Awareness of the nation’s epidemic of overweight, undernourished, and sedentary youth is leading to interventions in schools nationwide to provide environments supportive of healthy lifestyle behaviors. The 2004 Child Nutrition and WIC Reauthorization Act provides specific opportunities to combat childhood overweight, positively impact children’s health, and create healthy school environments (1). By the beginning of the 2006-2007 school year, the Act requires that each school district participating in federally funded school meal programs (e.g., school breakfast and/or lunch) have a local wellness policy in place (1). School districts must address goals for nutrition education, physical activity, other school-based activities, and nutrition standards for all foods and beverages in school.
Wellness policies are an opportunity for schools to improve students’ health through two important steps called for in the 2005 Dietary Guidelines for Americans (2): increasing consumption of fruits, vegetables, whole grains, and low-fat milk products, and increasing opportunities to participate in physical activity.
This Digest discusses the need to improve children’s health; why schools are an ideal setting to positively change children’s lifestyles; efforts to create a healthier environment in the nation’s schools, specifically how dairy is part of the solution; and resources/programs available to help schools develop and implement local wellness policies.
THE NEED TO IMPROVE CHILDREN’S HEALTHChildhood overweight is a growing epidemic, affecting more than twice as many children and almost three times as many adolescents as in 1980 (3,4). Among children aged 6 through 19 years, 16% are overweight and an additional 15% are at risk for overweight (4). Childhood overweight is more prevalent among minority populations (4). Poor eating habits (e.g., increased intake of total calories from non-nutritious snacks, sweetened beverages, and fried and nutrient-poor foods) and lack of physical activity are underlying causes of childhood overweight (2,5-7).
The 2005 Dietary Guidelines for Americans identifies five nutrients of concern for children and adolescents – calcium, potassium, fiber, magnesium, and vitamin E (2). In particular, children’s diets are low in calcium (8). Compared to the recommended dietary intake (Adequate Intake) of calcium of 1,300 mg/day for children ages 9 through 18 (9), median calcium intake (50th percentile) is 1,086 mg/day for males aged 9-13 and 837 mg/day for females of the same age. For males and females aged 14 through 18 years, median calcium intakes are 1,094 mg/day and 753 mg/day, respectively (8).
Schools are an ideal setting to improve children's nutrition and physical activity and help reverse the growing trend of childhood overweight.
Recognizing that the vast majority of people need to consume more dairy products, the Dietary Guidelines increased the number of dairy servings (3 servings/day) recommended for many age groups and listed low-fat and non-fat dairy foods among three groups of “Foods to Encourage” – along with fruits and vegetables, and whole grains (2). Dairy foods contribute more than 60% of the dietary calcium intakes for persons under 19 years of age (10). Milk, cheese, and yogurt are naturally nutrient-dense foods providing calcium, potassium, other minerals, vitamins, and protein essential for children’s growth and development (11).
According to the 2003 Youth Risk Behavior Surveillance study, 83% of high school students in grades 9-12 had not consumed 3 or more servings of milk/day and 78% had not eaten 5 or more servings of fruits and vegetables/day during the seven days preceding the survey (12). A study of more than 1,500 ten-year old children in Bogalusa, LA found that children who drank the most sugary drinks had lower intakes of milk compared to those with low, or no, sugary beverage intake (13). The trend of declining milk consumption and increasing intake of high energy, low nutrient beverages among children and adolescents can contribute to nutrient shortcomings as well as increase the risk for chronic diseases such as osteoporosis, hypertension and, as indicated by emerging science, failure to obtain a healthy body weight (5,14-16).
The 2005 Dietary Guidelines for Americans recommend that children and adolescents engage in at least 60 minutes of moderate intensity physical activity on most, preferably all, days of the week (2). A substantial proportion of children and adolescents fail to meet this recommended level and physical activity tends to decline as children become adolescents (6,12).
Children’s unhealthy food choices, sedentary lifestyles, and resulting overweight can have adverse consequences in terms of health, academic achievement, and economics. Overweight in children is associated with high blood pressure, hyperlipidemia, type 2 diabetes, low self-esteem, and social discrimination (5,17-19). Also, children and adolescents who are overweight are more likely to become overweight or obese adults than their healthy weight peers (5). In addition to overweight, nutrient deficiencies in children can contribute to chronic diseases (2,6,14,20). For example, children’s failure to meet their calcium recommendations can increase their risk of bone fractures and lead to osteoporosis in later years (14). Overweight and undernutrition can also have adverse academic (21-23) and economic (24) consequences. In addition, physical inactivity may compromise children’s readiness to learn. A meta-analysis of nearly 200 studies including children and adults found that physical activity supports learning (25). For more information about the link between nutrition, physical activity, and weight and academic performance, refer to the Action for Healthy Kids’ report, “The Learning Connection” (26).
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