Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Saturday, December 8, 2007

The Local Wellness Policy: Not Making The Grade—Jackie Ballou

Wellness Policies In Schools

On June 30, 2004 a policy went into effect that appeared to be a soaring leap in the right direction for the world of nutrition. This landmark event was the creation of the local wellness policy. In theory, the goal of local wellness policies is to improve wellness in schools. The policy requires all schools authorized by the Richard B. Russell National School Lunch Act and the Child Nutrition Act of 1966 to individually establish their own wellness policies. In 1946 Harry Truman signed the Richard B. Russell National School Lunch Act, a federal law providing subsidized low cost and free lunch to qualified students (1). The Child Nutrition Act of 1966 provided grants-in-aid to each state to better meet the nutritional needs of children in public schools. The act was strongly backed by both the success of the National School Act and research demonstrating that children grow, learn and develop more optimally when well-nourished (2). To repeat, the local wellness policy applies to all schools participating in these two government programs.

The Local Wellness Policy states required schools must have a wellness policy in place, within guidelines set jointly by the United States Department of Agriculture (USDA), the Centers for Disease Control and Prevention (CDC), and the US Department of Education (ED). According to the guidelines, each policy must include the following components: goals for nutrition education, physical activity and other school activities that promote wellness. Each school shall also set guidelines concerning foods available during the school day. These guidelines should promote student health, attempt to reduce childhood obesity, and support principles of the Child Nutrition Act and the School Lunch Act. Additionally, each school must be able to measure the implementation of the local wellness policy, and have one or more person responsible for ensuring the school meets those goals. The creation of the wellness policy should involve parents, students, representatives from the school food authority, the school board, school administrators and the public (3).

The Local Wellness Policy fails for three reasons: not requiring head of each policy to have appropriate training and education, because its promotion of physical activity conflicts with the sedentary atmosphere in schools and finally, the policy does not address the impact negative media messages have on children outside of school.

Interested in Heading a Local Wellness Policy? No Prior Education or Experience Needed.

The fact that the person overseeing each wellness policy need not have professional experience in the area of nutrition is highly disturbing. I first became skeptical of this aspect of the policy as my mother, a teaching aid in a fourth grade classroom in Massachusetts, shared with me a concerning piece of information. One of the rules set as part of her school’s wellness policy was that at snack time, children were to bring either a piece of fruit or a vegetable. If students brought a non-fruit or vegetable snack, they were told to put the culprit away and watch hungrily as other compliant students chomped on their apples and carrot sticks. What message is this sending? I understand the intent of the rule, to incorporate more fruit and vegetables into the children’s diets. However, as a future dietitian, I would not, as I believe other nutrition professionals would agree with me, ever limit snacks to just two food groups. By placing restrictions on snack time, foods are categorized into “good foods/bad foods.” Further, such strict rules may lead children to resent fruit and vegetables altogether. The only way to prevent flawed and problematic policies is to appoint a dietitian responsible for nutrition guidelines.

Although the policy does not require a nutrition professional be involved with development of nutrition goals and education, the task at hand involves exactly that level of expertise (4). The law is vague in that it does not imply what the nutrition guidelines should be, nor does it give schools advice on setting these goals. “Promoting health” and “reducing childhood obesity,” what the Local Wellness Policy states as its main objectives for each school, are not only lofty and intangible goals, but they are also much too general. Further, if 25-30% of American children have excessive body weight, clearly this is not a problem that can be fixed with a magic bullet as they health policy implies (5). Authors of the Local Wellness Policy suggest schools look to the Dietary Guidelines for Americans for assistance in making nutrition goals (5). However, it is written clearly in the Dietary Guidelines themselves, “The Dietary Guidelines are intended primarily for use by policymakers, healthcare providers, nutritionists, and nutrition educators” (6). Clearly there is a problem here. If people responsible for developing wellness policies are supposed to refer to the Dietary Guidelines for assistance, yet the Dietary Guidelines state almost as a disclaimer that their use is mainly for experts in the respective fields of policy making, health care and nutrition, there is obviously a disconnect. The Dietary Guidelines are not as clear cut as they may seem. For example, the 2005 Dietary Guidelines suggest 41 key recommendations, yet the recommendations never state that children should or should not definitely eat specific foods during the school day (6). An example of this confusion is the snack time rule made in my mother’s school. The head of that wellness policy translated the Dietary Guidelines to mean that fruit and vegetables are good snacks and all other snacks are poor choices. However, what about snacks containing beneficial nutrients such as calcium in yogurt? How about some satiating protein and fat in addition to a piece of fruit, such as an apple with peanut butter? The Dietary Guidelines are an excellent resource, however interpreting them and putting them into policy is not an easy job.

School nutrition professionals have experience in the art of translating complex nutrition guidelines into policy, while balancing nutrition values, children’s taste preferences, and the school’s budget. Dietetics professionals should be actively involved in promoting optimal nutrition in community settings and in programs and policy initiatives at local, state, or federal levels (5). Registered dietitians are most qualified to administer programs ensuring children and adolescents obtain safe, nutritious, and adequate food intakes for optimal nutrition and health (7). Nutrition professionals should have specific roles in community settings of nutrition education, such as applying evidence-based child nutrition research to nutrition programs in schools (7). Further, nutrition professionals can serve as resources for health educators and also can work with school administrators, teachers, parents and communities to make sure all foods and beverages served in schools contribute to the overall quality of children’s diets (7).

“Exercise, Exercise, Exercise, But At School: Sit, Sit, Sit”

Promotion of physical activity is contradictory to the sedentary environment of a typical school day. Children are told they must exercise to prevent obesity and chronic disease; however they are in an environment each day in which they are sitting for close to six hours. Further, physical education is continuously being cut from school budgets. Because of increasing demands to reform education, physical education has been pushed progressively lower on the list of budget priorities. Fewer than 6% of high schools in the U.S. require juniors and seniors in high school to participate in physical education, although the law states otherwise (11). Historically, Massachusetts State Law required 90 minutes of physical education per week in schools. In 1996 the State Board of Education repealed those regulations and allowed school districts to decide themselves how much physical education was required (11). At a time when physical education receives less and less funding, research consistently demonstrates the importance of including physical activity at school. Children will be active if they are given the opportunity and the inspiration (8). Students do not need a wellness policy telling them they need to exercise. They need to be given the chance to be active, especially while they are in a safe and supervised environment such as school.

Although I understand schools must mandate requirements for number of hours of learning in school per year, my question is, does learning have to occur in such a sedentary setting? Children learn by doing (9). Currently, Gov. Deval L. Patrick is allocating $6.5 million this year towards increasing the school day in Massachusetts to improve failing test scores (10). If children learn more effectively while being active, how are test scores going to improve by increasing their sedentary time in school? Massachusetts State Law says Physical Education is required in all grades by all students to promote the “well-being of students,” but fails to state a required number of hours students must participate in physical education daily or weekly. Like the wellness policy, it is general and vague, in its promotion of “wellness.” If students cannot see that the environment and regulations guiding the environment at school are consistent with the promotion of physical activity stated in the wellness policy, they may not believe the wellness policy is being actively supported by the school.

If activity is beneficial to learning, allowing children to be active during the school day would not only support the wellness policy, but may also boost test scores that the state is so worried about. Attention levels suffer when children sit for elongated periods (10). What children need to improve their grades is more physical education and regular breaks for recess. Providing children with more opportunities to be active at school would result in students that are more alert and attentive.

What’s On The Agenda After School? More Than An After School Special.

Agenda Setting Theory states that what determines people’s behavior is what people are talking about. What is on people’s minds is largely dictated by the media (12). Nutrition messages at school need to be based on sound research, for once children leave school they are exposed to television commercials, radio advertisements, websites and parental conversation that all could be misinformation. Children’s beliefs and actions may stem from what they see or hear in the media, which is likely information coming from food companies and unreliable sources. Children need a dependable and experienced authority figure such as a dietitian at school to address tough topics currently on the agenda, whether the subject is food advertising or popular diets.

The media exerts a powerful influence on children’s beliefs (13). For every hour of additional TV viewing per day, there is an associated 12% increase in risk for obesity (5). The U.S. food industry is the #1 buyer of advertisements featured on TV, radio, in magazines and newspapers (14). A total of $7.3 billion was spent by the industry on advertising alone in 1999, and interestingly enough, more than $1 billion went towards advertising in media specifically targeting children. Viewing more advertisements for energy-dense foods and beverages leads to increased intake of these products (13).

Soaring levels of food and beverage advertising marketed towards children as well as increasing amounts of screen time are to blame for the fact that American children view an average of 20,000 to 40,000 commercials per year (15). Approximately 1 in 6 commercials directed towards children promises a free toy (16). Cartoons are commonly used to sell products as well (17). The result of these strategies is that children falsely think that because cartoons are the ones advocating a product, or because a toy is behind a product, that these foods have health benefits. Seventy percent of children between the ages of 6 and 8 years think fast food is healthier than food cooked at home (18). Further, children who watch more television make choices of less healthful food when they were told to choose the more healthful choice (19). Finally, children under 8 years old do not have the level of cognitive development to differentiate claims made by advertisers. Children commonly believe that the intent of commercials on TV is to communicate information based on fact, not to advertise (20).

If children are exposed daily to such convincing messages about sugary, high fat and high calorie foods and beverages, but at school they are told they are only to eat fruit or a vegetables for a snack, there is a huge disconnect. A dietitian part of a wellness policy can ensure a proper educational component is put in place to help children distinguish the difference between healthful eating advertising.

Future Implications

The local wellness policy fails, for it does not appoint an experienced dietitian as part of policy development, the message being sent by the sedentary environment at school conflicts with the wellness policy’s call for more activity, and finally, children are flooded with negative media messages, yet there is no one at school trained at helping these youngsters decipher fact from fiction. Local wellness policies are a far cry from a movement that is actually needed. The government cannot rely on schools to make the policies themselves if all they are instructed to refer to are the Dietary Guidelines, which are inherently complex and meant to be put to practical use by nutrition professionals. Nutrition aspects of wellness policies are best handled by dietitians. Further, dietitians can work closely with health educators to figure out the best way to teach our children effectively about nutrition. Additionally, state officials would be wise to take a closer look at the environment in which the message of promotion of physical activity and “wellness” is sent. If the Local Wellness Policy states children need to be more active, it needs to start at school. Students learn best by a positive and supportive example. Finally, children should be able to feel confident going to health educators with questions about nutrition in the media. Nutrition professionals are dependable authorities who can do the necessary research to find out whether there is scientific evidence and sufficient research to support the claims being made by the popular media. Simply put, either include dietitians in the design of wellness policies, or risk not achieving the very definition of wellness, “The condition of good physical and mental health, especially when maintained by proper diet, exercise and habits.”

References

1. USDA Food and Nutrition Service: National School Lunch Program http://www.fns.usda.gov/cnd/Lunch/AboutLunch/ProgramHistory.htm

2. USDA Food and Nutrition Service: The National School Lunch Program Background and Development http://www.fns.usda.gov/cnd/Lunch/AboutLunch/ProgramHistory_6.htm

3. USDA Food and Nutrition Service: Sec. 204 Local wellness policy http://www.fns.usda.gov/tn/Healthy/108-265.pdf

4. Donze Black, J. Local wellness policies and the Dietary Guidelines: What Does it Mean to You? American Dietetic Association 2005; 105:891-894.

5. Explosion of Child Obesity Expected to Shorten U.S. Life Expectancy, Bess Andrews, March 5, 2005 http://www.eurekalert.org/pub_releases/2005-03/chb-eoc031605.php

6. U.S. Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans 2005. http://www.health.gov/dietaryguidelines/dga2005/document

7. American Dietetic Association. Position of the American Dietetic Association: Child and Adolescent Food and Nutrition Programs. 2006.

8. Sallis, J et al. The Association of School Environments with Youth Physical Activity. American Journal of Public Health 2001;91:618-620.

9. Hare, K. Creating a Great State for Learning: Physiology and the Learning Environment. Training the Trainer 2003;3: 1-2.

10. Schemo, D. Failing Schools See a Solution in a Longer Day. The New York Times March 26, 2007.

11. Dunn, B. ARHS Drops Gym for Seniors, Juniors. The Amherst Bulletin February 16, 2007.

12. Edberg, M. Social, Cultural, and Environmental Theories (Part II) (pp. 65-76). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health Boston, MA: Jones and Bartlett Publishers, 2007.

13. Story, M & French, S. Food advertising and marketing directed at children and adolescents in the US. International Journal of Behavior, Nutrition and Physical Activity. 2004;1:3.

14. Gallo AE. Food Advertising in the United States. In: Frazao E, ed. America’s Eating Habits: Changes and Consequences. Washington, DC: United States Department of Agriculture/Economic Research Service; 1999.

15. Strasburger VC. Children and TV advertising: Nowhere to run, nowhere to Hide. Journal of Developmental Behavior in Pediatrics. 2001;22: 185-187.

16. Kotz, K & Story, M. Food advertisements during Children’s Saturday Morning Television Programming: Are they consistent with Dietary Recommendations? Journals of the American Dietetic Association. 1994;94: 1296-1300.

17. Fischer, PM et al. Brand Logo Recognition by Children aged 3 to 6 years. Mickey Mouse and Old Joe the Camel. Journal of the American Medical Association. 1991;266: 3145-3148.

18. Donahue, T, Meyer, T & Henke, L. Black and white children: Perceptions of television commercials. Journal of Marketing. 1978;42:38-40.

19. Signorielli, N & Staples, J. Television and Children’s Conceptions of Nutrition. Health Communication. 1997;9:291-301.

20. Committee on Communications, American Academy of Pediatrics. Children, adolescents, and advertising. Pediatrics. 1995;95:295-297.

Labels: ,

2 Comments:

  • At December 13, 2007 at 6:50 PM , Blogger Victoria said...

    I agree with you - it seems like no one knows how to handle this policy they created. Obviously, telling children they have to eat a fruit/vegetable or nothing is the wrong message to send. Did anyone consider how to involve the parents? And what happens if the children's families can't afford whole foods to bring as snacks?

     
  • At December 14, 2007 at 11:00 AM , Anonymous Deinera said...

    I agree that the guidelines should be created by someone knowledgeable about nutrition, and that doesn't seem to have happened. I am not aware of the staffing of schools in Massachusetts- are RDs generally on staff? If not, how do you suggest schools afford this resource? Do you feel it should be up to the individual school to hire/ contract with an RD? Or should it be up to the school districts to create guidelines (with the help of an RD) for all schools in their jurisdiction? If schools do have to pay for their own RD, do you feel that schools (and the children who attend schools) with less financial resources would be at a disadvantage?

     

Post a Comment

Subscribe to Post Comments [Atom]

<< Home