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Child School Nutrition Standards in Transition

close up of cafeteria worker's hand placing lunch into a bowlI’ve worked with school nutrition managers and staff off and on for years and I’ve never met a more dedicated group of people in the field. Their budgets are low, requirements are high and they’re criticized by everyone, yet most enjoy what they do. What they hate, though, is seeing food go to waste. They know that even the best food isn’t nutritious unless it’s eaten.

And what goes into determining the content of those meals is what keeps us all up at night.

Parents of my patients say their kids complain about school meals, but in New York City, schools have done a dynamite job at implementing nutrition guidelines developed during the Obama administration. Kids are learning to enjoy more fruits and vegetables and they’ve adapted to having more whole grains in their sandwich breads, pasta and side dishes and breakfast cereals.

These are all changes that can, and should, continue now that we’re into a new administration. Calories are already tightly regulated, and what does the future hold for how those calories will be allocated?

The source and scope of those regulations are increasingly part of the public debate over food and nutrition. During her time as First Lady, Michelle Obama recognized a need to change dining culture in schools, adopting child nutrition as her platform. Changing a culture is massively difficult, usually requiring someone in a senior position to call out the flaws in our lifestyle and stay the course so that positive changes become ingrained. Yes, there were hiccups, but overall Mrs. Obama understood her mission—which resulted in two iterations of the U.S. Dietary Guidelines for Americans, in 2010 and 2015.

Gearing up for guidelines

Schools have to follow federal guidelines and modify meal menus to qualify for federal dollars. One example of where those regulations get applied is sodium intake. The 2010 guidelines recommended a maximum sodium intake of 1,500 mg for kids. This was probably unrealistic, as it was a more severe restriction than the standard low-sodium 2,000 mg/day diet found in hospitals. Kids had been getting about 1,500 mg of sodium in a single lunch. The 2015 guidelines got more realistic, allowing kids to get up to 2,300 mg per day, getting there in three stages by 2022.

New administration, new rules

Schools nationwide reached stage 1, and they were supposed to reach stage 2 this year and stage 3 within five years. The new administration has delayed the deadline for meeting target 2 until 2020. There is concern that the target will be discarded, and this could be a sign that much of the positive change in school meals will be rolled back by relaxing these regulations.

One area where I’m happy with the new administration is the loosening of restrictions on flavored milk. Given that at least 60 percent of kids 8–18 and up to 90 percent of teen girls don’t get enough calcium, we have a calcium crisis. Currently, plain fat-free and 1% milk and flavored fat-free milk are all that are allowed in schools. That’s going to change so that flavored 1% milk will again be a choice for kids. The sugar content in those drinks has been decreasing for years and it’s now down to about nine grams of added sugar—probably less than their parents are adding to their coffee, and less than in any other sweet beverage they might drink.

Ironically, only about 3 percent of the added sugar in their diets comes from flavored milk at school. Milk is one of the most nutrient-rich foods in kids’ (and adults’) diets—if they’d just drink it. When schools take flavored milk out of the lunch options, milk consumption goes down—way down. I’m glad to see it back on the menu, as the issue inappropriately takes up lots of oxygen in the child-obesity discussion.

Are kids only “schooled” in eating well?

Of course, changes to the school nutrition standards have led to some outrage. Howell Wechsler, the CEO of the Clinton Foundation’s Alliance for a Healthier Generation, took issue with the new guidelines, saying “Shouldn’t our schools be setting an example for our students about the importance of working hard to meet critical goals? We would not lower standards for reading, writing and arithmetic just because students found them challenging subjects, and we should not do it for school nutrition either.”

His analogy is poor, though, since we know that schools frequently graduate students who don’t meet established academic standards. Where I agree with Dr. Wechsler is that schools should set an example of healthy eating. Still, I see children outside a school setting and I wonder if any of their school meal patterns translate to the home setting. We may be teaching children how to enjoy healthy eating at school, but only at school. After all, school meals have changed a lot for the better, but child obesity persists. Maybe what’s needed is something to address what happens the other 18 nonschool hours of the day.

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Keith-Thomas Ayoob, ED.D.

Keith-Thomas Ayoob, ED.D.

Dr. Ayoob is associate clinical professor, pediatrics emeritus at Albert Einstein College of Medicine.

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