School Wellness Policies Marlene B. Schwartz, Ph.D. October 13, 2017
About the Rudd Center Mission: To promote solutions to childhood obesity, poor diet, and weight bias through research and policy.
15 years of research on school nutrition Fall 2002 my oldest daughter begins 1 st grade at the public elementary school They sell snack every day at lunch (e.g., ice cream, potato chips) I decide to pace myself In December, I get a notice for a school family event featuring a cookie eating contest I decide to get involved Principal and I started a wellness committee, drafted first policy
Parent comments from survey I prefer to see only healthy foods offered in public schools. The kids are exposed to lots of junk food and empty calories. Please take the junk out of the schools. This is the most important thing you can do for our children. Our child is overweight. We are trying so hard to make changes at home. The food at school is making things harder for us.
We though we would start with easy policies Only non-food celebrations in school Only non-food rewards in the classroom Remove unhealthy competitive foods from elementary schools
New parent comments there are so many rules and life seems like less fun now-a-days for kids. Even in the bible they celebrate with food.. this is America where we continue to fight and die for the basic rights of freedom - if parents and students choose to drink whole milk and eat ice cream they retain the right to do so. But birthdays are only once a year!
New Years Eve Birthday Party But it s only once a year... Birthday Party Valentine s Day Halloween Birthday Party Easter Birthday Party 4 th of July Mother s Day Father s Day Birthday Party Birthday Party St. Patrick s Day Christmas Birthday Party Graduation Birthday Party Birthday Party Birthday Party Thanksgiving Bridal / Baby Shower
Federal School Wellness Policies School Wellness Policies required by School Year 2006-2007 Polices must be created by a representative committee and must address: Goals for nutrition education Nutrition standards for all foods in school Goals for physical activity A plan for measuring implementation
Research Question How do you measure policies?
Created Quantitative Coding Tool 1. Nutrition Education 2. Standards for USDA Nutrition Programs 3. Nutrition Guidelines for Competitive Foods 4. Physical Education 5. Physical Activity 6. Communication & Promotion 7. Evaluation Schwartz, Lund, Grow, McDonnell, Probart, Samuelson, Lytle (2009) A Comprehensive Coding System to Measure the Quality of School Wellness Policies. Journal of the American Dietetic Association.
Three level coding scheme Code 0 if the item was not addressed at all in the policy Code 1 if the item was addressed in a vague, suggested, unclear manner Code 2 if the item was addressed in a clear, specific, and directive manner
Example Food as a reward in the classroom Code 0 No mention Code 1 We discourage teachers from using unhealthy foods as a reward in the classroom Code 2 The use of food as a reward in the classroom is prohibited
Two types of scores Comprehensiveness percentage of items addressed in some way Strength percentage of areas addressed in a clear and specific manner
www.wellsat.org Target audience state level government, district committees, advocates interested in monitoring policy strength and giving districts quantitative feedback Updated in 2015 and 2018
Policy strength increases implementation Principal reports from schools at every level in all Connecticut districts WellSAT scores for each district Positive and statistically significant relationship between the strength of policy and practices in the school Schwartz, Henderson, Falbe, Novak, Wharton, Long, O Connell, Fiore (2012). Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level. Journal of School Health.
State policies matter Student BMI trajectories are better in states with strong, specific, consistent laws regulating competitive foods (Taber, Chriqui, Perna, Powell, Chaloupka, 2013) Students in states with policies that require fruits and vegetables in school meals higher f/v consumption (Taber, Chriqui, Chaloupka, 2013).
Smart Snacks Began in the 2014-15 school year Limits on calories, fat, sugar, and sodium
National School Breakfast Program There have been strategies to increase participation in school breakfast Previous research and popular press articles raise concern that some children may eat two breakfasts Does this increase risk of obesity? Opportunity to do a study to inform policy
0 Methods Subjects o Followed the same 500 middle school students from 5 th -7 th grade o 12 CT schools o Universal free breakfast o SY 2011-2012, 2012-2013, & 2013-2014 Measures o Collected Body Mass Index (BMI) every Fall o Survey o Number of days they eat breakfast each week? (0-7 days) o Where they ate breakfast the previous day (home, school, neither or both)
Yesterday s Breakfast Location 100 90 80 70 Percent 60 50 40 30 20 10 Both School Home Did Not Eat 0 5th grade 6th grade 7th grade
Yesterday s Breakfast Location 100 90 80 70 Percent 60 50 40 30 20 10 Both School Home Did Not Eat 0 5th grade 6th grade 7th grade
Yesterday s Breakfast Location 100 90 80 70 Percent 60 50 40 30 20 10 Both School Home Did Not Eat 0 5th grade 6th grade 7th grade
Yesterday s Breakfast Location 100 90 80 70 Percent 60 50 40 30 20 10 Both School Home Did Not Eat 0 5th grade 6th grade 7th grade
Number of Days/Week Students Eat Breakfast 100 90 80 70 Percent 60 50 40 30 20 10 5th grade 6th grade 7th grade 0 0 days 1-3 days 4-5 days 6-7 days
Six Breakfast Consumption Categories 1. Frequent skippers 2. Inconsistent school eaters 3. Inconsistent home eaters 4. Regular school eaters 5. Regular home eaters 6. Double breakfast eaters
Percent 100 90 80 70 60 50 40 30 20 10 Double Breakfast Eaters Regular School Eaters Regular Home Eaters Inconsistent Home Eaters Inconsistent School Eaters Frequent Skippers 0 5th grade 6th grade 7th grade
Percent 100 90 80 70 60 50 40 30 20 10 Double Breakfast Eaters Regular School Eaters Regular Home Eaters Inconsistent Home Eaters Inconsistent School Eaters Frequent Skippers 0 5th grade 6th grade 7th grade
Percent 100 90 80 70 60 50 40 30 20 10 Double Breakfast Eaters Regular School Eaters Regular Home Eaters Inconsistent Home Eaters Inconsistent School Eaters Frequent Skippers 0 5th grade 6th grade 7th grade
Take home message Double breakfast eaters did not have greater weight gain compared to other students Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. (2016). School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatric Obesity, Mar 1-8
2010 Healthy, Hunger-Free Kids Act Championed by Michelle Obama Required USDA to update: National School Lunch and Breakfast regulations Gives authority to regulate competitive foods School wellness policy regulations
Plate waste has increased
Plate waste data Measured every item to get pre-weights Photographed and numbered trays Recorded selection of items Collected trays and measured food Recorded consumption
* 2012 100 90 80 * * 2013 2014 70 Percent Selected 60 50 40 30 20 10 0 Whole Fruit Vegetable Entrée Milk
100 90 80 * * 2012 2013 2014 70 Percent Consumed 60 50 40 30 20 10 0 Whole Fruit Vegetable Entrée Milk
The study actually affirms an increase in the amount of fruit thrown away by students under the new standards and supports SNA findings that 81% of school nutrition directors report an increase in the amount of food wasted at lunch.
Understanding plate waste Before: 100 students get lunch 100 students get lunch 50 students take a fruit 100 students take fruit Average 75% of each fruit is eaten and 25% is thrown away After: Average of 75% of each fruit is eaten and 25% is thrown away
Understanding plate waste Before: 50 ¾ apples eaten by the students 50 ¼ apples in the garbage After: 100 ¾ apples eaten by students 100 ¼ apples in the garbage Consumption has doubled Plate waste has doubled
Cost benefit analysis The question isn t whether consumption went up or plate waste went up We found that the proportion consumed vs. wasted went up or stayed the same Increase in consumption Increase in waste Compare cost to other interventions with comparable increases in f/v consumption
Research on impact of HHFKA School meals have gotten healthier significant improvements in nutrient quality, sodium, protein, fiber Participation rates have not gone down Johnson, Podrabsky, Rocha & Otten (2016) Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates
2016 Final Rule highlights Use evidence-based strategies for nutrition promotion and education, physical activity Must follow new school meal standards, Smart Snack standards even for fundraising Guidelines for all foods provided during the school day Food marketing only allowed for Smart Snack compliant foods
Reformulated products
2016 Final Rule highlights Involve key stakeholders in policy development, implementation, periodic review, and update Inform and update the public on content and implementation Triennial assessments Must establish leadership
New resources WellSAT-I o Interview measure to assess implementation of school wellness policies o Link up with WellSAT written policy items WellSAT 3.0 o Spring 2018 o Reflect 2016 final rule HHFKA o New items school gardens, school level wellness teams, lookalike snacks
National Wellness Policy Study Evaluating policy implementation nationally Focus groups and interviews with students, food service directors, superintendents, parents Connecting school wellness with Whole School, Whole Child, Whole Community Model
Conclusions Schools were the first battleground in the policy effort to improve the food environment Your role is to continue pursuing creative solutions to change the norm and track progress Our role is to listen to concerns and answer questions with research We all need to ensure that politics don t get in the way of children s health
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