Reading, Writing, and Arugula

The expanding role of schools in child nutrition

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When President Barack Obama signed the $4.5 billion Healthy, Hunger-Free Kids Act into law on December 13, he may have changed the lives of millions of children. The bill, which passed the Senate with unanimous consent last summer, reauthorizes the Child Nutrition Act through 2015 and pumps more funding into federal feeding programs, including the National School Lunch and School Breakfast programs, than ever before. The bill increases the reimbursement rate for each meal by 6 cents, the first time the reimbursement rate has risen in 30 years.

This new funding, if used as intended, is designed to help promote the use of healthier foods in schools--more whole fruits and vegetables, more whole grains--to bring the meals into compliance with the federal Dietary Guidelines for Americans. This funding goes hand-in-hand with another provision in the law, which gives the Secretary of Agriculture the authority to set nutrition standards for the meals served through the National School Lunch and School Breakfast programs, eventually expanding to all foods sold in schools, including a la carte lines and vending machines.

But the law goes beyond that to address the double-edged sword of childhood obesity and hunger. While it may seem ironic, child health advocates are quick to link the two problems together, noting that many children don't have access to the healthy food they need, and instead eat junk foods high in sugar, fat, and sodium that are calorie-dense but nutritionally poor. These children are getting more calories than they need, but not enough nutrients to keep them healthy. Add to that the lack of physical education classes in some schools, or inadequate places for them to play, and it's little wonder that one in three American children are obese or overweight.

The law also expands the availability of direct certification, automatically enrolling children whose families receive Medicaid benefits to receive school meals at a reduced cost or for free. This eliminates a stack of paperwork that parents need to complete, which may be confusing or get lost in the shuffle; categorical eligibility also automatically enrolls any children in foster care to ensure they receive those meals at school for free without troubling their foster parents or guardians with another set of papers.

The law also includes language that expands a program, currently in 13 states and the District of Columbia, which reimburses afterschool programs for providing a meal instead of just a snack to children who participate in an afterschool activity where some kind of enrichment is offered. The law allows for the expansion of this program to all 50 states, provided the afterschool program offers physical activity, either individually or in a group setting; mentoring or help with homework; or some other activity that adds an educational characteristic.

The law's passage has not been without controversy. The Senate passed the bill with unanimous consent, but there were objections when the House took on the Senate bill, instead of voting on a bill introduced by Representative George Miller (D-California). Miller's bill included some enhanced provisions, but was more expensive. Even the cost of the Senate bill was in question, as part of its offset was taken from the Supplemental Nutrition Assistance Program (SNAP, formerly known as the food stamp program). General opposition arguments were more on the principle of expanding the government's role in providing meals to children.

Healthy foods not always available at home

As noted by first lady Michelle Obama earlier this year, not every community has a grocery store or farmers' market that provides access to healthy foods. When she introduced her Let's Move! initiative in early 2010, one of the ways she suggested combating obesity and childhood hunger was through the elimination of food deserts, areas in which families don't have access to healthy foods including fresh produce, whole grains, lean meats, and unprocessed foods.

The need for eliminating food deserts was brought to light more recently through the publication of a report, , by the Department of Agriculture's Economic Research Service (ERS). According to the report, 85% of American households were food secure through all of 2009, meaning families had access to enough food to feed every member of the family at all times in order to live a healthy life. However, that also means that 14.7% of American families were food insecure during some point of 2009; 5.7% of families had very low food security. With the challenging economy and many adults struggling with job security or living from unemployment check to unemployment check, providing food for meals must be balanced against the funding needed to pay bills or purchase medicine.

"In households with very low food security, the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked the money or other resources for food," the report states. "Prevalence rates of food insecurity and very low food security were essentially unchanged from 14.6% and 5.7 %, respectively, in 2008, and remained at the highest recorded levels since 1995, when the first national food security survey was conducted. The typical food-secure household spent 33% more on food than the typical food-insecure household of the same size and household composition. Fifty-seven percent of all food-insecure households participated in one or more of the three largest federal food and nutrition assistance programs during the month prior to the 2009 survey."

Far and away the largest segment of the food insecure population is children: "Children were food insecure at times during the year in 4.2 million households (10.6% of households with children)," the report notes. "Although children are usually shielded from disrupted eating patterns and reduced food intake, children along with adults experienced instances of very low food security in 469,000 households (1.2% of households with children) in 2009, essentially unchanged from 1.3% in 2008."

Earlier in the year, the Obama Administration admitted that some families just don't have the ability to buy healthier foods for their children when they can afford to because they live in food deserts, where access to healthy food is limited at best. Food deserts might exist in rural areas, where a grocery store or farmers' market is several miles away, or in urban areas where the only food stores in the neighborhood are convenience stores that don't offer fresh fruits and vegetables or cuts of meat or poultry that could be used to make healthy meals.

In acknowledging that parents do have the lion's share of the responsibility in providing healthy food for their families, last February the Obama Administration also announced the $400 million Healthy Food Financing Initiative to eliminate food deserts. Some localities, like the suburbs of Los Angeles, have already started creating legislation reducing the opportunities for new fast-food restaurants to open, in the hopes of promoting the development of grocery stores, neighborhood shops, or other retail locations that would sell fruits and vegetables instead of burgers and fries. But the initiative would provide financial aid and technical assistance to community development institutions, nonprofits, and businesses. Funding would be distributed through a mix of federal tax credits, below-market rate loans, loan guarantees, and grants in the hopes of attracting businesses and private sector capital to double the investment, according to a statement from the administration. Federal funds would support projects ranging from construction or expansion of existing grocery stores to smaller scale projects like new refrigerators stocked with fresh foods in convenience stores. The Department of Agriculture (USDA) also released an interactive map showing the location of food deserts through ERS, which monitors the average distance a family has to drive to find a store that sells fresh foods, another tool the first lady says needs to be used to direct the funds made available through the Healthy Food Financing Initiative.

The USDA's Economic Research Service has an interactive map online, where users can see the food environment factors--including grocery store proximity, food prices, food and nutrition assistance programs, obesity rates, and community characteristics--that influence food choices in their communities. The map above shows the percentage of families without a car who live more than one mile from a grocery store, which ranges from 0% to 28% nationally.

By expanding the meal program to provide food to children in afterschool settings, where they may have been receiving a snack, these children now have the chance to get a full meal or supplement any food they might have at home, says Erik Peterson, a policy director with the After School Alliance in Washington, DC. According to Peterson, any program that receives food through the Child and Adult Care Feeding Programs under the jurisdiction of the USDA's Food and Nutrition Service is eligible to participate, provided it follows the recommendations established in the law for offering educational enrichment activities. "The Congressional Budget Office estimated that 19 million meals have been provided in 13 states and the District of Columbia over the past two or three years that this program has been in place, and through this new law, that could go up to 40 million meals by 2015," Peterson says. If the school supper program is included as part of the reauthorization process in 2015, that could expand further, reaching 50 million meals by 2020.

Meal reimbursement totals hit $250 million through the expanded program for the 2011-2015 time frame, Peterson says. This reflects food for millions of hungry children who otherwise might not know if they'd have dinner on any given school night.

To put it in a different light, consider this: Schools that currently provide snacks to children in afterschool settings receive a reimbursement of 76 cents per snack, which usually consists of a 100% juice box and some crackers or other small package of food, Peterson says. Under the new law, that reimbursement rate increases to $2.60 per meal, which will allow schools to provide a small meal with several components, including whole grains, fruit and/or vegetables, and lean proteins. "It doesn't have to be a meal, but it's something more substantial than what kids are receiving now," he says. "For families that struggle, this is an opportunity for more meals that are substantive that can either replace or supplement the meal that a child receives at home."

There is also some flexibility in when the afterschool meal is served. Many children receive their lunches between 10 a.m. and 11 a.m., so by the time the school day ends at 3 p.m., they're already hungry. Providing them with a meal at that time allows them to wind down from their day and start to focus on homework or getting extra help from teachers who pick up on academic struggles in class, Peterson suggests.

One possible enrichment that could serve as doubly beneficial to schools and children alike would be if schools used this afterschool time to have children plant and maintain a garden, Peterson says. The use of school gardens to teach children about nutrition and give them hands-on experience learning about fruits and vegetables is another of the first lady's suggestions through Let's Move!--one she has implemented herself with the help of students across Washington. Some of the students who helped her plant the White House garden joined her and the president when he signed the Healthy, Hunger-Free Kids Act into law. Planting gardens at schools also provides cheap and local venues for bringing more produce into school cafeterias, another focus of the new law.

Less paperwork means more funds for healthy foods

Perhaps the most important provision in the law that does not directly deal with funding or nutrition is the use of direct certification, which automatically enrolls certain vulnerable populations into the National School Lunch program. With this reauthorization, children in foster care and children receiving Medicaid are now automatically eligible, along with previously eligible children in families receiving Temporary Assistance for Needy Families (TANF) and SNAP, children enrolled in Head Start, and children who are homeless or migratory. This means children in foster care will no longer get lost in the shuffle if they need to move to a different family, says Sophie Milam, senior policy counsel with Feeding America.

Under the new law, "any child in foster care will be automatically eligible for free school lunch," Milam says. This eliminates the need for foster parents to fill out yet another form when enrolling a child in school and makes it that much easier for the child to get acclimated in his or her new school during an already sensitive time. But direct certification goes beyond that and may eliminate any stigma associated with getting a meal for free or at a reduced price, she notes.

This provision of the law does not apply to children in unofficial foster care arrangements, says Susan Acker, spokesperson for the Food and Nutrition Service. But for those children who are in official, formal foster care environments and their guardians, it's one less form to fill out in order to feel cared for and protected. There is a provision in the law that allows schools to use census data to determine how much of the population is receiving federal assistance and how much of the school population receives free or reduced-price meals. If 95% of a school's population is deemed eligible for free or reduced-price meals, the school can petition to offer meals free of charge to all students. In that scenario, the school district would be required to pay the difference in cost for the children who would otherwise be paying for their own meals, but the general consensus is that the school would be saving so much money by eliminating the administrative need to process all those applications, the district would be able to afford the difference, Milam says. This or one of the other categorical eligibilities (TANF, SNAP, or Medicaid) could cover some children in "unofficial" foster care.

Child nutrition advocates and members of Congress believe the use of direct certification will add at least 100,000 children to the lunch program over the law's five-year lifespan.

USDA to set nutrition standards for school foods in 2011

Now that the bill has been signed into law, the bulk of the work has shifted back to the USDA. The Secretary of Agriculture has been given the authority, for the first time, to establish nutrition standards for the meals served in schools. On December 21, the White House Office of Management and Budget released from its review the proposed rule in which the USDA will begin setting those standards. USDA is expected to use a report released by the Institute of Medicine in 2009 that encourages school meals to use more whole grains, whole fruits, a variety of vegetables, lean meats, and low-fat foods in order to provide nutrient-dense foods, instead of the calorie-laden processed foods that are high in sodium, trans fat, and saturated fat. Later, the secretary will also establish nutrition standards for all other foods sold in schools, including a la carte items sold in cafeterias outside the School Lunch program and foods sold in vending machines.

Contrary to what some opposed to the bill have stated, the rule will not ban the sale of baked goods at fundraisers, according to a statement released by Agriculture Secretary Tom Vilsack. Parents will still be able to send cupcakes to school for birthdays, for example.

There is funding in the Healthy, Hunger-Free Kids Act to provide training for cafeteria workers with the expectation that, given proper training and new equipment, students could begin having the option to receive freshly cooked meals in schools instead of frozen, premade meals. However, many schools long ago brought in deep fryers instead of other equipment that would make preparing fresh foods easier, so that transition may take more time and funding than is currently expected.

New focus on nutrition

Nutrition will be getting nearly unprecedented attention from the government in 2011, as the provisions of the Healthy, Hunger-Free Kids Act begin to be implemented and the 2010 Dietary Guidelines are released. The guidelines, also renewed every five years like the Child Nutrition Act, help USDA determine the nutrition standards for all federal feeding programs like SNAP, the Child and Adult Care Feeding Program, the Supplemental Nutrition Program for Women, Infants, and Children, and others.

There's also a possibility that Congress will look at expanding some of the federal feeding programs that cover children when schools are out of session, including summer break and vacations. Legislation had been introduced in the House by Representative Dina Titus (R-Nevada) and in the Senate by Senator Arlen Specter (D-Pennsylvania). The Weekends Without Hunger Act would improve feeding programs that ensure children have something healthy to eat when school isn't in session, but as the lame-duck session of Congress came to an end on December 22, the full Senate had not yet addressed the legislation, which had passed in the House on December 8. It will be reintroduced in the 112th Congress for consideration.

Amber Healy is a reporter in Arlington, Virginia, covering food safety and nutrition issues for Food Chemical News, a weekly regulation newsletter.

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