Advocating for Healthier Options in Schools:

New York State Healthy Schools Act

Annika Hofstetter, M.D.Emily Rothbaum, M.D.

Children’s Hospital of NY PresbyterianJune 2008

What is the Healthy Schools Act?

• Improve nutritional standards for foods and beverages available in schools

• Provide additional training and technical assistance to schools in complying with nutritional standards

• Increase access to and affordability of healthy meals, including breakfast

• Require school districts to develop and implement wellness policies for student health and nutrition

Health Article VII Bill, Governor’s Budget, 2008-2009

Why Do We Need the Healthy Schools Act?

Of the 4.5 million kids in NYS:• 1 million are obese

• 900,000 are overweight

• 3.3 million are school-age– 7,066 schools (4,943 public)– 705 school districts

Dennison, B. NYSDOH. “Update on NY’s Proposed Healthy Schools Act.” 4/2008

Increasing Prevalence of Childhood Obesity in New York

NYS (excluding NYC) New York City

Overweight, 85≤BMI Percentile<95

Obese, 95≤BMI Percentile<99

Morbidly Obese, 99≤BMI Percentile

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1988

2003-

2004

1989-

1990

2002-

2003

Dennison, B. NYSDOH. “Update on NY’s Proposed Healthy Schools Act.” 4/2008

Per

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Current Federal Nutritional Requirements

Nutrient & calorie levels’ weekly averages must meet USDA standards:

• 1/3 of 1989 RDA for protein, calcium, iron, vitamin A and vitamin C (lunches)

• 1/4 of 1989 RDA for these nutrients (breakfasts)

• Appropriate level of calories for each age/grade groups

Meals consistent with 1995 Dietary Guidelines for Americans:

• Limit % calories from total fat to 30% and from saturated fat to less than 10% of total calories offered

• Reduce sodium and cholesterol levels

• Increase level of dietary fiber

Benesch, M. USDA. “Stepping Up For School Nutrition, USDA’s Efforts.” 4/2008

Schools Not Meeting Standards

USDA. “School Nutrition Dietary Assessment III.” 11/2007

New York State Also Failing to Meet National Standards

Sheedy, S. “NY State Nutrition Program: Child Nutrition Program Administration.” 4/2008

• Approximately 7% of LEAs meet dietary guidelines & nutrient standards with no further action necessary

• Total fat, saturated fat, and sodium too high

• Fiber, calories, vitamins and minerals too low

12 16

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Fox, Tracy. LLC. “Overview of Institute of Medicine Schools Foods Report.” 4/2008

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Competitive Foods in Schools

Leading up to the Healthy Schools Act

• Previous Legislative Efforts– Time Restrictions for Sale of

Food of Minimal Nutritional Value in Schools (1987)

– Childhood Obesity Prevention Program (2003 – 2005)

– School District Child Nutrition Committees (2004)

– Child BMI Screening & School Reporting (2007)

• New York State Strategic Plan (6/2005)

• Local and Federal legislation mandating local school wellness policies (2006)

• IOM report on School Foods (2006)Dennison, B. NYSDOH. “Update on NY’s Proposed Healthy Schools Act.” 4/2008

Competitive Foods in Schools

Percentage of Schools Offering Competitive Foods

Food Venue Elementary Middle High

A la carte 67 88 91

Vending Machines

46 87 91

School Store/Canteen/Snack Bars

15 25 54

Fox, Tracy. LLC. “Overview of Institute of Medicine Schools Foods Report.” 4/2008

Nutrition Standards for Foods in Schools (2006)

• “The present and future health and well-being of school-age children are profoundly affected by dietary intake and the maintenance of a healthy weight.

• “Schools contribute to current and life-long health and dietary patterns and are uniquely positioned to model and reinforce healthful eating behaviors in partnership with parents, teachers, and the broader community.

• “Because all foods and beverages available on the school campus represent significant caloric intake, they should be designed to meet nutritional standards.

• “The recommended nutrition standards will be based on the Dietary Guidelines for Americans, with consideration given to other relevant science-based resources.”

Institute of Medicine. “Nutrition Standards for Foods in Schools” Ch 1. 11/07.

History of the Healthy Schools Act:

How did we get here?

• Introduced as Governor’s Bill in the NY State Legislature in ‘07-8

– Assembly and Senate both passed some elements

• Reintroduced in Gov. Spitzer’s Executive Budget in ‘08-09

• Cut from Executive Budget during legislators’ debates this year

• Introduced into NYS legislature as A8698• Referred to Assembly’s Education Committee . . .

AND STUCK THERE!

History of the Healthy Schools Act: Where are we now?

• Requires NYSED and NYDOH to establish regulations for nutritional and dietary standards for school meals, snacks and beverages.

• Requires ALL schools that participate in NSLP to provide breakfast for all students.

• Increases state subsidies to ensure breakfast and lunch free to qualifying students.

New York State Assembly Memorandum in Support of Legislation. A8698, “Healthy Schools Act.”

• Orders the Commissioner of Health to conduct a statewide physical education survey.

Impact of the Healthy Schools Act

• 1,200+ LEAs serve 6,000+ sites in NEW YORK STATE– 3 million students statewide

• 48% eligible for free or reduced price meals

• National School Lunch Program– 1.7 million meals per day

• 62% free or reduced price• 57% participation rate

• School Breakfast Program– 502,000 meals per day

– 80% free or reduced price

• 19% participation rate

• 1,500+ sites serving in the NEW YORK CITY DOE– 1.1 million students

• 73% eligible for free or reduced price meals

• National School Lunch Program– 626,000 meals per day in NYC

• 86% free or reduced price• 59% participation rate

• School Breakfast Program– 190,000 meals per day in NYC

• 85% free or reduced price• 18% participation rate

Sheedy, S. “NY State Nutrition Program: Child Nutrition Program Administration.” 4/2008

Why Support the Healthy Schools Act?

State Health Commissioner Richard F. Daines: With so many students eating several meals a day at school, we are able to teach them life-time lessons in nutrition which will affect the food choices they make today and in the future.

(Lieutenant) Governor David A. Paterson: Childhood obesity has become an epidemic in New York - leading to poor health and poor educational performance. The Healthy Schools Act provides important tools towards curtailing its spread among our youth . . . We all share responsibility for our children’s health - now schools will be a key front in this battle.

NY District AAP Chair, Dr. Henry Schaeffer: We can and should use the school cafeteria as a learning environment: A place where children are presented with healthy options and are encouraged to make healthy choices.

Critics in the Schools

• Barbara Donegan, assistant superintendent, Arlington School District:

– “We’ve moved very far in that direction already. We have no soft drinks or candy in our vending machines . . . My concern is . . . the tendency of the state to over-regulate and micromanage what we do in the districts.”

– “They talked about having minimum breakfast and lunch periods, but does that mean we need to have a longer school day? I worry about ironclad mandates that may take time or money away from something else.”

• Alan Muhlnickel, school lunch director, Poughkeepsie School District:

– “If the government makes these restrictions, then some of the stuff I get from the government won’t meet their restrictions anymore. This means that I will have to find a new way to pay for it. I give back to the community already in the form of free and reduced lunches for 75 percent of students here, and the price the government gives me does not cover my costs.”

Alberti, Mike. The Weekly Beat, 5/25/2007.

Is Something Better than Nothing?

• Loopholes and Other Language– Specificity, strictness of nutrition standards– Requirements for physical activity– Nutritionists

Hamlin, Amie. “New York Coalition for Healthy School Food Letter to Supporters.” 5/31/2007.

“If ineffective legislation is passed now, parents, school administrators and local elected officials will wrongly think - for years to come - that the myriad health-related issues related to school food have been resolved.”

Healthy Schools, Healthy Families: Insights for the

Healthy Schools Act?• Vending machine contents• “Healthy Snack” sales • Farmer’s Markets• SchoolFood Plus• Jeter Meter, in-class exercise,

after-school team sports• School Wellness and Nutrition

Committees

What Can We Do?

• Address the Issue!

– Discuss school food choices with your patients and their families.

• Advocate for the Healthy Schools Act!!

– Advocacy Letter

References• See: www.nysed.gov/cn/cnms.htm for Stepping Up for a Healthier School

Environment Powerpoint presentations.• New York State Legislature Bill Search. http://assembly.state.ny.us/leg/• Institute of Medicine. “Nutrition Standards for Foods in Schools: Leading the Way to

Healthier Youth.” 11/2007. http://books.nap.edu/openbook.php?record_id=11899&page=21

• USDA Food and Nutrition Service, Office of Research, Nutrition, and Analysis. “School Nutrition Dietary Assessment III.” 11/2007. http://www.mathematica-mpr.com/nutrition/schoolmealsstudy.asp

• Alberti, Mike. “No Fries With That: State’s ‘Healthy Schools Act’ has area districts already thinking healthy.” The Weekly Beat, 5/25/2007.

• Dennison, B. NYSDOH. “Update on NY’s Proposed Healthy Schools Act.” Presented at Stepping Up for a Healthier School Environment Forum, 4/16/2008

• Fox, Tracy. LLC. “Overview of Institute of Medicine Schools Foods Report.” Presented at Stepping Up for a Healthier School Environment Forum, 4/16/2008.

• Hamlin, Amie. “New York Coalition for Healthy School Food Letter to Supporters.” 5/31/2007. http://www.sugarshockblog.com/2007/06/new_yorkers_tak.html

• Sheedy, Sandra. “NY State Nutrition Program: Child Nutrition Program Administration.” Presented at Stepping Up for a Healthier School Environment Forum, 4/16/2008.