Schools really can serve healthy meals

For a child, eating a piece of fruit is not some big challenge like climbing Mount Everest.

It is realistic for us to expect school meals programs to meet the modest sensible new standards. All over the world, children are capable of eating the basic amounts of fruits and vegetables that are served under the new standards. Throughout longer-term U.S. history, I imagine children have eaten meals with these amounts. It is the recent history of fast food meals in school that are the aberration.

In a transitional year, it is not surprising to see some reports of increased plate waste. Everybody recognizes that plate waste may go up for new menu items, and then come down again as children become accustomed to them.

In this week's Congressional struggle over child nutrition programs, some folks describe the new rules in terms of a food police state run amok. This is not fair. In contrast with government restrictions on, say, advertising practices targeting adults, what we serve in schools has nothing to do with police power. Taxpayers and parents are entrusting schools with several billion dollars each year, in return for feeding our children. Surely the adults who receive these funds for this task can serve reasonably healthy meals.

I had the chance to discuss these issues with Alan Bjerga at Bloomberg, whose article was published today. He quotes both critics and supporters of the new rules. I pointed out that the new standards themselves are probably not the problem. I strongly suspect that the school food service operations would be better sports about this change if only Congress had offered them more than a measly six additional cents per meal to compensate for the potential cost increases that might result.

Other recent coverage comes from National Public Radio. The Robert Wood Johnson Foundation offers this infographic (which I saw on the Food Politics blog).

Advertising fast food to children

Leading fast food companies have pledged to follow specific advertising guidelines under the Children's Food and Beverage Advertising Initiative (CFBAI), a project of the Council of Better Business Bureaus (BBB).

These voluntary pledges remain quite weak. One recent summary of the argument that these pledges are insufficient [note: slight edit for clarity Apr 5] comes from the Rudd Center for Food Policy and Obesity at Yale University. The companies describe the pledges in shorthand, saying loosely that they now advertise only healthy food to children. In truth, more precisely, the companies still advertise both unhealthy and healthy food choices to children.

For example, a company pledge may claim to show only children's meals with comparatively healthy sides and beverages (such as apple slices and milk) and not less healthy options (such as french fries and sugary soda). Even with no further deception, the advertisements for the healthy meals help build brand awareness with children, increasing probability of generating a purchase occasion. Once the child and guardian are in the restaurant, the company heavily markets apple slices and french fries, milk and soda, whatever it takes to make the sale. The CFBAI guidelines address advertising on television and the web and do not prevent marketing of unhealthy options at the point of purchase, so the unhealthy options remain a large fraction of actual revenues for children's meals.

And, in any case, there is further deception. New research supported by the Robert Wood Johnson Foundation finds that most children who view Burger King advertisements showing apple slices think the advertisement is showing french fries. The apple slices look like french fries, and the children overlook a small apple symbol on the package.

I do not believe the confusion is accidental. Reason Magazine's Hit and Run blog credulously accepts an account in which the children's misunderstanding merely shows that Burger King is effectively marketing apples by presenting them in an "apple fries" format, but that sounds like spin to me.

You can judge for yourself. Here is the actual video from the research team, led by James Sargent, MD, co-director Cancer Control Research Program at Norris Cotton Cancer Center. Ask yourself, is Burger King advertising only apples (as the company's CFBAI pledge claims), or is Burger King also in practice advertising french fries to children (in which case the company's CFBAI pledge is dishonest)?

I'm enough of an economist that a fast food company's marketing fails to outrage me. I expect Burger King to market burgers and fries as vigorously as it can, subject to the dual limitations of government rules and social norms. What bothers me instead is that organizations that purport to be independent referees serving the public interest -- such as CFBAI -- pretend that the fast food companies really have voluntarily ended their advertising of unhealthy food to children. It is admirable to seek market-oriented business-friendly solutions to social problems, but let's not deceive ourselves by claiming that marketing unhealthy food to children is a problem we already have under control.

New research on breakfast in the classroom

Educators and school nutrition personnel in recent years have been discussing and debating the merits of serving breakfast in the classroom at the start of the school day, rather than in cafeterias. Participation is higher for breakfast in the classroom, leading to high hopes for increased impact on beneficial health and learning outcomes, while at the same time raising concerns about over-consumption for children whose in-class breakfast is their second meal of the morning.

New research in the Journal of Policy Analysis and Management uses a "difference in difference" design before and after implementation in a large urban school district in the southwest, finding that breakfast in the classroom rather than the cafeteria has a positive effect on test scores. It is possible that the benefits are due to improved performance on the day of the test (perhaps because the kids were less hungry that morning) rather than longer term learning, but the favorable results are still notable.

This research, and related research, is discussed in a new video from ChildObesity180, an initiative led by Christina Economos and many colleagues here at the Friedman School at Tufts. This video, which briefly summarizes both sides of the debate before arguing in favor of breakfast in the classroom, is part of an extensive video series on school breakfast issues.

McDonald's offers to make some alterations to beverages in children's Happy Meals by 2020

McDonald's this month announced at a White House event that it would make some changes to beverages marketed to children in Happy Meals.

The Alliance for a Healthier Generation, a project of the Clinton Foundation and the American Heart Association, praised the announcement warmly.  President Bill Clinton encouraged other companies to emulate McDonald's:

If we want to curb the catastrophic economic and health implications of obesity across the world, we need more companies to follow McDonald’s lead and to step up to the plate and make meaningful changes. I applaud them for doing it.

McDonald's appeared to say that sodas would be removed from Happy Meals.  A McDonald's ad (.pdf), and the press release from the Alliance for a Healthier Generation, both used the same language, saying that Happy Meals would:

Promote and market only water, milk, and juice as the beverage in Happy Meals on menu boards and in-store and external advertising.

That would be a big change if it were true.  But it appears not to be true.

As Marion Nestle and the Center for Science in the Public Interest (CSPI) later reported, McDonald's agreement with the Alliance for a Healthier Generation reads quite differently from the advertising copy and the Alliance's press release.  Instead of saying McDonald's would only "promote and market" healthy beverages on menu boards and in advertising, the agreement (.pdf) actually says McDonald's would only "feature" the comparatively healthy beverages.

The agreement explicitly adds that McDonald's may continue to put soft drinks on the Happy Meals section of menu boards.  In plain English, this contradicts the company's summary statement.  Moreover, a confusing sentence in the agreement appears to say that Fruitizz and Robinson's Fruit Shoot count as compliant with the "CGI commitment," which may indicate that sweetened fruit soft drinks will be treated as juice.  Finally, the commitment has a timeline that was not mentioned in the company's ad: it will apply to up to 50% of key markets within 3 years, and 100% of key markets by 2020 (and these key markets themselves represent 85% of all sales).

What lesson can we draw from this?

• If you think the marketing environment children face today is fine, and you don't believe any major change is needed, the small voluntary changes offered by McDonald's are satisfactory.
• If you want to see a substantial change in children's marketing environment, it is reasonable to think that these voluntary self-regulation initiatives are far too mild to make any difference, and that the government should take stronger action to protect our children.
• If you want to see a substantial change in children's marketing environment, but you are skeptical of government initiative to improve things, you should turn to one of the best private-sector tools for defending the consumer's interests -- you should speak up for yourself in every public forum you can.  Many sensible parents who prioritize their children's nutrition have simply concluded that nothing but grief comes from patronizing these quick service restaurant companies and their special meals targeting children.  Tell your friends and family what you are doing as a responsible parent in your own community.    

Revolution Foods in school meals

At the Menus of Change conference in Boston this evening, I especially appreciated the presentation by Kirsten Saenz Tobey, the Chief Innovation Officer of the ambitious new school food service company Revolution Foods.

The presentation took the form of an interview of Tobey by her former business school professor Will Rosenzweig, whose questions led her through the remarkable growth of her company from social entrepreneurship projects at university to a multi-million dollar corporation serving millions of meals.

Although Tobey and her collaborators had originally envisioned a not-for-profit corporation, perhaps principally with foundation funding, an instructive turning point happened when they realized that the amounts of capital required for kitchen renovations and other investments could not be raised except on a for-profit basis.

The company has had good coverage recently by Forbes, Take Part, and the Economist.  A difficult challenge is cost.  Revolution Foods may cost more, and San Francisco columnist Dana Woldow has been pressing for transparency on the full cost of the company's contract with that city's school system (and also rapping the company's knuckles for run-of-the-mill puffery in hinting at claims of improving student test scores).

Tobey says the company soon wants to challenge a major brand-name provider of packaged lunch meals sold in grocery stores (I can only think of Lunchables).  That is a worthy villain, and, at the same time, one can't help wondering if plain lunch ingredients sold as non-brand-name ordinary food might really be the more sustainable competitor to over-packaged brand-name lunches.

This is a company whose progress I want to watch in coming years.

Improving the nutrition environment in schools

For just a few more days, you can submit comments to USDA's Food and Nutrition Service (FNS) regarding the agency's new proposed regulations for "competitive foods," including vending machines and snacks for sale.

Highlights, according to the FNS summary, include:

• More of the foods we should encourage.  Promoting availability of healthy snack foods with whole grains, low fat dairy, fruits, vegetables or protein foods as their main ingredients.
• Less of the foods we should avoid.  Ensuring that snack food items are lower in fat, sugar, and sodium and provide more of the nutrients kids need.
• Targeted standards.  Allowing variation by age group for factors such as beverage portion size and caffeine content.
• Flexibility for important traditions.  Preserving the ability for parents to send in bagged lunches of their choosing or treats for activities such as birthday parties, holidays, and other celebrations; and allowing schools to continue traditions like occasional fundraisers and bake sales.
• Reasonable limitations on when and where the standards apply.  Ensuring that standards only affect foods that are sold on school campus during the school day.  Foods sold at an afterschool sporting event or other activity will not be subject to these requirements.
• Flexibility for state and local communities.  Allowing significant local and regional autonomy by only establishing minimum requirements for schools. States and schools that have stronger standards than what is being proposed will be able to maintain their own policies.
• Significant transition period for schools and industry.  The standards will not go into effect until at least one full school year after public comment is considered and an implementing rule is published to ensure that schools and vendors have adequate time to adapt.

To me, a fundamental issue is that schools are supposed to act with the child's interest at heart.  No matter what your view about other health policy proposals to regulate food sales (such as sales of soda in New York City movie theaters for example), we should all recognize that schools are different.  This is not a question of regulatory overreach.  This is a question about whether adults in publicly funded institutions should be making money for education programs by selling high-calorie snacks and sugary beverages to young children in the midst of widespread health concerns about childhood obesity.

Current information resources include earlier coverage on this blog, the FNS site, and (if you want to see an example of suggested comments from a leading public interest organization that has studied this issue closely) the Center for Science in the Public Interest (CSPI).

As deeper background reading, I greatly appreciate Janet Poppendieck's thoughtful book, Free for All: Fixing School Food in America (University of California Press).

For local eastern Massachusetts readers, I notice that Poppendieck is giving a free public lecture at Boston University (in the College of Arts and Sciences Building, Room 211, 725 Commonwealth Avenue, in Boston, on Tuesday, April 2, 6 pm).

Dairy industry petitions FDA to make it easier to flavor milk with aspartame

The International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF) have petitioned FDA to modify the standard of identity for milk, permitting companies to add a non-calorie sweetener without additional labeling.

The petition proposes to allow dairy companies to add the non-nutritive sweetener aspartame to milk, without being required to label the milk as "low-calorie" or "low-sugar."  Currently, aspartame is allowed in milk (just as in diet soda), but such milk must be labeled to let the consumer know.

It appears the dairy industry is especially interested in marketing low-calorie flavored milk through child nutrition programs.  The FDA summary of the petition explains:

IDFA and NMPF state that the proposed amendments would promote more healthful eating practices and reduce childhood obesity by providing for lower-calorie flavored milk products. They state that lower-calorie flavored milk would particularly benefit school children who, according to IDFA and NMPF, are more inclined to drink flavored milk than unflavored milk at school....

IDFA and NMPF argue that nutrient content claims such as "reduced calorie'' are not attractive to children, and maintain that consumers can more easily identify the overall nutritional value of milk products that are flavored with non-nutritive sweeteners if the labels do not include such claims.

My view is that milk with aspartame should be labeled as clearly different from regular milk.  The push to market sweetened milk through child nutrition programs is a debatable public health nutrition strategy, whether the milk is sweetened with sugar or aspartame.  The drive for sweetened milk seems like dairy industry marketing as much as sound nutrition program design.  It may be better to let children cultivate their taste for less-sweetened foods and beverages.  Although reasonable people may differ on that point, it would be unwise to settle the matter by allowing sales of aspartame-sweetened milk without noticeable labeling.

You can submit comments to FDA (by May 21) and read comments from others here. Some comments already submitted are strongly opposed.

Hat tip to Ashley Colpaart.

Consuming Kids Summit in Boston, March 21-23

For readers concerned about children's media and advertising issues:

Are you outraged by what’s marketed to children these days—junk toys, junk food, violent media, sexualized clothing? Do you believe it’s wrong that corporations have so much influence on children’s lives? Do you think children need more play time and less screen time? Do you want to do something about it?

Come to CCFC’s 8th annual Consuming Kids Summit in Boston on March 21-23. Learn. Network. Meet and mingle with today’s leading scholars, activists, and researchers—and people like you who believe that children should be nurtured, not manipulated for profit. Find out what you can do to stop the commercial exploitation of children.

This year’s summit features an amazing array of speakers, including many—like  advertising legend Alex Bogusky, the Praxis Project’s Makani Themba, and Melissa Wardy of Pigtail Pals and Ballcap Buddies—who will be presenting for the first time at a CCFC summit. We’re also thrilled to welcome back old friends like Tim Kasser, Nancy Carlsson-Paige, Diane Levin, and Michele Simon. Click here to learn more about our presenters and then don’t forget to register!

Competitive foods in schools: new developments from CDC and FNS

The "competitive foods" served in vending machines and snack bars outside of the federal school meals programs strongly affect both the economic viability of these programs and healthfulness of the nutrition environment for U.S. children.

It is widely thought that competitive foods are necessary for child nutrition programs to succeed economically, but I am not so sure.  In an article in Choices Magazine a couple years ago, a student and I discussed how competitive foods look from the perspective of a school nutrition director who is trying to break even across multiple lines of business:

Any successful business must understand the economic interactions across its product lines, but these interactions are particularly intense for a school food service. A child who consumes a reimbursable lunch and breakfast will have lower demand for a la carte items, while a child who skips a real meal may be hungrier for a snack. This interaction means that school food service decisions about competitive foods strongly affect the federal school meals program, and vice versa.

I suspect that having strong rules to rein in competitive foods may actually strengthen the hand of school food service directors who want to make a healthy meals program economically sustainable.

The Centers for Disease Control and Prevention (CDC) recently posted a new report (.pdf) summarizing state policies regarding "competitive foods" outside of the federal school meals programs.  One nice surprise is the states that appeared to have the strongest rules.  Hawaii and West Virginia were ranked by the CDC in the "third quartile" of adherence to nutrition policy standards; no states ranked in the "fourth quartile."  (I'll ask my statistics class this week whether there might have been a better word than "quartile" for this particular ranking method).

The CDC website has all sorts of great resources for people who want to get involved in encouraging good policies in their own states and communities.

Today, USDA's Food and Nutrition Service (FNS) announced proposed regulations for competitive foods in vending machines and snack bars.  Highlights, according to the FNS summary, include:

• More of the foods we should encourage.  Promoting availability of healthy snack foods with whole grains, low fat dairy, fruits, vegetables or protein foods as their main ingredients.
• Less of the foods we should avoid.  Ensuring that snack food items are lower in fat, sugar, and sodium and provide more of the nutrients kids need.
• Targeted standards.  Allowing variation by age group for factors such as beverage portion size and caffeine content.
• Flexibility for important traditions.  Preserving the ability for parents to send in bagged lunches of their choosing or treats for activities such as birthday parties, holidays, and other celebrations; and allowing schools to continue traditions like occasional fundraisers and bake sales.
• Reasonable limitations on when and where the standards apply.  Ensuring that standards only affect foods that are sold on school campus during the school day.  Foods sold at an afterschool sporting event or other activity will not be subject to these requirements.
• Flexibility for state and local communities.  Allowing significant local and regional autonomy by only establishing minimum requirements for schools. States and schools that have stronger standards than what is being proposed will be able to maintain their own policies.
• Significant transition period for schools and industry.  The standards will not go into effect until at least one full school year after public comment is considered and an implementing rule is published to ensure that schools and vendors have adequate time to adapt.

The proposed regulations will be open to public comment for 60 days.  I look forward to reading them, but also will be glad for your suggestions about which sections seem most interesting.

State-level data on children's poverty and nutrition programs

The Massachusetts Budget and Policy Center this week released new resources about breakfast and lunch participation in Massachusetts schools.  A chart pack (.pdf) illustrates data describing the extent of take-up of nutrition benefits, and a summary graphic (.pdf) traces a wide variety of nutrition assistance programs from the federal funding sources to the state and local implementation level.

More generally, the Kids Count data center from the Annie E. Casey Foundation has a wide variety of state-level data resources for all states.  For example, here is an interactive map showing children's poverty levels by regions within Massachusetts (you can mouse over selected counties to see specific statistics).

Reuters: Washington soft on childhood obesity

From yesterday's long report by Duff Wilson and Janet Roberts at Reuters:

At every level of government, the food and beverage industries won fight after fight during the last decade. They have never lost a significant political battle in the United States despite mounting scientific evidence of the role of unhealthy food and children's marketing in obesity.

Lobbying records analyzed by Reuters reveal that the industries more than doubled their spending in Washington during the past three years. In the process, they largely dominated policymaking -- pledging voluntary action while defeating government proposals aimed at changing the nation's diet, dozens of interviews show.

Is reducing childhood obesity a reasonable goal?

Under the headline "Obama's Government vs. Your Family," John Hinderaker of the conservative blog Powerline this week links to our coverage of the interagency working group that proposed voluntary guidelines for marketing food to children.  Hinderaker is upset that Michelle Obama considers reducing childhood obesity to be a public policy objective.

So the future weight of your minor children is a “goal” of the federal government. Of course, that is just one example out of many. For example, do you think it is a “private family matter” whether you feed your children Cheerios and corn flakes for breakfast? Think again.

I am tempted to speculate that Hinderaker read some parts of my post more closely than others.  He probably best liked the part where I investigated some of the arcane details showing that Cheerios would not meet the long-run guidelines, which suggests that the details of the guidelines might deserve further tweaking.  Perhaps he focused less on some of the other good links in my post, which supported the interagency working group proposal and emphasized that this approach really is moderate, reasonable, and market-oriented.

Making sure schools can serve our children badly

Although appropriations bills are supposed to be about spending -- not policy-making -- Congress took extra special care this week to make sure child nutrition programs do not have to follow the very reasonable and temperate guidelines recommended by the Institute of Medicine.

The conference committee report for next year's agricultural appropriations overturns key elements of USDA's proposed guidelines for child nutrition programs.  The proposed guidelines had included strong support for whole grains, a recommended limit on salt, and a stipulation that not too much of the vegetables served would be white potatoes.  Currently, school lunch programs contain far more salt than recommended limits, and many school systems use french fries and other forms of white potatoes as by far the dominant vegetable.

In a step that reminds us all of the Reagan administration's heroically foolish effort to define ketchup as a vegetable, the appropriations committees also intervened to make sure that the tomato puree in pizza counts toward vegetable requirements.

USDA officials were sharply critical, and I imagine that the hard-working staff throughout the department are upset.  The Associated Press coverage says:

USDA spokeswoman Courtney Rowe said Tuesday that the department will continue its efforts to make lunches healthier.

"While it's unfortunate that some members of Congress continue to put special interests ahead of the health of America's children, USDA remains committed to practical, science-based standards for school meals," she said in a statement.

It is fun to read the fine print of the conference committee report (.pdf).  See sections 743 and 746 on page H7443.  Although they have no expertise in meals programs or nutrition, the appropriations committee members were quite willing to do the food industry's bidding on these arcane provisions:

SEC. 743. None of the funds made available by this Act may be used to implement an interim final or final rule regarding nutrition programs under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) that—
(1) requires crediting of tomato paste and puree based on volume;
(2) implements a sodium reduction target beyond Target I, the 2-year target, specified in Notice of Proposed Rulemaking, ‘‘Nutrition Standards in the National School Lunch and School Breakfast Programs’’ (FNS–2007–0038, RIN 0584– AD59) until the Secretary certifies that the Department has reviewed and evaluated relevant scientific studies and data relevant to the relationship of sodium reductions to human health; and
(3) establishes any whole grain requirement without defining ‘‘whole grain.’’

A graduate student and I are taking a look at the diversity of comments that were submitted in response to USDA's proposed guidelines.  I will do a follow-up post in a couple weeks, noting which organizations suggested the policy reversals that Congress made this week.

In my children's schools, I see the need for well-written and reasonable guidelines.  The status quo is not good enough.  I believe the IOM and USDA did the best possible job in balancing nutrition and economic considerations.  Readers know very well that I will speak up against government overreach.  But these guidelines did not look to me like government overreach.  They looked judicious.

As a policy researcher, I think the public interest would have been better served by deferring to IOM and USDA.  As a parent, I am angry about Congress' intervention.  It seems clear that Congress is doing the food industry's bidding at the expense of our children.

New Rudd Center report on marketing beverages to children

Would you say Coca-Cola, the parent company for FANTA, is marketing to children here?

Would you say Coca-Cola is marketing to children in these lesson plans for elementary school students?

If you say "yes" to either question, then do you think Coca-Cola is breaking its pledge not to advertise to children?

Coca-Cola's pledge says:

We have a global Responsible Marketing Policy that covers all our beverages, and we do not market any products directly to children under 12. This means we will not buy advertising directly targeted at audiences that are more than 35% children under 12. Our policy applies to television, radio, and print, and, where data is available, to the Internet and mobile phones.

I can think of some ways that Coca-Cola could say these marketing efforts are consistent with the pledge. Perhaps one could find research showing that the FANTA cartoon characters are designed to appeal to 13-year-olds but not 11-year-olds. Perhaps the websites where these characters appear have a children's audience share under 35%.  Perhaps the lesson plans don't qualify as "marketing." Perhaps the use of the word "directly" is supposed to give the marketers some wiggle room.

Still, under any of these explanations, the detailed defense only serves to show how empty the pledge is. 

This post was provoked by reading the Rudd Center's new report on marketing sugar-sweetened beverages to children (.pdf).

Prevention Institute: "We're not buying it."

A video and petition from the Prevention Institute, about food marketing directed at children.