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What Do Pregnancy Weight, Marketing, and Schools Have in Common?. Linda D. Meyers, Ph.D., Director, Food and Nutrition Board Annual Meeting of The Association of State & Territorial Public Health Nutrition Directors (ASTPHND) and

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what do pregnancy weight marketing and schools have in common

What Do Pregnancy Weight, Marketing, and Schools Have in Common?

Linda D. Meyers, Ph.D.,

Director, Food and Nutrition Board

Annual Meeting of

The Association of State & Territorial Public Health Nutrition Directors (ASTPHND) and

The Association of Graduate Programs in Public Health Nutrition (AGPPHN)

Portland, Maine -- June 2007

  • Context for IOM reports
  • Updates on
    • Pregnancy Weight
    • Food Marketing
    • Nutrition Standards
iom at a glance
IOM At-a-Glance
  • Established in 1970
  • Private, independent nonprofit
  • Part of the National Academies
  • 150+ staff
  • 1600 elected members
  • 40+ published reportsper year
  • Mission statement: “Advising the Nation. Improving Health.”
the national academies
The National Academies

Institute of Medicine

National Academy

of Sciences

National Academy

of Engineering


National Research Council









iom boards
IOM Boards

Population Health andPublic Health Practice

Rose Marie Martinez


Health Sciences Policy

Andrew M. Pope


Health Care Services

Michelle Orza

Acting Director

Global Health

Patrick W. Kelley


Food and Nutrition

Linda D. Meyers


Children, Youth,

and Families

Rosemary Chalk


African Science Academy Development

Patrick W. Kelley


Health Policy Educational Programs and Fellowships

Marie E. Michnich

Program Director

Military and Veterans Health

Medical Follow-Up Agency

Rick Erdtmann


  • Committee Studies
  • Convening Activities, e.g.,
    • Workshops
    • Forums
  • Fellowships






Paid staff and volunteer experts

Not government

No line appropriation from Congress

About 80% of funding from federal agencies


Private (incld Foundations)

food and nutrition board
Dennis M. Bier, MD(Chair)

Baylor College of Medicine

Michael Doyle, PhD(Vice-Chair)

University of Georgia

Diane Birt, PhD

Iowa State University

Yvonne Bronner, ScD

Morgan State University

Susan Ferenc, DVM, PhD

SAF*Risk, Arlington, VA & Chemical Manufactures and Producers Assn.

Nancy Krebs, MD, RD

University of Colorado Health Sciences Center

J. Glenn Morris, MD, MPH&TM

University of Maryland School of Medicine

Reynaldo Martorell, PhD

Emory University

Suzanne Murphy, PhD, RD

University of Hawaii

Jose Ordovas, PhD

Tufts University

Jim Riviere, DVM. PhD

North Carolina State

Nicholas Schork, PhD

University of California,

San Diego

John Suttie, PhD

University of Wisconsin

Linda Meyers, Ph.D.(Director)

Food and Nutrition Board
food and nutrition board1
Food and Nutrition Board
  • Diet, Nutrient and Health Relationships
  • Quality, Adequacy, and Safety of the Food Supply
  • International Food and Nutrition
  • Military Nutrition Research
dietary reference intakes
Dietary Reference Intakes


development of dietary reference intakes 1994 2004 lessons learned and new challenges workshop
Development of Dietary Reference Intakes, 1994-2004: Lessons Learned and New Challenges Workshop
  • Taking Stock of Lessons Learned
    • Contracts with US and Canada Govts
  • Workshop September 18-20, 2007
  • Workshop Development
    • Planning Committee (John Suttie, Chair)
    • White Papers (background)
    • Presenters and Discussants


the influence of pregnancy weight on maternal and child health workshop report

The Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report

Released: February 27, 2007

Committee on the Impact of Pregnancy Weight on Maternal and Child Health

Sponsor: Health Resources and Services Administration, HHS

  • Maxine Hayes, M.D., M.P.H. (Chair), State of Washington Department of Health, Olympai
  • Barbara Abrams, Dr.P.H.,School of Public Health, University of California, Berkeley
  • Ezra C. Davidson, Jr., M.D.,Department of Obstetrics & Gynecology, Charles R. Drew University of Medicine and Science, Los Angeles
  • Lillian Gelberg, M.D., M.S.P.H., Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
  • Matthew Gillman, M.D., S.M., Department of Nutrition, Harvard Medical School and Harvard Pilgrim Health Care, Boston
  • Janet King, Ph.D.,Children's Hospital Oakland Research Institute, Oakland
  • Ronald E. Kleinman, M.D., Pediatric Gastroenterology, Massachusetts General Hospital, Boston
  • Gregg Pane, M.D., District of Columbia Department of Health, Washington, DC
  • Kathleen Rasmussen, D.Sc.,Division of Nutritional Sciences, Cornell University, Ithaca
  • Leslie Sim, Study Director
plan workshop and prepare workshop report that examines and explores
Plan Workshop and Prepare Workshop Report that Examines and Explores…
  • Examine research
    • that describes the distribution of maternal weight (before, during, and after pregnancy) among different populations of women in the U.S.
    • on the effects of different weight patterns during pregnancy on maternal and child health outcomes
    • on individual, community, and health care system factors that impede or foster compliance with recommended gestational weight guidelines
examine research and
Examine research and….
  • Explore opportunities
    • for Title V Maternal and Child Health Programs to help childbearing women achieve and maintain recommended weight (before, during, and after) pregnancy
    • to inform future research and data collection needs
key messages
Key Messages
  • No National Surveillance System
  • Adequately monitor pregnancy weight gain
    • Identify appropriate indicators to monitor
    • Monitor before, during, and after pregnancy, & infant/child weight
    • Nationally representative
      • Racial/ethnic minorities, adolescents, immigrant
key messages1
Key Messages
  • Update 1990 IOM Recommendations
  • New, but limited research available on factors that contribute to pregnancy weight gain
    • Components of gestational weight gain
    • Biological and social determinants
    • Underweight and overweight
  • Explore appropriate indicators and health outcomes for weight gain guidelines
    • BMI, infant/child health, chronic health conditions, others
  • Guidance needed for specific populations of women
    • Racial/ethnic minorities, obese women, adolescents, women of short stature
key messages2
Key Messages
  • Achieve and Maintain Appropriate Weight Gain
  • --Limited studies on effective interventions for achieving and maintaining appropriate weight during and after pregnancy
  • --Prepregnancy interventions non-existent in literature
  • --Explore prepregnancy and post-partum weight patterns on gestational weight gain and maternal and child health outcomes
  • --Explore possible dissemination efforts that would be effective to women of child-bearing age
  • --Importance of weight before, during, and after pregnancy on their health and their child’s health
report details
Report Details
  • Accessible on the National Academies Press website to purchase, read, or download free of charge: http://books.nap.edu/catalog/11817.html
  • Next: Reexamination of IOM Pregnancy Weight Guidelines – Project Development

Report Origin

Congressional request to CDC

18-month study

Review evidence for food and beverage marketing impact on diet and health of children and youth

Consider marketing approaches to promote healthful diets

J. Michael McGinnis(Chair), Institute of Medicine

Daniel Anderson, University of Massachusetts, Amherst

J. Howard Beales III, George Washington University

David Britt, Sesame Workshop (retired)

Sandra Calvert, Georgetown University

Keith Darcy, Ethics Officer Association

Aimee Dorr, University of California, Los Angeles

Lloyd Kolbe, University of Indiana

Dale Kunkel, University of Arizona

Paul Kurnit, Kurnit Communications & KidShop

Robert Post, Yale Law School

Richard Scheines, Carnegie Mellon University

Frances Seligson, Pennsylvania State University

Mary Story, University of Minnesota, Minneapolis

Ellen Wartella, University of California, Riverside

Jerome Williams, University of Texas, Austin

Co-study Directors: Jennifer Gootman and Vivica Kraak

major conclusions
Major Conclusions
  • Many factors influence the diets of children and youth
  • Strong evidence that marketing shapes their diets
  • Marketing is out of balance with healthful diets
  • Corrective initiatives must be both public and private
  • Industry commitment must be part of the solution
  • Current public policy needs to be strengthened
growth in new food products targeted to u s children and youth 1994 to 2004
Growth in New Food Products Targeted to U.S. Children and Youth 1994 to 2004

New products targeted to total market

New products targeted to children & youth

Source: Williams J. 2005b. Product Proliferation Analysis for New Food and Beverage Products

Targeted to Children, 1994–2004. University of Texas at Austin Working Paper.

10 recommendations
10 Recommendations
  • Food and Beverage Companies
  • Restaurant Chains
  • Trade Associations
  • Marketing Practice Standards
  • Media and Entertainment Industry
  • Parents, Caregivers Social Marketing
  • School Environment
  • Government and Public Policy
  • Research
  • Monitoring Progress
Diets of children and youth do not meet recommendations

Marketing is one of many influences on diets

Prevailing food and beverage marketing practices not balanced with overall diet recommendations

Industry can play a leadership role in bringing balance to food and beverage marketing

Report recommends voluntary actions, to be followed by legislation if industry action is insufficient

nutrition standards for foods in schools leading the way toward healthier youth
Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth
  • Congressional mandate to CDC for an IOM study
  • ~ 18 month study
  • Released April 25, 2007
the task
The Task

Review and make recommendations regarding appropriate nutrition standards for the availability, sale, content, and consumption of foods and beverages at school, with attention given to foods and beverages offered in competition with federally-reimbursable meals and snacks

committee on nutrition standards for foods in schools
Virginia A. Stallings (chair)

Children’s Hospital of Philadelphia, PA

Dennis M. Bier

Baylor College of Medicine, TX

Margie Tudor Bradford

Bardstown Independent School District, KY

Carlos A. Camargo, Jr.

Massachusetts General Hospital

Isobel R. Contento

Columbia University, New York

Thomas H. Cook

Vanderbilt University, TN

Eric A. Decker

University of Massachusetts, Amherst

Rosemary Dederichs

Minneapolis Public School District, MN

Jay T. Engeln

National Association of Secondary School Principals, VA

Barbara N. Fish

West Virginia Board of Education

Tracy A. Fox

Food, Nutrition, and Policy

Consultants, MD

James C. Ohls

Mathematica Policy Research Inc., NJ (ret.)

Lynn Parker

Food, Research, and Action Center, Washington, DC

David L. Pelletier

Cornell University, NY

Mary T. Story

University of Minnesota, Minneapolis

FNB Staff

Ann Yaktine, Study Director

Alice Vorosmarti, Research Associate

Heather Del Valle, Senior Program Assistant

Committee on Nutrition Standards for Foods in Schools
  • Gathered information-
    • Reviewed literature
    • Held workshops and public forums
  • Deliberated
  • Developed Guiding Principles
  • Developed 2 Tier Approach
the guiding principles
The Guiding Principles

The committee recognizes that:

1. 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.

2. 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.


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

4. Foods and beverages have health effects beyond those related to vitamins, minerals, and other known individual components.


5. Implementation of nutrition standards for foods and beverages offered in schools will likely require clear policies; technical and financial support; a monitoring, enforcement, and evaluation program; and new food and beverage products.


The committee intends that:6. The federally reimbursable school nutrition programs will be the primary source of foods and beverages offered at school.7. All foods and beverages offered on the school campus will contribute to an overall healthful eating environment.8. Nutrition standards will be established for foods and beverages offered outside the federally reimbursable school nutrition programs.


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

10. The nutrition standards will apply to foodsand beverages offered to all school-age children (generally ages 4 through 18 yrs) with consideration given to the developmental differences between children in elementary, middle, and high schools.

nutritive food and beverages


Nutritive Food and Beverages
  • Fat: < 35/10 / 0
  • Total sugars < 35% kcal
  • <200 kcal/portion
  • <200 mg sodium/portion
nonnutritive food and beverages


NonNutritive Food and Beverages
  • Nonnutritive sweetener in beverages in high school after school
  • Caffeine-free
all students during the school day


All Students During the School Day
  • Tier 1 foods and beverages
  • Water available and free
  • Sport drink limited to student athletes with >1 hr vigorous activity via coach
  • Not for reward or punishment for behavior or academic achievement
  • Minimize marketing of Tier 2 foods and beverages
after school setting


After-School Setting
  • Tier 1 for elementary and middle school
  • Tier 1 and 2 for high school
implementing the recommended standards
Implementing the Recommended Standards

The recommended nutrition standards are among several elements of a school policy that could significantly improve the nutritional quality of foods offered in schools.

The committee identified the key elements for success in implementing the recommended standards and actions to achieve them.

key elements for success
Key Elements for Success

Awareness and understanding of the standards by schools, parents, students, and federal, state, and local as well as other private stakeholders.

action for implementation
Action for Implementation
  • Policy making bodies providing:
    • Regulatory guidance
    • Designate responsibility
    • Performance guidelines
    • Technical and financial support
  • Federal agencies and food and beverage industry
    • Identification system for Tier 1 and Tier 2
    • Whole grain and combination products guidance
concluding remarks
Concluding Remarks

Federal school nutrition programs are the main source of nutrition provided at school.

However, when opportunities for students to select competitive foods arise, they should be used to encourage greater consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy foods.

The recommendations in this report ensure that competitive foods are consistent with the DGA and will help encourage students to develop healthful life-long eating patterns.

for more information
For more information
  • Purchase report, read it online, or download free summary at www.nap.edu search on school foods
  • Download Report Brief at www.iom.edu/SchoolFoods2006
what in common
What in common?
  • Influence of Pregnancy Weight on Maternal and Child Health
  • Food Marketing to Children and Youth
  • Nutrition Standards for Foods in Schools