EXHIBIT G

Schools and the Prevention of Schools and the Prevention of Childhood Obesity Childhood Obesity

Howell Wechsler, Ed.D., MPHDivision of Adolescent and School Health

National Center for Chronic Disease Prevention and Health PromotionJanuary 2004 EXHIBIT G Committee Name OBESITY Document consists of 50 SLIDES.

Entire document provided.Due to size limitations, pages ________________ provided. A copy of the complete

document is available through the Research Library (775/684-6827) or e-mail library@lcb.state.nv.us.

Meeting Date: 1-14-04

YOUTHYOUTH

Government Agencies

A A Small Small Number of Calories . . .Number of Calories . . .

• 10 unused calories/day = 3650 calories/year

• 3500 calories = 1 pound of extra weight/year

. . . Makes a BIG difference

Why Schools?Why Schools?

• Most children and adolescents are enrolled in school

• Physical activity and nutrition programs have long been part of the school experience

• Research shows that well-designed, well-implemented school programs can promote healthy behaviors

• Connections exist between physical activity, dietary behaviors, short-term health, and academic performance

In Arkansas, Schools to Score A Child's WeightThe Wall Street Journal (20 August 2003)

School children are used to getting grades in math, science and English. Now, Arkansas state officials want to score them on their weight.

Alarmed at the growing number of overweight children in their state, state health experts have pressured lawmakers to do something about it. A law enacted in April calls for the state's 308 public schools to record their students' weights and heights and then send the results home.

www.michigan.gov/documents/healthyweight_13649_7.pdf

Michigan Consensus Paper: Six Safeguards Michigan Consensus Paper: Six Safeguards Before Conducting ScreeningsBefore Conducting Screenings

• Full implementation of safe and supportive learning environment recommendations

• Classroom instruction on healthy weight concept

• Parental permission system

• Referral system

• Staff training

• Respectful screening (no labeling, no comments on weight during measurement, privacy, confidentiality, respectful letter to parents, same procedures for all)

Guidelines for School Health ProgramsGuidelines for School Health Programs

• The guidelines contain:recommendations to help states, districts, and schools implement health programs and policies, based on an extensive review of published research

Priority Actions for Schools to Take to Priority Actions for Schools to Take to Promote Physical Activity and Healthy EatingPromote Physical Activity and Healthy Eating

• Quality physical education

• Additional opportunities for physical activity (e.g., recess, after school, walk to school)

• Quality school meals • Healthy school nutrition

environment

• Coordinated school health program and school health council

• Self-assessment and planning process (School Health Index)

• Quality health education• Staff wellness programs

www.cdc.gov/nccdphp/dash/publications/pdf/ten_strategies.pdf

SelfSelf--Assessment and Planning ProcessAssessment and Planning Process

The School Health Index helps schools:

• Identify the strengths and weaknesses of their health promotion policies and programs

• Develop an action plan for improving student health

• Involve teachers, parents, students, and the community in improving school programs, policies, and services

www.cdc.gov/nccdphp/dash/SHI/

Sample Changes Made As A Result of Using SHISample Changes Made As A Result of Using SHI

• Hired a PE specialist for the first time

• Increased time spent in PE• Added healthy choices to

vending machines• Moved healthy choices to

the front of the food line• Incorporated health in

School Improvement Plan

Fit, Healthy, and Ready to LearnFit, Healthy, and Ready to Learn(FHRTL)(FHRTL)

• FHRTL– provides schools with a

guide to address broad policy issues, including policy development

– includes sample policies

www.nasbe.org/healthyschools/fithealthy.mgi

Percentage of U.S. High School Students Who Percentage of U.S. High School Students Who Attended Physical Education Classes Daily, Attended Physical Education Classes Daily,

1991 1991 -- 20012001

32%29%27%25%

34%

42%

0

10

20

30

40

50

60

1991 1993 1995 1997 1999 2001

Perc

ent

Source: CDC, National Youth Risk Behavior Survey

Quality Physical EducationQuality Physical Education

• emphasizes knowledge and skills for a lifetime of regular physical activity

• is based on national standards that define what students should know and be able to do

• provides many different physical activity choices

Quality Physical EducationQuality Physical Education

• meets the needs of all students, especially those who are not athletically gifted

• keeps students active for most of class time

• is an enjoyable experience for students

Quality Physical Education RequiresQuality Physical Education Requires

• Adequate time (150 min/week for elementary; 225 min/week for secondary)

• Appropriately trained teachers

• Adequate facilities and supplies

• Reasonable class sizes

CCurriculum urriculum AAnalysis nalysis TTools ools (CAT)(CAT)

Physical Education

Health Education

• To help users select, develop, or assess curricula

• Question/Answer format with scoring rubric

• Based on national educational standards and CDC’s school health guidelines

Coming from CDC in 2004

Physical Activity Breaks

After School Physical Activity Programs

Promoting Walking and Biking to SchoolPromoting Walking and Biking to School

Purpose• Increase daily physical activity

of children• Improve pedestrian safety• Educate and empower

communities to work together to create safe routes to school

International Walk to School Daywww.walktoschool.org

www.cdc.gov/nccdphp/dnpa/kidswalk

Strategies for Statewide ChangeStrategies for Statewide Change

• Physical activity and coordinated school health requirements (Texas, North Carolina)

• Curriculum (Michigan)

• School report cards and accountability (South Carolina)

Texas Law: Physical Activity Texas Law: Physical Activity for All Studentsfor All Students

• Every elementary school (K-6) must have physical activity a minimum of 30 min/day or 135 min/week

• All school districts must have a school health advisory council (SHAC) – Composed of teachers, administrators, students, and various

members of the community including business leaders

• Coordinated school health program– Provides for coordination of health, physical, and nutrition

education– Emphasizes parental involvement

North Carolina State Board of Education: North Carolina State Board of Education: Healthy Active Children PolicyHealthy Active Children Policy

• Requires students in preK-8 to participate in physical activity as part of PE curriculum (ES: consider 150 min/week; MS: consider 225 min/week; minimum of every other day, throughout the school year)

• Appropriate amounts of recess – not to be taken away as a form of punishment

• School health advisory council and coordinated school health program in each district

• Each district shall develop an action plan for policy implementation, in coordination with SHAC

Michigan’sMichigan’s Exemplary Exemplary Physical Education CurriculumPhysical Education Curriculum

Physically Physically conditioned for conditioned for life’s demands

Safety Safety equippedequippedThe EPEC Physically

Educated Personwww.michiganfitness.org

1-877-464-3732

The The EPECEPEC Physically Physically Educated PersonEducated Person

www.michiganfitness.orgwww.michiganfitness.org11--877877--464464--3732

life’s demands

3732Skilled in healthSkilled in health--

enhancing physical enhancing physical activities

Motivated to be Motivated to be physically activephysically active activities

Prepared for Prepared for citizenshipcitizenship

• K-5 materials 6-12 materials

Finished Modules In Progress Planned

South Carolina Physical Education South Carolina Physical Education Assessment ProgramAssessment Program

• Added to school report cards: % of students in each school who meet state PE standards

• Led to development and/or implementation of:– Performance indicators and assessment materials– Data collection– Staff development– Curricular changes– Increased visibility and prestige for PE

StateState--Level Policy Options to Help Schools Level Policy Options to Help Schools Promote Physical ActivityPromote Physical Activity

• Identify PE as a core academic subject• Require specified amounts of time for PE and

recess• Require teacher certification in PE• Support staff development in PE• Establish state systems of accountability for

student achievement of PE standards• Provide support for extracurricular physical

activity programs• Provide support for coordinated school health

School Lunches Are Now School Lunches Are Now Significantly Lower in FatSignificantly Lower in Fat

34

12

15

38

05

10152025303540

Total Fat Saturated Fat

SY 1991-92SY 1998-99

% o

f C

alo

ries

Target: 30% or

less

Target: less than 10%

Source: School Nutrition Dietary Assessment Study-II (School Year 1998-99)

Certification and Training ofCertification and Training ofFood Service CoordinatorsFood Service Coordinators

• Certification for district-level food service directors: 18% of states offer and 6% require

• District food service directors: 60% are certified, 40% have undergraduate degrees

• School food service managers: 52% are certified, 14% have undergraduate degrees

Source: CDC, School Health Policies and Programs Study 2000

Time to EatTime to Eat

• 20% of schools usually give students <20 minutes to eat lunch once seated

• 26% of schools serve lunch before 11 am

• 13% serve lunch after 1:00 pm

Source: CDC, School Health Policies and Programs Study 2000

Innovative Approaches to Promoting Innovative Approaches to Promoting Consumption of Fruits and VegetablesConsumption of Fruits and Vegetables

• Salad bars

• Prepackaged salads

• Gardening programs

• Farmer’s markets

• DoD Fresh Program

• Taste tests, promotions

• Free distribution

USDA / NCI in 2004

USDA’s Competitive Foods RegulationsUSDA’s Competitive Foods Regulations

• Prohibits sale of FMNV (foods of minimal nutritional value)--i.e., soda, water ices, chewing gum, and certain candies--in food service area during meal periods.

• FMNV does not include many popular snacks high in fat, added sugar, or sodium (e.g., potato chips, chocolate candy bars, donuts, juice drinks).

• States, districts and schools can impose additional restrictionson the sale of all foods at any time throughout the school.

Types of Foods Available in Types of Foods Available in School Vending Machines or StoresSchool Vending Machines or Stores**

• Soft drinks, sports drinks, fruit drinks: 76% of schools

• High-fat salty snacks: 64%

• High-fat baked goods: 63%

• 100% fruit juice: 55%

• Low-fat salty snacks: 53%

• Bottled water: 49%

• Chocolate candy: 47%

• Fruits or vegetables: 18%

*Among the 61% of schools with a vending machine or store

Strategies for ChangeStrategies for Change

• Adopt nutrition standards

• Negotiate vending contracts that promote health

• Limit access to foods and beverages

• Offer more healthful products

• Use marketing techniques to promote healthier choices

Adopt Nutrition StandardsAdopt Nutrition Standards

West Virginia prohibits the following at school:

• Chewing gum, flavored ice bars, candy

• Food or drinks containing 40% or more, by weight, of sugar or other sweeteners

• Juice or juice products containing less than 20% real juice

• Foods with >8 grams of fat per 1 oz. serving

• Soft drinks in elementary and middle schools

Adopt Nutrition StandardsAdopt Nutrition Standards

• Maine: Administrative order from the Education Department bans soft drinks and candy from vending machines in all public schools during the school day.

• Texas: Department of Agriculture prohibits – In elementary schools: FMNV throughout the

school day– In middle schools: FMNV during meal periods

and carbonated beverage with volumes greater than 12 ounces throughout the school day

Adopt Nutrition StandardsAdopt Nutrition Standards

Old Orchard Beach, ME

• Removed all soft drinks and replaced with milk, water, juice

• Removed candy, high-fat snacks and replaced with trail mix, pretzels, granola bars, and cereal/fruit snack mixes

• Maintained contracts with vendors, agreed to purchase only healthful snacks

• Maintained vending revenue

Negotiate Vending Contracts that Negotiate Vending Contracts that Promote HealthPromote Health

Fayette County, Lexington KY• Negotiated vending contract to increase

revenues and healthy options• Higher commission for healthful items• Advantageous pricing for healthful items• RFP gave points for promoting nutrition• Parent working in the food industry assisted

with the RFP

Limit Access to Foods and Beverages Limit Access to Foods and Beverages

• Alabama: No sales of FMNV during meal service anywhere on campus.

• Nebraska: No competitive foods anywhere on campus from ½ hour before until ½ hour after breakfast and lunch.

• New Jersey: No sales of FMNV anywhere on campus until the end of the last lunch period.

• Arkansas: No sales of foods and beverages through vending machines in elementary schools.

• Louisiana: No a la carte sales in schools.

Offer More Healthful ProductsOffer More Healthful Products

• Quad Cities, IA/IL: Sell milk, cheese, and yogurt through vending machines in 17 middle and high schools

• Central Middle School, Whitefish, MT: Replaced soft drinks and candy with milk, bagels, baked chips, fruit, homemade pretzels, pudding, salads, sandwiches, string cheese, and yogurt

Use Marketing Techniques to Promote Use Marketing Techniques to Promote Healthier ChoicesHealthier Choices

Vista, CA Child Nutrition Services

• Took over all school food options and began by conducting market research with consumers.

• Replaced candy and chips with crackers, pretzels, granola bars, peanuts, dried apricots, etc.

• Replaced soft drink machines with new beverage units selling milk, 100% juice, smoothies, water, sports drinks, and soft drinks.

– Soda, Pepsi or Coke

– Sports Drink

– Iced Tea

– Water

– Fruit Drink, 10% juice

Price $1.25

Use Marketing Techniques to Promote Use Marketing Techniques to Promote Healthier ChoicesHealthier Choices

Vista, CA: Results of Changes

• School district commissions and bonuses were more than twice as much as it received before CNS took over the vending operation.

• Capital investments will be recouped in 30 months.

• Some of the new revenue is being used to convert cafeterias to fitness and nutrition centers.

Students are most likely to make the Students are most likely to make the healthy choice . . . healthy choice . . .

When it’s the easy choice!

StateState--Level Policy Options to Help Schools Level Policy Options to Help Schools Promote Healthy EatingPromote Healthy Eating

• Require certification and continuing education for child nutrition staff

• Establish guidelines for meal schedules• Support promotion of fruits and vegetables, nutrition

education, and coordinated school health• Set nutrition standards for foods and beverages• Limit student access to foods and beverages• Promote inclusion of nutritional concerns in vending

contracts• Provide technical assistance to help schools offer and

market more healthy choices

Components of a Coordinated School Health Program

Components of a Coordinated School Health Program

Physical Education

Health Education

Health Services

NutritionServices

Counseling, Psychological and Social Services

Healthy School Environment

HealthPromotionfor Staff

Family and Community Involvement