[Senate Hearing 113-560]
[From the U.S. Government Publishing Office]
S. Hrg. 113-560
A NATIONAL PRIORITY:
THE IMPORTANCE OF CHILD NUTRITION
PROGRAMS TO OUR NATION'S
HEALTH, ECONOMY AND NATIONAL SECURITY
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON AGRICULTURE,
NUTRITION AND FORESTRY
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
JUNE 12, 2014
__________
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Committee on Agriculture, Nutrition and Forestry
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COMMITTEE ON AGRICULTURE, NUTRITION AND FORESTRY
DEBBIE STABENOW, Michigan, Chairwoman
PATRICK J. LEAHY, Vermont THAD COCHRAN, Mississippi
TOM HARKIN, Iowa MITCH McCONNELL, Kentucky
SHERROD BROWN, OHIO PAT ROBERTS, Kansas
AMY KLOBUCHAR, MINNESOTA SAXBY CHAMBLISS, Georgia
MICHAEL BENNET, COLORADO JOHN BOOZMAN, Arkansas
KIRSTEN GILLIBRAND, NEW YORK JOHN HOEVEN, North Dakota
JOE DONNELLY, INDIANA MIKE JOHANNS, Nebraska
HEIDI HEITKAMP, NORTH DAKOTA CHARLES E. GRASSLEY, Iowa
ROBERT P. CASEY, Jr., PENNSYLVANIA JOHN THUNE, South Dakota
JOHN WALSH, MONTANA
Christopher J. Adamo, Majority Staff Director
Jonathan J. Cordone, Majority Chief Counsel
Jessica L. Williams, Chief Clerk
Thomas Allen Hawks, Minority Staff Director
Anne C. Hazlett, Minority Chief Counsel and Senior Advisor
(ii)
C O N T E N T S
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Page
Hearing(s):
A National Priority: The Importance of Child Nutrition Programs
to Our Nation's Health, Economy, and National Security......... 1
----------
Thursday, June 12, 2014
STATEMENTS PRESENTED BY SENATORS
Stabenow, Hon. Debbie, U.S. Senator from the State of Michigan,
Chairwoman, Committee on Agriculture, Nutrition and Forestry... 1
Gillibrand, Hon. Kirsten E., U.S. Senator from the State of New
York........................................................... 2
Witnesses
Hawley, General Richard E., United States Air Force (Ret.),
Mission: Readiness, Newport News, Virginia..................... 4
Thornton, Otha, President, National Parent Teacher Association,
Fort Stewart, Georgia.......................................... 6
Cook, Stephen R., M.D., Physician, Associate Professor, School of
Medicine and Dentistry, University of Rochester Medical School,
Rochester, New York............................................ 7
Stanislaus, Yolanda, Principal, Francis Scott Key Middle School,
Silver Spring, Maryland........................................ 9
----------
APPENDIX
Prepared Statements:
Casey, Hon. Robert, Jr....................................... 30
Cochran, Hon. Thad........................................... 31
Leahy, Hon. Patrick J........................................ 33
Cook, Stephen R.............................................. 35
Hawley, Richard.............................................. 40
Stanislaus, Yolanda.......................................... 44
Thornton, Otha, Jr........................................... 46
Document(s) Submitted for the Record:
Stabenow, Hon. Debbie:
``A National Priority: The Importance of Child Nutrition
Programs to our Nation's Health, Economy and National
Security", Hon. Martin O'Malley, State of Maryland, Office
of the Governor............................................ 50
National Education Association, prepared statement........... 52
Question and Answer:
Stephen Cook:
Written response to questions from Hon. Debbie Stabenow...... 56
Written response to questions from Hon. Patrick J. Leahy..... 59
Written response to questions from Hon. Amy Klobuchar........ 59
Written response to questions from Hon. Michael Bennet....... 60
Written response to questions from Hon. Robert Casey, Jr..... 63
Hawley, Richard:
Written response to questions from Hon. Debbie Stabenow...... 66
Written response to questions from Hon. Michael Bennet....... 66
Written response to questions from Hon. Robert Casey, Jr..... 68
Written response to questions from Hon. John Boozman......... 70
Stanislaus, Yolanda:
Written response to questions from Hon. Debbie Stabenow...... 71
Written response to questions from Hon. Amy Klobuchar........ 71
Written response to questions from Hon. Michael Bennet....... 72
Written response to questions from Hon. Robert Casey, Jr..... 73
Thornton, Otha, Jr.:
Written response to questions from Hon. Debbie Stabenow...... 75
Written response to questions from Hon. Patrick J. Leahy..... 75
Written response to questions from Hon. Amy Klobuchar........ 76
Written response to questions from Hon. Michael Bennet....... 77
Written response to questions from Hon. Robert Casey, Jr..... 79
A NATIONAL PRIORITY:
THE IMPORTANCE OF CHILD NUTRITION
PROGRAMS TO OUR NATION'S
HEALTH, ECONOMY, AND NATIONAL SECURITY
----------
Thursday, June 12, 2014
United States Senate,
Committee on Agriculture, Nutrition and Forestry,
Washington, DC
The committee met, pursuant to notice, at 10:07 a.m., in
room 328A, Russell Senate Office Building, Hon. Debbie
Stabenow, Chairwoman of the committee, presiding.
Present or submitting a statement: Senators Stabenow,
Brown, Klobuchar, Gillibrand, Donnelly, Casey, Boozman, and
Thune.
STATEMENT OF HON. DEBBIE STABENOW, U.S. SENATOR FROM THE STATE
OF MICHIGAN, CHAIRWOMAN, COMMITTEE ON AGRICULTURE, NUTRITION
AND FORESTRY
Chairwoman Stabenow. Well, good morning. The committee
meeting will come to order. We are so pleased that all of you
are here today.
I want to welcome everyone to the committee's first hearing
as we begin the process of reauthorizing Child Nutrition
Programs. These conversations could not come at a more critical
time. Today, more than 16 million children in this country do
not have enough to eat. At the same time, childhood obesity
rates have tripled over the past 30 years. Something is wrong
with this picture.
These trends are not just a threat to the health of
America's young people, they are a threat to the future of our
national security, and we want to talk about that today. For
generations, the U.S. military has depended on the strength and
courage of young Americans to form the world's most elite
fighting force. Our military leaders recognize this, and
historically, when they have asked Congress for help, we have
responded.
Near the end of World War II, General Lewis Hershey came
before the Congress to explain that malnutrition and
underfeeding were to blame for recruits being rejected for
service in the Armed Forces. In response to the General's
concerns, Congress launched the National School Lunch Program,
calling it a measure of national security.
Today, as we will hear, our military leaders have a similar
request for Congress, and it is the same request we will hear
from pediatricians and school leaders and parents. They ask
that we protect and strengthen school nutrition programs so
that we can strengthen our nation's military preparedness and
improve the long-term health of the next generation of
Americans.
This request has even more urgency today than it had 70
years ago. That is because roughly 27 percent of Americans
between the ages of 17 and 24 are too overweight to serve in
the military. The proportion of new recruits who failed
physical exams during the past 13 years rose by nearly 70
percent.
Childhood obesity and weight-related diseases weaken our
nation's financial security, as well. It is estimated that the
nation spends about $14 billion a year to treat obesity and
preventable weight-related diseases in children alone, not
counting adults. Yet, for 14 cents, we can give a child an
apple in school. Fourteen billion a year or 14 cents. That
reminds me of what Benjamin Franklin once said. An ounce of
prevention is worth a pound of cure.
These are the critical types of investments that we can
make now to save billions down the road, reducing many of the
high costs associated with treating preventable diseases, like
Type 2 diabetes, hypertension, and liver disease.
In the classroom, a school breakfast can spur a lifetime of
learning and achievement. We know that children who receive a
healthy breakfast are likely to have better math scores and are
less likely to be absent from class. For many children, a
healthy lunch can form the foundation for a lifetime of good
health. Making sure children have healthy, nutritious food will
mean they can focus on what is important--learning, growing,
and ultimately becoming productive and successful in future
years.
While it is often easy to think of programs in terms of a
six-month budget or the annual appropriations, this hearing is
really about the big picture. School breakfasts and school
lunch are key components of child nutrition, but it is also
important to remember that child nutrition is also about
wellness policies, it is about WIC--Women, Infants, and
Children's Programs, it is about Farm to School efforts, and
day care. It is about reducing hunger for children after school
and during the summer months.
The authorization of Child Nutrition Programs is important.
Investing in our children's nutritional health is not only
about the cost of a meal, it is about investing in our nation's
future and our most critical priorities: Stronger national
security, long-term economic strength, educational success, and
the health and happy lives of our families.
I am pleased we have a great panel of witnesses today with
us who can discuss the big picture impact of investing in the
health of our children. We welcome everyone today.
Our Ranking Member is not able to be with us. I know we
will be joined by others as we proceed. If either of my
colleagues want to make a brief comment, we would be happy to
have it. Otherwise, we will go to our witnesses.
Senator Gillibrand.
STATEMENT OF HON. KIRSTEN GILLIBRAND, U.S. SENATOR FROM THE
STATE OF NEW YORK
Senator Gillibrand. I have a statement to introduce one of
our witnesses. Is that all right?
Chairwoman Stabenow. Absolutely. I will let you proceed.
Senator Gillibrand. Okay. Well, I would like to introduce
Dr. Stephen Cook. He is trained in pediatrics and adult
internal medicine. He currently serves as an attending
physician at the Golisano Children's Hospital at the University
of Rochester Medical Center.
Dr. Cook has served as a member of my Healthy Children's
Working Group and he has shared his research with us on child
and adolescent obesity and his work has been a resource to me
as I have developed my legislative agenda with respect to
children's health.
Dr. Cook's research focuses on children and childhood and
adolescent obesity by examining cardiovascular risk factors in
clinical studies on prevention intervention. Dr. Cook has been
an integral part of the Greater Rochester Obesity
Collaborative, which serves as a national model for obesity
prevention and treatment. The Rochester team was among ten
teams chosen to participate in the Healthy Weight
Collaborative, which is aimed at curbing the obesity rate in
the U.S.
Dr. Cook received his M.D. from SUNY at Buffalo School of
Medicine and completed his residency and a chief resident year
in Buffalo, New York. He has completed an academic pediatric
fellowship, during which he focused on research in clinical
aspects on nutrition, physical activity, obesity, and metabolic
complications that arise.
Dr. Cook has received a number of medical and research
awards and honors and has been recognized by the American Heart
Association for being the National Science Advocate of the Year
in 2011. He currently serves on the Governor's Anti-Hunger Task
Force in New York State as well as the Chairman and Membership
Committee for the Obesity Society.
We welcome him to the Senate Agriculture Committee today
and we look forward to his testimony.
Chairwoman Stabenow. Thank you very much, Senator
Gillibrand----
Senator Gillibrand. Thank you, Madam Chairwoman.
Chairwoman Stabenow. --and thank you for your advocacy and
leadership. We are very fortunate to have both Senator Brown
and Senator Gillibrand, who are strong advocates for the Child
Nutrition Programs, and I look forward to working with you in
partnership as we proceed to reauthorize in the coming year.
Let me proceed with our other witnesses. I am so pleased to
introduce our first witness on the panel, General Richard
Hawley, a retired four-star general in the Air Force who serves
on the Executive Advisory Council on Mission: Readiness,
Military Leaders for Kids, which is a nonprofit, nonpartisan
national security organization of hundreds of retired military
officers committed to strengthening future generations through
smart policy.
During General Hawley's military career, he served in a
variety of command and staff positions in the United States and
overseas. He commanded a group, wing, Numbered Air Force, and
two major commands. His assignments as a flag staff officer
included duty as the Air Force Director of Operations during
the First Gulf War, Commander of U.S. Forces Japan, and Fifth
Air Force, Principal Deputy Assistant Secretary of the Air
Force for Acquisition, and Commander United States Air Force in
Europe and Allied Air Forces Central. We welcome you.
Our second witness is Mr. Otha Thornton, President of the
National Parent Teacher Association, who is also a Senior
Operations Analyst with General Dynamics in Fort Stewart,
Georgia. Mr. Thornton is a retired United States Army
Lieutenant Colonel, and his last two assignments were with the
White House Communications Agency and United States Forces Iraq
and Baghdad. Mr. Thornton earned the Bronze Star Medal for
exceptional performance in combat operations during Operation
Iraqi Freedom in 2009-2010. As a PTA leader, Mr. Thornton's
military background has allowed him to volunteer throughout the
country and the world at various State, local, and council
levels, and we are so pleased to have you with us.
Let me now turn to Ms. Yolanda Stanislaus--we are so
pleased to have you--who is the Principal of Francis Scott Key
Middle School in Silver Spring, Maryland. She is an educator
for 21 years, starting her career as a high school earth
science and chemistry teacher in New York City Public Schools.
She also taught at Bethesda-Chevy Chase High School and served
as teacher and assistant principal at Silver Spring
International Middle School. Prior to becoming Principal at
Francis Scott Key, she was Principal of Galway Elementary
School.
Ms. Stanislaus has spent several years in the Montgomery
County Public School System, and the Montgomery County Schools
participate in the National School Lunch and Breakfast
Programs. In addition to providing meals, the schools
participate in other healthy food and hunger mitigation
programs, including After School Snack, Summer Meals, and Farm
to School activities.
We are so pleased to have all of you here with your
experiences and expertise to share with us. I would remind you,
we are asking for five minutes' worth of testimony. We are very
happy to accept whatever you would like to give us in writing,
as well.
We will start with General Hawley. Welcome.
STATEMENT OF GENERAL RICHARD E. HAWLEY, UNITED STATES AIR FORCE
(RET.), MISSION: READINESS, NEWPORT NEWS, VIRGINIA
General Hawley. Well, thank you, Chairwoman Stabenow and
members of the committee. First of all, thanks for holding this
hearing and for including me. I appreciate the opportunity to
join and give our perspective as a retired military flag.
It may seem odd to some here that a retired general officer
would be here talking about childhood nutrition, not exactly
our line of expertise. But, as the Chairwoman pointed out, the
National School Lunch Program was established in 1946, in large
measure in response to our experiences during World War II,
when we discovered that of those who were not qualified for
military service, about 40 percent of those were malnourished.
The Congress took action, established the School Lunch Program,
and it has had a great effect on the health of our potential
recruits upon who we depend to defend the nation.
Unfortunately, 70 years later, nutrition remains a national
problem and a problem for our military, but the pendulum has
swung a little and the issue is now we have too many children
and candidate recruits who are obese or overweight and, hence,
unfit to perform the service that we require for our nation in
the military.
About 75 percent of young Americans today are unfit for
military service, and that is a tragic figure. As the
Chairwoman pointed out, more than one in five of our youth are
too fat, overweight, obese, to meet the demands of military
service. Others cannot meet the educational requirements or
have a criminal background which disqualifies them.
Just to put a number on this, for the six years from 2006
to 2011, young men and women were denied enlistment at the rate
of 62,000. Sixty-two-thousand young Americans during that
period who could not qualify for military service because of
their weight. Just to put a little easier number on it, that
would man about 30 Air Force combat wings. It is an astounding
figure and one that demands action.
Twelve-hundred first-term enlistees are discharged every
year because of weight problems, 1,200. The military has to
then go out and recruit and train replacements. I do not know
how this adds up to the 14-cent apple, Chairwoman, but it is
$90 million a year that we spend to recruit and train those
replacements. That would buy a lot of apples.
DOD spends another $1.1 billion each year to treat obesity-
related illnesses through our military medicine and TRICARE
programs.
The military is responding to these problems. They have
launched a number of initiatives to deal with the issues, but
they need help, and that is why the school nutrition
environment is so important. A child who is overweight in his
preteen years has an 80 percent chance of being obese by age
25, and those are the ones who cannot meet the requirements for
military service.
In 2010, our group released a report, ``Too Fat to Fight,''
and another in 2012, ``Still Too Fat to Fight,'' and they
examine how obesity affects our military and highlight the need
for standards in our School Lunch Program. When ``Too Fat to
Fight'' was released in 2010, our children were consuming way
too many junk food calories, the equivalent of two billion
candy bars a year. By the way, two billion candy bars weighs
more than the Aircraft Carrier Midway.
But, the revised standards that this committee endorsed in
2010 are beginning to show results. The steady upward march in
rates of obesity is slowing, and in some age groups has been
reversed. Cultural change does not happen quickly, but if given
time to work their magic, the changes set forth in 2010 will
give us a stronger military in 2030 and a healthier nation, as
well.
On behalf of the 450 generals and admirals of Mission:
Readiness, I thank you for this opportunity to highlight the
link between childhood nutrition and national security. We look
forward to working with the committee as you continue this
important work. Thank you.
[The prepared statement of General Hawley can be found on
page XX in the appendix.]
Chairwoman Stabenow. Thank you very much for that
testimony.
Mr. Thornton, welcome again.
STATEMENT OF OTHA THORNTON, JR., PRESIDENT, NATIONAL PARENT
TEACHER ASSOCIATION, FORT STEWART, GEORGIA
Mr. Thornton. Chairman Stabenow, committee members, and my
fellow distinguished panelists, I am honored to have the
opportunity to speak before you on behalf of over four million
members of the National Parent Teacher Association. With more
than 24,000 local units, PTA exists in all 50 States, the
District of Columbia, Puerto Rico, the U.S. Virgin Islands, and
the Department of Defense Schools in Europe.
I currently serve as President of the National PTA, an
elected volunteer position that I assumed in June of last year.
In addition to my involvement with National PTA, I have been
active in State and local PTAs in Georgia, Maryland, Texas,
Michigan, and Kaiserslautern, Germany. I am currently employed
as a Senior Operations Analyst with General Dynamics at Fort
Stewart, Georgia, and I am a retired Lieutenant Colonel. Most
importantly, I have over two decades of experience as a father
of my two wonderful children with my wife, Caryn, Candice and
Tre.
PTA was founded in 1897 and is the oldest and largest
volunteer child advocacy organization in the United States.
PTA's legacy of influencing policy to protect the education,
health, and overall well-being of children has made an
indelible impact in the lives of millions of children and their
families. This legacy includes the creation of kindergarten
classes, a juvenile justice system, child labor laws, and
mandatory immunizations for school children. Our mission is to
be a powerful voice for every child.
With regards to today's hearing, one of the fundamental
purposes of PTA is to preserve children's health and protect
them from harm. PTA has been at the table from the beginning,
piloting a hot lunch program in schools in the 1920s that led
to PTA's advocacy for a National School Lunch Program, and each
subsequent reauthorization of the Richard B. Russell National
School Lunch Act.
Most recently, the PTA and our coalition partners fought
for the passage of the Healthy, Hunger-Free Kids Act, which has
made significant updates to our nation's Child Nutrition
Programs. PTA viewed this as both a win for the kids and also
the parents, because parents knew that, for the first time, no
matter what our kids purchased in the cafeteria, it was going
to be good for them. As for the primary decision makers in our
kids' lives, it also provided us as parents a stronger role
through local wellness policy development, implementation, and
evaluation. As I always say, if you are not at the table, you
are on the menu.
I mention these accomplishments not only to underscore
PTA's commitment to the well-being of our nation's children,
but also to provide a historical context for where we are
today. We have made a commitment to our children for over 70
years to do the right thing in the cafeteria and we cannot turn
our backs now.
I know some of my fellow panelists will address the reality
of our nation's obesity crisis as it relates to our overall
health and national security, so as a PTA leader and father, I
am here today to tell you that our parents and families are
committed to working together to ensure the continued success
of our nation's Child Nutrition Programs.
Where are we today? Schools are making exceptional progress
in the nutritional quality of the meals that they are serving
to our kids. There have been challenges along the way, but that
is to be expected. We are parents, after all. When was the last
time you changed rules for your kids in the interest of their
well-being and your kids were happy about it? Do we have anyone
here?
As a partner in the school building, PTA and parents
understand there are certain challenging realities. There is
never enough time, seldom enough money, and oftentimes minimum
resources, but that has never and can never be a free pass not
to do the right thing for our kids. For parents, it means that
we need to step up to the plate and support our schools, the
board, the administration, the school food service, the
teachers, the students to make sure that the school meals are
successful. That means having a seat at the table and finding
solutions to the challenges.
Do we need updated kitchen equipment to serve fresh food?
Well, how are we going to secure funding? Do we need volunteers
so breakfast can be served in the classroom? Well, let us get
some parents and grandparents together. Do we need to taste
test some of the new items? How can we help? Do we need to
adjust our fundraising practices? Let's do this.
One of the most common questions that we hear as we travel
around the country is, will our kids have enough time to eat
lunch? How can we solve this problem? We can do this together.
It may take a little bit of time and a lot of effort, but we
can do it.
In closing, thank you for having me here for this
testimony.
[The prepared statement of Mr. Thornton can be found on
page XX in the appendix.]
Chairwoman Stabenow. Thank you very much.
Dr. Cook, welcome.
STEPHEN R. COOK, M.D., ASSOCIATE PROFESSOR, SCHOOL OF MEDICINE
AND DENTISTRY, UNIVERSITY OF ROCHESTER MEDICAL SCHOOL,
ROCHESTER, NEW YORK
Dr. Cook. Thank you very much, Chairwoman Stabenow and
distinguished members of the committee. I am both a
pediatrician and adult internist from Upstate New York and an
American Heart Association volunteer.
The unintended benefit of my dual training is now being
realized in the current childhood obesity epidemic. Today, I
see young patients with Type 2 diabetes, high cholesterol and
fatty liver disease. These are conditions which I am familiar
with as an internist treating adult patients, but my pediatric
colleagues never saw before. In other words, our children are
developing adult diseases accelerated by their poor diets and
developing obesity.
The statistics are grim. Today, one in three kids or teens
are overweight or obese, nearly tripled from the 1960s.
Hypertension, high cholesterol, Type 2 diabetes are affecting
children and adolescents at unprecedented levels. Not
surprisingly, more than 90 percent of children meet none or
only one of the five components the American Heart Association
uses to define a healthy diet, such as eating more fruits and
vegetables or more whole grains.
Beyond the toll and human suffering, obesity is associated
with diseases with a steep price tag. The cost of treating
obesity-related illnesses in the U.S. tripled just over a
decade, from $78 billion in 1998 to $270 billion in 2009. Let
me tell you a story behind some of these statistics.
I currently work in a pediatric practice at the Children's
Hospital at the University of Rochester and I am on the front
line of the war against childhood obesity. Almost half the
students in the Rochester City School District are considered
overweight or obese, and nearly 80 percent of these students
qualify for Free and Reduced Lunch, in many instances, that
being the only healthy meal they receive all day.
It was during my fellowship training in Rochester that I
learned a very important lesson I would like to share with you.
I learned that I, as a pediatrician, must care for children and
families beyond the four walls of my office. I could provide
life-saving vaccines or medications, but what good would it do
if these very same children were doomed to a life of chronic
disease and early death brought upon in part by unhealthy
diets?
On a positive note, I have seen firsthand how children's
eating and activity habits are established very early in life.
It is a critical window when eating habits and healthy
lifestyles are imprinted behaviorally and biologically. It
provides a great, and, I would argue, unique opportunity for
improving the health of our nation's children, lowering medical
costs, and improving productivity.
I would like to illustrate the delicate balance of a small
change and consistent change in the life of a child and how, if
made correctly at the right times, allow for prevention and
treatment really to overlap. A colleague of mine and I had a
three-year-old patient who, during his annual check-up, was
found to have a BMI in the obese range, actually, 97th
percentile. She discussed with the child's mother the boy's
beverage habits and drinking, and which the mom did not think
was a problem until he returned for his four-year check-up in
which he was still obese, now at the 98th percentile for age.
They discussed cutting back on the sugary beverages along with
instituting some behavior changes related to nutrition and his
inactivity level.
He came in for regular visits over the next two-and-a-half
years and his weight continued to increase, but more slowly.
Over his last two visits, his weight actually decreased by just
over a pound. This was over seven months. But, by now, his BMI
percentile was 69th percentile for age, right where it should
be, right in the normal change.
These changes in behavior we discussed were not of a high
intensity level, like a treatment level needed for older
children or those more severely affected by obesity, but the
consistent message as part of well child visits, with age-
appropriate recommendations for nutrition, physical activity,
screen time, and sleep. This is also a motivated parent who
sought out resources, including ensuring her son attended a
high-quality child care center that was moving to improve
policies around meals and snacks. The patient is now on the
right path for a healthy life.
Programs authorized by the Healthy, Hunger-Free Kids Act
set the stage for millions of children to also get a head start
for a lifetime of healthy habits. Based on solid clinical
research, I urge the committee and Congress to continue the
good work with school districts to prioritize Child Nutrition
Programs. It is great up-front investment in our children and
our nation's future. To do less is unacceptable.
I also believe that we cannot let perfect be the enemy of
good. The USDA and schools can work through challenges while at
the same time applying evidence-based strategies for altering
the food environment and the presentation with minimal cost.
Let me conclude by noting that the programs in child
nutrition reauthorization play a critical role in improving the
health of our nation's children, their future, and our nation's
future. It is one of the many strategies that, while alone will
not be enough, must be implemented to turn the tide on obesity
and the many other chronic obesity-related conditions among
America's youth. The very lives of our children are at stake.
Thank you.
[The prepared statement of Dr. Cook can be found on page XX
in the appendix.]
Chairwoman Stabenow. Well, thank you very much, Doctor, for
that testimony.
Principal Stanislaus, welcome.
STATEMENT OF YOLANDA STANISLAUS, PRINCIPAL, FRANCIS SCOTT KEY
MIDDLE SCHOOL, SILVER SPRING, MARYLAND
Ms. Stanislaus. Welcome, and thank you for having me. Good
morning, Chairwoman Stabenow and members of the committee, and
thank you for this opportunity to share my experience and views
on the importance of Child Nutrition Programs like School
Breakfast and School Lunch.
When I think about this issue of school nutrition from the
perspective of a principal and parent of both a middle school
and elementary-age child, the benefits of universal or Free and
Reduced Meals Programs is obvious. In addition, I was a child
of two working-class parents who worked tirelessly to clothe,
feed, and nurture five children. As a child, I participated in
the meal program at my school. I recall looking forward to
going to school every day and wondering what was going to be
served for breakfast and lunch. I can testify firsthand that
the School Meal Program had a positive impact on my life and my
learning.
There are children in classrooms all over this nation, in
cities, in suburbs, and in communities, who are coming to
school extremely eager to learn. In order for students to learn
at high levels, they must be prepared and ready to concentrate
by starting their day off with a nutritious breakfast.
The numbers show that one out of five school-age children
struggle with hunger in this country. I can tell you that on a
more personal note, I have 65 percent of my students who
receive Free and Reduced Breakfast and Lunch daily, and they
are still struggling with having enough to eat at home. I can
also tell you that this makes it harder for them to learn.
I am not alone. There are teachers and principals all over
this country who will tell you the same thing. There are
children in classrooms all over the nation, cities and suburbs,
who are coming to school too hungry to learn. In some cases,
the nutritious school breakfast and lunch are the only meals
the students have on a daily basis.
Children who consistently do not get enough to eat tend to
go to the nurse more often, have trouble focusing on lessons,
which often result in off-task behavior and difficulties with
sharing their best thinking on their tests. Research shows that
students who do get enough nutrition on a daily basis feel
better, learn more, develop good eating habits, and grow up
stronger.
We spend so much time and thought and money in this nation
around educating our children. We ask questions like, how do we
improve our test scores? How do we ensure that students
graduate? There are some wonderful programs and innovations to
educate our kids, but if they are too hungry to learn, we have
lost them before we have begun.
There are two really key times I see hunger as a widespread
problem, in the mornings and after the summer and the start of
the school year. For students of low-income families, their
nutrition comes from school meals. Without school breakfast and
lunch, these students would not get the nutrition they need.
You can really see it in the morning. I have seen students
come to school and they have not eaten since lunch the day
before. They are irritable. They cannot focus. They are only
able to think about where their next meal is coming from. I am
grateful that my school has a universal Free Breakfast Program.
This program enables all of my students to receive nutritious
breakfast and start their day off right.
Another danger time is over the summer vacation. Students
do not get school meals when school is out of session. You can
see a real difference at the start of the school year between
students who had enough to eat over the breaks and those who
struggled. The ones who may not have been getting consistent
meals are more stressed out. They take longer to get into the
swing of the school year. They have forgotten a lot of what
they have learned the year before, and it makes a real
difference with their progress.
As a principal, I make it my duty to greet my students
every morning. This is an opportunity for me to quickly gauge
my students' current social-emotional state. This particular
morning, I noticed a student who appeared tired and unhappy.
Before I could ask him what was wrong, he asked me, ``Ms.
Stanislaus, are we going to be getting breakfast this morning?
I do not have any money.'' I quickly reassured him that
breakfast was waiting for him in his first period classroom. A
sense of relief came over his face and he quickly proceeded
into the building. This and many other stories similar to this
one confirms for me how important it is that schools have a
nutritious Breakfast and Lunch Program for students and how
much they rely on them on a daily basis.
I would like to share with you some current research
conducted by the nonprofit organization, No Kid Hungry, and the
consulting firm Deloitte. They analyzed the ways hunger affects
a child's ability to learn. Their research focused primarily on
what happens when students from low-income families get the
breakfast every day. Here are some of their findings. Their
attendance rate went up. Tardiness and absences went down. On
average, students scored 17.5 percent higher on math
assessments.
Higher attendance and higher test scores are closely tied
to graduation rates. Students who attend school regularly and
receive better grades are 20 percent more likely to graduate
from high school. This has a huge potential impact on their
futures and ours. High school graduates are more likely to find
better employment, make higher salaries, and become self-
sufficient.
I thank you for this time. Once again, I am the proud
Principal of Francis Scott Key Middle School.
[The prepared statement of Ms. Stanislaus can be found on
page XX in the appendix.]
Chairwoman Stabenow. Well, thank you so much. Thank you to
each of you for your important testimony.
First, let me start, General Hawley, with you. I know that,
as you have said, since 2012, the Department of Defense has
really expanded its efforts to combat obesity, and I think, as
you indicated, as well, people would be surprised that we start
this whole process of reauthorization talking about what is
happening in our military and Department of Defense, but it is
a very real, concrete example of what is happening in terms of
obesity in our country.
I know you are investing--the DOD is investing a lot of
time and funding to prevent obesity. Could you talk a little
bit more about those investments versus the amount of money
being spent to treat obesity?
General Hawley. I retired some years ago, so I cannot claim
to be an expert on everything going on in DOD today, but I do
know that they have instituted a number of trial programs--the
Healthy Base Initiative, which includes all of the services--to
institute programs to increase awareness of the problem among
our soldiers, sailors, airmen, Marine, and Coast Guardsmen,
because, as some of the testimony pointed out, sometimes people
do not even understand what their diet is doing to them.
They are doing things like color-coding items in the
commissary and in the dining hall, dining facilities, red,
green, yellow. The green says, hey, you can eat all that you
want. It is good for you. It will help you be a better person
in the military, a better soldier, sailor, airman. If it is
yellow, well, maybe not so much. If it is red, hey, why do you
not avoid that? That is full of sugar and that is not good for
you.
The Air Force, I know, has instituted a program recently on
a trial basis that they hope to expand, Better Food, Better
Body, again, trying to increase awareness among our airmen to
let them know that, hey, your nutrition is important. It is
going to affect how you perform. Of course, your performance is
going to affect how well you do in your career in our service.
There is a lot going on and I know it is going to expand
because this is a very important item.
The cost of those programs is insignificant compared to the
cost of treating the problem. I think I cited the number $1.1
billion to treat obesity and overweight-related illnesses in
our military medical system and the TRICARE program that
supports people like me and others. It is--you cited 14 cents,
I think, versus $14 billion. There is just no comparison.
Chairwoman Stabenow. Well, thank you.
Principal Stanislaus, could you talk a little bit about, as
a principal, how your school is working to ensure that kids are
receiving healthy breakfasts and healthy lunches. What kinds of
things are you doing?
Ms. Stanislaus. We were fortunate enough this year to
receive a grant from the State that allowed us to have a Free
Breakfast Program for not only the 65 percent of our students
who would receive a Free and Reduced Meals Breakfast, but for
all students. It is--we already had in place what we called a
Sustained Silent Reading in the morning, and once we received
the Breakfast Program, we were able to bring the breakfast
items into the first period classroom. Now we call it Books and
Breakfast and it works out really nicely.
The students--I have seen an increase in my attendance
rate. I have seen--and I check it every week. We are certain to
check if students are coming in on time and are there at school
and ready to learn. We have seen some great increases.
Another partnership that I formed was a partnership with
the University of Maryland at my former school, where they
would come in and actually have lessons with the students on
the importance of nutrition.
I really think that it starts with the advocacy of the
principal and tapping into the resources. I work very, very
closely with our Food Services Director and our program in my
county and I am consistently asking for opportunities for my
students and my community. We were selected for this summer,
one of 12 schools to receive a Summer Lunch Program. Not only
will my students benefit, but students who live in that
community up to age 18 are welcome to come to my school for a
free lunch.
Chairwoman Stabenow. Thank you.
One more question here before my time is up. Mr. Thornton,
could you talk from the parent standpoint about working
together to make the school programs a success, a little bit
more about how you see parents in the involvement.
Mr. Thornton. Madame Chairwoman, first of all, we believe,
and we really push for a solid wellness policy around our
school systems. PTA uses six standards for effective school
partnerships in working on issues such as nutrition. One,
welcoming all families into the school and communicating
effectively around these particular programs are two of the
standards.
Just to give you an example, at home we understand the
importance of the family meal. Sometimes, families do not have
the time to properly plan and we understand that. One of the
tools that we have is a partnership with the Healthy Weight
Commitment Foundation to provide grants to a lot of local PTA
units around the country to help parents work on nutrition and
educate them on nutrition within the schools. What does a
healthy plate look like? What does a healthy grocery shopping
trip look like? Those are some of the grants we've provided to
assist our parents; one of the strategies that we use.
Chairwoman Stabenow. Thank you very much.
Senator Brown.
Senator Brown. Thank you, Madam Chair.
I thank you all for your testimony. It was terrific. Thank
you for that.
I want to make three quick comments before I get to my
questions. First, I really appreciate General Hawley's comment
and Chairwoman Stabenow's comment about the National School
Lunch Program, created after World War II in response to far
too many recruits being malnourished. I think it is always
important to put anything this government does in historical
context because it teaches us for the future, so thank you for
that.
I wanted to mention, in Ohio, ProMedica, a health care
provider in Northwest Ohio, out of Toledo, and provides also in
Southeast Michigan, as the Chairwoman knows, announced a plan
to reduce hunger and improve childhood nutrition. They view
ending hunger not just as the moral issue that all of you view
it as, I think, but also as one of the most important ways to
lower health care costs.
The third point I wanted to make before directing some
questions to Ms. Stanislaus is the Summer Feeding Program in my
State, we have about 600,000 students every day that--in any
single day, on the average, and getting the School Free or
Reduced Breakfast or Lunch Program, 600,000 during the school
year. In the summer, and we are maybe slightly above the
national average, only about 60,000 students on any single day
are participating in the Summer Feeding Program. You think of
the difference there, 600,000 in a particular day in March or
April, and in July and August, it is one-tenth of that, and
what that says about what we are doing, where we need to go.
My questions are for Ms. Stanislaus. I would first say, if
I had teenage children, I would want them to go to Francis
Scott Key Middle School because I know the leadership that
principals show and what a difference that makes in the whole
school environment. Teachers are better. The students are
better. The custodians are better. Everything is better. Thank
you.
I held a conference call to Ohio reporters yesterday on the
issue of summer feeding and asking them to help--I usually do
not ask reporters or suggest what they write, but I asked them
to help get the word out for these Summer Feeding Programs.
Part of it is we only have about 1,700 sites, which is more
than we have had some other summers. We get AmeriCorps and some
other groups and individuals helping us build the sites. You
have got to build them in May or June and then take them down
in September, and you have got to find people to do it,
churches and schools and libraries and all.
But, talk to me, if you would, talk to the committee, Ms.
Stanislaus, what that means in terms of the huge drop-off, not
just weekends--do not talk the weekends and during the school
year, but in the summer, what that actually means to children,
to their development, to their physical and mental development,
to their preparation the next fall for school, all that means.
Ms. Stanislaus. Thank you. When I look into their faces,
that is where I start. I can see immediately if a student has
been really taken care of over the summer, has had nutritious
meals. You can tell by their physical appearance, by their
level of energy when they come back, just even--it does not
even take a summer. You can see over, like, a spring break, if
they come back, very often, it takes them a lot longer to get
ready for their school day, for their school week. If school
starts on a Monday, they may be ready by Wednesday.
What I have noticed was just a drop in their socialization.
I have noticed them misbehaving more, where when they have a
level of consistency, when they know that, they have eaten
every day and it is a nutritious breakfast, lunch, their
anxiety does not go up. Right now is the second-to-last day of
school in my school and many other middle schools, and as
principals talk, we are noticing that the anxiety in our
children are really increasing. I think a part of it is because
they know that they are not going to be able to come in and get
that free breakfast and free lunch.
I am fortunate to have a school that will have that this
summer, but not all schools in my system have it, only 12. So--
--
Senator Brown. Talk to me--if I could take another few
seconds----
Chairwoman Stabenow. Sure.
Senator Brown. Understanding, probably in the State of
Maryland, the Summer Feeding Program is roughly ten or 12 or 15
percent of those during the year. How does that compare? If you
have an active middle school like yours with however many
students that you said it is a universal free breakfast, how
many of them are there in the summer and what can we learn from
what you do there in your geographic location to reach into
communities and do better everywhere?
Ms. Stanislaus. Thank you. It starts with communicating.
That is first. I--this summer will be my actual first summer
with this school to see exactly how this program works. I do
have over 900 students. It is us really reaching out to the
parents----
Senator Brown. You have 900 during the school year----
Ms. Stanislaus. Yes.
Senator Brown. --or 900 in the summer----
Ms. Stanislaus. During this current school year.
Senator Brown. Okay. How many do you have in the summer
feeding? You do not know yet.
Ms. Stanislaus. Well, it is open to everyone, and I am not
sure yet, because this will be the first summer----
Senator Brown. But, last year, do you know how many they
had?
Ms. Stanislaus. We did not have the summer program----
Senator Brown. You did not have it last year.
Ms. Stanislaus. --and that is where, you know. We are
really excited to have it this year, and I will--I can get back
to you and let you know the success of it.
Senator Brown. Will you--if I can interrupt again. I
apologize.
Ms. Stanislaus. Sure. No problem.
Senator Brown. Sorry, Madam Chair. Do you use the same--I
know in most--it seems most that I have watched and been part,
I mean, been part as an observer, the breakfasts and lunches
and the snacks in the summer are pretty much pre-prepared in
boxes and all that. Will you, in the Summer Feeding Program,
because you are using the middle school's cafeteria, I assume--
--
Ms. Stanislaus. Mm-hmm.
Senator Brown. --will you prepare these lunches and
breakfasts the same way you do during the school year?
Ms. Stanislaus. Yes. They will get warm lunches. Breakfast
is usually a cold breakfast, a cereal and a bagel, a fruit.
But, for the lunch package, it is going to be prepared the same
way it would be prepared during the school year.
Senator Brown. So----
Ms. Stanislaus. They are actually going to have--hire staff
to come in and ensure that the teachers are teaching and the
staff who are working in our cafeteria----
Ms. Stanislaus. The reimbursement for this is enough to
fund the same kind of feeding program that you do during the
school year?
Ms. Stanislaus. Hmm?
Senator Brown. The same kind of preparation of food that
you do during the school year?
Ms. Stanislaus. Uh, yes.
Senator Brown. The funding----
Ms. Stanislaus. The county is handling the funding.
Senator Brown. The county is going beyond what USDA does.
Ms. Stanislaus. Yes.
Senator Brown. Okay.
Ms. Stanislaus. Yes.
Senator Brown. Sorry for the length of that, Madam Chair.
Chairwoman Stabenow. No, thank you very much. That is an
important question we are going to get into in reauthorization,
and breakfasts versus lunch.
Another great children's advocate--we are so lucky on this
committee to have Senator Brown and Senator Casey. Welcome.
Thank you.
Senator Casey. Madam Chair, thank you, and thank you for
having this hearing and we have great testimony here and great
witnesses.
Senator Brown was asking a lot of the questions that are on
the minds of each of us when it comes to kind of a general
point, the drop-off between the children that get either a
breakfast or a lunch or both during the school year, and then
in the summer, a huge drop-off.
In Pennsylvania, we have more than 1.8 million children
enrolled in the School Lunch Program. A fraction of that are
getting help in the summer, and that is one of our big
challenges.
Just at the outset, I just want to make a brief statement
about kind of a philosophy of mine, or a guiding principle for
me. I think one of the problems we have nationally in terms of
our national programs, national efforts--what you might even
call a national strategy, which I do not think we have for
children, but I think what we need--this question that we are
examining in this hearing is, I think, at least one of the four
pillars or one of the four parts of the strategy.
If we are doing the right thing--and we are not, we are a
long way from this--we should make sure that every child has
health insurance, every child has a quality early learning
opportunity--and when I say every child, I mean every single
one, that has to be the goal--that every child has the kinds of
basic protections from predators, and then, number four, and
not in this order, is the issue we are talking about today,
that children have access to enough food to eat, but making
sure that it is nutritious food. If we did those four things
for every child, we would be a much better country and our
national security would be enhanced.
This is one of those four, and I know we do not have time
for every question, but I wanted to ask--I wanted to start with
Dr. Cook. The WIC Program, talk to me about that in terms of
the Women, Infants, and Children Program as a preventative step
to cut back on the potential that child will be obese down the
road, if you can talk about that one particular program.
Dr. Cook. Sure, and thank you very much for the question.
The Women, Infants, and Children Program represents a great
opportunity. In New York, they piloted some of the first
changes and we were able to see in our community how the
offerings to the mothers were changing, more whole grains,
better variety of foods for the mothers who are breastfeeding
as well as for the infants and children, more culturally
diverse food offerings, as well, which we also know is very
appropriate. If a family comes from a certain cultural
background, yet what they are offered is not relative to the
parents who are preparing and serving these meals, it is not
really going to work.
I think it also represents a great window, as
pediatricians, where we look at another way to outreach to the
families. If we can get WIC workers in our office, in our
waiting rooms two days a month, where they can be there and
make available the information to families, we feel that is a
huge advantage.
I had mentioned before, 80 percent of children in our
community--in the City of Rochester qualify for Free and
Reduced Lunch, and because of that, the whole city school
district has universal Lunch Program, as well. In the two
largest practices in the city, ours and the other training
practice that is affiliated with another hospital in our
system, we have about 13,000 patients in each of them. Sixty-
five percent, if not more, are Medicaid/Medicaid-eligible, and
we know that just with those two practices, we reach
approximately 45 percent of the children in the city. Just with
those two sites, linking access to WIC and WIC enrollment
represents a great opportunity to get the information out.
For the past couple of years, we have been working with our
food pantry agency that is organizing the Summer Meal Programs,
as well as some of the advocacy agencies, to get the
information about where summer meals are into the pediatric
practices. We do not see every kid, but when kids are coming in
for a summer camp physical or for illness, we have that
information available. We always try to think a season or two
ahead, and that has been one of the strategies we have looked
at specifically.
I am very fortunate, because where I trained in Rochester,
the concept of community pediatrics was born because we felt we
had to really reach out to children and families. We have done
a great job with vaccines preventing so many illnesses in kids
that we are now seeing this wave of new morbidity, and
nutrition, physical inactivity, mental health issues are the
core of that wave, and so we really have to think outside the
four walls of our office.
Senator Casey. I was going to ask you a question, but I
will answer the question in my own way. I think if you just
looked at one indicator of how we are doing in terms of
national policy that undergirds a national strategy for helping
pregnant women, I do not think we would get a very high letter
grade, maybe a D. That is my opinion, but I think we have a
long way to go, and WIC plays a role in that, as you know.
I know we are almost out of time, but I wanted to ask our
principal, Principal Stanislaus, maybe just on a lighter note,
when you talked about irritability in the morning and Sustained
Silent Reading periods, that might help in the Senate.
[Laughter.]
Senator Casey. We do not need more irritability. We have
got plenty of that. But, Sustained Silent Reading, I think we
should consider for Senators. We are pretty irritable when we
are not eating.
But, just this whole question, which is so central to the
life of a child. I like to say that if kids learn more now,
they are going to earn more later, but you cannot really learn
if you are hungry. You cannot really learn if you have got a
lot of other things happening to you. But, just this basic,
fundamental question about the trouble that children have
concentrating----
Ms. Stanislaus. Mm-hmm.
Senator Casey. --because of lack of access to food or
nutritious food. Talk about that for a moment. I know you spoke
to it, but----
Ms. Stanislaus. Right. I think for me, personally, because
I was one of those children and I have a personal connection to
what that really feels like if you do not have your breakfast
because--or you do not have dinner because there is nothing at
home to eat and you are truly waiting to come to school for
that meal, I can get it because I can just kind of envision
what that feels like because I have lived it. I understand.
Even when my students are--it is middle schoolers. We all know
at times they say, ``Oh, I am fine,'' or try to be too proud. I
know what that really, really means. It may just mean taking
them into another location and saying, oh, here. Here is your
breakfast.
Yes, it plays a very, very heavy role. That is why, I
think, as a principal, you really need to be in touch with the
social-emotional side of where your children are and really get
to know them and get to know their families. Unfortunately,
there is a really big stigma with being a student who receives
Free and Reduced Meals. For some reason, they just know that,
oh, I am a student who receives Free and Reduced Meals. But,
having my Breakfast Program, it made such a difference because
now everyone, any child, it does not matter of the income of
their parent, can get their meal in the morning and it is no
stigma attached.
It is really pushing students past that in order to help
them unlock their best thinking, because if you cannot--if you
are hungry, you are not going to concentrate. You may get some
of the information, but you are going to miss most of the
information. At times, the hunger and the misbehavior tend to
go hand-in-hand. Once you take care of that fundamental need,
you often find that students are able to elevate their progress
throughout the course of the day, throughout the course of the
year.
Senator Casey. Thanks very much. Thank you, Madam Chair.
Chairwoman Stabenow. Thank you.
Senator Klobuchar.
Senator Klobuchar. Well, thank you very much. I am sorry I
was late. I was at a Judiciary hearing where we had some votes.
But, I knew I was at the right hearing when I saw Senator
Gillibrand's orange peels right here.
[Laughter.]
Senator Klobuchar. Thank you so much to our witnesses, and
thank you to the Chairman for holding this hearing.
In 2010, we overwhelmingly approved major reforms to the
Child Nutrition Programs through the Healthy, Hunger-Free Kids
Act, and I supported that legislation, felt very strongly about
it, and I oppose some of the current efforts to roll it back. I
think that we have shown a bit of progress with some stability
in the numbers and the rates of childhood obesity, but I think
we all know that there is a lot more work to be done.
I guess I would start with you, General Hawley. In your
testimony, you included an anecdote about school kids and the
consumption of nearly two million candy bars. I think you said
it weighed more than the U.S.S. Midway Aircraft Carrier. That
is quite a picture. I have worked closely with Senator Harkin
to change the standards for vending machines and a la carte
lines, and the Smart Snacks in school provision takes effect,
as you know, July 1st. In your view, what role do vending
machines and a la carte lines play in medical disqualifications
in recruitment?
General Hawley. Well, I think they play a huge role. We all
know that sugar is a primary contributor to this problem, the
over-consumption of sugar. I am not an expert on what is going
on in today's schools, because my kids grew up a long time ago,
but I can relate a tale from one of my partners in this effort
who related the fact that when he was a child growing up in
North Carolina, they had cigarette machines in the schools.
This is a place where kids go to get----
Senator Klobuchar. Okay.
General Hawley. --bad habits reinforced. Our experience in
the military is that by the time we get them as recruits, it is
almost too late to influence their habits, because we all know
that we develop eating habits early. I like the things that my
mother fed me when I was a child. I am 72 years old and nothing
has changed. These habits that our children form by accessing
these vending machines with unhealthy foods, sugary drinks,
Twinkies, you name it, shape their habits going forward----
That affects our ability as military services to recruit
adequately. It contributes to the fact that only 25 percent of
enlistment-eligible youth could join the military if they
walked into a recruiter's office today. We need to get a handle
on that.
Senator Klobuchar. Okay. Ms. Stanislaus, thanks for your
work as a principal. My mom taught second grade until she was
70 years old. She had 30 second graders at age 70, so I really
appreciate your work.
As implementation of the Healthy, Hunger-Free Kids Act
continues, USDA, as you know, has provided additional technical
assistance, including $25 million in grant funding to help
schools purchase kitchen equipment that will allow them to
provide healthier meals.
As an administrator who works closely with the cafeteria in
your school, do you think that there is going to be more
investment in kitchen equipment in order to provide healthier
meals?
Ms. Stanislaus. I think that for my county, the Food
Services Administrators, they often visit our school to monitor
and ensure that the lunches that we are serving are healthy. I
have to say that my county has done a really great job with
giving our school and all of the schools across the county kind
of a guideline as to what is acceptable nutritional values.
Days of pizza parties are gone, because we want to ensure that
the foods that we are serving are of really high nutritional
value.
I think about the vending machine. We do have a vending
machine. It is on a timer, and I thank you for ensuring that we
do have healthy snacks in the vending machine that are not only
befitting what the expectation here is for this committee, but
also the expectation for my county. Students, yes, they are
allowed to go to the vending machines, but after they have
eaten their meals.
Getting back to the equipment in the kitchen, everything
for our kitchen, we are really, I would say, pretty much doing
okay. But, if there is ever anything that we need, the county
is right there to support my staff.
Senator Klobuchar. Thank you, and our State has actually
been a leader in bringing the Farm to School Programs in place.
I am out of time here, but I will ask you about that in
writing. Thank you very much for all your work, and----
Ms. Stanislaus. Thank you.
Senator Klobuchar. --we know that change is not easy, but I
think these standards are very important and I do not think now
is the time to roll them back. Thank you.
Chairwoman Stabenow. Thank you very much.
Senator Thune.
Senator Thune. Thank you, Madam Chairwoman, and thank you
all for being here and for providing great insights on this
important subject.
General, thank you for your service. Welcome back. It is
nice to see you again. I am interested in the fact that 25
percent of our young people 17 to 24 are eligible, and you
listed academic preparedness, obesity, and criminal records as
the three, and I guess--where does obesity fit into that, and
how has that changed in the time that you were in the service
relative to those other factors?
General Hawley. Well, on the first point, our best--people
are disqualified sometimes for multiple reasons, so it is a
little hard to pin down exactly what percentage is due to
overweight or obesity, but better than one in five of the
disqualified applicants are attributable to overweight or
obesity.
Senator Thune. Okay.
General Hawley. The change is dramatic, of course, over the
course of my service. I became a Second Lieutenant in 1964. It
was a very different country then and obesity was not nearly
the problem that we have today. I cannot give you the number,
but I would guess it was below ten percent were rejected from
service because of their weight.
Senator Thune. Well, and you said 1,200 a year are
discharged because of that. Is that--when they are discharged,
we assume that when they came in, they met the weight
requirements, and then what contributes to that while they are
in the service? How do they----
General Hawley. I think most of them were borderline when
they came in, and, of course, we feed them very well.
[Laughter.]
Senator Thune. Right.
General Hawley. We exercise a lot, but we offer a lot of
food. Sometimes it is due to other factors. They have consumed
so many sugary drinks rather than milk and too few vegetables
so their bones are brittle and we wind up with--it is both a
weight-related problem and a diet-related problem, so they
suffer fractures, serious sprains, whatever. But, there is a
lot of issues with those, and every time we have to discharge
one for these problems, we spend about $75,000 to go recruit a
replacement and train them, to the tune of about $90 million a
year.
Senator Thune. Let me just--I can direct this to anybody on
the panel, but, just, what can be done to encourage parents to
do a better job, take more responsibility for providing
healthy, nutritious meals for children? I mean, people kind of
hearken back to their younger days. When I was growing up, I
grew up in a small town. We did not have a School Lunch
Program, so everybody either went home or they brought a sack
lunch to school. We, fortunately, lived close enough to the
school that we would go home, but my parents both worked, and
somehow, my mother managed to get up in the morning and get
something for us for breakfast and then put something in the
oven for lunch.
It is a very different world today, but what can we do to
encourage, better incentivize parents to complement the meals
that are provided at the schools and ensure that our kids are
getting the nutrition that they need?
Dr. Cook. I can speak on that topic from the standpoint of
I have yet to meet a parent that does not want to try to
provide the basic necessities, as we have heard. Feeding and
sleeping are probably the most important things to the parent
of a newborn. It is really important to craft that message and
think about that message very early. We are even looking at and
seeing research that it is at the time of conception and during
pregnancies, when mothers are planning what they are going to
do for their child--where they sleep, how they feed, if they
breastfeed, a number of things that go on that actually sustain
those behaviors very early.
It is really important to understand, and when I say
parents, unfortunately, this does become much a burden of
mothers because of their role. I think it is really important
to understand that identifying these issues very early at the
health of pregnancy can be one of the early windows to try to
identify where parents feel is normal and not normal, what is
really healthy versus perceived healthy.
We have hit on history a lot here and I find that very
important, and one of the best advocates I have often found is
when grandma is in the room, because that can be a great
resource for the family. Unfortunately, many of the families I
see, not really the traditional nuclear family are very
disconnected. They may not have the same type of social support
and social structure that can give that type of beneficial
anecdotal evidence.
I think it is important to understand, the evidence is very
difficult to figure out in kids because you cannot do a
research study in a child the same way you can in an adult.
They are a protected population. It is using history, using
families, and in this case, providing those resources at really
critical times, and in infancy and childhood, getting families
to adopt these behaviors is really an important time because it
can imprint these behaviors throughout their lifetime.
Senator Thune. Do you think that we put too much--I mean,
is it a disincentive to parents when you increase the number of
meals and parents start shifting that responsibility to the
schools and say, well, the school is going to take care of
that?
Dr. Cook. I think it is a really important balance to try
to strike, because the parents are assuming, and parents do
have a respect for the school to protect their child, and so I
think it represents that balance of they are assuming that it
is the right thing that is being done there. As we have had
parents engage schools around the PTA, around school wellness
policies, they become very concerned and shocked when they are
actually in there seeing what is available. I think it is a
balance of the responsibility of the parent as well as the
school, and that is why having parents involved in the process
actually is moving this forward very well.
Senator Thune. My time has expired, so thank you, Madam
Chairman. Thank you all.
Chairwoman Stabenow. Thank you very much.
Senator Gillibrand.
Senator Gillibrand. Thank you. Thank you, Madam Chairwoman,
for holding this hearing. I am very grateful.
Mr. Thornton, with the start of summer upon us, I am
reminded that many of our low-income students and children will
lose access to school breakfasts and lunches that they rely on
during the school year and that both hunger and obesity go up
during summer vacation. The Summer Nutrition Program ensures
that low-income children have access to healthy food throughout
the summer. Most Summer Nutrition Programs occur in tandem with
education enrichment programs that keep kids learning, engaged,
and safe during the summer months.
However, despite these benefits, summer meals only reach a
fraction of eligible children and many children often do not
have adequate access and go hungry during the summertime. Can
you talk a little bit about the need to ensure access to
healthy meals year-round so that children are returning for the
school year healthy and ready to learn.
Mr. Thornton. Senator, thank you for the question. Quickly,
to address the former, Senator, one of the things I talk about
to our over four million parents around the country is personal
accountability. Education begins at home. Dr. Cook mentioned
earlier, different people come from different stages in life. I
am one of those kids who did not always have access to food
during the summers. I mean, my family did the best they could,
but, again, we have to keep that in mind as we look at the
public school system its, use as a public good and that these
type of programs help kids that may not have the same privilege
or opportunity as other kids have had.
Senator, as for the programs we are looking at and working
on for our children, we are working with Secretary Vilsack and
the Department of Agriculture and other organizations to help
find those resources to get additional food for those kids in
the summer, recognizing, as we heard the principal talk about
today, the impact that it has on their academic performance and
coming back to school after having to deal with that. Very
directly, we are working with government agencies and our
advocates to try to get those programs in the communities.
Senator Gillibrand. Thank you.
Dr. Cook, in New York, we talk a lot about the intersection
of childhood obesity and actual hunger, that the quality of the
nutrition that some of our most obese children are receiving is
so low that they are actually obese but still starving. We
address this a bit in the farm bill with food deserts, trying
to make sure that inner cities or remote areas have access to
affordable fruits and vegetables. You would be surprised. There
are food deserts in the Bronx, in Brooklyn, in the North
Country. In a State as wealthy and rich as New York, it seems
outrageous.
But, can you talk a little bit about the intersection of
hunger and obesity and what are the dynamics at play, and what
are your best ideas for the School Nutrition Program to combat
both, or any other programs that you think are worth
mentioning.
Dr. Cook. Thank you very much for the question, Senator.
The interaction of hunger and obesity is a really important and
complex one. As research has actually really shown, the body
physiologically adapts to these different states. Anecdotally,
the story is always that at the beginning of the month,
families have more food. Near the end of the month, there is
less. We have seen evidence that shows that the eating
patterns, the foods available in the home are different at the
beginning of the month versus the end of the month.
The problem is that metabolically, physiologically, that
actually has an impact on the body, and biologically, we are
still cavemen. When we put on calories, the body's metabolism
when we store that alters to hold on to that, to defend that
weight, because we know we need to survive. Even though it is
not the Stone Age, our bodies physiologically still respond
that way, which makes weight loss extremely difficult.
You have a person, especially a child, who has gained a
tremendous amount of weight for whatever reason, whether the
origins are hunger, stress, depression, overfeeding and cyclic
feeding patterns that you would see if you are having more
calories at the beginning of the month versus the end. That
makes it more difficult to lose weight.
The stress that comes with hunger also drives up hormones
that drive up appetite. The distress that goes on in some of
our children is obesity is just one of the manifestations of
that. The hunger is always there. As we look at these children
metabolically, even though their weight may be normal or high,
they are nutrient deficient. We still see many children, obese
children, who are iron deficient, who are borderline Vitamin D
deficient, because while they get excess calories, they are not
getting the important nutrients. We know in childhood,
especially in infancy and toddlerhood when the brain is
growing, just like it is more susceptible to a small level of a
toxin like lead--a small amount of lead fed to a child or a
child is exposed to lead as a toddler has a big impact on the
brain.
Very concerning that the nutrition science is coming along
that is suggesting some of the same findings. Are we imprinting
eating behaviors, or because of nutritional deficiencies,
affecting the developmental growth, the brain growth in
children.
Senator Gillibrand. Thank you, Doctor.
Ms. Stanislaus, can you talk about ways to increase
participation in School Nutrition Programs, such as offering
breakfast or lunch for free for all students, allowing students
eligible for reduced price school meals to participate for
free, or implementing a Breakfast Program.
Ms. Stanislaus. I still struggle every year with having my
parents complete a form that will make them eligible for their
students to receive Free and Reduced Meals. As stated earlier,
I currently have slightly over 65 percent of my students who
are eligible for that, but I can assure you that I have more
children in my building whose parents may not have felt
comfortable filling out that form because it, in a sense,
stigmatizes them.
Once we received the Free Breakfast Program for all
students, it took that stigma away. Wow, would it not be
amazing to have a Free Breakfast Program and a Free Lunch
Program so that it would take away the stigmatism that goes
with having to fill out that form and turn it in and, oh my
gosh, what are they going to think about me.
I struggle with that every year. Sometimes, it is me
calling a parent into my office and kind of having a heart-to-
heart and letting them know, it is okay. I will take the form.
I will personally turn it in. It makes that difference, but
that is the difference, and the time that I am willing to take,
and many of my colleagues, to ensure that the children get what
they need.
In saying that, I think if it does not change, just
exciting students about learning about nutrition, like Dr. Cook
was saying, using food as fuel as opposed to, I just want to
eat it because it really tastes good. They may--trying
different things will excite them. In turn, I have found as a
principal, often it excites the parents.
But, going back to if it were free for all, I can imagine
that everyone would partake in the program.
Senator Gillibrand. Thank you, Madam Chair.
Ms. Stanislaus. Thank you.
Chairwoman Stabenow. Thank you very much.
Senator Boozman, we are so glad to see you.
Senator Boozman. Thank you, Madam Chair. Thank you very
much.
Ms. Stanislaus, I really do not have a question for you,
but I do want to thank you. As a principal, I know how hard you
all work. I was on the school board for seven years, and I tell
my colleagues, it does not matter what issue we are discussing
here, there are many school board issues that are much more
tougher. We do appreciate all that you represent and the people
that work with you to get this done.
Dr. Cook, in your testimony, you told the story about a
small change in beverage consumption that made a huge
difference for a young person and got them back into the normal
BMI range. Is there any other low-hanging fruit out there that
we can do in the same manner?
Dr. Cook. The area that we look at in terms of low-hanging
fruit----
Senator Boozman. Maybe it is fruit.
[Laughter.]
Dr. Cook. Low-hanging vegetables, I would add.
[Laughter.]
Dr. Cook. I think both of those are part of the key points,
and it is really important to find where the evidence is and
then what is feasible. I can give patients all kinds of advice,
but if it is not going to fit in their lifestyle, in their day,
in their routine, it is not going to work. Relative in terms of
the low-hanging fruit, early and often. Giving the message
seven times is kind of a joke, but really a useful strategy.
If we have some of these same messages that we are using in
our offices are being used in schools and day care centers
around screen time, physical activity, active play, where they
are running around--not necessarily has to be structured
sports. Fruits and vegetables are really important and really
tough, probably the toughest of all the behaviors because of
access, taste, presentation, so many steps that can go into it.
But, liquid calories really are very occult, and I say that
because you could drink this package full of water or it could
be a sugary beverage and the amount of fullness you will feel
will be the same, and will probably be minimal. Yet, you could
have 600 calories in there or you could have zero.
Senator Boozman. Right.
Dr. Cook. The amount of time a parent or a child--actually,
the amount of time a child needs to be active to burn 600
calories would probably drive a parent nuts----
[Laughter.]
Dr. Cook. --because of the amount of activity. I mean, a
big misperception is that children are very active and it burns
a lot of the calories. As liquid calories, being, really, an
important first step. Screen time and----
Senator Boozman. You run into--and I do not mean to
interrupt you----
Dr. Cook. No, go ahead.
Senator Boozman. But, you run into the same problem besides
the Coke-type beverages. You would run into the same problem
with some of the juice, high-calorie sugar----
Dr. Cook. Absolutely. I mean----
Senator Boozman. --or carbohydrates.
Dr. Cook. Yes. I mean, virtually almost all the liquid
calories we drink will fall into that range and it has a very
similar pattern. The low-hanging fruit, a lot of times, can be
liquid calories.
Again, screen time, very important. When we can bring in
more evidence to reinforce it to parents--the screen time is
bad because it is mindless time. They are not active. It is
actually more time for consumption. If you sit in front of a
screen for five or six hours, you may not burn 100 calories,
but you may eat 250 calories, and it is that occult eating that
you do not catch. The same thing with kids, and it becomes a
repetitive type of behavior. It also does not allow kids to
relax and fall asleep easier, and that, again, is a very
important concern for our parents.
Having the stealth type of intervention, or having the
collateral type of advantage of these small steps can be really
beneficial, and if we can give these in age-appropriate simple
steps in our office and in other settings that reach families
and children, like school, early child care programs, after
school programs, then we are hitting them with multiple
messages--the same message multiple times.
Senator Boozman. In your testimony, you equated that to a
normal BMI range. The BMI, it has some problems with it in the
sense that there are body types and things. I hear from parents
occasionally that you have a kid that is just a good, healthy,
normal looking kid, and yet the BMI says that they are obese.
Our body types are different. Is there another test that is
coming out that perhaps will do a better job of identifying
people that truly are in need?
Dr. Cook. I think that is a very important point, because
BMI is a useful tool on a population level, and if measuring a
thousand people, the top third fall in this range for health,
on the individual level, it can be more limiting because it
measures weight either as fat or as muscle. I always caution
pediatricians to think about it. When we try to use the data,
the higher the cut-off, the worse concern I have. But, in a
young child, I will also ask a pediatrician, if they are asking
for advice, what is the parent's weight, because having two
obese parents as a three-year-old is actually a much bigger
risk factor for that child to be an obese adult than their
actual weight at the time.
Additional measures really comes out of the research that
we are trying to develop and the importance of continuing this
research and looking in children, because children are a group
that are not studied as closely. We are putting more attention
to it, and we need to understand what is the really normal
physiological growth. I think the sad point is that we do not
have as many children going through normal physiologic growth
in our modern era than we would have even 30 years ago.
I would also add the point that, when parents will say,
well, they are big boned, or they are pretty large, most
toddlers, three-, four-, five-year-olds, do not have that much
muscle mass. Even when their BMI is high, it is more likely
going to have more components of body fat. Now, when it is
teenagers and body and muscle mass and fat mass are changing,
it is a different story and it can be very difficult.
But, I agree. It really does need to look at a mix of when
we can identify BMI as the first step.
Senator Boozman. Right.
Dr. Cook. What I like to say is, like not every tumor is
cancer, not every high BMI is obesity----
Senator Boozman. Right.
Dr. Cook. --and, so, we really do have to work on that.
Senator Boozman. I think you make a good point. Even among
the pediatric community, that is so well educated in this, my
concern is that at the school level, where you have an
administrator or whoever is doing these programs, and in many
of our smaller schools, there are people like that. They simply
look at a number, chart that in, and it is automatically that
way without using any common sense along with it.
Dr. Cook. I agree, and I think schools have a lot of things
on their plate, and doing fitness testing, we know, is
beneficial, and increased cardiovascular fitness is beneficial
for all kids. But, as we have seen in Rochester when asking
parents and doing surveys, they want to hear about this and
talk about this with their primary care provider. Even if we
can off-load some of those burdens from schools of doing it,
because that is where we are hearing----
Senator Boozman. I agree.
Dr. Cook. --the few but loud stories of, this is not really
an accurate measure of my child, well, that may or may not be
true. But, maybe if we put it in a different context when
health can be presented, it can take some of the burden off of
schools and can put it in a setting where parents may be more
comfortable to discuss it.
Senator Boozman. Right. Thank you, Madam Chair.
Chairwoman Stabenow. Thank you very much. Really important
questions and discussions.
We are going to be wrapping up, but I would like to ask
each of you a closing question, the same question, that would
be very helpful to us because we have been talking about child
nutrition and the impact both within the school, but also more
broadly for our country. If you could give the committee a
piece of advice as we consider reauthorizing Child Nutrition
Programs, what would you say is the most important thing we
could do to address some of the concerns and the ideas that you
have raised today.
I will start with General Hawley.
General Hawley. Well, I learned during my career that
probably the most valuable trait you can have is persistence.
As they say, persistence will out. I guess my advice would be,
stay with it. This is an important program. I am sure it is not
perfect and it can be improved. But, I think it is beginning to
work. My view is that this is a cultural issue in our country
and cultures take a long time to change. We should not expect
instant results from any program, least of all one that tries
to change the nation's eating habits. I give my advice, stay
with it. Keep up the good work. I think, in time, we will see
the results.
Chairwoman Stabenow. Okay. Great advice.
Mr. Thornton.
Mr. Thornton. Thank you, Chairwoman. As we talk about these
nutrition needs of our children, they remain the same whether
you live in Iowa or Georgia. It is impractical to try to force
parents to fight for access to healthier foods one school at a
time. Instead of reinventing the wheel while facing the same
obstacles, this is the way the reauthorization of these
programs can continue to make a difference.
PTA has worked very hard throughout the history to ensure
that kids had access to equal education, proper nutrition,
proper fitness, and it is very, very important. I just thank
you and the committee and all the panelists for engaging this
topic, which is critical to the future of our children and our
country. Make no mistake. The decisions during this
reauthorization will have a definite impact on our schools, our
hospitals, our economy, our military, our homes, and most
importantly, our kids.
I thank you for this time.
Chairwoman Stabenow. Thank you very much.
Dr. Cook.
Dr. Cook. Thank you very much for the question. I find it a
persistent question that we get a lot related to this as I give
presentations, and sometimes it is the, what is the one thing I
would do if I could do something, would be to get everyone to
realize there is not one thing you can do. Everything is part
of the problem. Each one of these strategies and proposals
represents one percent of the solution. It cannot be left off.
It is not the magic bullet. We need to include all of these.
We need to think global and act local, because that is
where I find, like, a lot of social change occurs. It is going
to occur at the grassroots level where it really can take hold
and have that local relevant context that is really important.
I thank you for the question. Just to conclude, with
obesity and with hunger, we discuss this a lot, and I think it
is really important that obesity has come up as a disease, but
it is probably the one disease that still exists that does not
carry the dignity of other chronic diseases, and that is even
more so a problem for children and adolescents. I think it is
really important to make this about health, about health at any
size, and promoting the health across all children and all
families.
Chairwoman Stabenow. Thank you very much.
Principal Stanislaus.
Ms. Stanislaus. Thank you, Chairwoman. We have mentioned a
few times today that how the schools are really on the front
lines. I thank you for this opportunity to share my thinking
and my experiences with our school and my school system. The
partnership is definitely something that I would say, let us
continue this conversation and think about what actions that we
will take and that we can take back to our schools and our
school districts, continued opportunities to increase the
education for parents.
What--just as a one principal schoolhouse, I often find
that we struggle with funding to have different events for
families, after school events. It does take money to put these
things together. At times, we are robbing Peter to pay Paul in
order to make this happen for our local communities. If we can
think about opportunities for these partnerships with
universities, as I mentioned earlier, or increased funding so
we can have buses after school so that we can not only have the
nutritious After School Program and Snack Program, but also
physical activities and clubs that students can be a part of so
they are not sitting in front of the screen at home.
I think this continued conversation, this conversation does
not need to stop here. Getting feedback from other principals
and schools would be a great welcome to different educators and
all educators. Thank you.
Chairwoman Stabenow. Thanks to each of you, and this
discussion does not stop here. This is just the beginning. It
was important to me that we start with the big picture of why
we have these programs, why should we care about this. We are
going to be hearing from all perspectives and working with
everyone to make sure that the way things are done makes sense
and are workable, and we certainly want to move forward, not
backward. We do not intend to move backward, so we are going to
move forward. But, we think it is very, very important that we
talk about why, as a country, why, as a community, why, as
parents and family members, that we need to care.
Thank you again to everyone. Let me just remind colleagues
that any additional questions for the record should be
submitted to the Committee Clerk five business days from today.
That is 5:00 p.m. on Friday, June 20.
The hearing is adjourned.
[Whereupon, at 11:34 a.m., the committee was adjourned.]
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