Institute of Medicine proposes foods guidelines for schools

by Josh Sosland
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WASHINGTON — Nutritional standards for "competitive" foods and drinks available in schools have been proposed in a report issued by the Institute of Medicine (I.O.M.).

The recommendations from the I.O.M., part of the National Academy of Sciences, promote consumption of fruits, vegetables, whole grains and nonfat or low-fat dairy products. The recommendations would limit the amount of saturated fat, salt, added sugars and total calories in food available at school. The proposal also restricts the sale of items containing caffeine.

The standards apply to products that "compete" with the traditional school lunch as a nutrition source. These are products sold in vending machines and at school stores, a la carte items at cafeterias and other foods available outside of federally reimbursable school meals, which already must conform to nutrition guidelines.

The I.O.M. described the new guidelines as largely mirroring the Dietary Guidelines for Americans issued in 2005.

"Making sure that all foods and drinks available in schools meet nutrition standards is one more way schools can help children establish lifelong healthy eating habits," said Virginia A. Stallings, who chaired the I.O.M. committee that developed the report. Dr. Stallings is the Jean A. Cortner endowed chair in pediatric gastroenterology at the University of Pennsylvania School of Medicine. She also is the director of the Nutrition Center at the Children’s Hospital in Philadelphia.

Food groups reacted to the I.O.M. proposals with a mixture of support for the encouragement of better eating habits in schools and opposition to the mandatory and rigid approach recommended, particularly for high school students.

Susan K. Neely, president and chief executive officer of the American Beverage Association, told Food Business News the I.O.M. recommendations for beverages are "virtually identical" to guidelines for younger children the association already is implementing as part of a program developed with the American Heart Association and the Clinton Alliance for a Healthier Generation.

"Our main disagreement is that we and the Alliance would inject a degree of parental choice and common sense," she said.

The proposed I.O.M. standards, which categorize food products in two tiers (see chart at right), apply only to items that compete with school lunch programs but not to the lunch programs themselves or bag lunches or snacks children bring to school from home.

Under the plan, Tier 1 products would be allowed at all grade levels throughout the school day and during after-school activities.

"The foremost criterion of foods and drinks included in this category is that they provide at least one serving of fruits, vegetables, whole grains, or nonfat or low-fat dairy," the I.O.M. said. Examples of Tier 1 foods include whole fruit, raisins, carrot sticks, whole grain, low-fat cereals, and nonfat yogurt with no more than 30 grams of added sugars. Tier 1 beverages would include plain water, skim or 1% milk, soybean beverages and 100% juice or vegetable juice, with limits on juice portions because of calorie content.

Tier 2 competitive foods and beverages do not necessarily provide a serving of vegetables, fruits, whole grains or low-fat or nonfat dairy, but would otherwise conform to the Dietary Guidelines. These items would be available only to high school students and only during after-school hours.

Examples of Tier 2 items include baked potato chips, pretzels, caffeine-free diet soda and sparkling water.

"Sports drinks should be available only to students engaged in an hour or more of vigorous athletic activity, at the discretion of coaches," the I.O.M. said. The committee recommended against making fortified water available as an option.

The I.O.M. suggested its proposal extend to school fundraisers, which it said should be limited to Tier 1 products for elementary and middle schools and Tier 2 products for high schools.

"Schools should encourage products used in celebrations such as holiday parties to meet the standards," the I.O.M. said. "Likewise, schools also should encourage foods and beverages sold at after-school and community events that include adults — such as athletic events and P.T.A. meetings — to conform to the standards."

Detailing benchmarks by which the success of its guidelines could be judged, the I.O.M. listed as keys awareness, understanding and implementation of the standards, with implementation achieved with the help of supportive legislation and supportive regulations. Success also could be measured by changes in product availability at schools and changes in children’s food and beverage sources and intake during the day. The group did not cite childhood obesity rates, a principal justification for the standards, as a success measure.

Senator Tom Harkin of Iowa, an advocate for stricter nutrition guidelines at schools, described the I.O.M. report as "the gold-standard recommendations" for regulatory changes.

"These recommendations offer a toolkit for local, state, and federal policymakers who already know that we need to do more — much more — to promote sound child nutrition and prevent childhood obesity," said Mr. Harkin, chairman of the Senate Committee on Agriculture, Nutrition and Forestry.

Also applauding the recommendations was the School Nutrition Association, which has been seeking uniform national nutrition standards for competitive schools.

"While supportive of the efforts of the I.O.M. committee’s recommendations, S.N.A. is concerned about implementation of the standards and the lack of enforcement of voluntary nutrition standards," the S.N.A. said. "S.N.A. remains an ardent supporter of enforceable, uniform, national school nutrition standards for foods and beverages available outside of the school meal programs, as well as for uniform, federal nutrition standards for school meals. The association continues to call on Congress to give the U.S. Department of Agriculture the authority to develop national nutrition standards for all competitive foods in schools."

Expanding on her concerns, Ms. Neely of the beverage group wondered about restricting 16- and 17-year old students from drinking diet soft drinks, bottled teas, light juice drinks and fortified waters.

"Our main disagreement is that when you’re talking about high school students old enough to drive a car, we think offering low-calorie choice is the way to go," Ms. Neely said. "In the same way grownups do, teenagers like beverage choices. Why not use schools to encourage students to choose beverages that are low in calories or have zero calories?"

In addition, Ms. Neely said proposed restrictions on sports drinks are "extreme" and contrary to pre-hydration recommendations of the American Academy of Pediatrics.

Ms. Neely also disagreed with the idea that high school students should be protected from caffeine in diet soft drinks.

"A cup of coffee has four to five times the caffeine as a diet soft drink," she said. "Let’s face it, we’re talking about older students, the ones I see lined up at Starbucks getting double espressos."

Even more guarded overall was, the Grocery Manufacturers Association. While thanking the I.O.M. "for its focus on children’s health and wellness," the G.M.A. said schools should be viewed "as a more holistic platform for educating children on the best ways to live a healthy lifestyle."

Criticizing an approach that views schools "simply as a place to ban or restrict the availability of certain foods," the G.M.A. said the report also fails to recognize the progress made improving the school food environment in recent years.

The prospect of mandatory guidelines is worrisome to the Independent Bakers Association.

"It remains disappointing that children are portrayed as victims of the foods they eat at school," said Dan Nagle, I.B.A. chairman. "Guidelines should remain voluntary. We are nervous the I.O.M. guidelines will find their way into the next School Nutrition Reauthorization. That would mean no more cupcakes or ice cream for birthdays, no soft drinks at the Friday night football game, and no more donut fundraisers and Girl Scout Cookie sales."

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