s vision and mission is to “be the authority and resource for school nutrition programs”, and “advance the quality of school meals through education and advocacy.” SNA wants to advance the quality of school meals- to me that is an affirmative statement in the direction of improving health. But, because some of SNA’s members have experienced decreased profits, SNA wants the healthy improvements eliminated. SNA would like to swap fruits and vegetables for high sodium, white refined flour products. SNA’s request is the exact opposite of improving health and is an exchange of child health for profits.
SNA states they do not want to “gut” the program. Instead SNA wants to eliminate whole grains, fruits, vegetables, and the sodium caps. This is the belly of the program. Filter out SNA’s request and the program is left with a calorie restriction, flavored milk, and 100% fruit juice.
The purpose of HHFKA is to work towards improving child health and combat obesity and chronic disease. Childhood obesity and chronic disease leads to adult obesity, adult chronic disease, excessively high healthcare costs, and a disabled, globally uncompetitive work force.
Some stats from the Centers for Disease Control and Prevention on childhood obesity:
•Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
•The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
•In 2012, more than one third of children and adolescents were overweight or obese.1
•Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.4
•Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.5,6
Health Effects of Childhood Obesity
Childhood obesity has both immediate and long-term effects on health and well-being.
Immediate health effects:
•Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.7
•Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.8,9
•Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.5,6,10
Long-term health effects:
•Children and adolescents who are obese are likely to be obese as adults11-14 and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.6 One study showed that children who became obese as early as age 2 were more likely to be obese as adults.12
•Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.15
•Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.6
•The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries.
•Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors.
THE American Heart Association ADVOCATES
The AHA will:
•Advocate for implementation of the new evidence based USDA school meal standards.
•Continue to support robust nutrition standards for competitive foods and beverages in schools that are based on a target of less than 1500 mg sodium per day by 2020.
•Support procurement standards for foods purchased by government agencies and employers that include criteria for strict sodium limits.
•Advocate for increasing availability of fruits and vegetables in schools through commodities, food purchasing, school gardens, and the Fresh Fruit and Vegetable Program.
As shown above the key component in fighting childhood obesity is an improved healthy lifestyle. Since school aged children spend the majority of their days in school. Smart health policy demands a healthy school food environment. Many child health researchers including the American heart Association and the CDC collectively agree fresh fruit and vegetables, sodium reductions, and whole grains are key elements to improve child health and fight long term health risks.
In my practice, I’ve worked with school food manufacturers and schools to implement the HHFKA standards. In my experience many children were unfamiliar with many fruits and vegetables and low fat dairy options. For example, fresh pears, zucchini, chickpeas, lentils, and yogurt. Many children would not drink white milk, instead selecting strawberry or chocolate flavored. And I received comments like, “real food” is the frozen kind you get out of a box. Why? Because many children were not accustomed to freshly prepared meals from natural ingredients.
To combat these challenges I worked with school staff and administration to encourage the children to try the foods. This included encouraging the staff and school administration to try the foods themselves in the presence of the children. I provided education materials on the meals, the HHFKA program, and general nutrition to the children. I also prepared education materials for the parents. To further encourage embracing the changes, I administered child surveys, observed lunch periods, and incorporated the changes accordingly.
Moving a generation from processed frozen boxed foods to naturally occurring cooked foods will not happen in one school year. Lifestyle change is a process affected by many forces. Time and multi-dimensional efforts will be needed to change the palate of America’s school children. SNA holds themselves out as acting in the best interest of child nutrition. Scraping nutrient dense foods for profits is not in the best interest of school children. SNA should rethink its position and funnel its corporate dollars into professional development for its members on how to successfully implement these changes.
Statistical information taken from the following:
Helen Rhynard Esq., M.S., RDN