Local Wellness Policies — Securing a Healthy Tomorrow for Today’s Youths
By Valerie Yeager
Today’s Dietitian
Vol. 7 No. 9 P. 44

Good-bye soda machines and processed convenience foods, hello 100% juice drinks and fitness programs. The school environment is undergoing a health makeover, thanks to new legislation.

“Life affords no greater responsibility, no greater privilege, than the raising of the next generation.”
— C. Everett Koop, former U.S. Surgeon General

With the number of overweight children aged 6 to 11 more than tripling over the past three decades, raising the next generation has become an issue of national concern.1

More than 9 million children and teenagers are overweight, and childhood obesity is responsible for 50% of new cases of pediatric diabetes, sleep apnea, and asthma.1,2 Will today’s youths be the first generation to have a shorter life expectancy than their parents? Will diminished lifestyles, via lack of physical activity (PA) and improper nutrition, affect a child’s ability to learn?

With children spending the majority of each day at school, the educational system can play an important role in promoting a healthy lifestyle that will extend well beyond the school-age years.

New Legislation Brings CHange
Federal Public Law mandates that by the first day of the school year beginning after June 30, every local education agency participating in a program authorized by the Richard B. Russell National School Lunch Act or the Child Nutrition Act of 1966 must implement a local wellness policy (LWP). Each LWP, established under the provisions of the Child Nutrition and WIC (Women, Infants and Children Program) Reauthorization Act of 2004, must set goals for nutrition and fitness education, PA, campus food provision, and other school-based activities designed to promote student wellness.3,4

The legislation supports President George W. Bush’s HealthierUS Initiative, which encourages all Americans, including children, to improve personal health through PA, a nutritious diet, preventative screenings, and other healthy choices.3

Between easily accessible vending machines containing unhealthy options and countless hours spent sluggishly behind a desk, school is an environment where young people have the opportunity to consume more calories than they burn. LWPs are hoping to change that; they are being designed and implemented to drastically alter youths’ lifestyle choices. However, a group effort is required for success—including educating parents so the lessons taught in school are transferred to home life as well.

Development and Implementation
Although mandated nationwide, the responsibility of developing an LWP is placed at the local level to ensure that the individual needs of each school district are addressed.

According to the National Alliance for Nutrition and Activity, each district should consider the following factors when tailoring its LWP5:

• socioeconomic status of the student body;

• school size;

• rural or urban location;

• presence of immigrant, dual-language, or limited-English students;

• amount of class time available for instruction;

• curriculum requirements; and

• funding and space constraints.

The School Nutrition Association, a national, nonprofit, professional organization representing more than 55,000 members who provide high-quality, low-cost meals to students across the country, recommends the following4:

• programs comply with federal, state, and local requirements;

• programs are accessible to all children;

• sequential and interdisciplinary nutrition education is provided and promoted;

• patterns of meaningful PA connect to students’ lives outside of physical education (PE);

• all school-based activities are consistent with LWP goals;

• all foods and beverages made available on campus (including vending, concessions, a la carte, student stores, parties, and fund-raising) during the school day are consistent with the current Dietary Guidelines for Americans;

• all foods made available on campus adhere to food safety and security guidelines;

• the school environment is safe, comfortable, pleasing, and allows ample time and space for eating meals; and

• food and/or PA is not used as a reward or punishment.

To ensure the aforementioned needs are taken into consideration and comply with federal, state, and local requirements, districts are required to involve a broad group of individuals in policy development. Among the recommended individuals are parents, students, teachers (including specialists in the areas of health and PE), the public, school administrators, representatives from the school food authority, school board officials, a school counselor, a school nurse and/or community health professional, and an RD. The federally mandated LWPs may increase the need for a school district to hire a full-time RD, creating more openings for RDs who may not be interested in the clinical environment.

Each Local Education Authority should have an established plan for measuring the LWP’s implementation. Following the policy’s creation, one or more persons—possibly, and hopefully, including an RD—must be designated to oversee the implementation and evaluation of the policy recommendations.

Better Food Yields Better Results
Billions of marketing dollars have lured children into believing processed foods are real foods. Packaged foods may be easy to distribute, prepare, and serve—and comply with budgetary pressures—but convenience shouldn’t take precedence over health.

Now, with the mandation of LWPs, many schools are switching to the increasingly popular concept of slow foods, choosing quality over quantity and convenience. Serving locally grown food ensures that fresh products are being served to students and also helps support the local economy.

Sen Tom Harkin (D-Iowa) theorized that students would consume fruits and vegetables if they were more readily available. He was correct. In 2002, he initiated the Fresh Fruit and Vegetable Program, which provides free fresh fruit and vegetable snacks to kids throughout the day.6 Using funds from the 2002 Farm Bill, each participating school receives a grant from the program to purchase produce. The USDA reports that students receiving the produce are more attentive in class and eat fewer high-calorie snacks from vending machines.6 School nurses are reporting fewer students with headaches and stomachaches. Congress is talking about expanding funding for this program and similar programs, making the development and implementation of the nutrition services section of LWPs—perhaps the most costly—more financially manageable for school districts.

Closing the Gap
The USDA spends $9 billion per year supplying breakfasts and lunches to students, but nutrition delivered through those meals may be sabotaged by junk food and sugary beverages elsewhere on campus—until now.7 LWPs will close that giant loophole.

The term competitive foods may be used to refer to any food offered for sale outside of full school meals.8 Many schools negotiate contracts with major corporations to provide competitive foods in vending machines and snack bars and sold through fund-raising. These contracts may generate substantial revenues and noncash benefits—such as products, services, and support of school events—but they often impose obligations on the school, such as minimum annual benefits.8

A study completed by the National Center for Education Statistics (NCES), “Calories In, Calories Out: Food and Exercise in Public Elementary Schools, 2005,” showed that 23% of public elementary schools reported that one or more companies had a contract to sell drinks or snack foods at the schools.8 Many of these drinks and snacks are processed foods that don’t support the concept of providing fresh, unprocessed choices to students.

According to Harkin at the Healthy School Summit in Washington, D.C., on September 27, 2005, “We need to return to the days when our public schools were special places—commercial-free zones that fed our children nutritious food and saw to it that recess and PE were a part of every school day. School should be a sanctuary, not just another marketplace hawking junk food and sugary sodas. I understand the pressures of fund-raising in schools, but should we sell out our children’s health to raise $10,000 or $20,000 a year in a given school? Of course not. Instead of selling out to the commercial culture, schools should be modeling an alternative culture that puts children and their well-being as the highest priority and the highest value.”7

Many industry insiders and corporations are realizing the problem and are helping by making it easier for schools to negotiate new contracts and amend existing contracts to provide healthier options to students.

Drink to Your Health
Although the responsibility for the successful implementation of each LWP is placed at the local level, government programs are being developed to encourage continual success. Harkin agrees: “The onus should not be entirely on local people. We need a more active federal government in setting guidance for public schools.”7

The establishment of government-sponsored programs may be a stepping stone for schools currently developing and implementing their LWPs. If districts know sugar-laden beverages won’t be permitted for sale in schools in the upcoming years, they may begin the trend now rather than later.

For example, on May 3, the beverage industry announced that it is voluntarily eliminating the sale of sodas, sports drinks, and fruit drinks that are not 100% juice from all elementary schools. The Alliance for a Healthier Generation—a joint initiative of the William J. Clinton Foundation and the American Heart Association—worked with representatives of Cadbury Schweppes, Coca-Cola, PepsiCo, and the American Beverage Association to establish new guidelines to limit portion sizes and reduce the number of calories available to children during the school day.8,9 This will affect approximately one third (34%) of elementary schools nationwide.8

The guidelines will cap the number of calories available in beverages in schools at 100 calories per container, except for certain milks and juices whose nutritional value warrants the higher number of calories. Under the terms of the agreement, the beverage industry will work to spread these standards to 75% of the nation’s schools prior to the beginning of the 2008-2009 school year and fully implement the guidelines by the 2009-2010 school year.9

Elementary schools will sell only water, 8-ounce servings of certain juices containing no added sweeteners, and fat-free and low-fat regular and flavored milks. Middle schools will apply the elementary school standard with portion sizes increased slightly to 10 ounces.9

“This really is a groundbreaking agreement,” says American Heart Association President Robert Eckel, MD. “Many school districts are headed in the same direction as our guidelines.”9

Nutrition Education
There are no shortcuts to solving the obesity problem. Providing students with healthy meal and snack choices is just one step to promoting lifelong wellness. It’s also about what they learn and what they do.

Educating and convincing students why they should eat healthier may be the most complicated task. Nutrition concepts should be integrated into core subject areas and comply with state standards. The concepts should also extend beyond the classroom into the cafeterias and hallways through educational posters and displays.

The Pittsburgh Public Schools’ LWP has developed a curriculum involving hands-on learning opportunities that address the “physical, emotional, mental, behavioral, and social dimensions of health, which provides lifelong habits of health that become for students a whole school experience/learning laboratory wherein wellness principles are holistically integrated with actual nutrition in the available foods on campus...”10

Physical Activity
The 2005 Dietary Guidelines for Americans recommend at least 60 minutes of daily PA for children aged 6 to 11.11 Children spend eight hours of each day at school, making it the perfect place to ensure that each student is experiencing at least some PA five times per week.

The PA component of LWPs should be geared toward teaching the skills and knowledge needed for everything from basic movement skills to lifelong fitness. The Pittsburgh Public Schools’ LWP enforces a planned, sequential curriculum that “provides cognitive content and learning experiences, such as basic movement skills; physical fitness; rhythms and dance; games; team, dual, and individual sports; tumbling and gymnastics; and aquatics, which will develop lifelong habits and love of being moderately to vigorously physically active.”10

In addition to a more sequential and planned curriculum, many schools are increasing the minutes of required PE and providing more options for PE electives. Also, the use of waivers to exempt students from PE is being minimized as much as possible. Participation in programs such as Walk-to-School Day, Hoops for Heart, Jump Rope for Heart, Safe Routes to School, and All Children Exercise Simultaneously may encourage more PA (see sidebar for additional resources).

The NCES report was conducted to address the national concern of obesity among school-age children. The first U.S. Department of Education study focused on food and exercise in public elementary schools, the survey was mailed to a nationally representative sample of 1,198 regular public elementary schools in early spring 2005.8 The study included information on three indicators for PA: recess, PE, and school programs or activities designed to encourage exercise.

The Institute of Medicine recommends that schools provide recess and PE on a daily basis.12 However, the study found that while 83% to 88% of public elementary schools provided daily recess, some schools did not schedule recess at all. The proportion of schools with no recess ranged from 7% for first and second grades to 13% for sixth grade.8

At least one half of all public elementary schools scheduled PE only one or two days per week, ranging from 50% for sixth grade to 55% for grades 1 through 4. One percent of the schools did not have a PE schedule while the proportion that provided daily PE ranged from only 17% to 22% across elementary grades.8

Many public elementary schools are using a range of nontraditional programs to encourage their students to exercise. The remaining schools should learn via their example. Nearly two thirds (64%) of the schools used nontraditional PE activities, such as dance or kick-boxing, to make PE enjoyable. Fifty-eight percent provided opportunities during the school day for organized PA outside of PE, and 51% offered school-sponsored before- or after-school activities that emphasize exercise (eg, walking or running, sports, dance, or group games). In addition, 55% of the schools participated in the President’s Challenge Physical Activity and Fitness Award program.8

Although the numbers may initially seem promising, consider that up to one half of today’s youths are not physically active at all during the eight-hour school day. With the temptations of video games and television at home, what are the chances they will be active during the evening hours?

Other School-Based Activities
LWPs are required to include goals for other activities that promote healthy choices and make the other elements of the LWP attractive to students—for example, allowing ample time for students to eat and socialize, offering recess before lunch so students don’t rush through eating, and providing safe and supervised areas in which students can eat and be physically active. Special consideration should be given to prohibiting the use of food as a reward or punishment by withholding food other students receive. Both nutrition and PA should not be portrayed as a chore or something one must earn.

Problems
Although no one can argue that improvements need to be made so today’s youths are better equipped to live a long, healthy life, there are still many challenges each school district must face when developing and implementing an LWP. Districts cite the following challenges4:

• lack of funding: 37.6%;

• lack of support from students: 29.3%;

• appropriate food and beverage products not available: 23.1%; and

• lack of support from administration: 23.1%.

Lack of funding is a major issue. The “Calories In, Calories Out” study found that high poverty schools were less likely to have any scheduled recess or daily recess compared with schools with lower poverty concentrations. When the times for PE and recess were combined, schools with high poverty rates had lower averages in minutes per week compared with other schools.8

With their already diminished PA and nutrition standards, how are low-income inner city or rural schools expected to find the resources to fund the programs and find health experts willing to assist in the development of LWPs? Success of a program depends on support from the local government, the school district itself, donations, grants, and parent and community volunteers.

Model Behavior
Although schools can provide a facility where many people can work together to change and maintain the well-being of young people, schools alone cannot address the nation’s most serious health problems. Families, healthcare workers, the media, community organizations, and young people themselves must also be involved.

I spoke with a friend who is an elementary teacher about the implementation of the LWP at the school where she works. She mentioned that her colleagues were worried their soda machine and junk-filled vending machine would be removed from the teachers’ lounge. Although designed for students, the LWPs aren’t only for young people; teachers, other school employees, and parents should all be implementing the same strategies. Ultimately, as much as we tell and teach children, the best way they learn is through example. It will take a long-standing and continual team commitment ensure success. According to author Wilfred A. Peterson, “Our children are watching us live, and what we are shouts louder than anything we can say.”

“The success or failure of these school wellness policies is going to depend on implementation and leadership. It’s going to depend on the energy, activism, and outspokenness of people in their local communities,” says Harkin.7 The lifelong health of our youths is at stake.

— Valerie Yeager is assistant editor of Today’s Dietitian.

References
1. U.S. Government Accountability Office. “School Meal Programs: Competitive Foods Are Widely Available and Generate Substantial Revenues for Schools (GAO-05-563).” Washington, D.C.: U.S. Government Accountability Office, 2005.

2. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. Accessed July 10, 2006.

3. United States Department of Agriculture. Food and Nutrition Service. Local Wellness Policy. Accessed July 10, 2006.

4. School Nutrition Association. Accessed July 10, 2006.

5. National Alliance for Nutrition and Activity. Model Local School Wellness Policies on Physical Activity and Nutrition. March 2005. Accessed July 10, 2006.

6. Buzby JC, Guthrie JF, Kantor LS. Evaluation of the USDA Fruit and Vegetable Pilot Program: Report to Congress. Accessed July 10, 2006.

7. Remarks of Senator Tom Harkin (D-Iowa) at the Healthy Schools Summit in Washington, D.C. September 27, 2005. Accessed July 10, 2006.

8. National Center for Education Statistics. Calories In, Calories Out: Food and Exercise in Public Elementary Schools, 2005. May 16, 2006.

9. Clinton Foundation. Alliance for a Healthier Generation — Clinton Foundation and American Heart Association — and Industry Leaders Set Healthy School Beverage Guidelines for U.S. Schools. May 3, 2006. Accessed July 10, 2006.

10. Pittsburgh Public Schools’ Wellness Policy, Adopted August 24, 2005. Accessed July 10, 2006.

11. U.S. Department of Health and Human Services. Dietary Guidelines for Americans 2005. Washington, D.C.: U.S. Government Printing Office, 2005.

12. Institute of Medicine, Committee on Prevention of Obesity in Children and Youth. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: National Academies Press, 2005.

Additional Resources
ACES (All Children Exercise Simultaneously) Program

Brain Breaks

Hoops for Heart

Jump for Heart

Take 10

USDA’s Team Nutrition

Walk to School Day

Model Policy
The National Alliance for Nutrition and Activity (NANA) convened a group of more than 50 health, physical activity, nutrition, and education professionals from a variety of national and state organizations to develop a set of model policies for local school districts that meet new federal requirements. The model is based on nutrition science, public health research, and existing practices from exemplary states and local school districts around the country. The NANA work group’s first priority was to promote children’s health and well-being, though feasibility of policy implementation was also considered. Organizations such as the American Cancer Society, American Dental Society, American Diabetes Association, American Dietetic Association, and American Public Health Association assisted with or support the development of the NANA’s model policies. The full report is available at www.nanacoalition.org.

— VY