Spurred by the rising rate of obesity among American youth and the increasing availability of high-calorie, low-nutrient products on school grounds, a new report by the Institute of Medicine proposes a set of nutritional standards for "competitive" foods and drinks available in schools. The standards promote consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products and limit the amount of saturated fat, salt, added sugars, and total calories. The standards also restrict the sale of caffeinated items.
Developed by an IOM committee at the request of Congress, the standards apply to a la carte cafeteria items, products sold in vending machines and at school stores, and other foods and drinks that are available outside of -- and therefore compete with -- federally reimbursable school meals, which already must conform to some nutrition guidelines. The proposed standards take into account the varying needs and responsibility levels of children and teens -- for example, by limiting the sale of caffeine-free diet soda to high schools after school only, and by recommending smaller juice portions for younger children.
"The alarming increase in childhood obesity rates has galvanized parents and schools across the nation to find ways to improve children's diets and health, and we hope our report will assist that effort by setting standards for foods and beverages that have so far escaped any requirements," said committee chair Virginia A. Stallings, Jean A. Cortner Endowed Chair in Pediatric Gastroenterology and director of the Nutrition Center, Children's Hospital of Philadelphia; and professor of pediatrics, School of Medicine, University of Pennsylvania, Philadelphia. "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."
The committee proposed two tiers of competitive foods and beverages that could be available in schools based on grade level. The standards apply only to competitive items sold or available on campuses, not to federal school meals or to bagged lunches or snacks that children bring to school.
Tier 1 products should be allowed at all grade levels during the regular school day and during after-school activities involving students. 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. In addition, Tier 1 snacks contain no more than 200 calories per portion, and entrée items that could be sold a la carte do not exceed calorie limits on comparable school lunch program items. Tier 1 items have no more than 200 milligrams of sodium per snack portion or 480 milligrams per a la carte entrée item. They contain no more than 35 percent of total calories from fat; less than 10 percent of total calories from saturated fats; no trans fats; and no caffeine except in naturally occurring trace amounts. They also contain no more than 35 percent of calories from total sugars; exceptions to this guideline are flavored milk, which may contain up to 22 grams of sugars per 8-ounce serving, and yogurt, which should not exceed 30 grams of sugars per 8-ounce portion.
Examples of Tier 1 foods include whole fruit; raisins; carrot sticks; whole-grain, low-sugar cereals; some multigrain tortilla chips; some granola bars; and nonfat yogurt with no more than 30 grams of added sugars. Examples of entrée items that meet the criteria are a fruit salad with yogurt or a turkey sandwich. Tier 1 beverages are plain water, skim or 1 percent milk, soy beverages, and 100 percent fruit or vegetable juice. Because of their calorie content, juices are capped at 4-ounce servings for elementary and middle-school students and 8-ounce portions for high school students.
Unlike Tier 1 items, Tier 2 competitive foods and beverages do not necessarily provide a serving of vegetables, fruits, whole grains, or low-fat or nonfat dairy, but they otherwise conform to the U.S. Dietary Guidelines for Americans. These items should be available to high school students only and after school only. Like Tier 1 items, Tier 2 foods contain 200 calories or less per portion, 200 milligrams or less of sodium per portion, 35 percent or less of total calories from fat, less than 10 percent of total calories from saturated fats, no trans fats, no caffeine except in naturally occurring trace amounts, and no more than 35 percent of calories from total sugars. Tier 2 drinks contain five or fewer calories per portion and no caffeine; they are not vitamin- or mineral-fortified, but may be carbonated and may contain flavoring or a sugar substitute.
Examples of Tier 2 items include single servings of baked potato chips, low-sodium whole wheat crackers, graham crackers, pretzels, caffeine-free diet soda, and seltzer water. Tier 2 beverages should be available only after school because students may otherwise forgo healthier choices such as milk and juice. In addition, sports drinks should be available only to students engaged in an hour or more of vigorous athletic activity, at the discretion of coaches, the report says. The committee recommended against making fortified water available as either a Tier 1 or 2 option.
The committee did not support the sale of caffeinated products to school-age children because of the potential for negative effects, including headaches, moodiness, and other results that could disrupt students' abilities to concentrate and learn. Although caffeine-free diet soda can be an after-school option for high school students, the committee did not recommend for or against foods containing sugar substitutes. While several studies indicate the overall safeness of consuming sugar substitutes, studies have not explored the effects of long-term consumption of these products starting in childhood.
Schools should allow only Tier 1 products to be sold as fundraiser items on elementary and middle school campuses; high schools could allow Tier 2 items to be used for on-campus fundraising. Schools should encourage products used in celebrations such as holiday parties to meet the standards. Likewise, schools also should encourage foods and beverages sold at after-school and community events that include adults -- such as athletic events and PTA meetings -- to conform to the standards.
The committee was not asked to recommend a plan for implementing the proposed standards. However, it noted that schools will need technical and financial support. Federal agencies should work with the food and beverage industries to develop a system for identifying products that meet the Tier 1 and Tier 2 criteria to help food service personnel more readily evaluate items.
The study was sponsored by the Centers for Disease Control and Prevention. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.
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