[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
IMPROVING CHILD NUTRITION PROGRAMS
TO REDUCE CHILDHOOD OBESITY
SUBCOMMITTEE ON HEALTHY
FAMILIES AND COMMUNITIES
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED ELEVENTH CONGRESS
HEARING HELD IN WASHINGTON, DC, MAY 14, 2009
Serial No. 111-21
Printed for the use of the Committee on Education and Labor
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice Howard P. ``Buck'' McKeon,
Donald M. Payne, New Jersey Senior Republican Member
Robert E. Andrews, New Jersey Thomas E. Petri, Wisconsin
Robert C. ``Bobby'' Scott, Virginia Peter Hoekstra, Michigan
Lynn C. Woolsey, California Michael N. Castle, Delaware
Ruben Hinojosa, Texas Mark E. Souder, Indiana
Carolyn McCarthy, New York Vernon J. Ehlers, Michigan
John F. Tierney, Massachusetts Judy Biggert, Illinois
Dennis J. Kucinich, Ohio Todd Russell Platts, Pennsylvania
David Wu, Oregon Joe Wilson, South Carolina
Rush D. Holt, New Jersey John Kline, Minnesota
Susan A. Davis, California Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Tom Price, Georgia
Timothy H. Bishop, New York Rob Bishop, Utah
Joe Sestak, Pennsylvania Brett Guthrie, Kentucky
David Loebsack, Iowa Bill Cassidy, Louisiana
Mazie Hirono, Hawaii Tom McClintock, California
Jason Altmire, Pennsylvania Duncan Hunter, California
Phil Hare, Illinois David P. Roe, Tennessee
Yvette D. Clarke, New York Glenn Thompson, Pennsylvania
Joe Courtney, Connecticut
Carol Shea-Porter, New Hampshire
Marcia L. Fudge, Ohio
Jared Polis, Colorado
Paul Tonko, New York
Pedro R. Pierluisi, Puerto Rico
Gregorio Sablan, Northern Mariana
Dina Titus, Nevada
Mark Zuckerman, Staff Director
Sally Stroup, Republican Staff Director
SUBCOMMITTEE ON HEALTHY FAMILIES AND COMMUNITIES
CAROLYN McCARTHY, New York, Chairwoman
Yvette D. Clarke, New York Todd Russell Platts, Pennsylvania,
Robert C. ``Bobby'' Scott, Virginia Ranking Minority Member
Carol Shea-Porter, New Hampshire Howard P. ``Buck'' McKeon,
Paul Tonko, New York California
Jared Polis, Colorado Brett Guthrie, Kentucky
George Miller, California David P. Roe, Tennessee
[Vacant] Glenn Thompson, Pennsylvania
C O N T E N T S
Hearing held on May 14, 2009..................................... 1
Statement of Members:
McCarthy, Hon. Carolyn, Chairwoman, Subcommittee on Healthy
Families and Communities................................... 1
Prepared statement of.................................... 3
Letters from children regarding the Activity Works
Braley, Hon. Bruce L., a Representative in Congress
from the State of Iowa, prepared statement of...... 71
Additional submissions........................... 72
Westley, Laurie A., senior vice president of public
policy, advocacy, and the research institute, Girl
Scouts of the USA, prepared statement of........... 69
Platts, Hon. Todd Russell, Senior Republican Member,
Subcommittee on Healthy Families and Communities, prepared
statement of............................................... 4
Statement of Witnesses:
Byrnes, Susan P., R.N., Susan P. Byrnes Health Educaton
Prepared statement of.................................... 36
Castle, Hon. Michael N., a Representative in Congress from
the State of Delaware...................................... 8
Prepared statement of.................................... 10
Copperman, Nancy, MS, RD, CDN, director, public health
initiatives, North Shore-LIJ Health System................. 25
Prepared statement of.................................... 27
Felton, Reginald M., director, federal legislation, National
School Boards Association.................................. 29
Prepared statement of.................................... 31
Paterson, Michelle Paige, first lady of the State of New York 13
Prepared statement of.................................... 15
Ritchie, Lorrene, Ph.D., RD, director and adjunct professor,
Dr. Robert C. and Veronica Atkins Center for Weight and
Health, University of California........................... 36
Prepared statement of.................................... 38
Stallings, Virginia, M.D., director of the nutrition center,
Children's Hospital of Philadelphia........................ 20
Prepared statement of.................................... 22
Woolsey, Hon. Lynn C., a Representative in Congress from the
State of California........................................ 6
Prepared statement of.................................... 7
IMPROVING CHILD NUTRITION PROGRAMS TO REDUCE CHILDHOOD OBESITY
Thursday, May 14, 2009
U.S. House of Representatives
Subcommittee on Healthy Families and Communities
Committee on Education and Labor
The subcommittee met, pursuant to call, at 10:04 a.m., in
room 2175, Rayburn House Office Building, Hon. Carolyn McCarthy
[chairwoman of the subcommittee] presiding.
Present: Representatives McCarthy, Tonko, Polis, Platts,
Staff present: Paulette Acevedo, Legislative Fellow,
Education; Tylease Alli, Hearing Clerk; Alejandra Ceja, Senior
Budget/Appropriations Analyst; Curtis Ellis, Legislative
Fellow, Education; Denise Forte, Director of Education Policy;
David Hartzler, Systems Administrator; Fred Jones, Staff
Assistant, Education; Jessica Kahanek, Press Assistant; Joe
Novotny, Chief Clerk; Kim Zarish-Becknell, Policy Advisor,
Subcommittee on Healthy Families and Communities; Stephanie
Arras, Minority Legislative Assistant; Cameron Coursen,
Minority Assistant Communications Director; Kirsten Duncan,
Minority Professional Staff Member; and Linda Stevens, Minority
Chief Clerk/Assistant to the General Counsel.
Chairwoman McCarthy [presiding]. A quorum is present. The
hearing of the House Committee on Education and Labor,
Subcommittee on Healthy Families and Communities, of
``Improving Child Nutrition Programs to Reduce Childhood
Obesity'' will come to order.
Before we begin, I think I heard one of our young ladies
talking about it. Make sure all cells and BlackBerrys are on
vibrate or quiet. I appreciate that.
I now recognize myself, followed by Ranking Member, Todd
Platts from Pennsylvania, for an opening statement. I would
like to welcome our witnesses to this hearing on how we can
reduce childhood obesity through the Child Nutrition
As a nurse for over 30 years, I have seen firsthand the
risks of illness that can result from obesity. In the last
several months, I have read the studies that one in five 4-
year-olds are obese, that kids have the arteries of middle-age
adults, and that the number of children who take medication for
chronic diseases has jumped dramatically.
In March, a study was released which indicated that
proximity to fast food is a factor in student obesity. Some of
these reports are shocking and, unfortunately, some are not.
Childhood obesity, diabetes and heart disease are all on the
rise in the United States, and one of the best tools that we
have to combat these illnesses is our ability to provide
wholesome and healthy nutrition to children in school.
Childhood obesity is found in all 50 states, in both young
children and adolescents, affecting all social and economical
levels. Low-income communities tend to have the highest obesity
rate due to factors such as lack of access to affordable
healthy foods, lack of safe, available venues for physical
activity, and a lack of education about nutrition and its
benefits. Furthermore, it has been found that minority children
are at the greatest risk for obesity.
There is no silver bullet to solve childhood obesity.
However, the school breakfast and lunch programs can make a
great impact because they provide more than 50 percent of a
student's food and nutrition intake on school days. The
decisions we are making during reauthorization are very
important to a great number of children, and that is why we
have assembled such a knowledgeable panel.
We were here today to explore how we can reduce obesity
through the Child Nutrition Reauthorization. There is a wealth
of information available on the issue of reducing obesity, and,
in my mind, it comes down to two things: healthy eating and
physical activity. These sound simple, but families all over
the nation know it is far from simple.
Given the current harsh financial realities, many families
in my district and throughout the nation, schools have an
increasingly important role to play in improving with
nutritious food during their days at school. I also hear from
folks in schools finding it more and more difficult to meet the
increased demand of meals with healthy, nutritious and high
quality foods without adequate funding.
We also know how critical it is to reach the youngest
children and infants as soon as possible. I hear from
constituents all the time how important the WIC programs are to
help families transition from poor eating habits to healthy
This is particularly important because WIC is working with
the youngest of our children. As we will hear about today, the
Institute of Medicine has undertaken a study to review and
provide recommendations to update the nutrition and meal
standards for school nutrition programs.
School meal standards are critical, and I appreciate Dr.
Stallings being here to discuss her work. Of course, children
aren't just eating school meals when they are at school.
Foods in vending machines and less healthy a la carte items
in the cafeteria are readily available. And while in school,
many children are subject to junk food advertisements. The
students are a captive audience, and advertisers have proven to
be remarkably effective at influencing their target customers.
Representative Woolsey has done a lot of work in this area,
and I am looking forward to her testimony regarding issues
surrounding competitive foods.
Finally, as I mentioned earlier, in addition to healthy
foods, physical activity is the other critical element in
reducing obesity. We know that change for adults is hard. But
if we start to educate our children early enough, we can
establish lifelong habits and the values of healthy living and
wellness for the future.
We also know that studies show children who are physically
active learn better. We will hear testimony today about some
terrific and innovative programs schools are using to address
We have our work cut out for us, but by taking a
comprehensive approach to nutrition, our children, families and
communities will all be healthier. I want to thank all of you
being here, and I look forward to your testimony.
I now recognize the distinguished gentleman from
Pennsylvania, Ranking Member Platts, for his opening statement.
[The statement of Mrs. McCarthy follows:]
Prepared Statement of Hon. Carolyn McCarthy, Chairwoman, Subcommittee
on Healthy Families and Communities
I'd like to welcome our witnesses to this hearing on how we can
reduce childhood obesity through the child nutrition reauthorization.
As a nurse for over 30 years, I have seen firsthand the risks and
illnesses that can result from obesity.
In the last several months, I have read the studies that one in
five four-year-olds are obese, that kids have the arteries of middle
aged adults, and that the number of children who take medication for
chronic diseases has jumped dramatically.
In March, a study was released which indicated that the proximity
to fast food is a factor in student obesity.
Some of these reports are shocking, and unfortunately, some are
Childhood obesity, diabetes and heart disease are all on the rise
in the US and one of the best tools we have to combat these illnesses
is our ability to provide wholesome and healthy nutrition to children
Childhood obesity is found in all 50 States, in both young children
and adolescents, affecting all social and economic levels.
Low income communities tend to have the highest obesity rates due
to factors such as a lack of access to affordable, healthy foods, lack
of safe, available venues for physical activity, and a lack of
education about nutrition and its benefits.
Furthermore, it has been found that minority children are at the
greatest risk for obesity.
There is no silver bullet to solve childhood obesity.
However, the School Breakfast and Lunch programs can make a great
impact because they may provide more than 50 percent of a student's
food and nutrient intake on school days.
The decisions we make during reauthorization are very important to
a great number of children, and that is why we have assembled such a
We are here today to explore how we can reduce obesity through the
child nutrition reauthorization.
There is a wealth of information available on the issue of reducing
obesity and in my mind it comes down to two things: healthy eating and
These sound simple, but families all over the nation know it is far
Given the current harsh financial realities for many families in my
district and throughout the nation, schools have an increasingly
important role to play in providing children with nutritious food
during their days.
I also hear from folks in schools finding it more and more
difficult to meet the increased demand for meals with healthy,
nutritious and high-quality foods, without adequate funding.
We also know how critical it is to reach the youngest children and
infants as soon as possible.
I hear from constituents all the time how important the WIC
programs are to help families transition from poor eating habits to
This is particularly important because WIC is working with the
youngest of children.
As we will hear about today, the Institute of Medicine has
undertaken a study to review and provide recommendations to update the
nutrition and meal standards for school nutrition programs.
School meal standards are critical and I appreciate Dr. Stallings
being here to discuss her work.
Of course, children aren't just eating school meals when they are
Foods in vending machines and less healthy a la carte items in the
cafeteria are readily available.
And while in school, many children are subjected to junk-food
The students are a captive audience, and advertisers have proven to
be remarkably effective at influencing their target customers. Rep.
Woolsey has done a lot of work in this area and I am looking forward to
her testimony regarding issues surrounding competitive foods.
Finally, as I mentioned earlier, in addition to healthy food,
physical activity is the other critical element in reducing obesity. We
know that change for adults is hard, but if we start to educate our
kids early enough, we can establish lifelong habits and the values of
healthy living and wellness for the future.
We also know that studies show children who are physically active
learn better. We will hear testimony today about some terrific
innovative programs schools are using to address obesity.
We have our work cut out for us.
But by taking a comprehensive approach to nutrition, our children,
families and communities will all be healthier. Thank you all for being
here and I look forward to your testimony.
Mr. Platts. Thank you, Madam Chair.
In the interest of time, with knowing we may have votes
soon and with two of our colleagues waiting, you well captured
the importance of this hearing and the importance of this issue
in the broad sense. So I will submit my statement for the
record and look forward to the testimony of our colleagues.
[The statement of Mr. Platts follows:]
Prepared Statement of Hon. Todd Russell Platts, Ranking Member,
Subcommittee on Healthy Families and Communities
Good morning. Welcome to our hearing. Today we are here to discuss
childhood obesity and child nutrition programs.
Over the last ten years, obesity in the United States has been
increasing at a staggering rate. The most recent data from the Centers
for Disease Control and Prevention states that more than 72 million
adults, or over one-third of the United States adult population, are
obese. In addition, 17 percent of children ages 2-19 are considered
overweight. Overweight children are more likely to become overweight
adults and have a greater risk of developing cardiovascular diseases,
diabetes, and certain cancers. Because obese individuals are estimated
to live 5-7 years less than their healthier counterparts, it is assumed
that our current generation of children will actually have a lower life
expectancy than their parents.
A number of initiatives have been created to combat this obesity
epidemic. The food industry and trade organizations have joined
together to phase-in healthier products and smaller portion sizes.
Other groups have been promoting increased physical activity for
children and adults alike.
The 2004 reauthorization of the Child Nutrition Act required school
districts to implement local wellness policies in all schools. The
objective of the local wellness plan is to change students' eating
habits while simultaneously encouraging increased activity. To meet
this goal, the plan must include nutrition guidelines, nutrition
education, physical activity goals, and school based wellness
activities. Many schools have incorporated creative ways to meet their
wellness plan goals. Today, we will hear from Ms. Susie Byrnes, founder
of the Byrnes Health Education Center in my Congressional District.
Many of the local schools bring students to the Byrnes Center to teach
students about healthy eating practices as part of their local wellness
There are a variety of parties that are responsible for helping to
address the issue of childhood obesity. At the federal level, we have a
responsibility to ensure that foods provided by the school breakfast
and lunch programs are nutritional and healthy. Local school districts
also play a role as they make decisions about the activities that take
place on their campus. I believe, however, that parents have the most
important role--as the primary caretaker of their child's well-being--
to ensure that their children remain active and consume nutritious
I am pleased we are joined by such a distinguished panel of
witnesses and am looking forward to hearing all of the testimony. As we
move forward to reauthorize the Child Nutrition Act, we must keep the
goal of reducing childhood obesity in mind while remaining conscious of
the impacts of new mandates on our local school districts.
Thank you Chairwoman McCarthy.
Chairwoman McCarthy. Pursuant to Rule Committee 7C, any
member may submit an opening statement in writing at this time,
which will be made part of the permanent record. Without
objection, all members will have 14 days to submit additional
materials or questions for the hearing record.
I would like to briefly introduce our very distinguished
panel of witnesses here with us this morning. The complete bios
of the witnesses will be inserted into the record.
Today, we will hear from two panels. On our first panel, we
will hear from two members of Congress, my colleagues and
fellow members of the Committee in Education and Labor--the
Honorable Lynn Woolsey from California, and the Honorable Mike
Castle from Delaware.
On the second panel, we will hear from six witnesses--First
Lady Michele Paterson of my home state of New York; Dr.
Virginia Stallings, an expert on child nutrition issues; Ms.
Nancy Copperman, who runs an obesity prevention program on Long
Island; Mr. Felton at the National School Boards Association to
discuss nutrition and standards; Ms. Susie Byrnes, founder of
the Susie P. Byrnes Health Educational Center; and Dr. Ritchie
of Dr. Robert C. and Veronica Atkins Center for Weight and
Health College on natural resources. I thank you all for being
In the interest of time, given the large number of
witnesses today, I will make my formal introductions short.
First, I would like to introduce our first panel. The Honorable
Lynn Woolsey from California and Mike Castle of Delaware have
both been in Congress since 1993, and I have served with them
on the Committee of Education and Labor since I came to
Congress. Ms. Woolsey serves as the chairwoman of the
Subcommittee on Public Works Protection.
Mr. Platts. Thank you, Madam Chair, and Mr. Castle is the
ranking member of the Education and Labor Subcommittee on
Childhood, Elementary and Secondary Education. He has a
distinguished public service career.
Actually, Mike, I was learning for the first time all the
offices you held, and delighted--deputy attorney general, state
legislator, lieutenant governor and two-term former governor of
the state of Delaware, and makes up the entire House delegation
of the state of Delaware here in Congress. So we are delighted
to have you and Lynn with us, and look forward to your
Thank you, Madam Chair.
Chairwoman McCarthy. Representative Woolsey and
Representative Castle have each used their voices as members of
Congress to call for action in areas where they are deeply
passionate. They care deeply about the health and wellness of
our youth, and I look forward to hearing their testimony on how
to fight childhood obesity.
Obviously, both of the members understand the light system
and the 5-minute time limit, so let's get started. I thank you
for taking the time out of what is an extremely busy day here
in Congress to address this subcommittee.
STATEMENT OF HON. LYNN WOOLSEY, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF CALIFORNIA
Ms. Woolsey. Thank you, Madam Chairwoman and Congressman
Platts, members of the committee. Thank you for the opportunity
to testify before you today on today's hearing on childhood
Our schools have a very powerful impact on the way our
children eat and the lessons they learn about healthy living.
With WIC and child nutrition programs set to be reauthorized
this year, we have an opportunity to actually take bold steps
to reverse these dangerous trends. I commend the subcommittee
for holding this important hearing, and I commend you for your
continued attention to the health and well-being of our
Children spend more than a third of their young lives at
school, including before and after school, and oftentimes
holidays as well. So it is important that schools provide
healthy foods throughout the entire school day. Unfortunately,
current nutrition standards for foods sold at school but
outside of the school meal programs are inconsistent, and they
are often unhealthy.
For example, doughnuts are allowed in vending machines, but
lollipops are not. Cookies are fine, but breath mints are
banned. These standards don't make any sense. They haven't been
updated since my children were in school in the 1970s.
And today, my grandchildren, who are in school, are faced
with the same junk food choices that should have been replaced
years and years ago. No wonder, Madam Chairwoman, that child
obesity is becoming an epidemic.
Today, 23 million children and adolescents are obese or
overweight. Obesity rates for children between 6 and 11 years
old have more than quadrupled over the last 40 years.
Throughout their lives, these children are at greater risk for
heart disease, type II diabetes, stroke, cancer, and social and
That is why I have re-introduced H.R. 1324, the Child
Nutrition Promotion and School Lunch Protection Act, which will
ensure that all foods sold in schools during the entire school
day are based on current scientific and sound nutrition
standards. In the Senate, Democrat senator Tom Harkins and
Republic senator Lisa Murkowski have introduced the companion
to this bipartisan bill in the House. And this bill has been
endorsed by more than 80 organizations, including a wide range
of school health and nutrition advocacy groups.
While critics might expect that schools that switch to
selling healthier foods might lose money, it turns out to be
just the opposite. According to a study conducted by the U.S.
Department of Agriculture and the Center for Disease Control,
the majority of schools switching to healthier competitive
foods in their vending machines and a la carte lines actually
increased their revenues. The Center for Weight and Health at
UC Berkeley in 2007 also found the 65 percent of schools that
provided these better meals and better choices had total
revenue increases of more than 5 percent after switching, and
providing, then, schools with improved nutrition standards and
also increased their revenues.
H.R. 1324 would require that nutrition standards for foods
sold in vending machines and a la carte lines meet standards
for caloric intake, saturated fats, trans fats and refined
sugars. The bill would depend on leading scientific experts to
make recommendations and would study the relationship between
certain foods and obesity.
Additionally, while H.R. 1324 would set strong nationwide
minimum standards, states could go above and beyond those
standards. It is obviously long past time to bring these
schools, Madam Chairwoman, into the 21st century. Unless
Congress updates these standards, students will continue to
spend money on unhealthy options that undermine their health
and their future.
So I look forward to working with the committee to get
these changes signed into law. And again, Madam Chairwoman,
thank you very much for having me today.
[The statement of Ms. Woolsey follows:]
Prepared Statement of Hon. Lynn C. Woolsey, a Representative in
Congress From the State of California
Chairwoman McCarthy, Congressman Platts, members of the Committee,
thank you for the opportunity to testify at today's hearing on
childhood obesity. Our schools can have a very powerful impact on the
way our children eat and the lessons they learn about healthy living.
With WIC and child nutrition programs set to be reauthorized this year,
we have an opportunity to take bold steps to reverse these dangerous
trends. I commend the Subcommittee for holding this important hearing
and its continued attention to the health and well-being of our
Children spend more than a third of their young lives at school--
including before and after school and often times school holidays. So,
it is important that schools provide healthy foods throughout the
entire school day. Unfortunately, current nutrition standards for foods
sold at school, but outside of the school meal programs, are
inconsistent and often unhealthy. For example, doughnuts are allowed
in, but lollipops are not. Cookies are fine, but breath mints are
banned. These standards don't make any sense. They haven't been updated
since my children were in school in the 70's. Today, my grandchildren
are in school, with the same junk foods available that should have
replaced years ago.
No wonder the childhood obesity is becoming an epidemic. Today, 23
million children and adolescents are obese or overweight. Obesity rates
for children between 6 and 11 years old have more than quadrupled over
the last 40 years. Throughout their lives, these children are at
greater risk for heart disease, Type 2 Diabetes, stroke, cancer, and
social and psychological problems.
That's why I've reintroduced H.R. 1324, the Child Nutrition
Promotion and School Lunch Protection Act, which will ensure that all
foods sold in schools during the entire school day are based on
current, scientific, and sound nutrition standards. In the Senate,
Democrat Tom Harkin and Republican Lisa Murkowski have introduced the
counterpart to my bipartisan bill, which has been endorsed by more than
80 organizations, including a wide range of school, health, and
nutrition advocacy groups.
While critics might expect that schools that switch to selling
healthier foods might lose money, it turns out to be just the opposite!
According to a study conducted by the U.S. Department of Agriculture
and the Center for Disease Control, the majority of schools switching
to healthier competitive foods in their vending machines and a la carte
lines actually increased revenues. The Center for Weight and Health at
U.C. Berkely in 2007 also found that 65 percent of schools had total
revenue increases of more than five percent after switching, proving
that schools offering improved nutrition standards can increase their
total revenues as well.
H.R. 1324 would require that nutrition standards for foods sold in
vending machines and a la carte lines meet standards for caloric
intake, saturated fats, trans fats, and refined sugars. The bill would
depend on leading scientific experts to make recommendations, and would
study the relationship between certain foods and obesity. Additionally,
while H.R. 1324 would set strong nationwide minimum standards, states
could go above and beyond those standards. It's obviously long past
time to bring these school food standards into the 21st Century.
Unless Congress updates these standards, students will continue to
spend money on unhealthy options that undermine their health and their
futures. I look forward to working with this Committee to get these
changes signed into law.
Again, Madame Chair, thank you for having me.
Chairwoman McCarthy. Thank you, Ms. Woolsey, for that
STATEMENT OF HON. MIKE CASTLE, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF DELAWARE
Mr. Castle. Thank you, Madam Chairwoman. Thank you, Mr.
Platts and other members of the committee. And I thank Lynn
Woolsey. We have worked together on this issue almost since we
have been in Congress, I think. And hopefully it is at least
working to a degree, but I think we can improve it.
As Lynn has very well pointed out, child nutrition programs
are a vital significance to the future of the children in our
country. We are all aware of the basic facts. Kids are not
eating enough fruits and vegetables. They are not getting
enough exercise. They are inside too much.
There may be a lot of reasons for this, but the bottom line
is there is an overweight issue among our children, and the CDC
data shows that approximately 17 percent of children and
adolescents are overweight. Our statistics in Delaware are even
higher than that. And in just two decades, the number of
overweight and obese young Americans has tripled.
And one of the direct effects of this has been diseases and
conditions associated with adults are now being associated with
children. Type II diabetes, high cholesterol, high blood
pressure, which did not used to happen, but happens on a
regular basis at this time.
It sort of reminds me. I was just sitting here thinking
when Lynn was speaking of the ads you see on TV for people who
have lost weight or whatever. I have never seen an ad for
people who have gained weight saying what a wonderful thing
this is. ``I feel so much better,'' or whatever it may be. I
mean, the bottom line is that, just from a social point of view
as well as a physical health point of view, and maybe mental
health, we need to worry about this particular issue.
The legislation, which we passed in the past in
reauthorizing this, and this new legislation is of vital
significance. In 2004, we did pass and the president signed the
law, the Child Nutrition and WIC Reauthorization Act.
In addition to other steps, the law put in place several
comprehensive solutions to address the childhood obesity
epidemic, nutritional education, which I think is of vital
significance, increased physical activity, efforts to combat
hunger and food insecurity. Included was a provision I authored
to require school districts to establish local school wellness
I might point out, Madam Chairwoman, also kids often can
educate adults, I have learned, in many of these areas, seat
belts, for example, and in this area as well, which is not
insignificant, either. Under the school wellness policies, the
school districts are required to establish policies, include
nutritional guidelines, nutrition education, physical activity
goals and school-based wellness activities to encourage the
development and implementation of programs to promote healthy
eating and increased physical activity among children.
School districts were tasked with developing these plans to
accommodate a variety of demographics, economic situations and
local food preferences. Policies were required to be developed
and implemented for 2006-2007 school year by school districts.
School districts developed these plans in an attempt to
accommodate a variety of different backgrounds. And resulting
from these policies, we have nutrition programs offering
healthier options, increased visibility of school nutrition
programs, changes in behaviors, and more healthy choices being
made by students.
So one emphasis I would like to make, and I don't know if
we are addressing it in legislation, or if some of the speakers
to follow us will address it, but I use the word ``options,''
healthier options. I still go to schools--well, a couple years
ago, I went to a school that had all the options. They were
serving, broccoli, whatever.
But one of the options was pizza. And I asked the people in
the cafeteria about that, and they said, ``Well, most of the
kids are taking the pizza.'' It might not be pizza. It may be
doughnuts for breakfast or whatever it may be, but the options
need to be carefully crafted as well.
You can't just offer them and say, ``We have
accommodated.'' You need to make sure that is what the kids are
eating. And I think we need to pay a little more attention to
what some of the options are.
In Delaware, each of our wellness plans is reflective of
the district's policies and views of how to best provide and
maintain a healthy and safe learning environment. And all that,
of course, is well and good, and they are doing that. And I
have seen it, and they are working to promote the integration
of nutrition education into all curriculum areas in K through
I think that is important, too, that people understand why
these decisions are being made. Limiting portion sizes of
snacks and beverages served in school, which is important, and
limiting food being used as rewards, which can be difficult for
teachers and parents sometimes, but is also important.
In certain of our districts, for example in Laurel Middle
School, music is played after lunch to encourage physical
activity. And at the Austin D. Baltz elementary school in
Wilmington area, Red Clay School District, hip-hop pageant
program is put on to encourage physical activity. Many schools
are implementing successful policies, but there are challenges.
Strong school leadership is needed. When you find
superintendents and principals and teachers who enforce it, it
makes a difference. We need a commitment to enhancing school
nutrition and wellness policies as implementation continues,
and we need the support and knowledge of communities and
families, which is essential to ensure wellness plans extend
beyond the school days.
We are fortunate to have the Nemours operation in Delaware
working in this area to promote healthy lifestyles in all
places that children live, learn, and play. Unfortunately,
Nemours, by the will of Mr. duPont, is only in Florida and
Delaware, but they make a vast difference in terms of these
As we move forward with reauthorization of child nutrition
legislation, we must work at the federal, state and local
levels to address this important issue and complex issue. We
have to strengthen local wellness policy and legislative
language to ensure all schools and students benefit from plans.
We have to target those with greatest risk. We need to
support programs under current law that promote nutrition
education and physical activity, and we need to meet the
financial commitment to see programs through from start to
I appreciate the opportunity of being here, and I look
forward to what this committee will be doing.
I yield back.
[The statement of Mr. Castle follows:]
Prepared Statement of Hon. Michael N. Castle, a Representative in
Congress From the State of Delaware
Good morning. Thank you Chairwoman McCarthy for holding today's
hearing. As a Member of the Education and Labor Committee and co-chair
of the Congressional Diabetes Caucus, I welcome the opportunity to
testify before the Healthy Families and Communities Subcommittee.
As debate begins in Congress on how best to reform a crumbling
health care system to care for the uninsured and help manage the
growing number of people who are living with chronic diseases, we are
more aware than ever of the need to foster a national culture that
believes in the need for health and wellness. In the context of today's
hearing, nutrition and health are both essential for fostering a
child's academic success.
We know that kids are not eating enough fruits and vegetables,
spend too much time in front of the TV or computer screen, are not up
and moving enough, and consume too many sugary beverages. Childhood
obesity has become a major health problem in the United States. In
fact, recent data from the Centers for Disease Control (CDC) shows that
an estimated 17 percent of children and adolescents ages 2-19 years are
overweight. In my home state of Delaware, approximately 36 percent of
kids and youth are overweight or are at risk of becoming overweight. I
believe this is a matter of great concern to us as Members of Congress,
to this Committee, and to society in general.
According to a report by the National Institute for Health Care
Management (2007), in just two decades, the number of overweight and
obese young Americans has tripled, and studies suggest that overweight
children are significantly more likely to become overweight or obese
adults. As a result, children are increasingly suffering from
conditions traditionally associated with adulthood, including Type 2
diabetes, high cholesterol, and high blood pressure.
Parents bear primary responsibility for ensuring that their
children eat well and exercise regularly. Schools, however, can and
should also play a positive role by giving children access to
nutritious meals and snacks, nutrition education, and time to engage in
daily physical activity.
In 2004, Congress passed, and the President signed into law, the
Child Nutrition and Women, Infants, and Children (WIC) Reauthorization
Act. The Law put in place several comprehensive solutions that
incorporate healthy habits, nutritional education, and increased
physical activity with ongoing efforts to combat hunger and food
insecurity to address the childhood obesity epidemic.
In addition to making certain students have access to fresh fruits
and vegetables, and milk; strengthening partnerships between local
farms, school gardens, and child nutrition programs; and ensuring food
safety by maintaining and strengthening quality and safety standards,
the Law included a provision I authored requiring school districts
participating in the program to develop and implement a comprehensive
wellness policy in their schools. Specifically, school wellness
policies include nutrition guidelines, nutrition education, physical
activity goals, and school-based wellness activities developed by
school districts in an effort to accommodate a variety of demographics,
economic situations, and local food preferences. The objectives of
these plans are to change students' eating habits while simultaneously
encouraging increased activity.
The majority of school districts passed these policies between May
and July 2006 to have them in place for the 2006-2007 school year, as
required by the Law. As a result, the vast majority of districts
established guidelines for food and beverages available in a la carte
and vending machines. And about 95% of districts established goals for
nutrition education and physical education (USDA, FNS).
Studies have shown that as a result of implementing these policies,
school nutrition programs are offering more healthy food options, there
has been an increased visibility of school nutrition programs to
students and adults, and there have been changes in healthy choices and
behaviors of students (School Nutrition Association and School
In Delaware, each school district's wellness plan is reflective of
the district's policies and views of how to best provide and maintain a
healthy and safe learning environment for students within the
district's care. Overall, however, each wellness policy in the state of
Delaware works to promote the integration of nutrition education into
all curriculum areas for students in grades k-12, limit portion sizes
of snacks and beverages served anywhere on school property during the
school day, limit food being used as rewards, and disseminate
consistent nutrition messages throughout district schools, classrooms,
cafeterias, and Delaware homes and communities.
In Delaware's Laurel School District at the Laurel Middle School,
more physical activity has been incorporated into the school's
curriculum. After lunch most days, music is played to allow for
students to do some large muscle activity. Additionally, in Delaware's
Red Clay Consolidated School District at the Austin D. Baltz Elementary
School all students have recess after lunch and the school implemented
the ``Hip Hop Pageant Program'' to encourage cardiovascular activity in
which students attend a hip hop class leading up to a hip hop pageant.
While many schools are implementing successful policies, there are
several challenges to implementing these plans as well. Schools need
strong leadership and a commitment to enhancing their nutrition and
wellness policies as implementation continues. The support of
communities and families is also essential to ensure that the work of
the wellness plans extend beyond the school day. In Delaware, great
work is being done by Nemours Health and Prevention Services in this
area to promote healthy lifestyles in all the places children live,
learn, and play, including schools. Finally, I am hopeful this
Committee will examine how we may strengthen the Law's language
pertaining to local wellness policies to ensure all schools, and
ultimately all students benefit from these plans.
As Congress works to reauthorize child nutrition legislation this
year to strengthen school nutrition programs, it is clear we must work
with state and local school districts to further address the important
and complex issue of childhood obesity by supporting programs under
current law that promote nutrition education and physical activity at
the state and local level; implementing programs with proven results in
improving health outcomes; and targeting those children who are at the
I hope that this Committee and Congress will continue to examine
this issue very closely. I look forward to working along with my
colleagues at the federal level, as well as the state and local level
to do our part in the battle against childhood obesity.
Thank you for allowing me to testify today.
Chairwoman McCarthy. I thank my colleagues for their
information and taking the time out on an extremely busy day to
be here. I hope that when we get this legislation through,
which I think we will, maybe we should start working on the
members of Congress on the choices of food that we have here.
Thank you very much.
All right. The debate that has been up here, apparently we
have been notified votes are starting. There are going to be
several votes, which unfortunately is going to take an awful
lot of time. But we believe that we should start. So if the
witnesses could come and sit at the table, we will start with
I want to thank you all for being here, and I now yield to
Representative Tonko of New York to introduce the First Lady of
New York, Michele Paterson.
Mr. Tonko. Thank you, Madam Chair.
It is my pleasure to introduce our first guest at the
second panel. It has been with distinction that our First Lady,
Michele Paige Paterson, has served New York state in her
current role as first lady since her husband, our governor,
David Paterson, assumed office on March 5th of 2008, but she
has a long history of work in healthcare and child obesity
Ms. Paterson has an M.S. in Health Services Management from
the Milano Graduate School in New York City and a B.A. from
Syracuse University. She has worked as the director of
community and government affairs at North General Hospital in
Harlem and as director of external affairs and corporate
contributions for the Health Plan of New York, where she worked
with community organizations, agencies and corporations on
issues such as healthcare and education. She currently serves
as director of integrative wellness at Emblem Health, where she
works on healthy living and childhood obesity issues.
In her capacity as our first lady, Ms. Paterson, as in her
usual warm and compassionate style, worked with organizations
and schools to help raise community awareness of childhood
obesity and its consequences. She spearheaded a statewide
initiative called Healthy Steps to Albany: First Lady's
Challenge. The program challenges middle school students to
lead healthy lifestyles through exercise and healthy eating
habits. The program encourages students to increase their
physical activity by competing in a 6-week fitness competition.
Madam Chair, I join with you, with my colleagues on the
committee and my fellow New Yorkers by welcoming our leader in
our state, our first lady, Michele Paige Paterson, here today,
and I thank her for accepting our invitation.
Chairwoman McCarthy. Thank you.
And welcome, Ms. Paterson.
Our next witness is Dr. Stallings. Dr. Stallings is the
director of the nutrition center at Children's Hospital of
Philadelphia and professor of pediatrics at the University of
Pennsylvania School of Medicine. Her research interests include
pediatric nutrition, evaluation of dietary intake and energy
expedition and nutrition and related chronic diseases. She
joins us today to discuss her work as chair of the National
Academy of Sciences Institute of Medicine's Committee on
Nutrition Standards for Foods In Schools.
Our next witness is Ms. Nancy Copperman, director of public
health initiatives for the North Shore Long Island Jewish
Hospital Healthcare System from my area of Long Island. She
will discuss her work in an innovative program in my district
called Activity Works.
Activity Works is a school-based program which delivers
physical activity right in the classroom. Five school districts
within my district are using this program, and from the
feedback I have gotten from the children, they love it.
Our next witness is Mr. Felton of the National School
Boards Association. He will discuss what locals are doing to
promote nutrition and also his thoughts on national nutrition
I yield to Ranking Member Platts for the--I am sorry, Ms.
Platts isn't in the building, so we will skip over and--I am
I am sorry, Ms. Byrnes is in the building, and she will be
up in a minute.
Our final witness is Dr. Lorraine Ritchie, Director of Dr.
Robert C. and Veronica Atkins Center for Weight and Health
College of Natural Resources. She has worked for nearly a
decade to promote the development of science-based solutions to
the obesity epidemic in children and families. She will discuss
her impressions of the WIC program and its role in reducing
I want to welcome all of our witnesses. And when Ms. Byrnes
comes, we will stop and have her be introduced.
I know that you all have been told about the--for those
that have not testified before Congress, let me explain our
lighting system. Everybody will get five minutes, including the
members. It is limited to 5 minutes of presentations and
The green light is illuminated when you begin to speak.
When you see the yellow light, it means you have 1 minute
remaining. When you see the red light, it means your time is
expired and you need to conclude your testimony. Please be
certain, as you testify, to turn on your--and speak into the
microphones in front of you.
We will now hear from our first witness.
STATEMENT OF MICHELE PATERSON, FIRST LADY OF THE STATE OF NEW
Ms. Paterson. Good morning.
Chairwoman McCarthy. Morning.
Ms. Paterson. And thank you, Congressman Tonko, for that
warm welcome. I would like to also thank Subcommittee
Chairwoman Carolyn McCarthy and Representative Yvette Clarke
and Paul Tonko from the great state of New York and the other
members of the subcommittee for inviting me here today to
present New York's efforts in fighting childhood obesity.
As first lady and in my professional career, I continue to
be committed to promoting programs that protect and support the
health of New York's children. Governor Paterson and I believe
that all of us share a common obligation to ensure that our
children have the opportunity to live healthy lives and are
given the promise of a healthier future.
But to have that healthier future, we need to address what
is perhaps the biggest challenge to the health and well-being
of our youth today: the obesity epidemic, which not only
adversely affects children's health, but it threatens to
shorten their life span.
As all of you know, the obesity epidemic touches all ages,
all neighborhoods, and all socioeconomic groups in New York
state. One in four children is overweight or obese, and in low-
income neighborhoods and neighborhoods of color, that number is
as high as one in three.
Even though New York state has a strong requirement for
physical education in our schools, the recommended 60 minutes
of daily physical activity is not enough to ensure good health
for our youth. The governor has proposed state legislation and
programs to improve the nutrition of foods available in
schools, reduce the availability of junk foods, and increase
the opportunity for physical activity.
He proposed again this year the Healthy Schools Act, which
would require the establishment of nutrition standards for all
food, school's lunch, school's breakfast and outside food sold
or served in schools. The governor also proposed and signed
into law this year the Healthy Food, Healthy Communities
Initiative which offers a new revolving loan fund to increase
the number of healthy food markets in underserved communities.
Additionally, our administration is working with schools,
communities and farmers to develop and expand the farm-to-
school program to promote the use of local fruits and
vegetables in schools and to support edible school gardens. The
governor's office collaborated with a wide group of partners
and stakeholders in New York, including the YMCA and the Boy's
and Girl's Clubs, to set model standards for nutrition,
physical activity and television and video game limits in
And we have worked with our healthcare providers and more
than 400 child daycare centers to provide nutrition training,
education and guidance to staff and parents.
For my part, I created a program called Healthy Steps To
Albany: First Lady's Challenge. This challenges teams of middle
school students, grades six through eight, are challenged to
walk 4 million steps over a 6-week period. Everyday activities,
such as biking to school, taking a dance or karate class after
school, or going for a family walk after dinner were compiled
to help the classes get their steps to Albany.
The Healthy Steps to Albany program is unique because
students are asked to think about the many ways they can
increase their daily physical activities. With the support of
their teachers and friends, students are encouraged to turn off
the TV, put down the video game controller, and be physically
I chose to focus on middle school students for a number of
reasons. It is at this age that many students are uncomfortable
with their changing bodies because they are going through
puberty. And studies show that children's physical activities
levels decline significantly during middle school years.
Today's youth spend an average of 32 hours per week in
front of a TV, video game or computer screen. This greatly
exceeds the recommended limit of 1 to 2 hours maximum per day.
Although I started Healthy Steps To Albany in Harlem before
I became first lady, this spring we expanded the challenge to
five large cities upstate New York, in Buffalo, Rochester,
Syracuse, Albany and Yonkers. Nearly 270 classes registered,
and the students walked more than 1.4 billion steps while
mapping their progress across New York state. In addition,
students had the opportunity to earn steps by making smart food
All the students benefited, because the 13 classroom teams
that walked the farthest earned a number of prizes, including a
visit to a local organic farm where they learned how food is
grown and prepared. Tomorrow, the governor and I will be in
Buffalo to share a healthy lunch and present awards to the
Buffalo and Rochester winners.
When I took the students from Harlem to a farm last year, I
realized how far our urban youth are from the sources of their
food. One student told me she didn't realize that cheese came
from cows. She just thought it came from the grocery store.
Another student never made the connection between potatoes and
If students do not understand the origins of the food they
eat every day, they cannot understand what they are putting
into their bodies. Students learn not only in the classroom,
but also in the cafeteria, the halls, the gym, the schoolyard
and their neighborhoods. They learn from teachers, parents,
classmates and neighbors.
They learn what they see. And too often, in too many
schools, students see high calorie, low nutrient foods and
Today, more than 1,000 schools in New York have already
implemented comprehensive wellness policies, enhanced nutrition
standards and increased the time of physical activity. I
believe we can do better. We need federal legislation that
raises the nutrition standards of all foods and beverages
available in our school.
Many of these standards can be addressed in the 2009 Child
Nutrition Act Reauthorization. We strongly support your efforts
to request that the USDA strengthen by regulation the nutrition
standards governing the federal national school lunch and
school breakfast programs, as well as to impose stricter
federal standards on competitive foods sold or served in
As you do so, be cognizant of how schools got into selling
outside food in the first place. They have to compensate for
the deficits caused by insufficient federal funding for the
school lunch and breakfast programs.
As you advocate for improving standards for school's food,
I ask you to also examine the cost to states to supply
healthier foods. I am confident you will find that school food
programs are severely underfunded.
Improved federal nutrition standards and reimbursement for
school lunch, school breakfast and competitive foods, combined
with programs to increase physical activity, will help children
and adolescents establish healthy behaviors. In turn, students
will be healthier, will have lower obesity rates, obesity-
related diseases, and they will have lower healthcare costs. It
can also contribute to increased capacity to learn, higher
academic achievement, and greater success in school and their
We look forward to working with you on these important
goals as the Child Nutrition Act Reauthorization moves forward,
and I thank you for your time and attention.
[The statement of Ms. Paterson follows:]
Prepared Statement of Michelle Paige Paterson, First Lady of the State
of New York
I would like to thank Subcommittee Chairwoman Carolyn McCarthy,
Representatives Yvette Clarke, and Paul Tonko from the great State of
New York, and the other members of the Subcommittee for inviting me to
present New York efforts in fighting childhood obesity.
I would like to congratulate the Subcommittee for convening this
hearing on the Child Nutrition Act reauthorization to address the
childhood obesity epidemic and to discuss initiatives that can and
should be taken at the local, state and federal levels.
As First Lady and in my professional career, I continue to be
committed to promoting programs that protect and support the health of
New York's children.
Governor Paterson and I believe that all of us share a common
obligation to ensure that our children have the opportunity to live
healthy lives and are given the promise of a healthier future.
But to have that healthier future, we need to address what is
perhaps the biggest challenge to the health and well-being of our youth
today--the obesity epidemic--which not only adversely affects
children's health, but it threatens to shorten their lifespan.
As all of us know, the obesity epidemic touches all age groups, all
neighborhoods and all socio-economic groups. The State Department of
Health estimates that one in four New Yorkers, including children, is
obese. Among low-income populations and communities of color, the
prevalence is even higher.
In our own family, we practice what we preach--we exercise
regularly and eat healthy foods, including fruits and vegetables from
the organic garden at the Governor's mansion.
Even though New York State has a strong requirement for physical
education in its schools, the Centers for Disease Control and
Prevention recommended 60 minutes of daily physical activity is not
enough time to ensure good health for our youth.
The Governor has proposed state legislation and programs to improve
the nutrition of foods available in schools, reduce the availability of
high calorie, low nutritional food (i.e. junk foods), and to increase
the opportunities for physical activity.
He proposed again this year the Healthy Schools Act, which would
require the establishment of nutrition standards for all foods--school
lunch, school breakfast and competitive foods sold or served in
The Governor also proposed the Healthy Food/Healthy Communities
Initiative, which the legislature passed this year. It offers a new
revolving loan fund to increase the number of healthy food markets in
Additionally, the New York State Departments of Health and
Agriculture & Markets have worked with schools, communities and farmers
to develop and expand the Farm to School program. They worked to obtain
procurement exemptions that would promote the use of local fruits and
vegetables in schools, and to support edible school gardens.
The Governor's office collaborated with a wide group of partners
and stakeholders in New York, including the YMCAs of New York State and
the New York State Alliance of Boys & Girls Clubs, to set model
standards for nutrition, physical activity, and television and video
game limits in after-school programs.
With the support of the National Governors Association, we launched
the Healthy Kids, Healthy New York After-School Initiative and
Governor's Recognition Program, which continues to provide training
toolkits and resources. In October, the Governor will recognize after-
school programs that have adopted and implemented these model
We've also work with more than 400 child day care centers
throughout the State to provide training, education and guidance to
child day care staff and parents. The goal is to provide supports for
healthy eating and physical activity, and to reduce media use.
Additionally, we collaborate with our healthcare providers by
offering training, toolkits and guidance for the implementation of
expert guidelines to ensure children are being screened for obesity
using Body Mass Index (BMI) and that they and their families are being
counseled about healthy eating and daily physical activity.
The New York State Office of Health Insurance Programs has launched
a 2-year Pediatric Obesity Performance Improvement Project in all
Medicaid managed care plans in the State. It ensures guideline-
concordant care to screen for, prevent and manage child and adolescent
While these successes are significant, working with one community,
one school, or one childcare provider at a time is not going to end the
obesity epidemic. We need federal policies, standards, regulations and
commitments that help make the healthy option the easy choice for New
Yorkers and all Americans.
To better monitor the epidemic, target high-risk communities and
identify successful community and/or school interventions, New York
passed legislation that supports a partnership among the state health
and education departments and the healthcare community. These groups
have developed and implemented a non-duplicative surveillance system
that is cost-efficient for BMI screening and determining weight status
assessment of school-age youth. The data obtained will provide obesity
rates at local, county and state levels by the end of this school year.
For my part, to encourage physical activity among the youth in my
home community of Harlem, I created a program called Healthy Steps to
Alban: First Lady's Challenge. Teams of middle school students, grades
six through eight, were challenged to walk 4 million steps over a 6-
week period. Small, everyday activities such as biking to school,
taking a dance or karate class after school or going for a family walk
after dinner were compiled to help the classes get their `Steps to
The Healthy Steps to Albany program is unique because students are
asked to think about the many ways they can increase their daily
physical activity. With the support of their teachers and friends,
students are encouraged to turn-off the television, put down the video
game controller, and be physically active.
I chose to focus on middle school students for a number of reasons.
It is at this age that many students are uncomfortable with their
changing bodies, and studies show that children's physical activity
declines significantly during middle school.
Today's youth watch an average of 32 hours per week at a
television, video game, or computer screen. This greatly exceeds the
recommended limit of 1-2 hours maximum per day.
Second, having a teenage son, I quickly realized that when he said
he was going to play football with his friends, he wasn't always
outside being physically active. He was often inside with a video game
or watching television.
Although I started Healthy Steps to Albany in Harlem before I
became First Lady, this spring we expanded the challenge to five large
cities in Upstate New York--Buffalo, Rochester, Syracuse, Albany and
Yonkers. Nearly 270 classes registered, and the students walked more
than 1.4 billion steps while mapping their progress across New York
State. In addition, students had the opportunity to earn steps by
making smart food choices.
All the students benefited, but the 13 classroom teams that walked
the farthest earned a number of prizes, including a visit to a local
organic farm where they learned how food is grown and prepared.
After meeting many of these young people and listening to their
experiences, I can tell you this program is a success. Tomorrow, the
Governor and I will be in Buffalo to share a healthy lunch and present
awards to the Buffalo and Rochester winners.
When I took the students from Harlem to a farm last year, I
realized how far our urban youth are from the sources of their food.
One student told me she didn't realize that cheese came from cows--she
just thought it came from the grocery store. Another student never made
the connection between potatoes and potato chips. If students do not
understand the origins of the food they eat every day, they cannot
understand what they are putting into their bodies.
The good news is that we can get our young people, their teachers
and parents excited about walking and being physically active, but we
need to help them stay active and to ensure that the school
environments and neighborhoods promote healthy behaviors.
Students learn not only in the classroom but also in the cafeteria,
the halls, the gym, the school yard and their neighborhoods. They learn
from teachers, parents, classmates and neighbors. They learn what they
And too often, in too many schools, students see high-calorie, low-
nutrient foods and beverages, which is often coupled with aggressive
marketing and advertising.
New York State has made a significant investment to improve the
school nutrition environment, as well as after-school programs and
child daycare settings. Healthcare providers and insurers continue to
work with employers, agriculture organizations, farmers and community
groups to help prevent childhood obesity.
New York's state and local health departments, partners, parents
and concerned citizens continue to work with schools to set nutrition
standards and limit the sale of low-nutrient, high-calorie foods and
beverages. More than 1,000 schools in New York have already implemented
improved comprehensive wellness policies, enhanced nutrition standards
for meals and snacks, and increased the time for physical activity.
I believe we can do better. We need federal legislation that raises
the nutrition standards of all food and beverages available in our
schools. Many of these standards can be addressed in the 2009 Child
Nutrition Act reauthorization.
We strongly support your efforts to request that the USDA
strengthen, by regulation, the nutrition standards governing the
federal National School Lunch and School Breakfast Programs, as well as
to impose stricter federal standards on competitive foods sold or
served in schools.
As you do so, be cognizant of how schools got into selling
competitive foods in the first place: they had to compensate for the
deficits caused by insufficient federal funding for the School Lunch
and Breakfast programs. As you advocate for improving standards for
school foods, I ask you to also examine the costs to states to supply
healthier foods. I am confident you will find that school food programs
are severely under-funded.
And as US Secretary of Education, Arne Duncan, seeks to reform
education in this country ``to provide a complete and competitive
education to all children'' to improve student performance and make
American students competitive in the world, he spoke about increasing
the school year and lengthening the school day.
Keep in mind that with a longer school day, a ``complete
education'' needs to incorporate daily time for physical activity,
including walking programs, like Healthy Steps to Albany and other
types of lifetime activities.
Also, remember that school breakfast is strongly linked to improved
academic performance and higher test scores, reduced truancy and
absenteeism. However, the breakfast must be high-quality and should
demonstrate healthy food options to our children.
Improved federal nutrition standards and reimbursement for school
lunch, school breakfast, and competitive foods, combined with programs
to increase physical activity, will help children and adolescents
establish healthy behaviors. In turn, students will be healthier, have
lower obesity rates and obesity-related diseases, and they will have
lower health care costs. It also contributes to increased capacity to
learn, higher academic achievement, and greater success in school.
Moreover, we strongly support your work on the WIC [Women Infants
and Children] program in the reauthorization. WIC provides nutritional
information and support outside of our schools. Through the program a
number of obesity prevention initiatives were implemented. They include
breastfeeding support, Fit WIC physical activity training for parents,
patient-centered nutrition education, low-fat milk promotion and the
new WIC food package that includes vegetables and fruits, whole grains,
and non-fat and low-fat milk. In New York, the WIC program reaches
518,000 low-income women, infants, and children through a network of
100 local agency contractors. These programs are part of a
comprehensive approach that is needed to combat childhood obesity.
We look forward to working with you on these important goals as the
Child Nutrition Act reauthorization moves forward. I thank you for your
time and attention.
New York State Recommendations to Improve School Meals
Specific recommendations for improvements to school meals,
consistent with the Dietary Guidelines for Americans issued jointly by
the USDA and the Department of Health and Human Services:
Increase Whole Grains. At least half of the grain products
served in school meals should be whole grains.
Increase Fruits and Vegetables. At a minimum, two servings
of fruits or vegetables per breakfast and three servings of fruits or
vegetables per lunch should be served. (Serving sizes will vary with
children's' ages and grade levels). Schools should offer, at a minimum,
five different fruits and five different non-fried vegetables over the
course of a week to help ensure variety. Only one serving of fruits or
vegetables per day should be juice.
Sodium. In order to help students stay within the 2,300 mg
per day tolerable upper intake level for sodium recommended in the
Dietary Guidelines, we urge the USDA to require that school lunches
contain no more than 770 mg of sodium (one-third of the daily limit of
sodium) and that school breakfasts contain no more than 575 mg of
sodium (one-quarter of the daily limit for sodium).
Fats. The regulations related to the fat content of school
meals should be updated to reflect the Dietary Guidelines. Total fat
should contribute 20 to 35 percent of the total calories in school
meals. Saturated fat plus trans fat combined should provide no more
than 10 percent of total calories.
Calories. School meal programs are nutrition promotion
programs and, as such, should model appropriate portion sizes, calorie
levels, and healthy choices from the food groups. The calorie levels
for ``moderately active'' children set forth in the Dietary Guidelines
for Americans and Dietary Reference Intakes should apply to school
meals to reflect the current activity levels of the majority of
Added Sugars. By the beginning of the 2009-2010 school
year, the USDA should establish a quantitative limit on added sugars
for the school lunches and breakfasts.
Milk. All fluid milk served with school meals should be
low-fat (1%-fat) or fat-free.
Commodities. Efforts to improve the nutritional quality of
surplus government commodities offered to schools should continue,
funding for the Department of Defense (DoD) Fresh Program which
delivers fresh produce to schools should increase, and other programs
that connect locally grown produce to schools should be supported.
New York State Efforts to Improve Nutrition and Physical Activity
The New York State Department of Health addresses obesity
prevention through physical activity and nutrition as part of its
Prevention Agenda Toward a Healthier State. The purpose is to prevent
health problems before they occur or before they worsen. The things we
do, the food we eat, the air, water around us and the design of our
communities contribute to the majority of deaths in New York and the
nation. To accomplish this, policy, systems and environmental changes
are pursued in collaboration with a wide range of organizations and
community members across a variety of settings.
Multiple contractors of the state health department have worked
with more than 1000 schools (of the over 7600 schools in state) to
improve opportunities for physical activity and healthier food choices,
including: development and implementation of comprehensive wellness
policies; enhanced nutrition standards for meals and snacks; and edible
school gardens and Farm-to-School programs. They have eliminated use of
food as a reward or punishment and increased time for physical activity
during, after and before the school day. Funded interventions in the
school setting include Eat Well Play Hard, Healthy Heart Program,
Overweight and Obesity Prevention Program, and Diabetes Prevention and
Child Day Care Centers
Multiple contractors of the state health department have worked
with nearly 500 child day care centers throughout the state to promote
healthier eating, increased physical activity and reduced media use
Chairwoman McCarthy. Thank you, Ms. Paterson.
We are going to have Mr. Platts introduce our witness. We
understand you were caught in traffic, so don't worry about it,
Mr. Platts. Thank you, Madam Chair.
I am delighted to give introduction to our final panelist,
Susie Byrnes, who is a great community leader in my hometown of
York. Susie, welcome. And as those of you who saw her entrance
and some of her props, the things she has brought with her,
Susie brings an amazing level of energy to all she does.
A registered nurse by training since 1988, she has devoted
herself to really trying to prevent the premature deaths caused
by unhealthy lifestyle choices by developing the concept of and
then following through on the creation of the Susie Byrnes
Health Education Center, which officially opened its doors in
1995. After its first decade, the center continues to grow and
reach its vision of becoming a leading resource of innovative,
high-quality, effective health education.
And I can tell you that I have had the pleasure of being at
the center in my official capacity and to partner with the
center in any way I can. But what was most informative, I have
been there as a parent chaperoning my son's sixth grade class
just recently for a wonderful program.
And Susie, we are honored to have you here with us, and
know that, when we get to your testimony, you will bring great
insights as a leader in the area of health education centers,
not just in York but across the country with the national
associate. So thanks for being with us.
Chairwoman McCarthy. And welcome.
We have a vote going on, and we have to get over to the
Capitol now to vote. We are going to have four or five votes,
so, unfortunately, we are probably going to be at least 45
minutes. So I think this is a good time for a break, for
everybody to stretch their legs, get something healthy to drink
and something healthy to eat, and we will be back.
Chairwoman McCarthy. We were just told that I am able to
start, being that there is no one here to object.
So, Dr. Stallings, please?
STATEMENT OF VIRGINIA A. STALLINGS, M.D., DIRECTOR, CHILDREN'S
HOSPITAL NUTRITION CENTER
Dr. Stallings. Madam Chair and Mr. Platts, members of the
committee, my name is Virginia Stallings. And as you have
heard, I serve as chair on the Committee of Nutrition Standards
for National School Lunch and Breakfast Programs that are under
progression of the Institute Of Medicine.
We have produced a Phase I report on the topic that came
out in late 2008. We are currently working on Phase II that
will provide recommendations for revisions to the nutrition
standards and the menu requirements for the program.
I also served as chair of the committee that prepared the
2007 report on ``Foods In Schools: Leading The Way Towards
Healthier Youth,'' that reviewed the scientific evidence and
provided nutrition standards for snacks and other foods and
beverages provided outside of the federally reimbursable meals
and snack programs. These were mentioned this morning by
Representatives Woolsey and Castle.
In 2008, at the request of the USDA, the IOM convened an
expert committee to provide recommendations for updating the
nutrition standards and meal requirements for the school lunch
and breakfast programs. These are the nutrition and health
foundations for these programs, and much has happened since the
current standards were last updated in 1995.
The school lunch program serves more than 30 million
children each day, and the breakfast program serves about 10
million. Thus, improvements to the programs offer tremendous
potential to improve the dietary intake and the health of
children. Together, the two school meal programs can make a
great impact because they may provide as much as 50 percent of
a student's food and nutrition intake on school days.
Also, as you know, depending on household income, a child
may receive meals at no cost, at reduced cost, or full price.
The program, therefore, serves as a safety net for children in
The school lunch program was established in 1946 as a
measure of national security to safeguard the health and the
well-being of the nation's children. Then, most of the
nutrition concerns of the United States were centered on
Although many of the overt deficiencies have now been
eliminated, other nutrition-related concerns have emerged. And
as the chair mentioned, the most notable is the high prevalence
of childhood obesity.
Revisions of the current program standards will enable the
programs to incorporate current public health recommendations
and the newer knowledge about nutritional needs of children and
adolescents, and what we now know about the impact of nutrition
on health both in childhood and throughout the lifetime.
Among the specific reasons for revising the standards are
substantial changes in the dietary guidelines for Americans,
which by law the school meal programs are required to follow.
We also have major changes in the nutrient intake
And again, as mentioned, this is on a background of the
increased prevalence of obesity. There are short and long-term
health consequences that will follow this epidemic of childhood
The USDA subsidized the cost through cash reimbursements,
and in 2007, this was near $10 billion. Also, though, the USDA
provides about $1 billion in the commodity foods programs.
Commodity foods available to schools have changed dramatically
over the years, and now states can choose from a list of more
than 180 agricultural commodities, including many more fruits
In Phase I, the committee reviewed the task, formulated
working principles, assessed the nutrient intake of
schoolchildren, and described our planning model. The report
was discussed in a public forum in January, and the committee
expects to complete this report with full recommendations for
new standards in this fall. I would like to mention the four
criteria that have guided this work.
The nutrition standards and meal requirements will be
consistent with current dietary guidance and nutrition
recommendations to promote health. The ultimate goal is to
improve childrens' diets by reducing the prevalence of both
inadequate and excess intake of foods, nutrients and calories.
The nutrition standards and meal requirements will be
developed based on age and grade groups that are consistent
with the age and gender categories that are important to
understanding child development and the recommendations. The
recommendations will also support menus that offer nutritious
foods and beverages that appeal to students. And lastly, the
recommendations will be sensitive to cost.
I will highlight several examples, very briefly, just to
illustrate how complex this process is going to be. With the
2004 Reauthorization Act of the Child Nutrition and WIC
program, schools were required to follow the dietary
guidelines, which means increase fruits, vegetables, whole
grains and low-fat and fat-free dairy.
However, in this setting, there were not specific enough
requirements for schools to implement this. Currently, the USDA
has two different programs that allow schools to plan meals,
one based on food, one based on nutrients, and the number of
servings and the requirements for servings of fruits and
vegetables are not the same in both programs.
The definition of whole grain products, which we now know
are important to health, will be considered. In the
marketplace, most foods that have whole grains represent
mixtures. The term ``whole grain'' and the serving size for
whole grain are not yet defined by the FDA.
So schools are in an awkward position of being given
recommendations but do not have definitions as to how to follow
compliance. Recommendations along these lines will help both
industry and the food service community.
Dietary guidelines include recommendations for sodium,
cholesterol, fiber, and trans fat. Again, not all of the
current recommendations follow the science or the current
dietary recommendation intakes.
By law, the dietary guidelines must be reviewed every 5
years. And in fact, this process has just begun, and there will
be new guidelines in 2010. We need to have a way that these
constant and important updates can be accommodated into ongoing
changes in the regulations for school foods at lunch and
Incorporating the standards--I think I will skip that in
the interest of time. Specifying the issue of age and grade
groups is very important. Nutrition and energy needs differ by
age, and as children grow older, both by gender and age. The
current DRI age groups different from the USDA age groups, so,
again, we need to harmonize these things.
This is particularly true when you think about energy
levels and calories as we think about issues of obesity. Energy
needs differ by age, by physical activity, by body size. And
when you think about kindergarten to 12th grade, you can
appreciate how vast that range is. It may be appropriate to
provide recommendations both for minimum and maximum energy
levels in recognition of the concerns about both under-
nutrition and obesity in school age children.
In conclusion, the National School Lunch Program and
Breakfast Program have a long and impressive history of
providing nutritious, low-cost meals to school age children.
There have been major developments in diet and health guidance
and scientific understanding since the last revisions were
made. It is now time to develop new recommendations so that
school meals and the programs that they represent can achieve
greater benefit for our nation's children.
With the recommendations for competitive and snack foods
which came out last year, and the recommendations to revise the
WIC food basket, which came out shortly before that, we have
the unprecedented opportunity to use evidence-based and public
health evidence to directly improve the dietary intake of
children and positively impact child health.
Thank you for the opportunity to testify.
[The statement of Dr. Stallings follows:]
Prepared Statement of Virginia Stallings, M.D., Director of the
Nutrition Center, Children's Hospital of Philadelphia
Good morning, Madame Chair and members of the Committee. My name is
Dr. Virginia Stallings. I am a pediatrician, Director of the Nutrition
Center at the Children's Hospital of Philadelphia, and Professor of
Pediatrics at the University of Pennsylvania, School of Medicine.
I serve as chair of the Committee on Nutrition Standards for
National School Lunch and Breakfast Programs of the Institute of
Medicine which produced the report, Nutrition Standards and Meal
Requirements for National School Lunch and Breakfast Programs: Phase I.
Proposed Approach for Recommending Revisions in 2008. We are currently
working on Phase II of the project that will provide recommendations
for revision of the nutrition standards and Menu Requirements for the
School Breakfast Program and the National School Lunch Program. I also
served as chair of the committee that prepared the 2007 Institute of
Medicine report on Foods in Schools: Leading the Way Toward Healthier
Youth that recommended nutrition standards for foods offered in
competition with federally reimbursable meals and snacks. Established
in 1970 under the charter of the National Academy of Sciences, the
Institute of Medicine provides independent, objective, evidence-based
advice to policymakers, health professionals, the private sector, and
In 2008, at the request of the US Department of Agriculture (USDA),
the Institute of Medicine convened an expert committee to provide
recommendations for updating and revision of the nutrition standards
and meal requriements for the school lunch and breakfast programs.
Nutrition standards and meal requirements provide the nutrition and
health foundation for the National School Lunch Program and the
National School Breakfast Program, and much has happened since the
current standards were last updated in 1995. The key question is: What
changes are needed to make these programs consistent with the current
understandings about diet and health as they relate to our nation's
The National School Lunch Program serves more than 30 million
children per day and the School Breakfast Program serves 10.1 million
students daily (FY 2007). Thus, improvements to the programs offer
tremendous potential to improve the dietary intake and health of
children. Together, the two school meals programs can make a great
impact because they may provide more than 50 percent of a student's
food and nutrient intake on school days and about half of the food
intake in a year. As you know, depending on household income, a child
may receive program meals at no cost, reduced cost, or full (but
partially subsidized) price. Thus, the programs serve as a safety net
for children in need.
When the National School Lunch Program was established in 1946 as a
``measure of national security, to safeguard the health and well-being
of the nation's children,'' nutritional concerns in the United States
centered on nutrient deficiencies. Although many of the overt
nutritional deficiencies in children's diets have largely been
eliminated, other nutrition-related concerns have emerged, most notably
a high prevalence of childhood obesity. Although program standards were
updated in 1980 and 1995, additional updates are needed. Further
revision of program standards will enable the programs to incorporate
current public health recommendations and newer knowledge about the
nutritional needs of children and adolescents and the impact on health
in chldhood and throughout the lifetime. Among the specific reasons for
revising the standards are substantial changes in the Dietary
Guidelines for Americans (which, by law, the school meal programs are
required to follow), major changes in nutrient reference values and
ways to apply them, and the alarming increases in the prevalence of
childhood obesity coupled with the short and long term health
consequences that will likely follow childhood obesity.
The nutrition standards and meal requirements provide the
foundation for the school meals programs. If the meals offered meet the
nutrition standards and meal requirements in USDA regulations, the USDA
subsidizes the cost through cash reimbursements. In fiscal year 2007
the value of the cash reimbursements were near $10 billion total for
both programs. In that same year, USDA also provided commodity foods to
the programs with a value of approximately $1 billion. Commodity foods
available to schools have changed over the years, and states may now
choose from a list of more than 180 agricultural commodities including
more foods that are encouraged by Dietary Guidelines for Americans,
such as fruits and vegetables.
The committee's work has been divided into two phases. I am going
to talk about the Phase I report issued in late 2008 that describes the
committee's proposed criteria and approach to use in making
recommendations for revisions to the nutrition standards and meal
requirements of the school meal programs. The report is available
electronically at no charge from the National Academies Press (http://
www.nap.edu/catalog.php?record--id=12512 or http://iom.edu/
During Phase I, the committee identified and reviewed available
data and information on the task, formulated working principles and
criteria, and reviewed and assessed the food and nutrient intakes of
schoolchildren. The committee then described its planning model and
analytical methods for developing recommendations. The report was
discussed during a public forum in January, the committee is now
engaged in Phase II, and expects to complete this report with
recommended revisions to the nutrition standards and meal requirements
for School Breakfast and Lunch Programs in Fall 2009.
The committee proposed four criteria to guide its work. The
proposed criteria are:
1. The nutrition standards and meal requirements will be consistent
with current dietary guidance and nutrition recommendations to promote
health--as exemplified by the Dietary Guidelines for Americans and the
Dietary Reference Intakes from the Institute of Medicine--with the
ultimate goal of improving children's diets by reducing the apparent
prevalence of inadequate and excessive intakes of food, nutrients, and
2. The nutrition standards and meal requirements will be considered
on the basis of age-grade groups that are consistent with the current
age-gender categories used for specifying reference values and with
widely used school grade configurations.
3. The nutrition standards and meal requirements will result in the
simplification of the menu planning and monitoring processes, and they
will be compatible with the development of menus that are practical to
prepare and serve and that offer nutritious foods and beverages that
appeal to students.
4. The nutrition standards and meal requirements will be sensitive
to program costs.
Through its discussion of specific topics that must be addressed in
order to revise nutrition standards and meal requirements, the Phase I
report explains why changes are needed. Perhaps most importantly, the
standards and requirements must be updated to be consistent with the
current Dietary Guidelines for Americans and the Dietary Reference
Intakes. There is also need to identify practical approaches to making
revisions, ,to address cost considerations, to continue providing a
safety net to children who are at risk of insufficient food intake
without contributing to excessive weight gain, to enable planning of
meals that student will eat and enjoy, and to address other factors
that affect feasibility of implementing the recommendations. I will
highlight the application of Dietary Guidelines for Americans and the
Dietary Reference Intakes to the school meals program, by way of
illustration of the complexities and the necessity for revisions.
Fruits, Vegetables Whole Grains, and Low-Fat or Fat-Free Milk
Products. The Child Nutrition and WIC Reauthorization Act of 2004
amended the National School Lunch Act to require increased consumption
of foods that are recommended in the most recent Dietary Guidelines.
These include fruits, vegetables, whole grains, and low-fat or fat-free
milk products. Further, the increased consumption of such foods can be
related to the decreased intake of other food groups (for example,
meats and refined grains). Addressing these issues requires careful
consideration of food-based and nutrient-based planning. Current
standards for the two approaches differ with regard to number of
servings and serving sizes of fruits and/or vegetables and fluid milk;
and neither requires whole grains. While regulations specify that all
schools must provide at least two types of milk, they do not restrict
the types of milk offered by fat content.
The definition of whole grain products will be considered. In the
marketplace, most foods that contain whole grain represent mixtures.
The term whole grain is not defined by Food and Drug Administration and
that agency has not provided a definition of a whole grain product or a
whole grain serving. To assess how well a school is meeting [potential]
nutrition standards concerning the inclusion of whole grains in menus,
the definition of whole grain in the school setting will need to be
clear. This will help industry and the school food service team.
Sodium, Cholesterol, Fiber, and Trans Fat. The Dietary Guidelines
includes recommendations for sodium, cholesterol, and fiber and
recommends limiting the intake of trans fat. Especially with regard to
sodium, it may be challenging to obtain prepared foods that the
children will find appetizing Further, not all the recommendations are
identical to those in the DRIs. Again, up to date uniform
recommendations will likely encourage industry to respond to the
nutrition and health needs of school age children.
Planning for Subsequent Revisions to Dietary Guidelines for
Americans. By law, the Dietary Guidelines must be reviewed every five
years. To date, changes have been made every five years. Especially
because the next revision to Dietary Guidelines is expected in the year
2010, it may be helpful if revisions for the school meal programs
include a way to accommodate ongoing changes to the Dietary Guidelines
in a timely way.
Incorporating Current Dietary Reference Intakes and Related
Planning Approaches for School Meals. The current nutrition standards
for school meals reference the older 1989 Recommended Dietary
Allowances. These have been replaced and expanded by the Institute of
Medicine's new reference values known as the Dietary Reference Intakes
(DRI) developed between 1994 and 2004. The standards for school meals
have not yet changed in response. The planning task is complex and
involves considerations related to program goals, nutritional aspects
(such as the selection of target nutrient intake levels), and program
implementation. The revisions to the nutrition standards and meal
requirements for school meal programs must take these and related
considerations into account.
Specifying Age-Grade Groups. Nutrient and energy needs differ by
age and, in older children, by gender. Currently, the regulations for
school meal programs specify a number of age-grade groups (for example,
kindergarten through grade three) and make no distinction by gender.
DRI age groups differ somewhat from the ages covered by the USDA-
specified age-grade groups.
Part of the committee's task is to propose serving sizes and
numbers of servings of the required types of foods of the nutrition
standards by age-grade group. These amounts would be used in menu
planning and in the evaluation of menus.
Recommending Energy Levels. Energy needs differ by age and by
physical activity and body size (which vary greatly, especially in
grades 7 through 12). Recommendations for energy will need to consider
the great diversity of needs of the ages of the children being served.
It may be appropriate to provide recommendations for both minimum and
maximum energy levels.
Specifying Nutrients to Be Covered by the Nutrition Standards.
Currently, regulations specify quantitative requirements for energy,
protein, calcium, iron, vitamin A, vitamin C, total fat, and saturated
fat. In addition, the nutrition standards encourage program operators
to reduce sodium and cholesterol levels and to increase fiber levels in
menus with no further specification given. The DRIs include targets for
all these nutrients plus many more, and the 2005 Dietary Guidelines
identified several nutrients of concern for children. These
developments indicate a need to reassess the list of nutrients that are
covered in the nutrition standards.
In conclusion, the National School Lunch Program and School
Breakfast Program have a long and impressive history of providing
nutritious low-cost meals to school-age children. There have been major
developments in diet and health guidance and nutrient reference
standards and their application to programs since the last major
revisions to the nutrition standards and meal requirements. It is now
time to develop recommendations for further revisions to the nutrition
standards and meal requirements of the school meal programs so that the
program can achieve greater benefits for our nation's children. Thank
you for the opportunity to testify. I would be happy to address your
Chairwoman McCarthy. Thank you, Dr. Stallings.
STATEMENT OF NANCY COPPERMAN, DIRECTOR, PUBLIC HEALTH
INITIATIVES OFFICE OF COMMUNITY HEALTH, NORTH SHORE LONG ISLAND
JEWISH HEALTH SYSTEM
Ms. Copperman. Chairwoman McCarthy and members of the
Subcommittee on Healthy Families and Communities, I am Nancy
Copperman, director of public health initiatives of the North
Shore LIJ Health System, the 10th largest not-for-profit health
system in the nation that serves the 5.4 million residents in
the New York metropolitan area. Thank you very much for giving
me the opportunity to discuss the importance of implementing
and monitoring physical activity goals of the local wellness
I would like to present some data in support of increasing
physical activity in schools, the barriers that prevent the
implementation of physical activity goals, and discuss a
school-based wellness program, Activity Works, that addresses
the needs of, and the obstacles to, implementing these
Over 33 percent of U.S. elementary school children are
overweight or obese. Increased Body Mass Index in children has
been linked to reduced physical activity. Physical activity
guidelines state that children should engage in 60 minutes of
activity daily. National surveys of activity patterns indicate
that less than 50 percent of children meet this goal.
The 2006 School Health Policies And Programs Study
indicates that only 3 percent of elementary schools provide a
daily physical education or its equivalent, and only 13 percent
of elementary schools provide physical education at least 3
days per week. A recent audit of the New York state elementary
schools compliance with physical activity regulations found
that students in 18 of the 20 sample districts did not meet
minimum requirements of daily physical education and a weekly
total of 120 minutes.
Students were provided only 48 percent of the required
daily classes and 72 percent of the required class time. School
districts cited the following reasons for failing to meet
recommendations: increased academic standards, requirements and
testing, lack of physical education staff, and inadequate
facilities and space.
A local wellness policy includes goals for physical
activity that are designed to supplement established physical
education programs, but not replace them. School districts have
been compliant in formulating physical activity goals.
However, there is very limited data on the implementation
and monitoring of these goals. School wellness committees have
reported that lack of resources such as staff, programs,
facilities impact on the achievement of these goals.
In 2007, the health system partnered with schools to
develop the Activity Work program, which focuses on increasing
childrens' daily physical activity through an integrated
classroom approach to meet the needs of wellness policies and
physical education requirements. It is a community benefit
program of the health system with additional support from a
community building grant from Bank of America and the in-kind
resources for the pilot program from five Long Island school
The program was developed using feedback from an eight-
month discovery process led by the health system and a work
group of parents, educators, administrators, public health and
healthcare professionals. The process included a review of best
practices and obesity prevention recommendations, as well as
group discussions regarding how to develop a successful school-
based wellness program.
The stakeholders felt that the initiative should be school-
based, measurable, sustainable, scalable and simple. The
Activity Works program is unique because it integrates subject
matter--math, science, language arts, social studies, health,
art and music--with an exercise physiologist designed by
permanent exercise protocol.
The CDs and DVDs contain 10-minute segments with original
music and activities choreographed to the protocol. The program
is easily implemented by a classroom teacher who simply loads
the CD or DVD into a player, and the audio and/or video directs
the class exercise program. The students learn while they
The physical education staff supervises its use throughout
the academic year. Student calendars and sticker rewards offer
positive behavior reinforcement. Parent newsletters bring the
program's healthy lifestyle messages home to families.
Five New York school districts, 30 classes and over 1,000
students participate in Activity Works. Program feedback has
been extremely positive. Administrator and educator comments
include improvement in student attention span, listening
skills, behavior, fitness and knowledge.
Students' feedback says the program is fun, interesting,
and the music and exercises are cool. Parents and their
children feel they are more--parents feel their children are
more healthy and active.
The program has been incorporated into the physical
education curriculum of three school districts and provides an
additional 50 minutes of physical education per week,
increasing daily activity without increasing staffing and space
needs. It is used as a morning assembly and indoor recess
program, along with the parent newsletters, enables the schools
to meet their wellness policy physical activity goals.
An evaluation study is also being conducted to assess the
program's effectiveness in obesity prevention, improvement in
students' self-concept and physical activity, and ease of
classroom implementation. In order for a wellness policy to be
effective in promoting healthy lifestyles and prevent obesity,
it must address physical activity as well as diet.
However, the support for implementing and monitoring of the
physical activity goals has been sparse. Schools encounter
barriers of limited space, time, equipment, programs, and
trained staff to achieve these goals. Physical activity
programs that are designed to be integrated into existing
curriculums using existing space and involve community
partners, parents and school staff need to be developed and
supported. Activity Works is an example of one such innovative
Thank you very much.
[The statement of Ms. Copperman follows:]
Prepared Statement of Nancy Copperman, MS, RD, CDN, Director, Public
Health Initiatives, North Shore-LIJ Health System
Chairwoman McCarthy and members of the Subcommittee on Healthy
Families and Communities, I am Nancy Copperman, MS, RD, CDN, Director
of Public Health Initiatives, Office of Community Health of the North
Shore-LIJ Health System. The Health System is the tenth largest not-
for-profit health system in the Nation that serves the 5.4 million
residents of Nassau, Suffolk, Queens and Richmond Counties in the New
York metropolitan area. Thank you very much for giving me the
opportunity to discuss the importance of implementing and monitoring
physical activity goals of the Local Wellness Policy requirement as
established by the Child Nutrition and WIC Reauthorization Act of 2004.
The local wellness policy was designed to promote the health of
students and address the growing problem of childhood obesity. I would
like to present some data in the support of increasing physical
activity in schools, the barriers that prevent the implementation of
physical activity goals of the Local Wellness Policies and discuss a
school-based wellness program, Activity Works, that addresses the needs
of and obstacles to implementing these policies.
The prevalence of pediatric overweight and obesity is increasing in
epidemic proportions in the United States. Over 33% of US children ages
6-11, were overweight or obese in 2006 representing a tripling of the
prevalence of obese children since 1980. Several environmental factors
have been linked to increased Body Mass Index in children. These
factors include reduced physical activity and increased leisure time
spent viewing television. Current physical activity guidelines from the
Expert Committee Regarding the Prevention, Assessment, and Treatment of
Child and Adolescent Overweight and Obesity are in agreement with
recommendations from the Centers for Disease Control, the American
Academy of Pediatrics and the Institute of Medicine. These physical
activity recommendations state that children should engage in 60
minutes of physical activity daily. National surveys of childhood
physical activity patterns indicate that less than 50% of children meet
this goal. Expanding physical activity programs in elementary schools
through the implementation and monitoring of Wellness Policies and
Physical Education requirements can play a significant role in
containing and even preventing overweight and obesity in children.
National data from the 2006 School Health Policies and Programs
Study indicates that only 3% of elementary schools provided daily
physical education or its equivalent (150 minutes per week in
elementary schools) and only 13% of elementary schools provided
physical education at least 3 days per week or its equivalent for the
entire school year for students in all grades in the school.
A recent audit of New York State elementary schools compliance with
physical education regulations found that students in 18 of the 20
sampled districts did not meet the minimum requirements of daily
physical education and a weekly total of the required 120 minutes of
physical education. On average, kindergarten through sixth grade
students were provided only 48 percent of the required daily classes
and 72 percent of the required class time. The audited school districts
cited the following major reasons for the difficulty in meeting the
minimum physical education requirements:
1. Increased academic standards, requirements and testing fill
elementary school schedules which results in limited time for a daily
physical education class.
2. Lack of adequate physical education staff to meet frequency and
time requirements due to budgetary constraints
3. Inadequate facilities/space to offer additional classes to meet
A local wellness policy for schools shall, at a minimum include
goals for nutrition education, physical activity and other school-based
activities that are designed to promote student wellness in a manner
that the local educational agency determines is appropriate. It is
designed to supplement established physical education programs but not
replace them. Schools districts have been compliant in formulating
these policies with physical activity goals. However, data on the
implementation and monitoring of these strategies has not been directly
measured and reported at this time. School Wellness Committees have
reported that lack of resources such as staff and facilities impact on
the implementation of physical activity programs related to their
physical activity goals.
In 2007 in an effort to address the childhood obesity epidemic, the
North Shore-LIJ Health System partnered with schools to develop the
Activity Works Program which focuses on increasing children's daily
physical activity through an integrated classroom approach to meet the
needs of Wellness Polices and Physical Education requirements. The
program is a community benefit program of the North Shore--LIJ Health
System with additional support from a Community Building Grant from
Bank of America and the in-kind resources for the pilot program from 5
school Long Island school districts. The program was developed using
feedback from an eight month discovery process led by community health
professionals from the North Shore-LIJ Health System which convened a
working group of parents, educators, administrators, public health and
health care professionals. The process included a review of best
practices and obesity prevention recommendations from expert panels,
professional organizations and pediatric obesity experts as well as
group discussions regarding the potential strengths, weaknesses,
opportunities and threats to developing a school-based wellness
program. The stakeholder's consensus was that there is an urgent need
for elementary school children to increase their physical activity both
in school and at home to meet not only New York State Department of
Education requirements but the Center for Disease Control's
recommendation of 60 minutes of moderate to vigorous activity per day.
The stakeholders felt that in order for the initiative to be successful
the following criteria should be met:
School-based--to impact children where they spend a significant
portion of their formative years.
Measurable--to demonstrate realistic outcomes throughout the pilot
Scalable--a viable offering to any child grades 1-5, anywhere.
Sustainable--by cultivating participation, usage and loyalty in all
Simple--ease of adoption and implementation as a critical factor
The goal of the Activity Works Program is to prevent obesity in
elementary school children and is addressed by the following program
1. Increasing children's physical activity both during school hours
and outside of school hours through a school-based program.
2. Decreasing the prevalence of overweight and obesity by promoting
daily physical activity and healthy nutrition messages.
3. Demonstrating the feasibility and usability and of a classroom
based physical activity program by cultivating teacher, administration
and PTA support.
4. Increasing the sustainability of the program by integrating it
into the Physical Education Curriculum of the school to aid in meeting
Physical Education requirements
5. Using the program to implement physical activity goals of School
6. Improving children's scholastic competence (knowledge, listening
skills, and attention span), athletic competence (exercise endurance)
and behavioral conduct through daily program participation.
The Activity Works Program is a unique elementary school physical
activity program that integrates subject matter (math, science,
language arts, social studies, health, art, and music) with an exercise
physiologist designed beat per minute exercise protocol. The CDs and
DVDs contain original music and activities choreographed to the beat
per minute protocol. The program was specifically created to be easily
implemented by a classroom teacher who simply loads the CD or DVD into
a player and the audio and/or video directs the class exercise program.
The Physical Education staff in-service the classroom teacher on the
program prior to its implementation and supervise its use throughout
the academic year.
The themed Activity Works ``toolkit'' includes facilitator
guidelines, activity CDs and DVDs, student calendars, sticker rewards
and parent newsletters. The purpose of the varying monthly themes is to
maintain high levels of engagement. Age-appropriate themes include
Human Body Tour, Walk through a Book, Visit an Art Museum, and US Tour.
The calendars and sticker rewards offer positive behavior reinforcement
for daily physical activity. The parent newsletters bring the program's
healthy lifestyle nutrition and physical activity massages home to
families. The program is currently in 5 New York school districts, 30
classes and reaches over 1000 students.
Superintendent, principal, educator, student and parent feedback
has been extremely positive. Administrator and educator comments
include improvement in student attention span, listening skills,
behavior, fitness and knowledge. Student feedback states that the
program is fun, interesting and the music and exercises are cool!
Parents feel their children are more active and healthy. The Activity
Works Program has been incorporated into the physical education
curriculum of 3 school districts. It is used outside the classroom
during standard physical education classes, morning assembly and indoor
recess. The program has provided an additional 50 minutes of Physical
Education /week increasing daily activity and meeting New York State
Department of Education Physical Education requirements without
increasing staffing and space needs. Its use as a morning assembly and
indoor recess program enables schools to meet their Wellness Policy
physical activity goals.
A North Shore-LIJ Institutional Review Board approved evaluation
study is also being conducted in a sub-set of students from schools
implementing the Activity Works Program and schools without the program
who are acting as control subjects. The purpose of this pilot study is
to evaluate the Activity Works Program effectiveness in obesity
prevention, improvement of student's self-concept and physical activity
and ease of classroom implementation by collecting and analyzing
In order for a school Wellness Policy to be effective in promoting
healthy lifestyles for students and prevent obesity it must address
diet as well as physical activity. A well supported and resourced
structure has been created by previous Childhood Nutrition
Reauthorization Acts to improve nutrition standards and nutrient
quality for school nutrition services including nutrition education
components. These supports enable schools to implement the nutrition
goals and objectives of their Wellness Policies. However, the support
for implementing the Wellness Policy physical activity goals and
objectives has been sparse. Schools desiring to increase physical
activity encounter barriers of limited space, time, equipment and
trained staff to achieve this goal. Physical activity programs that are
designed to be integrated into existing curriculums utilize existing
space and involve both physical education and classroom school staff
need to be developed and supported. By increasing physical activity
through the integration of subject matter and prescribed exercise in
the classroom in daily 10 minute sessions, schools can address their
physical activity wellness policy goals with gradual expansion to after
school and home activities. Activity Works is an example of one such
Chairwoman McCarthy. Thank you very much.
STATEMENT OF REGINALD FELTON, FEDERAL RELATIONS DIRECTOR,
NATIONAL SCHOOL BOARDS ASSOCIATION
Mr. Felton. Thank you.
Chairwoman McCarthy, Ranking Member Platts and members of
the subcommittee, my name is Reginald Felton, director of
federal relations for the National School Boards Association.
Representing the nation's nearly 15,000 local school districts
and over 95,000 local school board members through our state
school board associations, we wish to thank you for the
opportunity to address the committee on this important issue
affecting children enrolled in our public schools.
Without question, NSBA believes that child nutrition is
vitally important to fostering a healthy and positive learning
environment for children to achieve their full potential, and
that includes efforts to prevent childhood obesity. We believe
that improving health requires the commitment of all of us and
our communities, including families, government, employers, and
local schools. Therefore, local school boards across the nation
continue to actively promote nutrition education, physical
education and obesity prevention.
As an organization, we want you to know that, through our
school health programs department, we help school policymakers
and educators make informed decisions about health issues
affecting the academic achievement and healthy development of
students and the effective operations of schools. Services are
provides with and through NSBA's member state associations in
partnership with other national organizations, such as the
National Association of State Boards of Education, the Alliance
for a Healthier Generation, and Action for Healthy Kids.
Additionally, NSBA is very proud of its efforts to promote
nutrition in the schools and to prevent childhood obesity
through Web-based services, educational programming, and
publications. A summary of our efforts is provided as an
appendix to our statement.
In addition to the work of our own organization, local
school boards are engaging their communities, through
partnership and coalitions, to ensure that all facets of the
community are more informed regarding both the value and cost
savings associated with improved nutrition. We are convinced
that local communities and states are assuming greater
responsibility for the health and well-being of its residents,
and very much appreciate the strong support of the federal
government through incentives and grants that enable school
districts and local communities to further expand their local
commitment and energy.
We know that educating children as to the healthy behavior
is most important if we are to ensure sustained changes in
nutritional habits. As you prepare for the reauthorization of
the Child Nutrition Act, we urge you to increase and expand
those incentives and grants that will garner solid buy-in and
commitment on the part of local communities rather than to
establish broader mandates beyond the current federally
subsidized food programs.
We appreciate your concern to improve nutrition, but we are
very much concerned with the unintended consequences that are
beyond the control of our local schools. We remain concerned
that the behavioral changes that you desire and expect, through
expanded federal mandates and restrictions beyond currently
federally subsidized programs, may not be achieved. We believe
that there would be significant increases in the purchases
beyond the school grounds, particularly where high school
students are permitted to leave the campus.
Secondly, we believe that increased regulatory
disagreements in schools over what foods and beverages should
and should not be sold as new products are developed and
marketed using newly developed food substitutes, and thirdly,
we believe that there will be increased misunderstandings and
complaints from parents regarding the banning of certain foods.
Additionally, local school boards view federal efforts to
regulate or codify into the statue the types of foods and
beverages that can and cannot be sold at school events,
particularly all those school-sponsored activities, as
intrusive and burdensome on school districts. Such efforts we
believe would dismiss the work of wellness councils and usurp
the jurisdiction of local school boards to create a policy that
reflects the values and capabilities of local communities.
Therefore, NSBA urges you to reconsider any efforts to
enact expanded legislation. Beyond the concerns over the
operational impact of--restrictions, local school boards are
also concerned with the potential impact on local budgets and
revenue streams beyond the vending machines. As you are aware,
the expansion of such federal restrictions on all food and
beverages beyond the vending machines substantially reduce
revenues that local schools need to support athletic programs
and other activities.
As examples, based on the literal interpretation of the
language in the proposed bill, local catering businesses
desiring to provide financial support to schools would be
allowed to provide to students food products not meeting
federal standards but would be prohibited from selling those
same standards to the same students, or schools sponsoring a
field trip out of town could find itself in noncompliance
because some of the food products available to the students in
their travels might not fully meet federal standards.
As you can see from these two examples, such restrictions
could result in enormous challenges for our local school
officials. A national vision for child nutrition is indeed
needed, but that should not convey, nor equate, to federal
In closing, we want to reiterate that local school boards
are committed to improving child nutrition and preventing
obesity, and we clearly view wellness policies as important. We
are very committed to changing attitudes and sustaining
positive behavior related to nutrition. Therefore, we feel that
community-based decisions are much more effective in the long
run than mandates from the federal government.
Federal mandates on our public schools should not be the
vehicle for changes in society. In our view, federal mandates
on what is sold in all school-sponsored activities is far
beyond what is needed or should be adopted.
We look forward to working with you as you approach the
reauthorization. And again, thank you for the opportunity to
[The statement of Mr. Felton follows:]
Prepared Statement of Reginald M. Felton, Director, Federal
Legislation, National School Boards Association
Madam Chairwoman: My name is Reginald M. Felton, director of
federal relations at the National School Boards Association (NSBA).
Representing the nation's nearly 15,000 local school districts and over
95,000 local school board members through our state school boards
associations, we wish to thank you for the opportunity to address the
Committee on this important issue affecting children enrolled in our
Without question, NSBA believes that child nutrition is vitally
important to fostering a healthy and positive learning environment for
children to achieve their full potential--and that includes efforts to
prevent childhood obesity. We believe that improving health requires
the commitment of all of us in our communities including families,
government, employers and local schools. Therefore, local school boards
across the nation continue to actively promote nutrition education,
physical education, and obesity prevention.
As an organization, we want you to know that through our School
Health Programs department, we help school policymakers and educators
make informed decisions about health issues affecting the academic
achievement and healthy development of students and the effective
operation of schools. Services are provided with and through NSBA's
member state associations of school boards, in partnership with other
national organizations, such as the National Association of State
Boards of Education, Alliance for a Healthier Generation, and Action
for Healthy Kids.
Additionally, NSBA is very proud of its efforts to promote
nutrition in the schools and to prevent childhood obesity through web-
based services, educational programming, and publications. A summary of
our efforts is provided as an appendix to our statement.
In addition to the work of our own organization, local school
boards are engaging their communities through partnerships and
coalitions to ensure that all facets of the community are more informed
regarding both the value and cost-savings associated with improved
We are convinced that local communities and states are assuming
greater responsibility for the health and well-being of its residents,
and very much appreciate the strong support of the federal government
through incentives and grants that enable school districts and local
communities to further expand their local commitment and energy. We
know that educating children as to healthy behavior is most important
if we are to ensure sustained changes in nutritional habits.
As you prepare for the reauthorization of the Child Nutrition Act,
we urge you to increase and expand those incentives and grants that
will garner solid buy-in and commitment on the part of local
communities rather than to establish broader mandates beyond the
current federally subsidized food programs. We appreciate your concern
to improve child nutrition, but we are very much concerned with the
unintended consequences that are beyond the control of our local
We remain concerned that the behavioral changes that you desire and
expect through expanded federal mandates and restrictions on foods
beyond current federally subsidized programs may not be achieved. From
a local school board's perspective, we believe that what is likely to
happen is that there would be:
1. Significant increases in purchases beyond the school grounds,
particularly where high school students are permitted to leave the
campus for lunch;
2. Increased regulatory disagreements in schools over what foods
and beverages should and should not be sold as new products are
developed and marketed using newly developed food substitutes; and
3. Increased misunderstandings and complaints from parents
regarding the banning of certain foods and beverages.
Additionally, local school boards view federal efforts to regulate
or codify into statute the types of foods and beverages that can and
cannot be sold in schools throughout the entire school day and at
school events as overly intrusive and burdensome on school districts.
Further, such efforts would dismiss the work of wellness councils and
usurp the jurisdiction of local school boards to create a policy that
reflects the values and capabilities of local communities.
In our view, these new requirements could also result in additional
unintended consequences that could require the redirection of time and
resources away from the school's primary responsibilities. Therefore,
NSBA urges you to reconsider any efforts to enact expanded legislation.
Beyond the concerns over the operational impact of such expanded
restrictions, local school boards are also concerned with the potential
impact on local budgets and revenue streams. As you are aware, the
primary responsibility of local school boards is to deliver high
quality educational programs to ensure that students are career- and
college-ready to compete in the global society. The expansion of such
federal restrictions on all foods and beverages could substantially
reduce revenues that local schools need to support athletic programs
and other activities that promote the overall development and well-
being of all students.
As examples, based on a literal interpretation of the language in
the proposed bill, local catering businesses desiring to provide
financial support to a school would be allowed to provide to students
food products not meeting the federal standards--but would be
prohibited from selling those same products to the same students * * *
or a school sponsoring a field trip out of town could find itself in
non-compliance because some of the food products available to the
students in their travels might not fully meet federal standards. As
you can see from these two examples, such restrictions could result in
enormous challenges for local school officials.
We do not want local school districts to be caught in a bind
between demands to sustain a quality learning environment and concern
over potential allegations of non-compliance because of the complexity
in operations of such proposed legislation. Therefore, NSBA urges
Congress to refrain from enacting legislation that would further
restrict local authority and create additional operational barriers.
A New Federal Role
A national vision for child nutrition is needed but that vision
should not convey nor equate to federal mandates. A national vision for
child nutrition should reflect the understanding of current authority
and Constitutional responsibilities of states and local communities,
and re-define the role of the federal government so that it promotes
national policies within the framework that supports states and local
communities. Beyond child nutrition, the federal government should
acknowledge more broadly that the efforts over the previous decade to
employ a ``top-down approach'' have not worked. The federal role should
be one of partnership and support to the states and local communities.
In a paper entitled A New Era in Education: Redefining the Federal Role
for the 21st Century, NSBA suggests a potential theme for the new
federal role might be ``facilitate, don't dictate.''
Local School Board Commitment
As you are aware, the Child Nutrition and Women, Children, and
Infants Reauthorization Act, passed by Congress in 2004, requires every
school district participating in the federal school meals program to
enact a wellness policy by the 2006-2007 school year. These policies
Goals for nutrition education;
Goals for physical activity;
Nutrition guidelines for all foods available at school;
Goals for other school-based activities designed to
promote student wellness;
Assurances that school meal guidelines are not less
restrictive than federal requirements; and
Plans for evaluating implementation of the policy.
To illustrate the success of the current law, a study conducted by
the Pennsylvania State University on Local Wellness Program (LWP)
implementation among Pennsylvania local school districts indicates
84 percent of the districts have written implementation or
action plans developed for some of their goals.
91 percent of the school districts have functioning
With respect to nutrition education:
50.3 percent of the school districts reported that their
students receive more minutes of nutrition education now than they did
prior to the establishment of local wellness policies.
58.2 percent of the school districts reported that their
students are receiving higher quality nutrition education now than they
were prior to the establishment of local wellness policies.
This data suggests that a majority of local school boards across
the nation are actively engaging their communities, as they should, to
create policies and local requirements that have the full support of
the people in their local communities.
In closing, we want to reiterate that local school boards are
committed to improving child nutrition and preventing obesity, and we
clearly view wellness policy as important. We believe that as these
local school board actions increase, positive changes in behavior will
take place reflecting the will of the local communities. We are very
committed to changing attitudes and sustaining positive behavior
related to nutrition. Therefore, we feel that community-based decisions
are much more effective in the long run than mandates from the federal
Federal mandates on our public schools should not be the vehicle
for changes in society. In our view, federal mandates on what is sold
in our schools and what cannot be sold in our schools beyond federally
subsidized food programs should not be adopted.
We believe that significant improvements in child nutrition and
health will not be achieved through the expanded authority of the
Secretary of Agriculture. Rather, it will be through the active
engagement of local communities that hold strongly to the belief that
those at the local level should best make such determinations.
Thank you again for the opportunity to share our views.
National School Boards Association's Efforts to Support Child Nutrition
Web-based Services through NSBA's School Health Programs:
``101'' packets on Wellness, Nutrition, Physical Activity
and Coordinated School Health to provide the data, background
information, research and sample policies to support local school board
``Promising District Practices'' website that provides the
``stories'' of how school districts have acted to address healthy
eating and physical activity.
``Updates and Special Announcements'' that alert school
officials to new research and reports on a wide range of health topics,
including childhood obesity, to inform decision making. Users can sign
up to obtain the ``Updates'' via an RSS feed.
Searchable database of research, information and sample
At NSBA's annual conference, several sessions in
partnership with such organizations as the Alliance for a Healthier
Generation, Action for Healthy Kids, and the School Nutrition
Symposium on Childhood Obesity (July 2008, Little Rock,
AR) for 12 state teams that include members of state boards of
education and local school board members to drive initiatives/policy
change in states based on state conditions, needs and capacity. Follow-
up technical assistance provided to state teams. This activity is
supported by Leadership for Healthy Communities, a national program of
the Robert Wood Johnson Foundation.
Special report in American School Board Journal (February
2009) on ``Health and Leadership'' focusing on childhood obesity. This
report was produced with support from Leadership for Healthy
Communities, a national program of the Robert Wood Johnson Foundation.
Articles on nutrition, physical activity, health and
wellness are frequently published in American School Board Journal.
Participation in the development of Action Strategies for
Healthy Communities, a new toolkit for state and local policymakers to
develop policy measures addressing issues around childhood obesity,
including nutrition in schools (in partnership with Leadership for
Healthy Communities, a national program of the Robert Wood Johnson
Chairwoman McCarthy. Thank you.
Ms. Byrnes, I am sorry that you had to wear whatever you
are wearing all this time. Hope you are going to demonstrate
what that is.
STATEMENT OF SUSAN P. BYRNES, FOUNDER, SUSAN P. BYRNES HEALTH
Ms. Byrnes. I will demonstrate. And thank you very much for
inviting me here. I am thrilled to finally find where everyone
First of all, I wanted to share with everyone that no goal
in life is possible without one's health. In 1988, I quit my
job as an emergency department nurse. Professionally and
personally, I had witnessed physical and emotional suffering of
patients and families due to unhealthy lifestyle choices. I
made a new life goal: to keep people well.
In 1989, with support from hundreds of dedicated business
professionals, healthcare providers, educators, parents and
organizations that sustain our communities every day, the
Central PA Health Education Center was incorporated as a
501(c)3. In 1995, after 6 years of planning and preparation,
the bright red doors of the newly dedicated and renamed Susan
P. Byrnes Health Education Center were open to the children and
citizens of central Pennsylvania and northern Maryland.
What began as two teaching theaters in a refurbished
downtown historic car dealership site has blossomed into
today's 20,000 square foot home with five teaching theaters,
over $1.5 million of interactive exhibits, and over 50
specialized educational offerings that include regional
outreach programs to children and students and teachers in
In addition to this, children and teachers throughout the
United States, and indeed internationally, over 168 countries,
log onto our e-learning site. We have 95,000 international
members that log on to learn about health on our Web site.
All 50 programs at the Byrnes Health Education Center meet
state and national guidelines. Our nutrition and fitness
programs are offered as an integrated series that empower
students to adopt healthier lifestyles.
For pre-K and kindergarten students, we offer, ``The Inside
Story;'' grade two, ``Fueling My Special Body;'' grade three,
``Let's Get Physical;'' grade four, ``Just Fueling Around;''
grade five, ``Healthy Hearts;'' grade six, ``Fat: What is Up
With That,'' and I will get to that; and grade eight, ``Extreme
How do schools come to the Byrnes Health Education Center?
If you were a fifth grade teacher, you would look at our
program guide. We have over 50 programs listed here.
You would look and you would see what you are teaching in
your classroom. You would come for one or two programs. You
would get on your school bus and you would come to the Byrnes
Health Education Center.
If you couldn't afford to do that, we have outreach
programs. And if you couldn't afford to do that, that is where
we have our free Web site called learntobehealthy.org.
What we have in our teaching theaters, if you would come to
our theaters, we have enthusiastic educators that teach with
our larger-than-life interactive exhibits. They incorporate the
wow factor and the fun factor into health education. We believe
that students learn by seeing, hearing and doing, and the
students are involved in the educational activities.
What I would like to do is demonstrate. This is one of our
least expensive exhibits. This is 20 to 25 to 30 pounds of fat.
We are not sure.
But why I brought this is, for every pound of fat that we
put on our bodies, our bodies have to produce 200 miles of
blood vessels to nourish that fat. That is what these little
red things are. Those are the blood vessels that nourish fat.
So if you put on 20 extra pounds, you are putting on 4,000
miles of blood vessels that your little heart that weighs less
than a pound has to now pump through. And if those vessels
become filled with fat, imagine what happens to this little
heart that has to pump through--normally we have 60,000 miles
of blood vessels.
The kids actually put this on, and then we ask them to run
and/or to do jumping jacks. And what we are trying to show them
is we are trying to give them information so that they will
continue to make healthy choices.
When Dr. Oz came to our health education center this past
October, he was teaching a heartbeat--a heart-healthy program
with our little ones. And he looked at me and he said, ``Why
doesn't every community have a health education center?'' And I
said, ``Well, in fact, 34 communities in this nation have
health education centers in 22 states,'' and we reach 10,000
school districts. And every year, 3.7 million students are
educated in health education centers.
However, the National Coalition of Healthcare says that, in
2009, the United States is going to spend $2.9 trillion on
disease. So it is time to turn the corner. And I am here,
thanks to Todd, to say to you that every community can have a
health education center.
[The statement of Ms. Byrnes follows:]
Prepared Statement of Susan P. Byrnes, R.N., Susan P. Byrnes Health
In 1988, I quit my job as an Emergency Department R.N.
Professionally and personally I had witnessed physical and emotional
suffering of patients and their families due to unhealthy lifestyle
choices. I made a new life goal: keeping people WELL.
In 1989, with support from hundreds of dedicated business
professionals, healthcare providers, educators, parents and
organizations that sustain our communities every day, the Central PA
Health Education Center was incorporated as 501(3)c.
In 1995, after six years of planning and preparation, the bright
red doors of the newly dedicated and renamed, Susan P. Byrnes Health
Education Center, were opened to the children and citizens of Central
PA and Northern MD.
What began as two teaching theaters in a refurbished, downtown,
historic car dealership site has blossomed into today's 20,000 sq. ft
home with five teaching theaters, over 1.5 million dollars of
interactive exhibits and over fifty specialized educational offerings
that include regional outreach programs to seven counties. Children
throughout the U. S. and over 168 countries around the world now
utilize our health educational tools through our e-learning programs.
The business community provides customized, educational programs to
employees and their families through our corporate wellness works
All 50 Programs of the Byrnes Health Education Center meet state
and national health education guidelines. Our Nutrition and Fitness
programs are offered as an integrated series that empower students to
adopt healthier lifestyles:
Pre-K/K: Inside Story
Grade 2: Fueling My Special Body
Grade 3: Let's Get Physical
Grade 4: Just Fueling Around
Grade 5: Healthy Hearts
Grade 6: Fat: What's Up With That
Grade 8: Extreme Makeover
Our enthusiastic educators teach using our dramatic, larger that
life, interactive exhibits. They incorporate the WOW and FUN factors
into every program. We believe that students learn by seeing, hearing
and doing and they are very hands-on with our health education lessons.
(demonstration of fat vest with Todd Platts)
When Dr. Oz participated in our heart healthy program with special
after school scholars in Oct. '07, he asked: ``Why doesn't every
community have a health education center?''
There are 34 health education centers in 22 states that reach
10,000 schools and 3.7 million students every year!
We are organized as the National Association of Health Education
Our collective VISION as a national organization is that empowered
children and adults building healthier communities result in decreased
In 2009, the U. S. spent 2.9 trillion dollars on treatment of
It is time to spend billions on health education and prevention.
Thank you for the opportunity to speak with you today.
Chairwoman McCarthy. Thank you.
STATEMENT OF LORRENE DAVIS RITCHIE, PH.D., RD, DIRECTOR OF
RESEARCH, ATKINS CENTER FOR WEIGHT AND HEALTH
Ms. Ritchie. Good afternoon, Madam Chair, Congressman
Platts, and members of the committee. My name is Lorrene
Ritchie, and I am the director of research at UC Berkeley's Dr.
Robert C. and Veronica Atkins Center for Weight and Health.
The Center for Weight and Health is one of the only obesity
prevention research centers in the nation to focus primarily on
environmental and policy solutions to preventing pediatric
overweight. Thank you for the opportunity to provide input on
the reauthorization of the special supplemental nutrition
program for women, infants and children, particularly in
regards to preventing child obesity.
The WIC program offers us an unparalleled opportunity to
prevent the development of nutrition-related health problems at
the most critical stages of life--during pregnancy, post-
partum, breastfeeding, and in early childhood and infancy.
As you have heard today, it is critical, too, because child
obesity oftentimes begins very early in life. Obesity
prevention strategies must therefore begin at a very, very
We have a golden opportunity here to position federal child
nutrition programs to prevent obesity. And if we do not, this
generation of children may be the first in our nation's history
to live a shorter life than their parents.
I offer the following four suggestions for strengthening
WIC's nutrition services to better address child obesity. My
first recommendation is to increase time for nutrition
education in WIC. Making healthful choices for one's family
requires a knowledge base, yet many parents have minimal or no
education in nutrition. I myself had to go to graduate school
before I learned what to eat.
Optimal nutrition education requires sufficient time at WIC
appointments. How can this be achieved? First, ensure that
there is adequate funding for the nutrition services and
administration portion of the WIC appropriation.
Second, redirect time from time-consuming processes like
certification activities to education. Currently, states have
the option to certify infants and breastfeeding women for 1
year at a time.
However, the eligibility period for children, who make up
one-half to two-thirds of those enrolled in WIC, remains every
6 months. Allowing annual certification for children would
allow WIC staff to redirect their focus from paperwork to the
provision of much-needed guidance on obesity prevention.
My second recommendation is to increase targeted funding
for breastfeeding promotion. The values of breastfeeding are
numerous and well documented in the scientific literature.
Breastfeeding not only reduces infectious disease and chronic
disease, but it also helps reduce the risk of obesity.
WIC is a proven national leader in breastfeeding promotion.
In California, for example, rates of breastfeeding have
increased by as much as 11 percent in WIC agencies that have
implemented the breastfeeding peer counseling program with
special funds appropriated by Congress.
Evaluation of this peer counseling is important so that we
can identify ways to adapt it to different populations and
different settings, yet funds are currently not allocated for
evaluation purposes. Moreover, current funding for peer
counseling is not adequate to ensure that all WIC mothers who
need it, get it.
My third recommendation is to coordinate nutrition
messaging across federal nutrition assistance programs. Among
the child nutrition programs, WIC is the leader in nutrition
education. A key way to strengthen WIC is to align the
nutrition messages in all federal food programs, particularly
the supplemental nutrition assistance program and the childcare
food program, which serves similar populations.
Without this, WIC messages are more likely to get diluted
and lost in what you know is a daily barrage of alternative
messages we more oftentimes hear for less nutritious foods.
My fourth and final recommendation is to increase funding
to support WIC evaluation and outcomes research. To ensure that
WIC continues to provide the most nutritious packages of foods
possible within its budgetary constraints, Congress should
protect the scientific integrity of the new food packages and
require periodic reassessment. The WIC food packages should be
re-evaluated at a minimum of every 10 years to reflect
important changes in what we know about science and nutrition
and updates in the national nutrition guidelines.
Lastly, I urge you to increase funding for evaluations that
will help us build the evidence base for cost-effective and
transferable WIC best practices that demonstrate promise in
preventing obesity. We need to discard what isn't working and
strive to optimize the return from WIC's proven investment in
nutrition services for the millions of at-risk families with
young children who participate in WIC.
Thank you for the opportunity to share with you these
comments on strategies to strengthen the invaluable WIC
[The statement of Ms. Ritchie follows:]
Prepared Statement of Lorrene Ritchie, Ph.D., RD, Director and Adjunct
Professor, Dr. Robert C. and Veronica Atkins Center for Weight and
Health, University of California
My name is Lorrene Ritchie, and I am the Director of Research at UC
Berkeley's Dr. Robert C. and Veronica Atkins Center for Weight and
Health. The Center is an obesity prevention research center, the only
one in the nation focusing on primarily environmental and policy
approaches to prevent pediatric obesity. I am a co-author on the book
Obesity: Dietary and Developmental Influences. I have also been an
Evidence Analyst for the American Dietetic Association (ADA), co-
authored the ADA's Position Paper on Pediatric Weight Management and
was a member of the ADA's Pediatric Weight Management Workgroup to
formulate evidence-based practice guidelines for dietetic
Thank you for the opportunity to provide input on the
reauthorization of the Special Supplemental Nutrition Program for
Women, Infants and Children (WIC) particularly regarding approaches to
reducing the epidemic of childhood obesity. The WIC program offers an
unparalled opportunity to prevent the development of nutrition-related
health problems at the most critical stages of life--pregnancy,
infancy, and young childhood. Additionally, the program reaches a
population in the U.S. with the highest risk for obesity and its
related health challenges, while at the same time having the least
access to resources for prevention. This is an unprecedented time for
WIC, because across the country WIC is beginning to implement the new
Food Packages. We applaud the USDA's decision to contract with the
Institute of Medicine to conduct a study of the WIC foods and to adopt
the resulting recommendations into the Final Food Package Rule. The
changes to the WIC Food Packages represent an extraordinary step in
improving this federal nutrition program to address child obesity. In
addition to the food package changes, WIC's impact can be strengthened
by enhancing the nutrition services provided as identified in the five
recommendations I will outline.
The statistics on child obesity are staggering and unprecedented.
Obesity rates among children in the United States have more than
tripled in the last 30 years (Ogden, 2002, 2008). Of most concern,
obesity is increasingly affecting our nation's youngest children.
Before beginning school, nearly one out of every 5 preschool-age child
is already obese (Anderson, 2009). Obese preschoolers are more likely
to grow into obese adolescents and obese adults (Nader, 2006; Gardner,
2009). Increasing numbers of children are developing type 2 diabetes,
early signs of clogged arteries, and sleep and breathing difficulties--
side-effects of poor nutrition and excess weight gain (Dietz, 1998;
Messiah, 2009). Obesity in youth is contributing to escalating health
care costs (Trasande, 2009). Poor nutrition is also related to reduced
concentration and behavioral problems, which in turn, can impact a
children's ability to succeed in school (Florence, 2008). A growing
body of research further suggests that a child's dietary and health
habits form at a young age--prior to entering elementary school
(Patrick, 2005). The link between early behaviors and obesity later in
life leads to the conclusion that successful obesity prevention
strategies must begin at a very young age. In fact, they should begin
prenatally and in the first hour of life. If we do not take bold steps
now to improve nutrition and prevent obesity, the present generation of
young children will likely be the first in our nation's history to live
a shorter life than their parents.
What is contributing to this excess weight gain? On the surface,
this problem seems deceptively simple--too many calories consumed and
too few calories burned. However, the forces that lead to this energy
imbalance on a population level are numerous and pervasive. Healthy
food and beverage options generally require more time, money, energy
and effort to consume than less healthy options. In particular, low-
income families face numerous challenges including excessive weight
gain in pregnancy, low initiation and duration of breastfeeding,
overfeeding of formula, and inaccessibility to healthful foods. It is
essential to position federal child nutrition programs so that we can
begin to address these issues.
Fortunately, there are several changes to WIC to consider that
could continue to make WIC an even more effective public health
nutrition program. I offer the following suggestions for strengthening
the nutrition services components of the WIC Program to address child
Recommendation #1: Maintain and increase time for nutrition
education in WIC.
Making healthful choices for one's family requires a knowledge
base. Many young parents have had minimal or no nutrition education and
as they begin their family they are charged with the most important
preventive health decisions for their families. Our WIC studies show
that WIC education can be effective. Optimal nutrition education
requires sufficient time at WIC appointments to talk with WIC families
about their nutrition-related concerns and assist them with overcoming
the many barriers to healthy choices. One way to address the need for
additional staff time with WIC participants is to ensure that there is
adequate funding for the Nutrition Services Administration portion of
the WIC appropriation. Another way is to reduce time spent on time-
consuming administrative activities.
Precious minutes with WIC families can be saved by extending the
``certification period'' (how often a child has to be assessed for
eligibility for WIC) for children. Currently states have the option to
certify infants and breastfeeding women for 1 year at a time. However,
the current eligibility period for children--who make up nearly two-
thirds of those enrolled in WIC--remains every 6 months. This simple
change would allow WIC frontline staff to redirect their focus from
paperwork to the provision of timely and preventive anticipatory
guidance for a vulnerable population.
Recommendation #2: Congress should ask the USDA to commission a
comprehensive scientific review of WIC biochemical assessment and
There is no question that WIC has a role to play in screening for
and educating about prevention of iron-deficiency. But it is time to
ask: what is the suitable WIC role, and what level of screening is
appropriate, given the current public health challenges facing our
population? Given the reduction in iron deficiency anemia concurrent
with the dramatic rise in childhood obesity (Sherry, 2001; Polhamus,
2009), an evaluation of the relevance of the WIC blood test
requirements is warranted in much the same way that an evaluation of
the relevance of the WIC Food Packages was conducted (CWA, 2009).The
substantial cost of WIC anemia screening takes precious Nutrition
Services funds from focusing on obesity prevention. These funds could
be better used by local programs to harness the WIC program's full
capacity to address the obesity epidemic.
Recommendation #3: Increase targeted funding for breastfeeding
The values of breastfeeding are numerous and well known. WIC can be
extremely successful in this arena. Breastfeeding is a low-cost way to
promote health in children--it reduces infectious disease and chronic
disease as well as reduces risk of obesity (Ip, 2007). Targeted funding
for breastfeeding promotion and support activities, including the
Breastfeeding Peer Counseling Program funding, is critical for WIC to
continue its efforts to increase the rates and duration of exclusive
breastfeeding. In California, breastfeeding rates have increased by as
much as 11% in WIC agencies that have implemented the Breastfeeding
Peer Counseling Program with special funds appropriated by Congress
(Public Health Foundation Enterprises WIC, 2009). Careful evaluation of
the Breastfeeding Peer Counseling Program is important so we can
understand which interventions are most effective and why. However,
none of the funding for the program can be used for evaluation.
Moreover, current funding for the Breastfeeding Peer Counseling Program
is not adequate to ensure that all WIC mothers who need it have access
to peer counseling.
Recommendation #4: Coordinate nutrition messaging across federal
nutrition assistance programs.
Studies show that nutrition education can be effective in
influencing knowledge, attitudes and behaviors. A key way to strengthen
WIC is to strengthen and align the nutrition messages in the other
federal food programs. Otherwise the WIC messages get diluted and lost.
It is critical to improve coordination of nutrition messaging and
health education efforts between WIC and other nutrition assistance
programs serving the same population, in particular the Supplemental
Nutrition Assistance Program (SNAP--the new name for federal Food Stamp
Program) and the Child and Adult Care Food Program (CACFP--which is the
school meal program equivalent in the child care setting).
Federal nutrition education messages need to be targeted and
cohesive, strategic, providing families with young children with
coordinated, culturally appropriate messages that encourage and support
healthy food and activity choices and promote breastfeeding.
Unfortunately, federal nutrition education efforts are the David to
private industry's Goliath in terms of resources spent, thus making the
need for strong, consistent federal messaging even more important until
food marketing to young children is eliminated.
Recommendation #5: Increase funding to support WIC evaluation and
Lastly, I urge you to increase funding for additional large-scale
and robust evaluations that will help us build the evidence-base for
cost-effective and transferable WIC-based best practices, special
interventions and service delivery innovations that can demonstrate
promise in preventing obesity, its precursors, and its consequences. I
am not suggesting we invest more money to prove once again that WIC
achieves its overall goals to improve participant nutrition and
health--numerous studies have repeatedly demonstrated that WIC improves
diet, birth outcomes, infant feeding practices, cognitive development
in children, immunization rate, and savings in health care costs (USDA,
2009). Instead, I emphasize the critical need for a closer examination
and comparison of the costs and benefits of multiple strategies used in
nutrition services delivery, nutrition education, breastfeeding
promotion and direct service activities so that we build upon what
works, discard what isn't working and continue to get the most return
from WIC's unique investment in these nutrition services to millions of
For example, as a result of the FitWIC obesity prevention
initiative, we learned that investing in staff wellness was important
in increasing staff's effectiveness in engaging participants in obesity
prevention behaviors (Crawford, 2004). Based on these findings and
other studies, California WIC has supplemented implementation of the
new WIC Food Packages to include employee wellness training, enabling
staff to counsel more effectively while supporting them to adopt
healthy behaviors in their own lives (California Dept. of Public
Health, 2009). In our WIC studies, we have noted a great deal of
variation in outcomes across WIC agencies. Systemically examining the
factors that contribute to these variations between agencies is another
example of how evaluation could lead to program improvements.
Recommendation #6: Finally, to ensure that the WIC Food Package is
responsive to changes in nutritional needs of women, infants and
children and in the food supply, we urge periodic assessments of the
While, we are thrilled with the Final Food Package Rule and greatly
appreciate the leadership demonstrated by USDA in making significant
changes to the Food Packages, we want to be sure that there is
opportunity for timely future revisions. To ensure that WIC continues
to provide healthy food that complements the most current nutrition
education and information provided to families by WIC staff, we
strongly urge that the Child Nutrition Act be strengthened to require
that the WIC Food Packages be re-evaluated at a minimum of every ten
years to reflect current national nutrition guidelines, thus coinciding
with the updates to the Dietary Guidelines.
Thank you for the opportunity to share with you these comments on
strategies to continually strengthen and update the invaluable WIC
Anderson SE, Whitaker RC. Prevalence of obesity among US preschool
children in different racial and ethnic groups. Arch Pediatr
Adolesc Med. 2009;163:344-348.
California Department of Public Health. Healthy Habits Campaign. 2009.
California WIC Association. Time to Re-evaluate WIC Blood Test
Requirements! April 2009. Available at: www.calwic.org.
Crawford PB, Gosliner W, Strode P, Samuels SE, Burnett C, Craypo L,
Yancey AK. Walking the talk: Fit WIC wellness programs improve
self-efficacy in pediatric obesity prevention counseling. Am J
Public Health. 2004;94:1480-5.
Dietz WH. Health consequences of obesity in youth: childhood predictors
of adult disease. Pediatrics. 1998;101:518-25.
Florence MD, Asbridge M, Veugelers PJ. Diet quality and academic
performance. J Sch Health. 2008;78:209-15.
Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ.
Contribution of early weight gain to childhood overweight and
metabolic health: a longitudinal study (EarlyBird 36).
Harris JL, Pomeranz JL, Lobstein T, Brownell KD. A crisis in the
marketplace: how food marketing contributes to childhood
obesity and what can be done. Annu Rev Public Health.
Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau
J. Breastfeeding and maternal and infant health outcomes in
developed countries. April 2007. Agency for Healthcare Research
and Quality, Rockville, MD. Available at: www.ahrq.gov/clinic/
Messiah S. Overweight Preschoolers Raise Their Heart Disease Risk.
American Heart Association's Cardiovascular Disease
Epidemiology and Prevention Annual Conference. Palm Harbor, Fl.
Nader PR, O'Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman
S, Mei Z, Susman EJ; National Institute of Child Health and
Human Development Early Child Care Research Network.
Identifying risk for obesity in early childhood. Pediatrics
Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US
children and adolescents, 2003-2006. JAMA. 2008;299:2401-5.
Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in
overweight among US children and adolescents, 1999-2000. JAMA.
Patrick H, Nicklas TA. A review of family and social determinants of
children's eating patterns and diet quality. J Am Coll Nutr.
Polhamus B, Dalenius K, Borland E, Mackintosh H, Smith B, Grummer-
Strawn L. Pediatric Nutrition Surveillance 2007 Report.
Atlanta: U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention. 2009.
Public Health Foundation Enterprises WIC Peer Counseling Program Data,
Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of
anemia in low-income infants and children in five states.
Trasande L, Chatterjee S. The impact of obesity on health service
utilization and costs in childhood. Obesity (Silver Spring).
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USDA. Food and Nutrition Service. How WIC Works. 2009. Available at:
Chairwoman McCarthy. Thank you very much for that insight.
We appreciate that, and we heard a few recommendations that you
We are going to start our round of questionings. My first
question will go to Ms. Copperman.
I wanted to commend you for the work that you have been
doing, especially in my district. I understand you have an
Activity Works program in several of the schools. Roosevelt,
Westbury, those are part of my district. I have seen a number
of the letters from the children that have been sent to me, and
how they are thrilled with the Activity Works program.
For example, one student named Ramona Robinson says, ``This
school year, our class began a new exercise program called
Activity Works. It is a quick, fun way for us to get up and
move. We are exercising, but it doesn't feel like it.''
I have about 10 student letters and would like unanimous
consent to submit these letters for the record. Hearing no
objection, so ordered.
[The information follows:]
Chairwoman McCarthy. As I understand it, the program is
used by children in first, second and third grade. What made
you target that age group?
Ms. Copperman. We started with that age group as a pilot
study because we felt that kindergarten children had special
needs that were very different than one through three or one
through four as far as the curriculum and the physical activity
that they could accomplish in the classroom.
So we decided to target that age group because we could
reach more children, and we knew that these children were not
meeting their physical education requirements, as well as the
physical activity goals of their wellness policy.
Chairwoman McCarthy. With some of the issues that Mr.
Felton brought up, the concern that it might cost the school
money, time-wise and everything else, how would you answer
Ms. Copperman. Well, one of the things that we did is we
talked to the schools and worked with them in designing this
within the budgetary constraints that they had. So that is how
we came up with a program that would be delivered by the
classroom teacher and supervised by the physical education
teacher so that the schools would not need to devote space or
extra staff. And the program itself basically costs about $16
per child per year, so it is fairly cost-effective for the
amount of activity as well as regulations that it fits.
So that was one of the reasons why we developed the program
in the way we did and pilot it to show that it can be
integrated into a curriculum and that it is feasible before we
went out and then said, ``Here is a program that is available
Chairwoman McCarthy. You said that Bank of America
basically was involved in working with you on the program. Was
that developing the program, or was that helping possibly at
Ms. Copperman. We applied for a community-building grant
from Bank of America, and that helped us with the production
costs of the DVDs and CDs so that we would have a product that
was appropriate for children and that captured their interest,
because our students now are very sophisticated by the type of
videos that they watch, so we wanted something--and audios they
hear. We wanted something that was of equal caliber so that it
would pique their interest and would be successful, and that is
how Bank of America helped us.
Chairwoman McCarthy. Just one final question to you, is
that with the data that you are collecting, what kind of
results are you seeing? Do you have any hard data?
Ms. Copperman. Okay.
We started collecting the data in the beginning of the
school year. And currently, now, we are collecting the follow
up. The data that I do have that is hard is that the teachers
are using this program four to five times a week on their own,
so that is number one, and kids are getting daily physical
activity. The teachers and the educators report that their
classes are more active, are more interested in learning, and
are doing better as they see from a subjective point of view.
The things that we are collecting are BMIs. We want to look
at prevalence. We don't expect to see a decrease in necessarily
obesity rates, but what we hope to see is a prevalence
leveling. This is just one component of a program. I think that
you also have to look at comprehensive other measures, as
policies and environmental changes.
The other thing that we are looking at is self-concept, the
idea of how kids look at themselves and how they feel about
themselves, and is that improved by this type of program. And
as I said before, three out of the five school districts so far
have integrated this into their curriculum, which shows
sustainability, which was a major factor that the schools were
worried about and were hopefully working with other school
districts in New York state. And we would like nationally to
show this as a solution to meet their physical education
requirements and prevent obesity by daily physical activity and
meet the CDC goal of 60 minutes of physical activity per day.
Chairwoman McCarthy. You know, obviously I am very
interested in this type of program, and we are probably going
to need a little bit more data as it goes on. So certainly we
would appreciate any data as you go down further in the testing
Ms. Copperman. Yes. I will send it.
Chairwoman McCarthy. One of the questions that I wanted to
ask Dr. Virginia--I have time--Stallings, you recommended
specific nutrients to be covered within the nutrition
standards. Can you give us some specific areas that you want to
Dr. Stallings. Well, as you know, the committee is still
actively deliberating, so I am limited about what I can talk
about, but those will be part of the recommendations this fall.
The nutrients that I did mention are the ones that are on the
And then, as we go to the dietary guidelines and the review
of the nutrient intake requirements, comparing that with what
children are eating today from our most recent data, what we
find is the younger children are doing pretty well with getting
enough nutrients. And actually, elementary school children--and
all this is in the Phase I report--are doing better with not
getting too many calories. As you go to middle school and high
school, you see physical activity go down and energy
requirements thus go down, and the food intake is not going
down with that.
Lastly, the thing we learned, as we go into high school,
and particularly for the adolescent females, many
micronutrients are being consumed at rates that would be
considered inadequate, so as you look across the board, the
vitamin E, the vitamin A, certainly fiber. So we are able to
use that as our background. But it is very important, and that
is part of the work of this committee, is to look across the
different ages, because there is a lot of change in both
developmentally and food intake patterns as you go from being
kindergartener to a high schooler.
The other part of this is looking at things that there are
too much of, and that, from the evidence we have now, is
saturated fat and calories as the primary pieces to that, and
sodium. Should mention sodium. So those will be nutrients of
special consideration in the follow-up report.
Chairwoman McCarthy. Thank you.
Mr. Platts. Thank you, Madam Chair.
I want to thank all of our witnesses here today for taking
time. And I know the chairwoman and I both share our regrets in
the amount of time you have had to spend. And that is just
Murphy's Law with the vote schedule around here, and especially
here where we had the motion recommit, which adds about a half-
hour to that last series.
So your patience is greatly appreciated, and your focus on
this issue, both as elected officials who are the spouse, first
lady of the state of New York. My wife is from outside of
Buffalo. My father-in-law has now passed on, but my mother-in-
law is still in the town of Williamsville, and so New York is
kind of my second home now as we are back and forth regularly.
And to all of our witnesses, your input--I look at this
issue as a member of Congress, but again as a dad of a sixth
grader and fourth grader. I am regularly in my childrens'
schools, and the most regular visit I make is to have lunch at
their schools, from when they were in kindergarten to--my sixth
grader in middle school still invites me to come in, which is--
yes. How long that will last, I don't know.
And it is interesting that I sit in lunch, and we have the
card system where we can regulate, as a parent, what they are
allowed to buy in addition to the main meal, which is a very
good empowerment for parents so that you can have some say in
what your children are eating. And we do have a responsibility,
so, as a parent, I am grateful for what each of you are doing
in your respective lines of work on this issue.
Susie, I am going to start with you, because your story in
York is just such a wonderful one. And I think one of the
successes of the center has been the ability that you have
reached out, and all the staff at the center, in partnering
with our local schools.
Do you want to touch on how that came to be and the buy-in
that you have had, which has been so important to the number of
students that you have been able to reach?
Ms. Byrnes. Well, I learned very early on you want to start
from the top, which are the superintendents, but also with the
teachers and the parents, as well--and the school boards, as
But from the very beginning, we got the superintendents and
the teachers on our Board of Directors, if you will, and then
we just kept them very close to us. We have also involved them
in our curriculum. And as I stated, all of our programs are
tied to state and national health education guidelines.
The other thing we did is I just visited--we are a regional
center, so we are in seven counties. But we went out and we
visited with all the superintendents in our county, which
happened to be 16, and they all just were singing the praises
that came up from their teachers after they have been to
programs at the health education center. So, really, the
programs and the curriculum really does sell itself.
But the thing that makes the health education center so
unique are our educators. And with the exhibits, with the $1.5
million worth of exhibits and our educators, we make learning
about the body fun and exciting for both students, the parents
that are visiting, and then also, of course the teachers. So we
keep that ongoing dialogue with the schools. And believe me,
the only reason that more schools aren't coming--we see about
60,000 kids a year--is due to money.
Mr. Platts. Yes. Well, I can vouch for your educators. The
last program I attended with my sixth grader was diversity
education, which was outstanding, and then the drug prevention,
and the educators in both were really wonderful. The kids and
the adults all left thinking, ``Wow,'' you know, it was great.
And we want you to keep up that great job for our local
community and have that emulated elsewhere, certainly as we
referenced, just 22 states. We have a few more to go.
Ms. Byrnes. A few more.
Mr. Platts. Dr. Ritchie, I wanted to touch on--you hit on
something that I really appreciate in the WIC program, the
issue of breastfeeding. I am blessed with an incredible wife
who, with both of our children, breastfed both of them, even to
the point where when she went back to work at about 10 months--
when our first son was 10 months old, for about 8 months or so
before coming home, she would pump at work and bag the milk for
And when T.J. would go with me to the state capital--I was
in the State House--I would take frozen milk with me so that
his diet was breast milk. I got a lot of looks when I was in
the men's room thawing out breast milk. But through Leslie, I
learned the extreme importance of this.
You reference in your testimony about the peer counseling
program and how there are so many not able to participate. Do
you have any data of what percentage--you talk about the
importance of additional funding for this program, of how many
we are reaching as a percentage. And so, how big is the
challenge from a funding standpoint?
Ms. Ritchie. Yes. I am afraid I can't answer that question
completely, but what I do know is that only a small minority of
women have access to the peer counseling program.
So what that means is that this very effective and proven
program is not getting to many of the women who could use it.
And what we see instead is that a lot of women, for example,
when they have their baby in the hospital, they are sent home
with coupons. They are sent home with a bag full of formula.
There are a lot of things that set them up to fail in
And yet, if they can reach out and be engaged with somebody
who they can relate to who has had those same experiences like
your wife and has gone through pumping and storing and all of
the things that go into nursing, they can be empowered to
overcome the other obstacles that they have in their life.
So I can't give you the exact statistics on how many WIC
sites participate in the breastfeeding peer counseling program,
but what I can tell you is that it is highly effective and that
we need to do more to get other women that program.
Mr. Platts. Yes. I see it in a similar way with--we have
such data with brain development zero to three, and 85 percent
of brain neurons and stimulation of the brain. This is--if we
can make that investment at the very beginning, the first hours
and beyond with breastfeeding, the immunity system and
everything is so much healthier for the rest of their lives.
Ms. Ritchie. Yes. It is the perfect nutritious food, plus
the added benefit of the fact that the scientific literature
supports that it reduces risk of obesity later in life, not
even during when the child is----
Mr. Platts. Yes. I appreciate your highlighting that,
something that we definitely take a look at as part of the
Ms. Ritchie. Thank you.
Mr. Platts. Thank you, Madam Chair.
Chairwoman McCarthy. Thank you for that.
Kim, who is here on the committee, worked with me in my
office on educational issues. And she had triplets, and then--
Chairwoman McCarthy. Twins.
Voice. And then a baby.
Chairwoman McCarthy. And then another baby soon after that.
But anyway, we actually had started here in Congress where
we are going to have a nursing room, because so many of the
members of Congress, believe it or not, are having babies--we
just had a friend of ours, a colleague, have a baby yesterday--
and most of them all breastfeeding. And I would like to think,
because of this committee, we have educated more and more
people that breastfeeding is an important feature.
Mr. Tonko. Thank you, Madam Chair. I have to say, I have
been sitting here trying to calculate how many additional miles
of blood vessels I might have created in my activities.
My first question would be to First Lady Paterson about the
Healthy Steps To Albany campaign. Can you just discuss, maybe
develop further for us, please, Michele, the success that has
been driven by this whole effort?
Ms. Paterson. Well, when I started the program about 2
years ago in Harlem, and we had some of the winners come to the
mansion for the healthy lunch, the kids got up and they talked
about their experience in the contest, and they talked about
how they now walk home from school instead of taking the bus,
how they got their parents involved. They told their parents
they need to be buying more fresh fruits and vegetables, and
how their parents even started buying pedometers and got
involved in the contest.
And at the end of the 6 weeks, many of the kids talked
about how they lost weight, and the parents talked about how
they lost weight as well. Even though that wasn't the focus of
the contest, that was one of the initiatives.
And this week tomorrow, as I mentioned, we will be going to
Buffalo, and then following on Monday to Albany to congratulate
the winners. So I haven't really had a chance to talk to them
personally about their experiences, but I am hearing that many
of the teachers who were involved in the contest as well, with
the kids encouraging them, got a team together and rallied
around this initiative and are eating healthy and exercising
more as well.
Mr. Tonko. Do you see this as a program that perhaps could
be replicated across more cities in the state, or beyond the
state, to include in the country somehow?
Ms. Paterson. Most definitely. Actually, this is a 2-year
program, start with upstate this year. Next year we are
focusing on the five Boroughs--Long Island, Westchester, Orange
And I also would like to get the Department of Health
involved with this initiative to help us maybe track some of
the results, and it is something that I would like to talk to
some of the other first ladies around the country about doing
in their states.
Mr. Tonko. In your testimony, you also spoke of the
partnership in New York with the Health and Education
Departments and the healthcare community, referencing that to
the Body Mass Index calculations that are done, the
measurements that are done.
That screening obviously is helpful in getting results. Can
you cite any discrepancies or disparities that might have been
portrayed by that screening? Were there areas of target that
you think would----
Ms. Paterson. Well, I am not really aware of right now. I
know we have a lot of community schools that have nurses in
their schools and a health center in their schools, and we are
trying to get them involved more with the BMI testing. But that
is something that we will have to work on with the Department
Mr. Tonko. And Dr. Stallings, you made mention of the
simplification of the menu planning and monitoring processes.
Can you just elaborate a bit on that, especially with the
monitoring program, and what you think needs to be improved
Dr. Stallings. Well, again, as I mentioned, what I can
speak to is in our Phase I report. We have taken a great deal
of time to try to understand the challenges at the food service
director's level and in the schools.
And there are a number of opportunities, I think, to make
this more simple. As I said, right now, there are two different
approaches, and really two and a half approaches to putting
your menu plan out and getting it monitored. Those could be
simplified and allow then the food service people to focus on
things, planning that will result in the kind of nutrient and
food patterns we want.
We have also heard through testimony and looking at the
reports from the USDA that, currently, the monitoring and the
goals of the program aren't completely synchronized. And again,
it is partly because this has been updated intermittently since
the late 1940s.
And what we have the opportunity to do with our committee
is to look at this thoroughly. We have a number of committee
members who serve on the ground level, and I can attest that
they are very appropriately vocal to make sure we keep thinking
about both the rules being simple, easy to understand, what
kind of labels we might need to make that work, not being
dependent on high skill sets in every setting across the
That is not necessarily the work environment, and then the
issues of how we take those, and also continue to understand
what children want to eat and will eat and turn those, if you
will, our cultural food patterns for children into more
healthful diets. And we believe we have got a committee
together that can address all those operational issues and
ultimately work with industry.
As we have been told, both when I was working on the WIC
program and this, from an industry point of view, if we can
provide well substantiated recommendations that the government
would endorse, that helps them actually to produce new and
helpful products for the school setting.
It is a really big market. I think we have a really great
opportunity to engage them around some of these issues. So they
want a level playing field. They want to know what they should
Mr. Tonko. It seems to me that it was, like, a three-E
repetition here today, the exercise, the eating right, and the
education. That kind of equals the soundness of an outcome.
Across the board, I would ask you, which of those three Es
do you think is the weakest link that perhaps needs the most
Dr. Stallings. Well, thank you. That is an incredibly
important question. And not to diminish the importance of any
of the three of those, because I agree they are all absolutely
But we know from, if you will, the energy balance,
literature and experience, that we have to deal with the food
side of it first because you can easily--it is very hard to
exercise enough to overcome overeating. It is very easy to
overeat, and just the calories per intake an hour of activity.
So there are very important things to the physical
activity, including fitness, as well as burning calories, and
the evidence supports that some kids learn better in that
Education is very important, but we also know from
extensive experience that education does not always change
behavior, and what we have to do is keep working towards that.
And I will step back now.
As a pediatrician and a community member, the opportunity
to make the school a very special place for food--I mean, it is
a special place for learning, but the idea of making it a
special place for what food is available in that environment,
which does represent about 50 percent of eating opportunities,
is I think the keystone. That is not to detract from the
importance of physical activity, which has been well
demonstrated, and absolutely nutrition continues to need to be
a part of the curriculum.
But we can't rely on those other two pieces to be effective
against, really, overeating and obesity, and we know that from
studies in children and adults of all ages.
Mr. Tonko. Thank you.
Anyone else want to comment on that one?
Mr. Felton. Well, sir, I guess our concern is that, while
schools provide a great opportunity for partnerships, that we
all recognize that, again, it is the education--it is the
commitment of families and communities to support that so
that--we, too, believe that nutrition has to be part of our
school day, and improved nutrition is very, very important. We
want to be sure that whatever happens in the day is also
accompanied and supported by the total life and lifestyle of
our children, or else it just simply will not work.
Mr. Tonko. Were you going to say something else, Doctor?
Dr. Stallings. Just to follow up on that, again recognizing
that it is a complex environment, but there are virtually no
other opportunities where we could impact helpful eating at
that level. And that doesn't in any--50 percent of the food or
the eating opportunity.
And that doesn't in any way limit the other opportunities
outside the school environment where the parents are really
often at the child's side or making decisions about what to
bring into the house or the food eating. So, again, as a
pediatrician and an advocate, I would say that we have a more
unique opportunity in school, but it is meant no ways to limit
the freedom and the opportunities for families to make other
decisions in other settings.
Families are not aware often of what their children are
eating in schools. They are often not aware of what is in the
vending machines or the snack bar. And if you go to the
evidence that was prepared in that first report about
competitive foods, I think that walks through the behavioral
issues you brought up, that this is an opportunity, but it is
in no way meant to take away the authority of the parents or
those many, many other opportunities at nights and on weekends
Mr. Tonko. If I could just toss a final question out there
in terms of how all of this relates to agriculture, I know
there have been some programs--I have assisted some in the
state of New York--where we take perhaps damaged produce that
may not be marketable, but it is certainly edible.
Is there a way to stretch the opportunities here to reach
our schools with locally produced so that we are addressing the
energy delta, the energy input that is so important these days
because of the energy it takes to import or ship in from other
regions of the country our food sources? Is there a way to
stretch the opportunity with our Ag community to provide
wholesome nutrition for our children?
Dr. Stallings. Well, I will be happy to start on that.
One of the things that, again, our committee has learned a
lot about is the commodity foods programs and the Department of
Defense fruits and vegetable program, and I would like to
compliment our public servants. In most of what we thought of
as the commodity foods program when all of us were growing up
is substantially different.
And I believe that we have partners there that can address
some of the very things you are talking about, because their
purchasing power and their transportation opportunities are
really vast. So as we have gone about collecting information, I
believe that is an opportunity as well, that the USDA, and
particularly the commodities group, are very interested in
being a part of the success.
The other issues that you bring up are ones from a
nutrition science point of view, not so much the ecology and
the energy, transportation energy. What we have been learning
is, yes, local and fresh and involvement with the community is
a wonderful part of it, but most of us live where that would
really severe--when things are in season, those are great
But I also want to mention the strength of the--if you
will, the whole agricultural industry now, that the fruits and
vegetables that are picked at prime time and frozen and canned
that then are in compliance with USDA regulations to be a part
of the school breakfast and lunch program are really very high
And so, if you had asked some of us nutritionists, again,
20 years ago, we would have said, ``Oh, fresh fruits and
vegetables sitting out on the stand are always the most
nutritious.'' We have come to understand that is not always the
So I would like for the committee to bear in mind these
other opportunities and purchases and money-saving
opportunities are all potentially part of the solution, as
well. And the quality of the foods served in school is and
should be, again with this backdrop of specifications for
purchase, should be as high a quality as we would have in our
homes than in any other setting, which is what we would want
Mr. Tonko. Thank you.
Mr. Felton. I agree generally with that statement. Again,
our concern is we would not want a one-size-fits-all approach,
because, again, in our rural communities and some of our
suburban communities, it may be an appropriate way to do that,
which may be inconsistent with some of our larger school
districts that provide--that do central food preparation.
But I think the point is we should all be concerned with
the quality of food and ensure that there are options to local
school districts and local schools in terms of how they are
able to secure those products.
Chairwoman McCarthy. Mr. Polis?
Mr. Tonko. I think the first lady was going to say
Chairwoman McCarthy. Oh, I am sorry.
Ms. Paterson. I just wanted to mention that, at the
executive mansion in Albany, New York, we are going to start
inviting school kids to come to the mansion and have the
executive chef there teach them how to make some healthy meals.
We also have a garden at the mansion where, every year, we
invite children to come in and help us plant fruits and
vegetables and herbs at the mansion.
Chairwoman McCarthy. Speaking as a gardener, I will tell
you, if you get kids involved in gardening and growing their
vegetables, it is a lot easier to get them to eat them.
Mr. Tonko. Yes. I think, Madam Chair, too, if I might just
conclude with this, it is important for us to not deal just in
silos, because we are dealing with wonderful dynamics here for
our children and across-the-board nutrition, but there is that
energy quotient that is involved, too.
And if we can begin to do smarter things as energy
consumers by buying locally and buying fresh, we can
incorporate several dynamics of policy into one package. And
that big-picture view I think is so critically important to
progressive policy development.
Chairwoman McCarthy. And we are probably going to go on to
a second round, so what I am--because we were so late in
staying, we understand time restraints and everything else. We
are very used to that, and especially for the first lady.
If you need to leave, or anyone needs to leave, we
understand that. You are not insulting us at all. But we do
have more questions, and if you would like to stay, we would
love to ask them.
Mr. Polis. Thank you, Madam Chair.
I represent the state of Colorado, which has some of the
lowest obesity rates in the country. But like a lot of other
states, it is heading in the wrong direction.
Today, more than one in 10 Colorado children is obese. And
this not only affects their health, but very important to us as
a committee and our Congress, it affects their achievement and
their education. A study of fifth graders found that those with
a poor diet, too much fat and refined sugar and not enough
fruits, vegetables and whole grains, were from 26 to 41 percent
more likely to fail standardized reading and writing tests than
their peers who consumed healthier diets.
Healthy habits start early in life, and the public
overwhelmingly supports immediate action to reverse the obesity
trend. According to a poll of people in Colorado by the
Colorado Health Foundation, 86 percent of Coloradoans support
requiring 30 minutes of physical education each day in our
schools even if it takes time away from other subjects, and 82
percent support efforts to remove snacks of low nutritional
value from snack vending machines, an issue that I worked on
while I was on the state Board of Education in Colorado, and
replacing them with healthy snacks.
My first question is for Ms. Copperman. What are some of
the challenges that you found in creating and implementing
strong wellness policies throughout the United States? What are
some of the biggest challenges to both creating those policies
as well as successfully implementing them?
Ms. Copperman. Okay. I can speak to the New York state
experience in conjunction with the audit that was done by the
state controller, looking at physical education, now nutrition,
is that there seems to be a lack of monitoring and evaluation,
and that is what came out of the physical education
requirements, that the requirements were there, but that the
monitoring wasn't there to kind of look and see that the
legislation that was already enacted was actually being
And I think with the wellness policies, it tends to be the
same thing, is that if schools aren't meeting their physical
education, then when you go to the wellness policies, they have
these policies, and they sat down and they have developed them,
but there has really not been a way of looking at the
implementation and the monitoring of the goals and whether
these goals are actually being successful in what they are
And I can say that when we went to the school districts and
asked them what would you like to do to prevent obesity in
schools, we gave them a choice. And they felt that there was a
support somewhat for nutrition. They felt that there could be
more education support and, again, monitoring and following.
But they felt that the physical activity goals were
completely unsupported because they weren't meeting the
physical education requirements. And that is why they asked us
to focus on physical activity.
One of the things we did is that we understand that
physical activity--and as a registered dietician by training,
physical activity goes hand-in-hand with nutrition. So what we
tried to do was to kind of take nutrition ideas and integrate
them with physical activity with curriculum subjects. And what
found is, by doing that, that is what helped us overcome the
barrier of getting it going and implement it in the classroom,
which was the major problem that the schools had.
Mr. Polis. And that kind of leads into my second question.
With all the interest to improve the school food environment,
clearly nutrition education is part of that, to really
integrate nutrition education into the classroom and the entire
campus, whether it is in the cafeteria or the history class or
And it seems to me that this should be part of the
education reform movement, more broadly, and I am wondering
what ideas you might have about how we can approach and impress
others with the merits of nutrition education from a broader
lens in these systemic reform discussions.
Ms. Copperman. Yes. I think several things are important.
Number one, the school environment is a place where
children spend 10 months out of the year, so all their
formative years are basically spent more time in school than at
home. So I think it offers us a wonderful opportunity to
I think what winds up happening is that it becomes not
coordinated, that there aren't the resources or the national
support that enabled the schools to take a program that has
best practices and shown its been successful and actually
implement it into the classrooms and into the cafeteria and
into the physical education classes and into the PTA and into
the whole environment of the school.
So I think what is needed is really looking at best
practices and offering the schools programs that work, because
there are a lot of programs that are out there and that have
been proposed by different groups, but when you go to evaluate
what is needed--and I think that is the second part of it, is
that there needs to be some sort of support that allows the
schools the awareness to the program and the implementation
that is within budget.
We would all like to see the Cadillacs and very expensive
programs come in, but the schools really cannot afford that. So
I think it needs to be what we found in Activity Works--
targeted, simple, economical and utilizing what the schools
have. So I think those are the nutrition education programs
that would be effective.
Mr. Polis. Thank you.
I have one more question, Madam Chair, if I may, for Mr.
According to the Colorado Children's Campaign survey, which
is a nonprofit focused on education policy in Colorado, our
current lieutenant governor is former executive director of
that organization, they did a survey of 22 of our largest
school districts in Colorado. Only three of them require
nutritional standards for all school snacks for children.
So given that reality in my state, and also the reality
nationally, why do you think school districts will remove junk
foods from schools without federal or state legislation
requiring that they meet nutritional standards?
Mr. Felton. Well, I think our concern is that, as
communities are more engaged and understand the value of
nutrition, that they are certainly willing to move toward that
direction. And it is not that any school district or school
wants to say they don't want their children to be knowledgeable
about nutrition or that they want to have healthy foods within
that school day.
But I think that if we look at schools, its primary role,
of course as we know, is to deliver quality education. But
there is a business aspect of schools, and they need to be sure
that they can balance all of these requirements.
If we look at, for example, how we evaluate school
performance, we are looking primarily at our students doing
well in three areas. When schools and school districts have
very limited budgets, that is where they focus their attention.
So I don't think it is an issue of not wanting to meet
standards. The question is, is it realistic in every situation.
And again, our concern is that, if there is a federal law that
provides for some mandated standards, that there is at least
some relief out so that we understand, in some cases where it
doesn't work, there is another approach without now being
labeled as not in compliance and, therefore, a poor school.
Mr. Polis. Yes. And I would just submit that not only in
Colorado but in other states, it simply hasn't happened at the
district level, which I think is why there is a very legitimate
discussion about these kinds of guidelines at the federal level
and, indeed, in many states as well.
Thank you, Madam Chair.
Chairwoman McCarthy. Mr. Platts?
Mr. Platts. Thank you, Madam Chair.
Mr. Felton, I would maybe pick up there a little bit. In
your testimony, you talked about the concern that School Board
Association has about restrictions could reduce revenues to
schools that help pay for activities, extracurricular
In our colleague's testimony at the beginning, she talked
about a study done by the CDC and Department of Agriculture
that showed that revenues actually went up as schools engaged
in providing healthier opportunities as opposed to losing
revenues. Have you, the School Board Association, looked at
that study? Are you familiar with it and have a response
regarding the findings of that study?
Mr. Felton. Yes, sir. We are familiar with the study.
For the most part, the focus has been on do schools lose
money in terms of their vending machines, and there has been
enough data, mixed reporting, but certainly there isn't the
significant loss in revenues in vending machines. Our concern
is that the proposed legislation would seek to restrict all
foods sold on any related school activity.
So, for example, if we think about as--as I said earlier,
the local field trip to New York and the community is able to
get a sponsor who will provide boxed lunches for those
students. If those boxed lunches aren't in compliance with the
new standards of foods served and sold during the school day,
then local school districts, for example, could find themselves
potentially in litigation because they have not complied. Or
Mr. Platts. But there would be nothing prohibiting the
school from saying, ``Hey, we appreciate that support. Here are
the guidelines, if you can work with us.''
Mr. Felton. Oh, certainly. Certainly.
Mr. Platts. Right. And I would say, I am not convinced--and
I haven't taken a position on Lynn's legislation because I am
torn between local control school districts and elected school
Board members in Pennsylvania having a say versus me telling
them what to have to do on this issue.
But there do seem to be some ways you could address that
concern and still comply with the law if it was adopted.
Mr. Felton. Oh, certainly. And again, many states
voluntarily are moving toward establishing their own standards
that are very, very strong because they have the commitment of
local communities that are willing to say, ``Not only are we
committed to stronger nutrition policies, we are willing to pay
for whatever is necessary to ensure that,'' as we heard
earlier, ``it is properly implemented and evaluated.'' And
where communities have that kind of support, it works.
What our fear is that, if it simply becomes another federal
mandate without fully understanding all the operational aspects
within a local community and school district, then we could
find ourselves having some unintended consequences.
Ms. Ritchie. If I may add just a minute, I am from the
Center for Weight and Health who did one of those studies that
was mentioned earlier. And what we actually found--and we
didn't look at field trips--but foods sold not only in vending
but in all other aspects besides the school meal and the school
breakfast, so that could include a la carte foods----
Mr. Platts. Would that include, like, football game sales,
that type of thing, too?
Ms. Ritchie. It did not include football game sales,
because those are outside of the school day. But anything sold
within the school day, including vending but not exclusively of
vending, what we found is that, when you limit those what we
call competitive foods, the worry was that then there would be
a lot less money coming into the school and into food service
and into the clubs, et cetera, that use those foods for
What they found was that the bottom line in terms of the
school was actually a net positive because more kids
participated in the school meal. And when more kids participate
in the school meal, the revenues go up. So, like I said, we
didn't look at fundraising in terms of outside of the school
day, and we didn't look at field trips and that sort of thing.
But in the school day, the net result is that schools are
not losing money, at least in our study, that they are staying
in the red. In fact, they are getting more in the red because
of the increase in the school meal participation.
Mr. Platts. Yes. I think one of the--if children and
adults, if we provide healthy alternatives, it is all the more
likely we will embrace them.
I am a perfect example. I am a sweet tooth fanatic, and my
wife this morning when I left the house, said about 10 of 5 to
be down here early for a school group. I made a point of
grabbing some celery that she had soaking in water to give it a
little crisper that I ate on my drive down here.
I commute from my district in Pennsylvania each day, and so
I was eating some delicious celery because my wife made it
available and right there waiting. So I opened that fridge, I
saw it--and crunchy, yes.
Ms. Ritchie. She makes you eat celery, and she breastfeeds.
What a perfect wife.
Mr. Platts. Oh, my wife puts me to shame, as my staff will
tell you, when it comes to fitness and healthy eating.
Ms. Ritchie. I was also going to add, and I am happy to
share this with the committee at a later date, but we have at
the Center for Weight and Health done a very comprehensive
review of what works best across all different sectors, so not
only in the school, not only in programs like WIC, but at
worksites, at community-based interventions, looking at the
real science as opposed to what people think or hypothesizing
And while, of course, I am a researcher, so I always say we
need more studies to base our conclusions upon, what we did
come to conclude, as a base of, again, looking at all of these
different sectors, was that it is the marriage between the
education and the policy and environmental supports that really
make the difference.
So as Nancy Copperman was saying, when you integrate the
education with the policy and environmental supports is when
you really see change. So you were asking whether it is the
education or the PE or the nutrition.
It is really both, intertwined, integrated and coordinated
so that a child can go to class and hear the message, ``I need
to eat more fruits and vegetables,'' and then go to the
cafeteria and see a fresh salad bar with lots of fruits and
When those messages aren't coordinated is when we get into
trouble, and then the nutrition education by itself doesn't
work. The policy isn't so helpful. But when they are combined
Mr. Platts. Yes. I saw that--and I will wrap up here
quickly--I represent a lot of the apple orchards, and promoting
apples as a healthy snack. And there is an annual apple
promotion week where, in schools, they do the Great Apple
Crunch program, I think is what it is called.
I guest served in the cafeteria that week, and one of the
options was fresh apple slices. And it was wonderful to see the
kids enjoying them, and like, ``I will take his if he doesn't
want them.'' It is promoting and tying in--they did a program
in school tied into the product being offered, so it was
education along with the opportunity for the kids to have that
as part of lunch.
Ms. Ritchie. Right. Kids really learn by experiential
opportunities. And I was going to add, we also have a
reviewed--not that we did this one, but one that I have that
shows a farm-to-school movement. And again, we don't have a lot
of studies on it, but it is showing that it does increase
childrens' fruits and vegetables intake, and that combination
of being exposed to local produce plus having the experience
with it is probably what is contributing to that success.
And I am very excited about the new WIC food package and
the new alignment with the education, because that is exactly
what we are talking about, providing fresh fruits and
vegetables, whole grains, all of the things that we know people
should be eating, along with the educational part. So we are
really excited about evaluating that in the upcoming year and
Mr. Platts. And if I could, Madam Chair, one final comment
about the importance of this issue, because our focus has been
about kids. But one of my colleagues I think earlier--it might
have been Mr. Castle--mentioned about how kids end up teaching
adults, and he used the seat belt example.
I am a perfect example that--me learning from my kids,
because one of the things my children do get snacks, but thanks
to my wife, healthier more so than my eating habits of the
past. But one thing they still don't have at age 10 and 12 is
they still don't get soda at all, and never have. And I used to
drink about a case of soda a week. And sitting at the dinner
table, with all my commuting, I was always drinking the
caffeine, and not good soda--or not that there is necessarily
good or bad.
But sitting at the dinner table, I had a glass of soda. And
my then-4\1/2\, 5-year-old, said, ``Well, Dad, if it is bad for
us, why do you drink so much?'' That was about 4\1/2\, 5 years
ago--well, no, almost 6 years now, and I went cold turkey that
week. And so my kids taught me, by them being healthy, they
ended up influencing me.
So what you are doing won't just benefit the children, as
we know from seat belts. It will ultimately benefit the
parents, too, because the kids developing those healthy eating
habits can help their parents complement what they are doing
with their children. So all the more how important your work
is, and thank you for all of your testimonies and work, day in
and day out.
Thank you, Madam Chair.
Ms. Ritchie. May I also point out, you could see the
opposite happen. So no, we no longer have soda in California
schools, but I have talked to many, many parents who said,
``Well, my kids get soda at school, so it must be good for
you.'' So that is an example of how the school can set a tone
for both positive and not-so-positive education around foods.
Mr. Felton. And again, from our perspective, we agree that
schools provide that opportunity. Our concern is that we must
look at not only the school environment, but the work
environment and what happens in the community. And together, we
can address this issue.
Mr. Platts. I have already used up my time.
Chairwoman McCarthy. Well, no. We are actually very lucky
on this committee because we both tend to agree that we would
like to expand, if possible, among just the usual 5 minutes. I
feel bad when people travel from all over the country to sit
down in front of us for 5 minutes, and then it is over.
So, being that no one here seems to be complaining about
leaving--we are going to shut it up soon, though, because we
are going to have votes again.
What I would like to--and I know my colleague wants to ask
another question--I happen to believe very strongly that, when
I think about what has been mandated in some states or
whatever, children wearing helmets when they ride bicycles or
roller skating, teaching children not to smoke, let me tell
you, they have the most powerful effect on adults.
If I get on a bicycle with my grandchildren, ``Where is
your helmet?'' Now, I never wore a helmet in my life. I had to
go out and buy a helmet, mainly because they were right.
And I think it is going to be the same with nutrition. If
we can bring good nutrition into the schools--and I don't
particularly like any kind of unfunded mandate to go down to
anywhere. I believe in--I am looking at this as a nurse--we
need to look at our schoolchildren, which unfortunately, across
this nation, they are overweight.
This has become a country--and our life differences--they
are different. When we were young, you were out of the house at
9:00 a.m., and your mom said, ``Be back by dinner.''
Now, it was different days. I agree with that. But we are
competing now with kids watching TV, kids being on their
computers, the games that they are on, so they are spending a
lot of time inside.
And I think that that is not the best and healthiest thing
in the world to do. So what we are trying to do, on a number of
ways, is educate the children on nutrition, get them more
active, into physical activity, and that brings me up to a
question, and I will throw it out there.
We have been talking about a lot of the children, but no
one is talking about those children with special needs, those
children that are in a wheelchair. They can do exercise, but
they also need good nutrition. So if you have any data on any
of the work that you have done with children with special
needs, I think that the committee needs to hear about that
Dr. Stallings. Well, let me speak to that a little bit. In
fact, one of the areas that I have worked on for years is
children with cerebral palsy. And across the spectrum, from
mildly affected to quite severely affected for ambulation and
And I think you are correct, in the issues in those
children, because they are not running around and riding their
bike and that sort of thing, there is a decrease in total
energy needs. And the milder the defect, probably the more we
will see that difference.
In children who are severely affected, the interesting
thing is they are--feeding those children is so difficult that
some of the most striking examples of malnutrition and under-
nutrition are children with cerebral palsy who have spastic
quadriplegia and that sort of thing. So part of the challenge
in a school setting is now often you have a very big spectrum
of children with special needs.
I think the schools, again, with some of the
recommendations, because there will be a section on children
with special needs, the focus, as you mentioned, really is
around calories. Most of the other nutritional needs don't
change very much as long as you adjust them for body size. So
if they are overweight, we know a bit about that, but certainly
if they are underweight.
Many of the other children with special needs in a school
setting are children with medical problems that aren't the same
as the visible disabilities. And for those children in the
current environment, the system of having them known by the
school and by the food service people is part of the program.
Now, whether they are able to meet their needs as well with the
current recommendations, I don't think we have any evidence
So, in summary, the energy issue is a big deal, and the
physical activity component, like you said, we have learned
from both children and from the elderly the kind of physical
activity you can do from sitting and that sort of thing. Those
are all areas we can improve.
But I think within the food, school lunch and breakfast
program, in the professional oversight that is there and the
commitment of the teams you have already got on the ground, as
long as we have good clarity about what the conditions are, it
should go more directly to the amount of food, which is
calories, and then the texture or special feedings. And as long
as we make the commitment that those children will be educated
in those school buildings, the issue around food and physical
activity should be paired with that.
Ms. Copperman. I would just like to add a couple of
In our work with Activity Works, it wasn't designed
specifically for children with special needs, but it has been
used in classrooms with children with severe learning
disabilities. And it was quite interesting to see that the
teacher's feedback felt that the kids were moving, exercising
and learning, and it increased their listening skills. And the
repetition--they used it differently--was very helpful, and
they felt it would work.
I do have, in one of my schools, a child who is in a
wheelchair. And this child had a mat set up in the back of the
class. And when Activity Works comes on, he goes down on the
mat and he does all the exercises that the kids are doing from
the upper body, and it is just accepted and something that they
do. And in the audits for New York state physical education
requirements, they found that the one thing that they were
meeting was really providing physical education for this
In my practice as a clinical nutritionist dealing with
overweight and obese children for 20 years, I can tell you that
my interaction with schools dealing with children that were
overweight and obese and educating the schools on what is
appropriate was very successful in helping those children do
well in school, change the nutrition that they were receiving
Many times when you have a child with special needs, the
idea is that food is love and that over-feeding is doing the
children a favor. And that was one of the things that I was
able to do, was to educate and work with teachers and looking
at foods as rewards in special needs schools and changing
things and actually making the kids healthier and actually
functioning better and being able to do the activity.
Another case would be children that have psychological
issues that are required to be on medications that can make
them gain 20 to 30 pounds in a year. and they need these
medications, otherwise they can't function. So what do we do
with this population, which is increasing? And again, working
with the families and using nutrition and physical education
strategies to help change and work with the school.
So I think that it is a partnership of using nutrition
professionals and using physical therapist and bringing the
team together to deal with this in setting up program and
awareness in the schools that they can help. And I have seen
that been successful in my career and in working with Activity
Works and seeing how they are increasing their activity.
Mr. Felton. We think that, obviously, schools have come a
long way in terms of both the academic preparation for students
with disabilities and providing free appropriate education, as
well as dealing with other kinds of services like nutrition.
So I don't think it is an issue of, ``Well, we will not
deal with these students because we aren't aware.'' I think as
Ms. Copperman has pointed out, there is the opportunity to
collaborate on what is needed for each child. And even for
those students that aren't formally identified as being
disabled, there is a wide, broad range of skill sets and
learning that takes place.
So as we all know, it is a very, very complex issue. The
key for us is that the political will, both at the community
level, state and federal level to do that and to--the resources
and the appropriate development for teachers and other staff
officials so that it works as a total program and not viewed as
Chairwoman McCarthy. Mr. Tonko?
Mr. Tonko. (OFF MIKE)
Chairwoman McCarthy. Oh, I am sorry. Did someone else want
Ms. Byrnes. I just wanted--since I haven't spoken for a
while, I just--but I just wanted to reiterate what you were
saying about the children. And part of being a nurse as well, I
realize that we have to start with the children, and then they
take that information home to their parents. And we also do
adult wellness in businesses.
So we have to complete the circle, but never underestimate
the power of a child and how they can influence parents and
Mr. Tonko. Madam Chair, if I might, the craze of late is
high-energy drinks loaded with caffeine, loaded with sugar, and
they sound good. They sound harmless. Sound like they are going
to build up your opportunity to perform.
What do we need to do? Because so much of this is being
ingested by the young crowd because they think it is the cool
thing to do, or a good thing to do. How do we deal with this?
Dr. Stallings. If I may start, in the report on the
competitive foods, there is a whole section that looked at
beverages very systematically. And in that evidence review, if
you look at caffeine, there--and as, of course, we all know,
caffeine is a drug. It has physiological impact with heart
rate, with changes in metabolism, including glucose metabolism.
And yes, it is performance enhancing. It is a performance-
So I know that in a military setting, they have gone
through this and found opportunities to use this. And maybe we
might want our airline pilot to have his caffeine.
But if you read through the report, I think you will come
away, after looking at the evidence, that this is a drug. It is
not appropriate in a school setting. And as the committee
described, having a performance-enhancing drug in the school
setting, again, goes against everything we are trying to
So in that setting, what this committee came out with is
the beverages that are appropriate in school would not have
caffeine, would not have any other special enhancements,
including adding vitamins and minerals, because the committee
recommended that the focus be on food, and healthful foods and
beverages, not the idea that you put a vitamin in a sport drink
or something like that.
The one other issue about sports drinks being a little
different from the high-energy, which are really highly
caffeinated, the evidence, again, supports that, except in very
special situations where kids are in team sport-type training
settings in hot environments or very humid environments, there
is no evidence to support the need for rehydration fluids in
the school setting in the noncompetitive setting.
So the idea that you might have sport drinks for the
varsity teams during practice and performance comes within the
idea of safety and in the domain of the coach and looking at
the whole environment.
The idea of having those beverages in the school during the
normal day, or in the gym after you have had PE class, again,
the committee did a lot of work to provide the evidence that
does not support the necessity of those in that setting. They
are high in sodium, high in calories, high in caffeine,
depending on which ones you are looking at. So they may have a
place in other settings, but the committee would suggest that
is not the school.
Mr. Tonko. Well, we are promoting these drinks, and the
young mentality is just consuming to them.
Dr. Stallings. Right. And again----
Mr. Tonko. At a dangerous level.
Dr. Stallings. But the evidence that has come out with the
impact of the media and being able to influence food and
beverage decisions in children as young as 5 and 6 is very,
very compelling. And so, we know that if kids are exposed to
that kind of media attention, then it is effective, and they do
begin to make decisions based on that.
Ms. Ritchie. Oh, I am sorry. I was just going to add that
one of the reasons for our recommendation to coordinate the
nutrition education messages across the federal food programs
is because of some of what you just brought up, that kids are
bombarded with messages that tell them to do the opposite thing
of eating healthy and being physically active.
The average child sees 5,000 commercials on television a
day, 90-plus percent of which are for unhealthy foods. We have
to find ways to counteract that. And I would also add, in
regards to your discussion about sweetened beverages, that we
published a book, our center, called ``Obesity: Dietary And
Developmental Influences,'' which examines all the evidence on
a lot of dietary factors in terms of which are contributing to
obesity and which may not be. And sweetened beverages came up
right at the very top of the list.
Mr. Tonko. And we are also dealing with the struggle that
many districts have, where there are enticements to put in
machines that are selling high sugar in liquid formats through
drinks, unhealthy snack food, and getting lights on a field,
bleachers put on a field, athletic fields paid for, and
everybody is saying, ``Well, it is the resource we get, and we
need to keep''--what is the cost of doing that into the future,
when we are growing unhealthy kids? The price tag to society is
far beyond the benefit, I think, that comes at the beginning.
So how do we address that?
Mr. Felton. Well, I think it goes, again, back to what is
the political will, and----
Mr. Tonko. Well, political will versus consequences,
Mr. Felton. That is true. But 20 years ago, certainly 20
years ago, we may not have envisioned a smoke-free environment,
and yet we have in many states now smoke-free environments
because there was, one, not only the support for incentives to
move in that direction, but again, the commitment and
engagement of people who said, ``This is the right thing to
I mean, if you look at--, you look 40 years ago when people
were throwing trash out the windows on highways, I mean, we
create a model and we create a value in this country which will
then drive this behavior. I just think we have to be very, very
Sure, the feds want to push this thing, and it is very,
very important, but just keep in mind that many local
communities are working with that to the extent that the feds
can provide leverage so that states and local communities can
move at a much more accelerated pace, I think it is very
important and should not be discounted.
Mr. Tonko. I hear you, but I think at the same time the
enticements are pushing us backward--can push us backwards
rather than move us forward, or even hold us where we are at.
Ms. Byrnes. I would think this would be a wonderful
opportunity for school boards to really look at their school
districts and say exactly what you were saying, is what is more
important, putting lights on our field or having a third of our
children being obese?
And I will tell you, if you put soda in--they wanted to put
a soda machine in the Health Education Center, and I said
absolutely not. Absolutely not. So we have water. We have a
water machine. But unfortunately, it says ``Coke.'' You know,
the machine says, ``Coke.'' But sometimes you just have to take
a tough stance.
Mr. Felton. Well, I think, again, it is ensuring that the
values of a community are well respected and are influenced so
that we can have sustained programs, not just the point of the
Friday night games. At some of our communities, Friday night
football is a major part of that core society. Now, it is easy
for us to say, ``Get rid of the Friday night games because we
don't have bleachers.'' I think that that local community
ultimately will make that choice about what is best for their
kids, and they should.
Chairwoman McCarthy. I am sorry, but I have to call this to
an end. We have a vote.
I just want to say that last year, after we had a hearing,
one of our first hearings on nutrition, we heard from a lot of
the manufacturers, and they understood that they needed to step
up to the plate a little bit more.
Now, with that being said, are they there yet? No. But do
you notice more of the snacks are now in smaller bags, 100
calories? So we are getting there.
It is an education not only of the schools, not only of the
general public, but also the manufacturers. Hopefully we will
continue to work with the manufacturing companies. They are
putting in water into the machines. Airports are carrying more
and more water.
Now we have just got to figure out how we are going to
drink all that water without, unfortunately, too many bottles
all over the place. New York is going to probably start
charging 5 cents even now for the water bottles.
So we have a long way to go, but you know what? We will get
I want to thank everybody here for their testimony. We do
have our work cut out for us. I am going to bypass my closing
statement, if nobody minds.
As previously sorted, members will have 14 days to submit
additional materials for the hearing record. Any member who
wishes to submit follow-up questions in writing to the witness
should coordinate with the majority staff within the requested
Without objection, this hearing is adjourned.
[Additional submissions of Mrs. McCarthy follow:]
Prepared Statement of Laurie A. Westley, Senior Vice President of
Public Policy, Advocacy, and the Research Institute, Girl Scouts of the
Girl Scouts of the USA respectfully submits this testimony to the
Subcommittee on Healthy Families and Communities of the House Education
and Labor Committee.
Girl Scouts and Healthy Living
Girl Scouts is the world's preeminent organization dedicated to the
leadership development of girls, serving nearly 3 million girl members
in every corner of the United States, Puerto Rico, the Virgin Islands,
and almost 100 countries worldwide. Throughout our 97-year history,
Girl Scouts has had a long standing commitment to the well-being of
girls and continues to be an authority on their healthy growth and
development. From our healthy living programming and a historic
emphasis on health in the Girl Scout experience, girls are educated and
empowered to take action to strengthen their physical and emotional
well-being and positively impact their communities and the world. Girl
Scouts is deeply invested in improving the health of our country's
children and adds a unique voice and proven solutions for Congress to
consider while forming policies to address childhood obesity and
improve our youth's physical and emotional health.
The Girl Scout Research Institute's original research report, The
New Normal? What Girls Say About Healthy Living, provides what is too
often missing from the dialogue surrounding nutrition and childhood
obesity: the voices of girls and youth who are directly affected by
this health crisis. This research offers insight into how America's
girls view their own health and healthy living. We found that girls
believe being healthy combines good nutrition and physical fitness with
emotional and social well-being. Most importantly, we found that
without including emotional wellness in exercise and nutrition
programs, these programs will not work well for girls.
Incorporating Girls' Voices Into Policy
The New Normal? What Girls Say About Healthy Living, sheds light on
the childhood obesity crisis by asking girls directly how they define
health and what motivates them to lead healthier lifestyles. The report
combined focus group research with surveys of more than 2,000 eight- to
seventeen-year-old girls. Girls expressed that their emotional and
social wellness is equally important to their physical health. For
girls, being healthy is more than just eating right and exercising; it
is also includes feeling good about oneself, being supported by friends
and family, and appearing ``normal.'' The study found that girls define
health holistically, and our nation needs to take a comprehensive
approach to healthy living programs and policies if we want them to
resonate well with girls.
Emotional wellness, which includes self-esteem and a girl's body
image, plays a critical role in girls' attitudes about diet and
exercise. According to The New Normal? What Girls Say About Healthy
Living, for girls, being healthy has more to do with appearing
``normal'' and feeling accepted rather than maintaining good diet and
exercise habits.\1\ Moreover, physical appearance is of greater concern
to girls than their nutrition or how much they exercise.\2\ If our
country wants to end the childhood obesity crisis, we should form
policies and programs that not only encourage good physical health, but
emotional well-being as well. Girl Scouts has learned that
comprehensive approaches are the most effective with helping girls
develop healthy nutrition and exercise habits. We recommend that
nutrition programs should include a focus on emotional wellness that
empowers girls and all youth to develop self-esteem, a positive body
image, healthy eating and exercise habits, and an overall healthier
For girls, health is also about being supported by their peers and
family. Relationships are crucial to girls' physical and emotional
health. The Girl Scout Research Institute's original research report,
Feeling Safe: What Girls Say, found that emotional safety is a top
concern for girls. Girls feel the safest and most confident when they
have strong relationships with their peers who they can trust.\3\
Relational aggression, or emotional bullying, damages girls' emotional
and physical health and safety. Efforts to improve girls' health should
include the prevention of relational aggression, since healthy
relationships are crucial to girls' physical and emotional well-being.
The New Normal? What Girls Say About Healthy Living also highlights
the important role that adults, in particular mothers, play in shaping
girls' self-esteem and their nutrition and exercise habits. Girls cite
their mothers not only as role models but also as leading sources of
nutritional information and emotional reinforcement. A mother's weight,
body image, and health habits are strong indicators of whether or not
her daughter is overweight, physically active, satisfied with her body,
and looks to her mother for advice on health living.\4\ In general,
having obese parents significantly increases a child's risk of being
obese. One study suggests that children of obese mothers are fifteen
times more likely to be obese by age six than children with normal
weight mothers.\5\ This strong correlation between a daughter's health
and her mother's health habits indicates the powerful influence mothers
have over their daughters' emotional and physical health. Efforts to
inspire and motivate girls to make healthier choices should focus on
educating parents, teachers, and adult volunteers on how to encourage
youth to develop healthier lifestyles, as well as teach adults that
their choices model behaviors for how to live a healthy life.
Finally, our original research shows that the most effective
policies and programs give health social relevance, which requires
framing healthy living in terms that are socially significant to girls
of different ages, ethnicities, and backgrounds. Hispanic, African
American, and Native American children are disproportionately affected
by obesity when compared to the general population. The highest
prevalence of obesity among girls is found among African American and
Latina girls.\6\ Children from low-income backgrounds are also at a
higher risk for becoming obese; for girls of all ages, obesity is
highest at the lowest income levels and drops precipitously at the
highest income levels.\7\ Policy solutions should be culturally
competent and built upon the different needs of children from all
backgrounds if we truly want to improve all children's health.
Any reframing or redefining of health needs, including nutrition
and physical activity policies, will be most effective if the policies
focus on the positive emotional outcomes, such as forming healthy
relationships, building strong self-esteem, and developing a positive
body image, that are likely to result from comprehensive, healthy
behavior, rather than strictly focusing on maintaining normal weight
and eating nourishing food. According to The New Normal? What Girls Say
About Healthy Living, a strict focus on physical health does not
resonate with girls. Policies that acknowledge the importance of
emotional wellness and incorporate emotional health in nutrition and
exercise programs will be the most successful among girls and all
Girl Scouts strongly supports H.R. 2276, The Improved Nutrition and
Physical Activity Act or IMPACT Act, because it meets a critical need
for a comprehensive approach to obesity and eating disorder prevention
and improving children's emotional and physical health. This
legislation is taking groundbreaking steps by recognizing that youth,
especially girls, view health holistically. It also promotes cross-
sector collaboration among schools, health professionals, and youth-
serving organizations, such as the Girl Scouts. We greatly encourage
the members of the Subcommittee to partner with Representatives Nita
Lowey and Mary Bono Mack to support this legislation that will provide
invaluable resources for communities to work together to improve
children's nutrition, physical activity, and emotional wellness.
Girl Scouts has a crucial role to play in ensuring the needs of
girls are addressed in policy solutions. We are a powerful community-
building tool, and our research and programming offer proven solutions
towards promoting healthy living. As such, we seek to partner with the
Subcommittee in the future as you develop policies that will build a
generation of healthy girls and youth. Listening to the voices of girls
and what they have to say about healthy living can inform the programs,
policies, and messages that touch their lives. Only by engaging girls
in the process do we ensure that today's girls will grow into
tomorrow's healthy women. Girl Scouts thanks the Subcommittee for its
leadership in examining this important issue and including our
statement in the record.
\1\ Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman, The New
Normal? What Girls Say About Healthy Living, Girl Scout Research
Institute (New York, NY: Girl Scouts of the USA, 2006).
\2\ ``Health Status--Adolescents.'' Child Health USA 2003. 2003
HRSA Maternal and Child Health Bureau. Accessed 13 June 2005.
\3\ Judy Schoenberg, Toija Riggins, and Kimberlee Salmond, Feeling
Safe: What Girls Say, Girl Scout Research Institute (New York, NY: Girl
Scouts of the USA, 2003).
\4\ Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman, The New
Normal? What Girls Say About Healthy Living, Girl Scout Research
Institute (New York, NY: Girl Scouts of the USA, 2006).
\5\ Whitaker, R. et al. ``Predicting Obesity in Young Adulthood
from Childhood and Parental Obesity,'' New England Journal of Medicine,
vol. 337, No. 13. September 25, 1997. Berkowitz, R. ``Growth of
Children at High Risk of Obesity during the First Six Years of Life:
Implications for Prevention,'' American Journal of Clinical Nutrition,
vol. 81, No. 1. January 2005.
\6\ Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman,
Weighing In: Helping Girls Be Healthy Today, Healthy Tomorrow. Girl
Scout Research Institute (New York, NY: Girl Scouts of the USA, 2004).
\7\ Girl Scout Research Institute. What Girls Say: Healthy Living
Inside and Out, Integrated Report of Qualitative and Quantitative
Findings. (New York, NY: Girl Scouts of the USA, November 2005).
[The statement of Mr. Braley follows:]
Prepared Statement of Hon. Bruce L. Braley, a Representative in
Congress From the State of Iowa
Chairwoman McCarthy, I rise today to discuss and urge support for a
bill that I recently introduced, House Resolution 2322, the Healthy
Food Choices for Kids Act. I strongly urge the Education and Labor
Committee to consider including my legislation within the
reauthorization of the Child Nutrition Programs and the National School
Lunch Act. My bill would set up a Pilot Program that would be available
to 100 schools (10 schools in each of 10 states). These schools would
receive funding in order to meet three requirements:
1. The schools would be required to post nutritional information on
the food items served in their school cafeterias.
2. The schools would be required to develop and implement a school
nutrition awareness program to teach children how to make healthy food
3. The schools would be required to consult with a Registered
Dietitian, Nutritionist, or School Nutrition Specialist at least once a
My legislation would also include an evaluation which would be
reported to the House Education and Labor Committee. The evaluation
would report on the successes and challenges of the program. I believe
my legislation would be an excellent opportunity to test the idea of
labeling the foods served in schools with nutritional information.
I also believe that Iowa would be a perfect state to test this
idea. There are at least 3 schools in Iowa that are already doing some
form of nutritional labeling of the foods they serve in their schools.
With this statement I have included two examples of current school food
labeling already being done in Iowa. One example comes from Dubuque,
Iowa and the other comes from Cedar Falls, Iowa. My bill requires that
at least 3 schools in each state must already be providing nutritional
content information for the foods served in the school cafeteria. This
would make Iowa an excellent choice as one of the 10 states to receive
this Pilot as they already fulfill this requirement.
In addition, my legislation would require that the Secretary of
Agriculture choose states for this pilot program with a sufficient
number of rural schools. As a mostly rural state, Iowa would fit this
criteria well. By implementing this pilot program in a state like Iowa,
the Secretary will have the opportunity to thoroughly evaluate how this
program works in both rural and urban schools, which could provide
useful information towards our goal of increasing children's nutrition
I urge the Education and Labor Committee to consider including H.R.
2322, the Healthy Food Choices for Kids Act in the upcoming
reauthorization of the School Lunch Act. This legislation will create a
new opportunity in the continuing effort to fight childhood obesity.
[Additional submissions of Mr. Braley follow:]
[Whereupon, at 1:47 p.m., the subcommittee was adjourned.]