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Call to Action > Healthy Eating Challenge
  Healthy Schools


Promoting Healthy Eating Behaviors: The Challenge

Five leading medical associations and the U.S. Department of Agriculture challenge schools and communities to promote healthy eating among the Nation’s students.

Many of today’s children and youth have unhealthy eating patterns that can have negative consequences for their health and education. We have a responsibility to promote knowledge, attitudes and behaviors among our school children that will develop eating patterns that improve health, intellectual development, and overall quality of life, today and into the future. To achieve this change, students, their parents and teachers, school officials, community and business leaders, and local, state, and federal program administrators must be actively involved in ensuring that school environments promote healthy eating patterns.

The American Academy of Family Physicians, American Academy of Pediatrics, American Dietetic Association, National Hispanic Medical Association, National Medical Association, and the U. S. Department of Agriculture (USDA) call on schools and communities to recognize the health and educational benefits of healthy eating and the importance of making it a priority in every school. At the same time, the associations are encouraging their members to provide leadership in helping schools promote healthy eating for our Nation’s children.

The recent report of Healthy People 2010 (1) and the report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans 2000 (2) outline significant areas for improvement in the eating behaviors of children and adolescents in the United States. These science-based reports are useful resources in advocating for school environments that will help students develop healthy eating patterns.


Health Implications

Childhood obesity has reached epidemic proportions with 4.7 million youths, ages 6 to 17, now overweight or obese.(3) Overweight and obesity substantially raise the risk of illness from high blood pressure; high cholesterol; Type 2 diabetes; heart disease and stroke; breast, prostate and colon cancers; and a number of other illnesses.(1) Healthy People 2010 selected overweight and obesity as one of the ten leading health indicators, citing the fact that they are major contributors to many preventable causes of death. The Dietary Guidelines Advisory Committee included "Aim for a healthy weight" and "Be physically active each day" among its recommendations for the Dietary Guidelines for Americans 2000.(2)

The Dietary Guidelines Advisory Committee recommends that food choices be guided by the Food Guide Pyramid, emphasizing a variety of grains, especially whole grains, and a variety of fruits and vegetables to form the base for healthy eating. Further recommendations include food choices low in saturated fat and cholesterol and moderate in total fat; beverages and foods that limit intake of sugars; and foods with less salt.(2)


Students are Flunking Healthy Eating

  • Only two percent of youth meet all the recommendations of the Food Guide Pyramid; 16 percent do not meet any of the recommendations.(4)
  • Less than 15 percent of school children eat the recommended servings of fruit, less than 20 percent eat the recommended servings of vegetables, less than 25 percent eat the recommended servings of grains,and only 30 percent consume the recommended milk group servings on any given day.(5)
  • Only 16 percent of school children meet the guideline for saturated fat on any given day.(5)
  • Teenagers today drink twice as much carbonated soda as milk (6) and only 19 percent of girls ages 9 to 19 meet the recommended intakes for calcium.(1,7)
  • About 12 percent of students report skipping breakfast.(8,9) Only 11 percent report eating a breakfast that contains foods from three food groups and food energy intakes greater than 25 percent of the Recommended Dietary Allowance.The likelihood of eating breakfast declines with the age of the student.(9)


Schools, Parents, and Communities: Partners in Change

Changing health behaviors requires changes in physical and social environments as well as the development and implementation of policies and interventions.(1) The challenge of improving students’ eating patterns is a shared responsibility by schools, families, and communities. Schools can be the cornerstone of change and are most likely to be successful in improving students’ eating patterns by

  • Helping them learn skills needed to practice lifelong healthy eating,
  • Giving them repeated opportunities to practice healthy eating skills,
  • Ensuring consistent messages in the classroom, dining room and other eating areas in the school,
  • Providing nutrition education activities that are fun, and
  • Implementing USDA’s Team Nutrition (10) throughout the school community.

These efforts will signal to students, parents, and the community that the school recognizes healthy eating as an important life skill and is committed to making it part of the school’s total education program.


Benefits of Change

Healthy eating patterns during childhood affect eating patterns in later years. Students who eat the school lunch that meets the requirements of the National School Lunch Program (NSLP) eat more vegetables, drink more milk and fewer sweetened beverages, eat more grain mixtures, and fewer cookies, cakes and salty snacks than students who make other lunchtime choices.(8) The School Breakfast Program (SBP) also has nutrition standards consistent with the Dietary Guidelines for Americans. By choosing the complete NSLP lunch or SBP breakfast, students are assured a meal that meets national nutrition standards and complies with the recommendations of the Dietary Guidelines for Americans. Research shows that students who eat breakfast at school have increased standardized achievement test scores, improved attendance and reduced tardiness.(11) Other research shows that students who eat breakfast have improved academic, behavioral, and emotional functioning.(12)

However, fewer than 60% of students choose the NSLP lunch.(8) Food options beyond the school lunch and breakfast are available to students in many schools; these foods sold a la carte, in school stores, in snack bars or in vending machines do not currently have to meet any standards for nutritional quality. Establishment of local policies that create a supportive nutrition environment in schools will provide students with the skills, opportunities, and encouragement they need to adopt healthy eating patterns.


Prescription for Change: Ten Keys to Promote Healthy Eating in Schools

Ten keys have been developed to assist each school community in writing its own prescription for change. These keys incorporate ideas from a variety of recent nutrition and school health publications.(10,13,14,15,16,17,18)

1.  Students, parents, food service staff, educators and community leaders will be involved in assessing the school’s eating environment, developing a shared vision and an action plan to achieve it.

2.  Adequate funds will be provided by local, state and federal sources to ensure that the total school environment supports the development of healthy eating patterns.
3.  Behavior-focused nutrition education will be integrated into the curriculum from pre-K through grade 12. Staff who provide nutrition education will have appropriate training.

4.  School meals will meet the USDA nutrition standards as well as provide sufficient choices, including new foods and foods prepared in new ways, to meet the taste preferences of diverse student populations.

5.  All students will have designated lunch periods of sufficient length to enjoy eating healthy foods with friends. These lunch periods will be scheduled as near the middle of the school day as possible.

6.  Schools will provide enough serving areas to ensure student access to school meals with a minimum of wait time.

7.  Space that is adequate to accommodate all students and pleasant surroundings that reflect the value of the social aspects of eating will be provided.

8.  Students, teachers and community volunteers who practice healthy eating will be encouraged to serve as role models in the school dining areas.

9.  If foods are sold in addition to National School Lunch Program meals, they will be from the five major food groups of the Food Guide Pyramid. This practice will foster healthy eating patterns.

10.  Decisions regarding the sale of foods in addition to the National School Lunch Program meals will be based on nutrition goals, not on profit making.


Call for Action

Students, parents and community leaders should check out their school’s environment and advocate for changes to encourage and support healthy eating if they are needed. Individuals, organizations, federal, state and local agencies, schools, and communities are strongly urged to join members of the American Academy of Family Physicians, American Academy of Pediatrics, American Dietetic Association, National Hispanic Medical Association, and National Medical Association in endorsing and implementing the Ten Keys to Promote Healthy Eating in Schools.

American Academy of Family Physicians
R. Michael Miller
Deputy Executive Vice President

American Academy of Pediatrics
Janice Guerney
Assistant Director
Department of Federal Affairs

American Dietetic Association
Ann Gallagher
President

National Hispanic Association
Elena Rios
President

National Medical Association
Lorraine Cole
Executive Director

References

1.  Healthy People 2010: Understanding and Improving Health. Conference Edition. Washington, DC: U.S. Department of Health and Human Services or at www.health.gov/healthy people/. Accessed February 15, 2000.

2.  Excerpts of the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2000. Washington DC: U.S. Department of Agriculture, Agricultural Research Service; 2000. Available at www.ars.usda.gov/dgac/. Accessed February 15, 2000.

3.  Troiano R, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. "Overweight Prevalence and Trends for Children and Adolescents," Arch of Pediatr and Adoles Med. 1995; 149: 1085-1091.

4.  Munoz KA, Krebs-Smith S, Ballard-Barbash R, Cleveland LE. "Food Intakes of U.S. Children and Adolescents Compared With Recommendations," Pediatr. 1997; 100: 323-329. Errata: Pediatr. 101 (5):952-953.

5.  Gleason P, Suitor C. Changes in Children’s Diets: 1989-91 to 1994-96. U.S. Department of Agriculture, Food and Nutrition Service, 2000. In press.

6.  Department of Agriculture, Agricultural Research Service. Food and Nutrient Intakes by Children 1994-1996, 1998. Online at www.barc.usda.gov/bhnrc/foodsurvey/home.htm. Accessed December 15, 1999.

7.  Department of Health and Human Services, National Center for Health Statistics. The Third National Health and Nutrition Examination Survey 1988-1994. Hyattsville, MD, 1994.

8.  Burghardt J, Devaney B. eds. "The School Nutrition Dietary Assessment Study," Am J Clin Nut. 1995; 61 (suppl): 213S-220S, 232S-240S.

9.  Devaney B, Stuart E. Eating Breakfast: Effects of the School Breakfast Program. U.S. Department of Agriculture, Food and Nutrition Service, 1998.

10.  Team Nutrition. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service; 1995. Available at http://www.fns.usda.gov/tn. Accessed February 15, 2000.

11.  Meyers AF, Sampson AE, Weitzman M, Rogers BL, Kayne H. "School Breakfast Program and School Performance," Am J Dis Child. 1989; 143: 1234-1239.

12.  Murphy JM, Pagano ME, Nachmani J, Sperling P, Kane S, Kleinman RE. "The Relationship of School Breakfast to Psychosocial and Academic Functioning," Arch of Pediatr and Adoles Med. 1998; 152: 899-906.

13.  "Guidelines for School Health Programs to Promote Lifelong Healthy Eating," Morbidity and Mortality Weekly Report Recommendations and Reports. U.S. Department of Health and Human Services. 1996; 45: RR-9, June 14.

14.  Allensworth D, Lawson E, Nicholson L,Wyche J. eds. Schools and Health: Our Nation’s Investment. Washington, DC: National Academy Press, 1997.

15.  Marx, E, Wooley, SF, Northrop, D. eds. Health is Academic. New York, NY: Teachers College Press, 1998.

16.  Martin, J, Conklin, MT. eds. Managing Child Nutrition Programs: Leadership for Excellence. Gaithersburg, MD: Aspen Publishers, Inc., 1999.

17.  Centers for Disease Control and Prevention. School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide. Elementary School Version. Atlanta, GA, 2000. In press.

18.  Centers for Disease Control and Prevention. School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide. Middle School/High School Version. Atlanta, GA, 2000. In press.