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School Meals: IOM 2009 Recommendations March 2011

School Meals: IOM 2009 Recommendations March 2011. Ronald E. Kleinman, MD MassGeneral Hospital for Children Harvard Medical School Boston MA. In FY 2010, schools served 2.9 billion free NSLP lunches 0.5 billion reduced price lunches 0.2 billion reduced price breakfasts

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School Meals: IOM 2009 Recommendations March 2011

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  1. School Meals:IOM 2009 RecommendationsMarch 2011 Ronald E. Kleinman, MD MassGeneral Hospital for Children Harvard Medical School Boston MA

  2. In FY 2010, schools served • 2.9 billion free NSLP lunches • 0.5 billion reduced price lunches • 0.2 billion reduced price breakfasts • 0.3 billion paid breakfasts These figures do not include non-Federally reimbursable a lacarte meals or other non-program foods.

  3. Prevalence of obesity among children and adolescents by age group – United States1963-2008

  4. VIRGINIA A. STALLINGS (Chair) Children’s Hospital of Philadelphia KAREN WEBER CULLEN Baylor College of Medicine ROSEMARY DEDERICHS Minneapolis Public Schools MARY KAY FOX Mathematica Policy Research, Inc. LISA HARNACK University of Minnesota, Minneapolis GAIL G. HARRISON University of California, Los Angeles MARY HILL Jackson Public Schools, Mississippi HELEN H. JENSEN Iowa State University RONALD E. KLEINMAN Massachusetts General Hospital GEORGE P. MCCABE Purdue University SUZANNE P. MURPHY University of Hawaii at Manoa ANGELA M. ODOMS-YOUNG University of Illinois at Chicago YEONHWA PARK University of Massachusetts at Amherst MARY JO TUCKWELL inTEAM Associates, Wisconsin Consultant Subject Matter Expert and Writer CAROL WEST SUITOR IOM Staff CHRISTINE L. TAYLOR, SHEILA MOATS, JULIA HOGLUND, HEATHER BREINER IOM Committee on Nutrition Standards for the National School Lunch and Breakfast Programs

  5. Summary of Process and Changes Recommended by IOM Committee : What’s different?

  6. IOM 2009 Report (and USDA Rule): Overview • Goal • Focus of the recommendations • Meal Requirements, effects on food costs and necessary implementation efforts • Recommendations for evaluation and research

  7. IOM Report: The Goal • Review and assess the food and nutritional needs of school-aged children in the United States using the 2005 Dietary Guidelines for Americans and the IOM Dietary Reference Intakes (DRI) • Use that review as a basis for recommended revisions to the NSLP and SBP Nutrition Standards and Meal Requirements.

  8. IOM The Goal • reflect current nutritional science • increase the availability of key food groups as appropriate • better meet the nutritional needs of children, foster healthy eating habits and safeguard children’s health • Development of a set of well-conceived, practical, and economical recommendations for standards that:

  9. IOM Key Steps in the Process • Set age-grade groups based on current school configurations and the age groups of the Dietary Reference Intakes • Conduct a new review of schoolchildren's dietary intakes based on those age-grade groups • Test methods of setting the Nutrient Targets • Propose Nutrient Targets

  10. IOM Key Steps in the Process (continued) • Use preliminary targets in developing the Meal Requirements • Check possible requirements against the Phase I criteria considering • Consistency with Dietary Guidelines and DRIs • Practicality • Administrative concerns • Student acceptance • Costs • Adjust proposed Meal Requirements to achieve the best balance • Issue recommendations for Nutrient Targets and Meal Requirements

  11. Consider public comment Select age-grade groups Test methods of setting Nutrient Targets Evaluate consistency with DRIs and DGAs Propose Nutrient Targets Consider costs Consider practicality Write menus Propose Meal Requirements Evaluate nutrients offered Recommend Nutrient Targets and Meal Requirements Consider student acceptance Consider administrative concerns IOM Phase I: Develop criteria, propose approach, and assess dietary intakes of schoolchildren for recommending revisions to Nutrition Standards and Meal Requirements Phase II: Use criteria and proposed planning method to revise current Nutrition Standards and Meal Rqmts

  12. IOM Focus of the Recommendations • Nutrient Targets (Age-Grade Groups) • Standards for Menu Planning • Standards for Meals as Selected • Implementation • Operators • Available Foods • Training • Costs • Evaluation • Research

  13. IOM Recommendation • FNS should adopt the Nutrient Targets as the scientific basis for setting standards for menu planning for school meals but should not adopt a nutrient-based standard for school meal planning and monitoring.

  14. NUTRIENT TARGETS Goals for School Meals MEAL REQUIREMENTS Standards for Menu Planning Standards for Meals as Selected by the Student IOM Recommendation

  15. IOM Criteria for Nutrient Targets and Meal Requirements • Consistent with current DGA’s and DRI’s (to improve children’s diets by reducing inadequate and excessive intakes of food, nutrients, and calories) • Considered on the basis of age-grade groups (consistent with current age-gender categories used for DRI values and with widely used school grade configurations) • Simplification of menu planning and monitoring • menus that are practical to prepare and serve • nutritious foods and beverages • appeal to students of diverse cultural backgrounds • Sensitive to program costs and school administrative concerns

  16. IOM Recommendation • Key Aspects of Recommended Nutrient Targets • Nutrient Targets are recommended for use in the development of the standards for menu planning, not for menu planning or for routine monitoring of the nutritional quality of the meals. • Recommended targets cover both minimum and maximum calorie levels. • The number of specifications increased from 8 requirements to 24 targets for nutrients and other dietary components.

  17. IOM Recommendation Nutrient Targets*1,2 • Calories** • Fat • Saturated; Linoleic; Linolenic; Transfats • Protein • Vitamins • A,C,D,E,B1,2,3,6,12 Folate • Minerals • Iron, Magnesium, Zinc, Calcium, Phosphorus, Potassium, Sodium*** • Fiber *1set to reduce prevalence of inadequacy –TMI- leading to higher nutrient density (Fe,Mg,Zn,K,Fiber) *2Breakfast 21.5% and Lunch 32% age-grade TMI **max and min ***UL

  18. IOM Recommendation Sodium • Current average daily sodium intake is 2-3 times DRI • Reduce sodium intake to 22.7% of UL at breakfast • Reduce sodium intake to 33.6% of UL at lunch • Ten year goal with decrease every 2 years

  19. IOM Recommendation • Criterion for Whole Grain-rich Foods • A serving of the food item must be at least the portion size of one Grains/Breads serving as defined in the USDA Food Buying Guide for Child Nutrition Programs (USDA, 2009). • AND • The food must meet at least one of the following: • The whole grains per serving > 8 grams. • The product includes the following FDA-approved whole grain health claim on its packaging. “Diets rich in whole grain foods and other plant foods, and low in saturated fat and cholesterol may help reduce the risk of heart disease.” • Product ingredient listing lists whole grain first. • *Whole grain ingredients are those specified in the Healthier US School Challenge Whole Grain Resource Guide

  20. IOM Recommendation Age-Grade Groups • 5-10 years (Kindergarten-grade 5) • 11-13 years (grades 6-8) • 14-18 years (grades 9-12)

  21. IOM Recommendation • To align school meals with the DGA’s and improve the healthfulness of school meals, the FNS should adopt standards for menu planning that increase the amounts of fruits, vegetables and whole grains; increase the focus on reducing the amounts of saturated fat and sodium provided; and set a minimum and maximum level of calories.

  22. IOM Recommendation Major Change in Approach to Menu Planning • A single approach that combines a food based meal pattern with 3 nutrient-based specifications: • minimum and maximum calorie levels • maximum saturated fat content • maximum sodium content.

  23. IOM Recommendation

  24. IOM Recommendation Recommended Changes in Food • More fruit is specified. • Fruits and vegetables are not interchangeable. • Weekly amount of vegetable subgroups are specified for lunch. • Whole grain-rich foods are defined and minimum amounts specified. • Selections from food groups must not provide more calories than the maximum (averaged over the 5-day week).

  25. IOM Recommendation Changes in Minimum Amounts and Types of Food–Breakfast • ½ cup of fruit increased to 1 cup per day. • 2 grains or 2 meats/meat alternates or 1 of each changed to a daily average of • 1.4 to 2 grains per day plus • 1 to 2 meat or meat alternates per day. (Ranges reflect differences by grade group.) • At least half of the grains to be whole grain-rich (all of the grains within 3 years. • Fat content of milk to be 1% or less.

  26. IOM Recommendation Changes in Minimum Amounts and Types of Food–Lunch • ½ to 1 cup per day of fruit and vegetables combined increased to • ¾ to 1 cup of vegetables plus • ½ to 1 cup of fruit per day. • No specifications for vegetables changed to • Weekly requirements for dark green and orange vegetables and legumes and • Limits on starchy vegetables.

  27. IOM Recommendation Changes in Minimum Amounts and Types of Food–Lunch (cont’d) • 1.8 to 3 ozeq of grains changed to 1.8 to 2.6 ozeq(daily average over 5-day week). • 1.5 to 3 ozeq of meat/meat alternate changedto 1.6 to 2.4 ozeq(daily average over 5-day week). • At least half of grains to be whole grain-rich (all of the grains within 3 years). • Fat content of milk to be 1% or less.

  28. IOM Recommendation • To achieve a reasonable balance between the goals of reducing waste and preserving the nutritional integrity of school meals, create meal plans for foods that are selected by the student.

  29. IOM Recommendation Committee’s Preferred Option for Standards for Meals As Selected by the Student Under Offer versus Serve

  30. Nutrition Standards in the National School Lunch and School Breakfast ProgramsFood and Nutrition Service, USDAProposed RuleFederal Register/Vol. 76, No. 9/p.2494/January 13, 2011

  31. USDA Proposed Rule Offer Versus Serve at Breakfast • Proposed rule: Students may decline one item at breakfast, but they must take at least one fruit or fruit juice or non-starchy vegetable.* • IOM alternative: Students may decline one item at breakfast, but they must take at least one fruit or fruit juice. *The proposed rule recognizes that some schools offer vegetables at breakfast. The cost effects of this change are minimal.

  32. IOM Implementation: A Focus on Improving the Foods that are Available to Operators Recommendation • USDA should work with HHS, the food industry, professional organizations, state agencies, advocacy groups, and parents to develop strategies and incentives to: • reduce the sodium content of prepared foods • increase the availability of whole grain-rich products while maintaining acceptable palatability, cost, and safety. Recommendation • The Food and Drug Administration should take action to require labeling for the whole grain content of food products.

  33. USDA Proposed Rule Whole Grains • Proposed rule: Within two years of implementation of a final rule all grains offered to students must be whole grain rich (a minimum whole grain content of 51 percent). • IOM alternative: Within three years of implementation, the whole grain content of grain products offered to students must average at least 50 percent.

  34. USDA Proposed Rule Sodium Targets • Proposed rule: Reduce sodium content of school meals to the levels specified by IOM within ten years of a final rule. Set three intermediate sodium targets, 2 years, 4 years, and 10 years after implementation of a final rule. • IOM alternative: Reach sodium targets by 2020. Set intermediate targets every,2 years.

  35. USDA Proposed Rule

  36. USDA Proposed Rule Low Fat Flavored Milk • Proposed rule: Low fat milk cannot be flavored. Only fat-free milk can be flavored.

  37. USDA Proposed Rule Phase-In Implementation of IOM Recommendations • Proposed rule: All schools are expected to implement the proposed rule beginning with school year 2012–2013, with final whole grain requirements implemented by the school year 2014–2015.

  38. Costs to Implement Recommended Meal Requirements

  39. The boston glove is a very;’akdj f;kljal;ksdfl;k ;klk;j’pla Green beans up 13c/lb; Tomatoes up 45c/lb; Lettuce up 28c/head

  40. IOM Process Used to Evaluate Costs • Selected 12 representative baseline menus from menus in SNDA-III • Matched food items with food codes from the School Lunch and Breakfast Cost Study-II • Estimated the cost of meals using SNDA-III data on student take-up rates • Developed modified baseline menus • Limitations in the nutrient database limited the ability to find good matches for foods in the modified menu • Estimated the cost of meals for the modified baseline menus using estimated student take-up rates • Compared the cost of the representative menus to the cost of the modified baseline menus

  41. IOM Reasons for Change in the Estimated Food Costs of School Meals (under IOM recommended requirements) • Addition of fruits and vegetables, and additional meat or meat alternate* • Fruit serving (about $0.14–0.15 per serving) • Vegetable serving (about $0.07–0.09 per serving) • Addition of meat or meat alternates (about $0.30–0.33 per 2 oz serving) • Whole grain-rich item in place of refined item (increase 3–20%) *Representative costs based on 2005–2006 prices.

  42. IOM Estimated Increases in Reimbursed Food Costsof Modified Menus • Students’ food selections under the new Meal Requirements cannot be known in advance.

  43. IOM Factors Limiting the Precision of Food Cost Estimates: VolatileChanges in Food Prices • SLBCS-III was conducted during SY 2005–2006 • 2006–2009: Food prices rose 12.2 % • Prices for food away from home rose 12.4% • 2006– 2008: prices of bakery, dairy, eggs and processed fruits and vegetables rose at a faster rate than many other foods • 2008–2009: price of meats and eggs fell dramatically • 2011: prices for commodities rising dramatically

  44. USDA Proposed Rule • The proposed rule will raise the average cost of producing and serving school lunches by almost 7 cents and school breakfasts by 37 cents on initial implementation. • By FY 2015, when the 100 percent whole grain rich requirement takes effect, the cost per lunch will be 14 cents higher than the baseline estimate; the cost per breakfast will be 50 cents higher. • Across all SFAs the total cost of compliance will be $6.8 billion over five years. • Although about 99 percent of SFAs enroll fewer than 50,000 students, they enroll only about 80 percent of all students. If they serve about 80 percent of all meals (no data available on meals served by SFA size), then these small entities would incur roughly 80 percent of estimated costs. • Changes in Food Costs

  45. IOM Implementation: A Focus on Direct Assistance to Operators Recommendation • The FNS, along with state agencies, professional organizations and industry, should provide extensive support to enable food service operators to adapt to the many changes required by the revised Meal Requirements. • Technical assistance related to menus, ordering, controlling costs, and maintaining quality–including revisions to the Food Buying Guide. • New procedures for monitoring the quality of school meals that • Focus on meeting relevant Dietary Guidelines and • Provide information for continuous quality improvement and for mentoring food service workers to assist in performance improvement.

  46. USDA Proposed Rule • SFAs must adjust their current training agenda to include the new requirements, as no funding has been provided in the proposed rule to accommodate new training. • TRAINING COSTS

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