Comprehensive Comprehensive School Wellness School Wellness

ProgramProgramDr. Matthew CummiskeyDr. Matthew Cummiskey

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WHY the FocusWHY the Focus on Local Wellness on Local Wellness

Policies?Policies? The The prevalence of overweightprevalence of overweight among among

children aged 6–11 has more than children aged 6–11 has more than doubleddoubled in the past 20 yearsin the past 20 years

Overweight children and adolescents are Overweight children and adolescents are more likely to remain overweight or more likely to remain overweight or become obese adults and become obese adults and develop chronic develop chronic diseasedisease

One in three American children born in One in three American children born in 2000 will develop 2000 will develop diabetesdiabetes in their lifetime in their lifetime

The

Problem

DID YOU KNOW????DID YOU KNOW????

Overweight children miss an Overweight children miss an average of average of 1 day per month more1 day per month more of of school than their average weight school than their average weight counterparts. counterparts.

***National School Boards Association******National School Boards Association***

The

Problem

The

Problem

The

Problem

The

Problem

The National Picture

Source: Behavioral Risk Factor Surveillance System, CDC.

19961991

2003

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

(* BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ? 25%

The

Problem

U.S. Prevalence of Recommended

Physical Activity (Moderate intensity, 30 min, 5 day/week)

                                                            

The

Problem

The

Problem

The

Problem

Overfed But Undernourished

0

20

40

60

80

100

120

6-11 Mo. 1 Yr. 1-4 Yrs. 5-8 Yrs. 9-14 Yrs. 15-19 Yrs.

CalciumFolate

% Children Consuming Daily

Recommended Intake

MagnesiumVitamin A

Vitamin C

Zinc

Iron

Phosphorus

Critical Age

Data compiled by Dr. John Lasekan, Ross LabsNHANES 1999-2000 and the Continuing Food Survey 1994-96, 1998

The

Problem

Percentage of students

who attended physical

education class daily.

The

Problem

Percentage of students who ate

five or more servings of fruits

and vegetables per day during the past

seven days

The

Problem

Snapshot of Schools

• 55 million students attend U.S. schools• 35-40% of daily energy consumed at

school• School Breakfast and National School

Lunch Programs (USDA) are effective• Competitive foods -- a la carte, vended

foods, school stores -- dilute school’s power

• “Open” lunches – promote fast-foodFrench, Am J Pub Health 2003; 93:1161

The

Problem

90% of schools offer a la carte lunch

Vending machines for students 76% of high schools55% of middle schools15% of elementary schools

School stores, snack bars or canteens41% of high schools35% of middle schools 9% of elementary schools

School Nutrition Dietary Assessment Study, 2001

Competitive Foods

The

Problem

A la carte Foods Affect Diet Quality

• Non-participants in NSLP consume 3x more sugars (21% vs 64%)

• Top sellers: pizza, chips, soda, french fries, candy and ice cream

• Access to a la carte and snack bar meals =– lower fruit, vegetable and milk – higher sweetened beverages and fried

veggies

Cullen, Am J Pub Health 2004; 94:463

The

Problem

Good News

Effects of Improving Effects of Improving Nutrition on LearningNutrition on Learning

Improved behavior.Improved behavior.

Less visits to school nurse.Less visits to school nurse.

Increased attention, creativity and Increased attention, creativity and

test scores.test scores.

Essential for growth and Essential for growth and

development.development.

Good News

Parental SupportParental Support Nearly two-thirds of parents support restricting access to high-

calorie, low-nutrient snack foods in schools, and half of parents feel their child’s school is doing an “excellent” to “good” job in this area, according to a 2005 Action for Healthy Kids national public opinion survey.

However, the CDCP report that between 60% and 95% of schools allow students to purchase snack foods or beverages from vending machines or at the school store, canteen, or snack bar.

Another illustration of a “disconnect” between parents’ priorities and perceptions and what actually happens at school occurs in the area of physical activity. Seventy-seven percent of parents support requiring daily physical education for all children, and 62% rate their child’s school as “excellent” or “good” on “making daily physical education available for all students.” However, in reality only 5.8 to 8.0% of schools nationally (depending on grade level) provide students with daily physical education.

83% of parents are unaware of the Local Wellness Policy mandate required by the Child Nutrition and WIC Reauthorizaton Act of 2004

Good News

Nutrition Enhances Nutrition Enhances AchievementAchievementComprehensive School Health

Reading and math scores of third and fourth grade students with comprehensive health education were significantly higher.

Schoener, Guerrero, and Whitney, 1988

School Breakfast Programs Increase learning and academic achievement, improve student attention to academic tasks, reduce visits to the school nurse, decrease behavioral problems.

Murphy, Pagano, Nachmani,Sperling, Kane, and Kleinman, 1998

Positively impact academic performance, absenteeism, and tardiness among low-income elementary school students.

Meyers, Sampson, Weitzman, Rogers, and Kayne, 1989

Enhanced daily nutrient intake and improved nutrient intake were associated with significant improvements in academic performance and psychosocial functioning and decreases in hunger.

R.E. Kleinman et al, Annals of Nutrition and Metebolism; 2002.

Good News

Physical Education, TooPhysical Education, TooStudents who participated in school physical education programs did not experience a harmful effect on their standardized test scores, though less time was available for other academic subjects.

Sallis, McKenzie, Kolody, Lewis, Marshall, and Rosengard, 1999; Shephard, 1996; Dwyer, Coonan, Leitch, Hetzel,and Baghurst, 1983.

Physical activity is positively associated with academic performance.

Dwyer, Blizzard, and Dean, 1996

Regular (3 – 5 times per week) periods of moderate to vigorous physical activity enhances the health, academic performance, attitudes and classroom behavior of children at school. Physical education programs are valuable to students and teachers.

Keays JJ, Allison KR; Canadian Journal of Public Health; 1995

Good News

Part of the SolutionPart of the Solution

Child Nutrition and Child Nutrition and WIC Reauthorization WIC Reauthorization

ActActSigned by President Bush on June 30, Signed by President Bush on June 30, 2004.2004.

Section 204 of this Act requires each Section 204 of this Act requires each district participating in the USDA School district participating in the USDA School Meal Program to have established a Meal Program to have established a local local school wellness policyschool wellness policy by the school year by the school year beginning July 2006.beginning July 2006.

LegislationLegislation (a) IN GENERAL - Not later than the first day of the (a) IN GENERAL - Not later than the first day of the

school year beginning after June 30, 2006, each local school year beginning after June 30, 2006, each local education agency participating in a program authorized education agency participating in a program authorized by the Richard B. Russell National School Lunch Act (42 by the Richard B. Russell National School Lunch Act (42 U.S.C.1751 et seq.) or the Child Nutrition Act of 1966 U.S.C.1751 et seq.) or the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) shall establish a local school (42 U.S.C. 1771 et seq.) shall establish a local school wellness policy for schools under the local educational wellness policy for schools under the local educational agency that, at a minimum— (paraphrased)agency that, at a minimum— (paraphrased) 1) Includes goals for nutrition education, physical activity and 1) Includes goals for nutrition education, physical activity and

other school- based activities that are designed to promote other school- based activities that are designed to promote student wellness student wellness

2) Includes nutrition guidelines selected by the local educational 2) Includes nutrition guidelines selected by the local educational agency for all foods available with the objectives of promoting agency for all foods available with the objectives of promoting student health and reducing childhood obesity; student health and reducing childhood obesity;

3) Provides an assurance that guidelines are being met3) Provides an assurance that guidelines are being met 4) Establishes a plan for measuring implementation of the local 4) Establishes a plan for measuring implementation of the local

wellness policywellness policy 5) Involves parents, students, and representatives of the school 5) Involves parents, students, and representatives of the school

food authority, the school board, food authority, the school board, school administrators, and the public

Plan The MenuPlan The Menu

Policy must include the following:Policy must include the following:

1a. 1a. Nutrition education goalsNutrition education goals

1b. 1b. Physical activity goals Physical activity goals

1c. 1c. Other school-based activities Other school-based activities

2. 2. Nutrition guidelines/standardsNutrition guidelines/standards

3. 3. Assurances that USDA school meals Assurances that USDA school meals guidelines are being metguidelines are being met

4. 4. Plan for measuring implementationPlan for measuring implementation– Designation of 1 or more people to ensure Designation of 1 or more people to ensure

wellness policy is being met at all school wellness policy is being met at all school buildingsbuildings

We recommend having a specific workgroup We recommend having a specific workgroup designated to work on each of the above sections.designated to work on each of the above sections.

Sample Goals from USDA

Tremendous Tremendous Resource!!!!!!!!!Resource!!!!!!!!!

http://www.actionforhealthykids.org/wellnesstool/index.php

Group Work: Group Work: Practical Practical StrategiesStrategies for the Wellness for the Wellness

Policy:Policy:Areas to ConsiderAreas to Consider Nutrition Nutrition

EducationEducation Physical Education Physical Education

& Physical Activity& Physical Activity Other School Other School

Based ActivitiesBased Activities Health EducationHealth Education Family/Home Family/Home

InvolvementInvolvement

TechnologyTechnology Interdisciplinary Interdisciplinary

connections to connections to wellnesswellness

Brain Primers Brain Primers (Energizers)(Energizers)

Intramural/After Intramural/After SchoolSchool

School NurseSchool Nurse Wellness AdventuresWellness Adventures Eating EnvironmentEating Environment

SchoolSchool Wellness Policy Wellness Policy ProvisionsProvisions

Requirement #2Requirement #2 Nutrition guidelinesNutrition guidelines for all foods available for all foods available

during the school day:during the school day:• school mealsschool meals• a la carte foods, a la carte foods, • vending machines, vending machines, • snack bars, school stores, concession standssnack bars, school stores, concession stands• any school-sponsored fundraising activitiesany school-sponsored fundraising activities

School Wellness Policy School Wellness Policy ProvisionsProvisions

Requirement #3Requirement #3

Assurance that nutrition guidelines Assurance that nutrition guidelines for school meals for school meals will not be less will not be less restrictiverestrictive than federal regulations. than federal regulations.

School Wellness Policy School Wellness Policy ProvisionsProvisions

Requirement #4Requirement #4

A plan for measuring the effectiveness of the A plan for measuring the effectiveness of the wellness policy,wellness policy, including the designation of including the designation of at least one personat least one person to oversee the activities to oversee the activities and maintain responsibility for program and maintain responsibility for program operation. operation.

Recommendation - periodically assess how Recommendation - periodically assess how well the policy is being managed and well the policy is being managed and enforced, and evaluate any financial impact to enforced, and evaluate any financial impact to vending policies. Evaluation and feedback are vending policies. Evaluation and feedback are very important in maintaining a sound, school very important in maintaining a sound, school wellness policywellness policy..

Assessment ToolsAssessment Tools USDA Team NutritionUSDA Team Nutrition – “Changing the – “Changing the

Scene”,Scene”, a tool kit designed to address a tool kit designed to address improvements in the school improvements in the school nutrition nutrition environmentenvironment. The State of Michigan . The State of Michigan modified this improvement checklist (a link is modified this improvement checklist (a link is available from this website) to help you available from this website) to help you measure progress as you take action.measure progress as you take action.

http://www.fns.usda.gov/tn/Resources/changing.htmlhttp://www.fns.usda.gov/tn/Resources/changing.html Centers for Disease Control/Healthy Centers for Disease Control/Healthy

YouthYouth – “School Health Index”, – “School Health Index”, a self- a self-assessment and planning guide that enables assessment and planning guide that enables schools to schools to identify strengths and weaknesses identify strengths and weaknesses of their health policies and programs, of their health policies and programs, develop action plans for improving student develop action plans for improving student health, and involve teachers, parents, health, and involve teachers, parents, students, and the communitystudents, and the community in improving in improving school policies, programs, and services. This school policies, programs, and services. This assessment tool is now available to schools assessment tool is now available to schools online and includes online tools for online and includes online tools for summarizing results. summarizing results.

http://apps.nccd.cdc.gov/shi/http://apps.nccd.cdc.gov/shi/

http://apps.nccd.cdc.gov/shi/default.aspx

SHI FormatSHI Format No CostNo Cost

Completed by school health Completed by school health teamsteams Meets Section 204 requirementMeets Section 204 requirement Members should represent each school in districtMembers should represent each school in district Involving youth in the process is highly desirableInvolving youth in the process is highly desirable

Two separate versionsTwo separate versions Elementary SchoolElementary School Middle School/High SchoolMiddle School/High School

Self-Assessment: Self-Assessment: Consists of 8 modules which follow the Coordinated School Consists of 8 modules which follow the Coordinated School

Health Program modelHealth Program model 4 of 8 relate to Local School Wellness Policy 4 of 8 relate to Local School Wellness Policy

Worksheets lead to development of a “Plan for Action” for Worksheets lead to development of a “Plan for Action” for improvements improvements

Well tested and frequently used Well tested and frequently used

Sample Section of SHISample Section of SHI

Other Evaluation ToolsOther Evaluation Tools

Collect BMI’sCollect BMI’s Illinois Nutrition Education and Training Illinois Nutrition Education and Training

ProgramProgram Action For Healthy Kids WebsiteAction For Healthy Kids Website

State profiles & assessment toolsState profiles & assessment tools School Nutrition Association’s “Keys to School Nutrition Association’s “Keys to

Excellence”Excellence” Michigan Healthy School Assessment Tool Michigan Healthy School Assessment Tool

(HSAT) (HSAT) Marketing Assessment Tool, CA Project LEANMarketing Assessment Tool, CA Project LEAN

Recipe for Success (CD available)• West Virginia interactive video which you can give to administration or share over lunch.

Sample Wellness PoliciesSample Wellness Policies

Sample Wellness Policies–NANASample Wellness Policies–NANA Sample Wellness Policy-OKSample Wellness Policy-OK Sample Wellness Policy-KASample Wellness Policy-KA Sample Wellness Policy-ILSample Wellness Policy-IL Sample Wellness Policy-ND (many Sample Wellness Policy-ND (many

district examples)district examples) http://www.ag.ndsu.edu/k12wellpolicy/http://www.ag.ndsu.edu/k12wellpolicy/

policies.htmlpolicies.html ImageImage

ResourcesResources

Slides and materials used from several government Slides and materials used from several government and public websites. and public websites.

Action for Healthy KidsAction for Healthy Kids www.actionforhealthykids.orgwww.actionforhealthykids.org

Team NutritionTeam Nutrition www.fns.usda.gov/tn/healthy/wellnesspolicy.htmlwww.fns.usda.gov/tn/healthy/wellnesspolicy.html

National Alliance for Nutrtion and ActivityNational Alliance for Nutrtion and Activity www.schoolwellnesspolicies.org/www.schoolwellnesspolicies.org/

Making it Happen – School Nutrition Success Making it Happen – School Nutrition Success StoriesStories www.fns.usda.gov/tn/resources/makingithappen.htmlwww.fns.usda.gov/tn/resources/makingithappen.html

School Nutrition AssociationSchool Nutrition Association www.asfsa.org/childnutrition/fsoperations/policies/index.awww.asfsa.org/childnutrition/fsoperations/policies/index.a

spsp

ResourcesResources

http://www.schoolwellnesspolicies.org/WellnessPolicies.htmlhttp://www.schoolwellnesspolicies.org/WellnessPolicies.html http://http://www.schoolwellnesspolicies.org/WellnessPolicies.htmlwww.schoolwellnesspolicies.org/WellnessPolicies.html http://www.schoolnutrition.org/uploadedFiles/SchoolNutrition.org/Chihttp://www.schoolnutrition.org/uploadedFiles/SchoolNutrition.org/Chi

ld_Nutrition/Local_School_Wellness_Policies/SNALocalWellnessPolicyld_Nutrition/Local_School_Wellness_Policies/SNALocalWellnessPolicyGuidelinesFinal.pdfGuidelinesFinal.pdf

http://departments.oxy.edu/uepi/cfj/resources/healthy_school_foohttp://departments.oxy.edu/uepi/cfj/resources/healthy_school_food_policies_05.pdfd_policies_05.pdf

www.mihealthtools.org/schoolswww.mihealthtools.org/schools

The CDC's data on The CDC's data on obesity trends:obesity trends:httphttp://://www.cdc.gov/nccdphp/dnpa/obesity/trendwww.cdc.gov/nccdphp/dnpa/obesity/trend//

The CDC's The CDC's Youth Risk Youth Risk Surveillance System: Surveillance System: http://http://www.cdc.gov/HealthyYouth/yrbs/index.htmwww.cdc.gov/HealthyYouth/yrbs/index.htm

Action for Healthy Kids' Action for Healthy Kids' State Profiles for ActionState Profiles for Action httphttp://://www.actionforhealthykids.org/state.phpwww.actionforhealthykids.org/state.php

Questions & CommentsQuestions & Comments