PSYC 123: The Psychology, Biology and Politics of Food

Lecture 20

 - Schools and Nutrition: Where Health and Politics Collide (Guest Lecture by Marlene B. Schwartz)


Dr. Marlene Schwartz discusses the topic of food policy in schools. She presents the history of federal regulation of the National School Lunch Program, the debate about competitive foods in schools, and describes research on influence of school food on student nutrition. She describes Rudd Center research conducted in collaboration with the Connecticut State Department of Education on the effectiveness of policy changes at the district and state level. She also shares lessons from her personal experiences as a parent advocate in her own school district and describes how her volunteer work in the community informs her academic research.

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The Psychology, Biology and Politics of Food

PSYC 123 - Lecture 20 - Schools and Nutrition: Where Health and Politics Collide (Guest Lecture by Marlene B. Schwartz)

Chapter 1. Introduction to Dr. Marlene Schwartz [00:00:00]

Professor Kelly Brownell: Welcome everybody. I was just curious, how many of you guys would be up at this hour anyway if it weren’t for this class? About six it looks like — well, I’m happy I could help the rest of you be up early in the morning like Ben Franklin says, it’s good for you.

Before I introduce today’s guest speaker, I wanted to announce that Monday we’ll have a guest lecturer as well, somebody that you’ll really want to see. His name is Brian Wansink. Brian is a Professor at Cornell University, a professor of marketing, and has done a tremendous number of very interesting studies about the factors that drive what people eat. Factors like the size of the portions, how much is in a container, the shape of glasses and things like this that end up in the press a good bit, so you probably about his work already. He wrote a book called Mindless Eating that has received a lot of attention and so he’ll be very interesting to hear from based on his own research.

Then in addition to that, Brian was recruited to the U.S. Department of Agriculture to take a high position in a part of the USDA that establishes nutrition policy. It’ll be very interesting to hear him discuss how his academic and scholarly work comes together with public policy. In addition to that he is a very engaging speaker, so I’m sure you’ll like him.

I’m very happy today to introduce a colleague of mine, Dr. Marlene Schwartz. Marlene is the Deputy Director of The Rudd Center for Food Policy and Obesity, and in that position has a key role in establishing the direction of The Rudd Center and coordinates essentially all the activities of The Rudd Center. She was trained at Yale University, has a PhD in clinical psychology from Yale, spent a number of years as Director of The Yale Center for Eating and Weight Disorders. So in addition to the work that she’s going to talk about in schools today, she’s an expert on the treatment of eating disorders, obesity, and various body image related issues.

Then in more recent years, has become very interested in children’s nutrition, parents’ role in shaping their children’s nutrition and the schools, and has been very heavily involved in the national scene about schools and nutrition. In the state of Connecticut, as I mentioned before, we have the strongest school nutrition legislation in the country. Marlene was very involved in providing the academic and scholarly basis for that public policy.

She’s asked to consult around the country on various school nutrition related issues and she’ll probably talk today about her work on school nutrition wellness policies, school wellness policies. There’s an interesting history having to do with federal legislation and what actually happens on the ground in schools with this, and Marlene’s work has been used for the basis of a number of interesting decisions regarding school nutrition around the country.

It just so happens that a number of you — and I’m very grateful for all you guys sending me articles that you see and video clips and things like that, which are really nice — a number of you sent me an article that was in The New York Times on Monday and it was on schools and nutrition, and Marlene was quoted in that article. Let’s please welcome Dr. Marlene Schwartz.

Chapter 2. Guidelines and Access: A History of Regulating School Food [00:03:27]

Dr. Marlene Schwartz: So as Kelly said, I was trained here at Yale University. What he didn’t mention is I was trained here at Yale University by him, and so what you’ll notice as I go through my work, is it probably will seem very familiar to you in terms of the way that I think about research and the way I think about combining research with public policy.

What I’ll be talking about today is a little of history about regulating school food. Even though it’s something that seems to be a new issue, it actually goes back quite a few decades, and I think it’s good to have that perspective. Secondly, I’ll be reviewing some of the research on how school food influences student nutrition and health. I’m going to give you a little directory of who’s who in the school food movement in the United States and in the UK, and then share some of my own experiences in the process of trying to make local changes, and then discuss in more detail this newer phenomenon of school wellness policies.

One of the questions that I often get asked when people know that I care about childhood obesity, is: why are you focusing specifically on schools? There’s some pretty clear answers to that question. First, it’s where the kids are, so they have access to 95% of all American children, and The National School Lunch Program serves 29 million children each day, so if you can make a change in The National School Lunch Program, you’re going to immediately affect the intake of millions of children. They also are subject to both federal and state regulation, which means from a policy perspective there are a couple of avenues through which you can try to make changes in the school system.

Another thing is I feel like schools have a precedent for setting higher safety and health standards. I often give the example that when I was in high school we had a smoking area specifically for students, where if your parents signed a permission slip you were allowed to go and smoke during the school day. That was one of the first things that was banned, and that had to be done well before we started seeing things like no smoking in restaurants or other public buildings.

Finally, schools are really the ideal setting where you can combine education with the environment, and sort of teach children about nutrition, but then help them sort of live the lessons that you’re teaching them while they are eating at school.

In terms of the history, this may come as a surprise to you, you may have not such terrific memories of school lunch, but the official school lunch — the thing that had all the different components, the protein, the grain, the fruit, the vegetable, and the milk has always been required to meet certain nutrition guidelines. So there really were rules about the chili dog or the chicken nuggets, where that meal did have to come together and meet these guidelines which originated back — The National School Lunch Program was originated in 1946, and The Breakfast Program in 1966.

School meals have to cover one-third of the recommended daily allowance for calories, protein, and several vitamins, and iron, and calcium. They also are legally supposed to have fewer the 30% of their calories from fat and fewer than 10% of their calories from saturated fat. People sometimes find that hard to believe, but those are the guidelines that food service directors are required to follow.

The problem has been what’s called competitive foods. Those are the foods that are sold in addition to the school lunch in the cafeteria. As many of you probably remember, in the school cafeteria, you had sort of the official lunch of the day but then there were often other snacks or beverages, or just one component of the lunch like one hamburger, or just French fries that you could buy separately. Those are all competitive foods because they compete with the full school lunch.

These competitive foods started coming into schools in the late 1960s. In 1970 the USDA were concerned that some of these competitive foods were being sold by people other than the school lunch program, and so they were essentially taking money away from the school lunch program. They proposed that any food offered at school, during lunch, could only be sold by the program. What that meant is that other groups like clubs, or the PTA, or things like that, were not allowed to do any type of fundraising during the lunch period, either through vending through school stores, bake sales, things like that.

Well, in 1972 there was a lot of controversy about this, and the federal authority from the USDA to set this regulation was actually removed, and was given instead to the states. At that point states could set their own guidelines for whether or not other foods were allowed to be sold in competition with school lunch. This was helpful for the people who wanted to do fundraising during school, so these other organizations could then sell food during lunch, and get money for their causes from the students. However, then there was a concern that there were very inconsistent state standards, so in some states the school lunch had no competition, in other states there was a lot of competition.

So in the late 1970s, the USDA got their authority back. They introduced this concept of foods of minimal nutritional value, which is a term that you hear a lot when you start really getting into the trenches with the school lunch. These are foods that are defined because they contribute less than 5% of the recommended daily allowance of certain important nutrients, and they fall into four categories. They fall into candy, soda/water, frozen desserts, and chewing gum.

In 1980, the USDA decided that these foods of minimal nutritional value, which include soft drinks and candy, were prohibited anywhere in the school until after the last lunch. They were trying again to sort to clear out the cafeteria from these other foods. In doing so, make sure that kids were more likely to buy the lunch.

The health advocates didn’t like this, because they felt it wasn’t restrictive enough. They wanted those foods out of the building entirely. But The National Soft Drink Association on the other hand, thought they were too restrictive. They said that the USDA was taking advantage of their power and this law was arbitrary, capricious and abusive discretion and otherwise not in accordance to the law. S they filed a lawsuit and they requested a preliminary injunction meaning that they didn’t want this law to go into effect until they had a chance to appeal it.

In June of 1980, the district court denied that request, they appealed, and in 1983 the U.S. Court of Appeals overturned the time and place portion of the role. What that means is that they said in fact these foods — those soft drinks would be sold in schools. In 1984, they finally said that those foods of minimal nutritional value couldn’t be sold during the meals, but they could be sold before and after the lunch period.

That’s pretty much how things have been since 1984. Right now the situation is that during the school lunch period the school can sell these — the regular lunch, they can sell some of these sort of snack items but not the foods of minimal nutritional value. Those can only be sold early before the lunches start, and later after all the lunches finish.

One of the things that’s been talked about a lot is that we need an expanded definition of foods of minimal nutritional value. I have this list up here, and if you just want to take a moment and just jot down which one you personally would consider junk food. What do you think is a food of minimal nutritional value? Then, I’m going to show you which ones technically are foods of minimal nutritional value.

What’s striking about this is what’s not: so French fries, ice cream, candy bars, cookies, chips, snack cakes, and donuts are all not considered foods of minimal nutritional value. In other words, those can be sold during the school day, and are not considered a food that is not a healthy choice for a child. Clearly this list needs to be updated.

What does the school food environment look like right now? Well I quote Kelly who said, “It’s a 7-Eleven with books,” in testimony to the U.S. Senate. In fact, it is remarkably like that. If you — this was from 2004, there was a study looking across the country to look at the competitive foods across elementary, middle, and high schools. What’s striking about this is if you look at the vending category in the high schools, which is in sort of the blue/green color, you can see that over 90% of American high schools have vending machines in their schools, so this is a huge, huge issue.

Now what I think is interesting is when you look at that environment, having the vending machines in your high schools, and how consumption of milk and soft drinks have changed over time for American teenagers. These are some data from the USDA, and you can see back in the late 1970s, boys had about 15 drinks of milk a week, girls about 10, and then both boys and girls had about seven drinks a week of soft drinks. By the mid-1990s you can see that milk consumption had significantly dropped and soft drink consumption had significantly increased. You’ve got boys — teenage boys tend to be some of the highest consumers of soft drinks — is up to 20 beverages a week, so clearly there’s been a significant shift in what teenagers are drinking. I would argue it’s because back in 1970s the only thing you had to drink was milk or water from the water fountain, whereas, by the mid-1990s, 90% plus of these schools had vending machines that sold soft drinks.

Now I’m going to give you a sneak preview of your speaker on Monday, Brian Wansink, because he did a study which has actually been very influential in my own thinking of how to change the school environment. What he did, is he went into office buildings with bowls of M&M’s. He’s actually done a lot of M&M studies, which he’ll probably share with you next week; but this was one of the M&M studies where he had bowls of M&M’s and in some offices, he put the M&M’s on the desk. In other offices he put the bowl of M&M’s over on the printer stand, which as you could see was maybe a foot and a half away from where the person was sitting. Then he — and maybe his students snuck into office buildings at night and looked to see how many M&M’s were left in the bowls from these different locations.

Amazingly, what they found was that if your M&M’s were right in front of you where you could just reach out and get them, you were significantly more likely to eat those M&M’s than if you had to actually get up and take two steps to your printer stand and get them over there.

What’s interesting about this is it shows how very subtle changes in the environment — I mean you don’t think of that as being a major difference in terms of your access to M&M’s, can actually significantly influence how many of something you’ll eat and how quickly you will eat it.

Another thing that’s also infiltrated the schools is the use of food as a reward in the classroom. This is just an example. This was a program from Dunkin’ Donuts where they told teachers that if their students did their homework, they should hand out these coupons which were good for two free donuts. In addition to the physical food that’s being sold, there’s also been an effort on the part of the food industry to get their product sort of advertised and promoted within the school setting. What influence does this have? How does the environment influence student nutrition and health?

Well, there have been a bunch of studies looking at the school environment and what changes it seems to make in terms of student nutrition. One of them found that students who choose The National School Lunch actually eat two times as many fruits and vegetables as children who don’t. This is interesting because again, The National School Lunch has a pretty bad reputation, but what they found was that if you did order the lunch, which by law has to offer a fruit and a vegetable, you were better off than if you just bought the a la carte items or even if you brought your lunch from home.

There’s also been research showing that as students transition from elementary school, which tends to have fewer competitive foods to middle school where there are more, their diet deteriorates. They’ll eat fewer fruits, non-fried vegetables, less milk and more sweetened beverages. Again, this was just another way of documenting how the environment can really significantly change the way kids are eating.

There’s been some research looking at schools that don’t have the a la carte or competitive foods, and they found that the students in those schools eat more fruits and vegetables and fewer calories from fat.

Finally, one of the studies that I find most convincing is one that looked at high schools — this was done in Minnesota and they interviewed high school principals and asked them about the types of policies they had that limited student access and consumption of foods, so these were things like having a closed campus as opposed to an open campus, whether or not they allowed eating in the classroom, whether or not they allowed eating in the hallway, things like that.

What they found is that the schools that had more policies to limit consumption actually had a lower prevalence of obesity then the schools that had fewer of those policies. This is a really interesting study because unlike just the others that look more at behavior, this one actually found a link to student weight.

In addition to those, there have been a number of large-scale studies that have tried to go in and do interventions at the school level to see if they can have an influence on student weight. These tend to include things like nutrition and physical education; teaching the people working in the cafeteria to do different types of cooking, so for example, to use low fat cooking methods or switch to low fat versions of foods, ideas on increasing more physical activity in schools, so different types of ways to get kids moving in the classroom so it’s not just about P.E. A lot of these programs include communication with parents about the importance of nutrition.

Then the two specific things that have gotten quite a bit of research attention is recommending that students decrease their television watching, because that’s been shown to be an important predictor of body weight, and also recommending that students decrease their soft drink consumption.

When you look at the literature as a whole, there have been behavior changes documented in many of these studies. However, the research hasn’t found that many strong changes in body mass index or in other types of physical measures — health measures. The field, I think, has been kind of frustrated because a lot of effort has gone into doing these sorts of interventions and the findings haven’t been as strong as researchers would have liked.

One thing that came through is that the best predictors of seeing a change in body mass index were decreasing soda consumption, and decreasing television watching. Then very recently a researcher named Gary Foster who’s at Temple University, published a study he did in Philadelphia with middle school students, where he found that if you go in and make a lot of these substantial environmental changes, he was able to document that he could prevent the onset of overweight in the students — in the middle schools that got this intervention.

So in other words, there was sort of the average rate of overweight that was going to happen in both schools. In the intervention school, he was able to decrease the number of students who became overweight in the two years of this study. He was also, and this is really important, able to show that he could reduce the number of students who developed Type II Diabetes. It’s interesting that this more recent study has been able to show an effect, and so I think that researchers have gotten better at assessment, gotten better at doing some of these programs, and have really in this study in particular, had very strong policies as part of the program in terms of what they could provide in the school.

Chapter 3. Who’s Who in School Food [00:19:15]

Here’s a — sort of a quick tour of who’s who on the school food issue. This is Jamie Oliver, and you all — some of you may be familiar with him. He goes under the name The Naked Chef and he has a lot of cookbooks. A few years ago he learned about the school food in the UK and he was furious. He thought that it was absolutely appalling. He has a very big personality, and he had a television show, and what he did is he used television, and quite frankly humiliation tactics, to really embarrass the government and persuade them to increase the funding for school lunches. He is really credited with providing the political will to increase the amount of funding that schools got in Britain.

Someone here in the United States who’s been a real hero is Alice Waters. She is the owner and chef of Chez Panisse in Berkeley, California; she is also the mother of a Yale — former Yale undergraduate. She created something called The Edible Schoolyard, which is at a middle school in Oakland, California where they created a garden on the grounds of the school and they’ve done a really remarkable job incorporating the gardening and the food that they grow in the garden into not just the cafeteria but also the curriculum. It’s really a model program of how to have a garden in the school and to make it part of the child’s experience. Right now, there is research going on to try to assess what the effectiveness has been of that program in terms of changing children’s overall nutrition and health.

Then linked to that program is a woman named Ann Cooper who was originally a gourmet chef from Vermont. She then went to a place called The Ross School in New York and completely revamped their cafeteria, and then was recruited to go to Berkeley, the school district where Alice Waters is involved, and take over as the Food Service Director of The Berkeley Unified School District and — which is a huge school district — and to prove, and her sort of personal mission is to prove that you can have healthy, affordable food that children will eat.

She’s another just really charismatic, high energy person who has taken this on and done what many thought was really impossible, which was to change the sourcing of where the food is coming from in school lunches, making it as healthy as possible, and showing that children will in fact eat that food if it’s served to them.

Then on the political front, another real hero is Senator Tom Harkin who is from Iowa and he’s been probably the strongest champion of children’s nutrition and has introduced a number of bills over the years to set higher standards for school food. Most recently, he was behind the introduction of a federal law that said that every school district in the country needed to write a School Wellness Policy. I’ll talk a little bit more about this later, but he’s really been just sort of a tireless advocate for improving school food.

I should also mention The Clinton Foundation has been involved in this issue through The Alliance for a Healthier Generation, and they’ve done quite a bit of work with The American Heart Association and the beverage and snack food industries and to help the industries set voluntary guidelines that they have agreed to follow in terms of the types of foods they’ll sell in schools. It’s a little bit controversial because those guidelines are not as strong as a lot of public health advocates would like, but at the same time the philosophy there is that it’s better to work with the industry and get the industry to agree to make these changes.

Another person is the former governor of Arkansas, Mike Huckabee. He is another very charismatic speaker, very passionate about this issue, and always talks about his own personal experience of losing 100 pounds. He’s really become a crusader on this. While he was governor he, I think, introduced the most comprehensive statewide changes to public schools in Arkansas. This actually included a lot of things in terms of changing the food they had; they’re changing the contracts with vending machines, but the part that got the most press was this controversial BMI report card, which is they had each child get weighed and measured at school, they calculated their BMI. Then a report was sent out to the parents telling the parents what your child’s BMI is, where it falls in terms of being normal weight, overweight, or obese and then some guidelines and ideas of what kind of changes you can make at home.

A lot of people felt that this was really inappropriate for the school to get into this, and I think the media was really more upset about it then the parents were, because they’ve been — in Arkansas they’ve actually continued this program for I guess they’re probably in about the fourth year of it now. They’ve really found that people have gotten used to it, that people are not upset about it; you are allowed to opt out if you don’t want to get the information. What’s been great about it is they can now track BMI in the entire state, and so they’ve been able to show that their efforts have actually leveled off the increase in childhood obesity that they were seeing before.

Then right here in Connecticut locally, I would say another important figure has been our senate president Donald Williams. He has introduced legislation both in 2005 and 2006 to strengthen the nutrition standards we have in schools here in Connecticut. I’ll tell you the story in more detail in a bit, but this did as Kelly mentioned, result in the strongest legislation in the country on beverages.

Then finally I think credit has to go to The Robert Wood Johnson Foundation, which as a private foundation has committed to spend $500 million dollars of obesity to, as they say, reverse childhood obesity by 2015. Their approach has been not at all a medical model but much more of a public health model, where their projects all are about improving access to affordable healthy foods and increased physical activity. They specifically are focusing on schools and communities, so a lot of the research going on looking at schools right now is being supported by The Robert Wood Johnson.

Chapter 4. Parent Advocacy, Negative Responses and Finding Solutions [00:25:19]

Now I’m going to talk about sort of how you make changes on the local level, and tell a little bit about how I got involved in all of this as a parent advocate. These are my three kids Anna, Molly, and Charlotte. Molly and Charlotte are identical twins, Anna’s three years older than they are.

Basically I was working at The Yale Center for Eating Weight Disorders doing research in this area in the fall of 2002. Kelly was in the middle of writing Food Fight and my oldest daughter started first grade at the public elementary school. What I learned right away was that they sell snack everyday at lunch, and snack they defined as ice cream, potato chips, things like that they called them all snack.

My daughter of course came home and wanted fifty cents every day to buy this snack, and I was really troubled by this, because I really didn’t want her to be buying snack, but then I was worried about upsetting her. We ended up negotiating and she was allowed to buy snack on Fridays, but I was really uncomfortable. I wanted to go to the school but I thought, gosh she’s only been at school for a week, I should probably not go marching in there right away. I just decided to pace myself and I was going to wait and see what happened.

Well then, by December I got a notice that they were having a family event featuring a cookie eating contest as a fundraiser, and I basically just decided that that was the last straw, that I couldn’t really sit quietly while they were have cookie eating contests. Of course Anna wanted to be in the cookie eating contest, I had to explain no you can’t.

So I called the principal and I decided to get involved. Fortunately in the district where I live, the principal of my daughter’s school was very interested in this issue and I think, in fact, had probably just been waiting for a parent like me to come along to support her in trying to make some changes.

What I learned is that the food service is self-supporting, and this is really true across the country. Part of what happened with the competitive foods was this vicious cycle where they weren’t making a lot of money from the lunch sales, so they started selling the competitive foods to make more money. The more they did that the lower down their lunch sales went because kids came in and spent their money on the snacks instead of the lunch, and they really got themselves into a position where the majority of their income was coming from the snacks and not from the actual lunch. That was problem number one.

Number two, I learned that most of the teachers actually didn’t want to have all the birthday parties and things like that in the classroom and all the food being brought in for holidays, but they were actually afraid of the parents. When I heard that, I was like oh no, I’m sure you should not be afraid of the parents, because I’m sure that most parents feel just the way I do.

I set out to prove that in fact they all felt the same way I did. I decided I would do a survey. The first thing I did was an online survey in our school district of all the parents, where I asked lots of questions about how you felt about the school food, how you felt about child’s nutrition, were you worried about your own child, things like that.

What I found was that 92% of them said they did not want food offered as a reward in the classroom, and then about two-thirds felt that their child’s diet wasn’t as nutritious as it should be, and 62% said their child eats too many sweets. I was gathering this information so that I could make the argument that most of the parents in my town actually were concerned about their child’s diet, did think that their child was eating too much junk, and would like to see some of these policy changes.

I got some comments that I was able to then take back to The Board of Education saying, people saying things like I prefer to see only healthy foods in the public schools, the kids are exposed to lots of junk and calories, please take the junk out of the schools, this is the most important thing you can do for our children. So I was pretty sure that this was going to be just fine.

The second thing that I did in working with the committee in my district is we did a nutrition survey of all the fourth graders, because this way I felt like I could show that the students really weren’t eating as well as we would like them too. We found a few things. The good news was we found that actually the children were drinking the right amount of milk so it did seem that that was not a problem; these are fourth graders. Although we found that the children were eating about half as many servings of fruits and vegetables as they need, and they were eating nearly three times the number of cookies, ice cream, candies, fries, and chips as recommended. I specifically looked at cookies, ice cream, candy, fries, and chips because those were the things that were being sold in the cafeteria.

With that information, the committee met with the superintendent who suggested that we sort of pick our battles and we start with the youngest children, so we decided to focus on the elementary schools in the beginning. The Food Service Director agreed to take out all snacks, which is pretty huge. No snacks whatsoever — so just the school lunch and then introduce some new lunch options, things like wraps, soups, and salads so that there were more healthy options there.

Then the principals were still scared of the parents with the snack foods being brought in for birthday parties and things like that, so rather than saying parents were not allowed to do it, they sort of politely asked parents to please bring in healthy snacks for birthdays, and so they would see how that would go.

Well, here’s my advice to anyone who ever tries to do this: is be prepared for negative responses. Because on the one hand most parents were very happy to see the food service change its behavior, but what I learned was the teachers were right: that once parents were asked to change their own behavior, they felt very differently.

First, I was called the ‘cupcake police’ and someone sent me this cartoon. Then I started getting emails with different complaints, so I have a few quotes of some of my favorites. One is, ‘there are so many rules and life seems like less fun nowadays for kids, even in the Bible they celebrate with food.’ Then there was ‘This is America where we continue to fight and die for the basic rights of freedom. If parents and students choose to drink whole milk and eat ice cream, they retain the right to do so.’ This was really interesting because it was really showing that this wasn’t so much about food, this was really about this is America, and we have rights in this country. Then I got the ‘Come on birthdays are only once a year.’

I started thinking, okay how can I respond to these? The first thing I did is I started going around to all the different parent organizations and doing presentations for the PTOs and try to explain the rationale behind this. I did come up with this slide to address the only once a year, because what I was realizing is that parents think of their own child’s birthday but they don’t necessarily think about every else’s child. I made this slide to show all the things that happen only once a year. Then I added in all the birthday parties, and then I added in all the cupcakes. What it really showed is that in the life of these elementary school kids they are actually exposed to a lot of these foods, and even though taken individually it seems like they don’t happen that often, that put together, there are a lot of events where kids are fed these foods.

Then came the really hard part, which was having to walk the walk. After making a big fuss, I mean everyone in the whole town knew who I was because I made such a fuss about these parties, my daughter’s birthday is in July, so at the end of the spring semester they say all the summer birthdays can come in and have a party to celebrate their birthday.

Of course my daughter wants to bring in cupcakes.I was put in this very difficult position where I had to say to my little six going on seven year old, I’m sorry honey, but mommy can’t be seen bringing cupcakes into the school. We need to come up with a new solution.

This was really tricky and I tried to think of something and I came across — and now it’s actually fairly well known, but a while back this was one of the early stages in — this is called Edible Arrangements — you all have probably seen these products before. They make these fruit bouquets where they cut up the fruit, it’s very beautiful, it looks like flowers, it easily costs ten times as much as a package of cupcakes from Stop N’ Shop, but I had a point to make so money was no object.

Anna and I we went online, we checked out the website, we picked out the arrangement, I drove to East Haven, I picked it up, and I was all ready and having to talk about walking the walk, I have to share with you that one of the most terrifying moments in this whole thing was walking down the hall from the parking lot to my child’s classroom thinking, if those kids don’t like this fruit bouquet, I am in big trouble. I just had to keep trusting that it was going to be okay.

I got there, good news there is a very happy ending to this story: that the kids saw it, they came running over, they were completely excited, this little girl named Megan who I will be clapping loud when she graduates someday, was the first one to come over and say, ‘wow you’re so creative, that’s so great!’

And so the kids lined up and they were completely fine, nobody said where are the cupcakes, nobody was disappointed, they truly did not care. They were a bunch of first graders, there was a novel, sort of interesting thing coming in, they were allowed to eat it. I learned a really important lesson, which is in a lot of this, it’s the parents who are so scared of disappointing the children or having the children get upset with them, that they really are afraid to try new things. That was, I think, an important experience in all of this.

Chapter 5. Responding to the Critics [00:34:28]

Then another one of the things that I heard was ‘You’re going to make things worse by taking the snacks out of the school, because this is going to lead to children binge eating on those snacks at home.’ That’s an empirical question that we were able to answer. Fortunately, because I sort of knew that these snacks were going to get removed the next year, before the end of the school year in 2004, I went in and I did an assessment asking kids about the snacks they ate school and the snacks they ate at home. I was able to show that, as you can see, they’re eating a lot of snacks at home and they’re eating a lot of snacks at school, so the home is the ice cream, the school is the red part on top of that.

Then in the second year, I redid the survey at the same time, year two, and found that consumption at school had gone down obviously, I mean it wasn’t being sold there anymore, but home consumption was staying the same. Now what’s interesting about this is some people say well home consumption should have gone, like somehow we should have made children stop thinking about ice cream altogether. Well, that didn’t happen.

What’s more important is home consumption did not go up, so it wasn’t as though the children knew, somehow were aware that they had been deprived of their ice cream at school and ate twice as much at home. They ate the exact same amount at home as they had eaten before, and we did this for several products, and it was the exact same finding. This is potato chips, this is frozen desserts, this is cookies, brownies, and donuts.

We consistently saw that children were not doing this compensatory behavior that people were worried about. Interestingly, we did see that some of the healthier snacks were increasing in consumption at home, like granola bars, low sugar cereals, and baked chips. It seemed like we were also observing kind of a cultural shift in terms of what people saw as appropriate snacks for their kids.

Now, at the same time, a lot of things were happening the state in terms of changing the snack offerings in Connecticut schools. I had the opportunity to work with The State Department of Education on a much larger study where we looked at three middle schools across the state and three sort of comparison schools, and essentially did the same thing. Went in, did an assessment of how the children were eating, the next year removed the unhealthy snacks and beverages from the school and then at the end of that year did a second assessment of the students to see how they were eating.

We replicated the finding from The Guilford Study that snack consumption decreased at school and it didn’t change at home, it stayed exactly the same. We were also able to get to another question had been raised which was that we were somehow going to trigger eating disorders with this type of work. That we were going to increase student concerns, dieting behavior would skyrocket, and there would be all of these negative effects. We were able to assess both weight concerns and dieting behavior across both conditions and found that it was exactly the same. That there certainly is weight concern and there is dieting behavior among middle school students, but there was no difference between those in the school where we did the intervention and those in the school where everything stayed the same.

I think that that’s really important, because unfortunately in this field, there has been a problem of eating disorder professionals sometimes being opposed to obesity prevention efforts because they feel by definition it’s going to encourage sort of unhealthy weight restriction and food restriction behavior, but there really hasn’t been evidence of this. Not in our research and in Arkansas they’ve also been tracking this. Even with those BMI report cards they’ve seen no increase in the reporting of eating disorder behavior or eating disorders, so I think that’s an important thing to keep in mind.

Another source of criticism or concern that we were hearing was from other food service directors. Some of the food service directors in the state were making changes but others said I can’t make these changes because we’re going to lose money. We did do some research, both with the Connecticut data and a colleague of mine, Chris Wharton, reviewed the literature from other places that had tried out these programs and found that schools that make changes like this on average do not lose money and this is a really, really important thing to be able to document.

Basically what happens is, I kind of mentioned that vicious cycle before, is that when you take out the unhealthy a la carte, and put in things like baked chips, or low fat frozen yogurt, and your a la carte sales do go down, so definitely children are less likely to buy the baked potato chips then the regular potato chips. However, they’re still hungry, they have to eat something. What happens is most times, it’s as though the kids say of fine I’ll just buy the school lunch since there’s nothing good over here with these snacks, and so your lunch sales go up.

What we know from the previous research that kids who are eating the school lunch tend to eat better. This is really a win, win because the nutrition is going to improve, the amount of federal reimbursement the school’s going to get from their higher level participation in the school lunch program is going to improve, and I think it’s definitely a beneficial thing, but it was a leap of faith for these early food service directors to try it and find out that indeed that’s what happened.

Getting back to Brian Wansink’s M&M study; so I was thinking about this accessibility and the idea that very subtle changes in how close you are, like physically close you are to a food, will affect how likely you are to eat it. I was visiting my daughter’s school and watching the kids go through the line and noticed that as part of the school lunch, as I mentioned there are these five components, the fruit, the vegetable, the protein, the grain, and the milk.

However, in order for a food service director to get reimbursed for an official — for like selling an official school lunch, students only have to take three of the five components, and it’s their choice which three they want to take, so what I was seeing was that kids were taking the protein, the grain, and the milk and they were leaving — some of them were leaving their fruit and vegetable behind.

I thought to myself, well what would happen if instead of letting them decide whether or not to take it? If the people working there basically put it on their tray and or told them they needed to take it, so that when they left — when they walked out of the line and went to sit down there was a piece of fruit sitting on their tray.

I approached the committee with this idea, one of the principal’s was willing to give it a try, so we randomly assigned two elementary schools to the experimental and control condition. In the control condition they just left it the way it was, the kids could make a choice; and in the experimental condition, we trained the food service directors to say to the student, or the people working there to say to the student, would you like juice or fruit? Because both fruit and 100% juice would count as a fruit serving.

Basically, the implication of that question is you’re taking one or the other — which one would you like? They did that, and in the control schools what I have here is showing how many kids took the juice and the — I mean the fruit and the juice, and how many kids actually then ate the juice and the fruit. I had parent volunteers go in and observe, and then we collected the trays at the end so we could actually measure and see how much they ate.

What you can see is about 65% of the kids took either the juice or the fruit, and 45% then ended up eating both the juice and the fruit. In the intervention school, it was much, much higher so the kids really responded just from this verbal prompt, would you like the fruit or the juice, kids took it with — close to 100% actually taking it, and then interestingly the same proportion of those kids ended up eating it, so you ended up instead of 45% of the kids eating the fruit serving, it was closer to 65%.

What was really surprising and contrary to what people were saying, is that the children who chose their fruit, who actually sort of their own volition picked it up, were just as likely to eat it as the children who were served the fruit. People had thought that if you served it that you’d end up wasting a lot more because all the kids who wouldn’t have taken it anyway, would throw it away, and that’s not what we found. The proportion was the same, 70%.

It’s notable though, that because so many more kids were taking it and the proportion was the same, the percent that got thrown away did result in sort of at the baseline, more fruit getting through in a way. So it’s bigger numbers to begin with, but at the same time that I think the important point is at the end of the day more kids ended up eating it than not eating it.

This was published last year, and this study got a fair amount of attention and I think is being replicated in other places, because this idea that subtle intervention can actually increase fruit consumption, as opposed to all the effort it would take to do sort of nutrition education and imploring children to eat more fruit, just putting it on their tray may end up being the most effective way to do it.

Chapter 6. State School Food Policy in Connecticut 2005-2008 [00:43:25]

Now, I’m just going to review what’s happened here in Connecticut in terms of school food policy from 2005 to now. As I mentioned, we have our hero, Connecticut Senate President Don Williams. He had — let me back up — he had introduced this bill in 2005 that set very strong nutrition standards and was going to cut out a lot of the snack foods, all of the sugared soft drinks, and he got it through the House and the Senate, it was approved.

It went to the Governor’s desk, and then Jodi Rell in June of 2005 vetoed it, which I personally was devastated when this happened. One of the things she said was that Connecticut has a proud tradition of local control. Those are sort of code words for politically, really leaving things up to the local individual, as opposed to the state or the federal government, making these sweeping policy decisions. She said that what she would prefer is that instead of us having a state law, the local district should write their own school wellness policies, and this is at the same time as the federal mandate was coming out to do this, and that that would be the best way to handle the situation.

During this time, these were due actually September 2006 but the idea to start writing these policies actually came out a couple years earlier. Every district in the country, and so obviously every district in our state, was required to write a School Wellness Policy which had to include certain components.

First of all it had to be created by a committee. It couldn’t just be written by the board of education or the superintendent; it had to have a committee that included parents and the food service director, and administrators, and students, so it was supposed to be a representative group.

It needed to include goals for nutrition education in the school; it had to include nutrition standards for all the foods being sold in the school. It had to have goals for physical activity, and it had to have a plan for measuring implementation. I really felt like the law written in a way that really encouraged people to do a very kind of thoughtful job putting together their policy.

What it didn’t have was any actually requirements for the quality of the policy, so they didn’t set any standards, for example, for nutrition, for what foods you could sell. They just said you need to set some standards at your local school district.

The concern that I had was that these may not work similarly across the board. That there might be some school districts that take this really seriously and write a really fabulous policy and end up with a much improved school food environment, and there might be some districts that don’t have the time or the resources, or the interest to do more than the bare minimum and basically just write a policy that really doesn’t say anything. Then there would be increased disparities that you’d have some districts with great policies, and the district next door with terrible policies, and you’d end up with this really big difference.

My original hypothesis was that I thought it was going to be the low-income districts that were going to have the worst policy. I was sort imagining here in Connecticut, we have parts of the states that are very — parts of our state that are very wealthy and I thought of them having these really great policies and then other cities in our state that are really low economic areas where I was worried that they just wouldn’t have the ability to focus on this as an issue and they would end up with worse policies.

We submitted a grant to The Robert Wood Johnson Foundation to study this, and were funded to do that. So what we did in 2005,2006, this was the year before those policies went into effect, we did a baseline assessment where we surveyed the food service directors to find out what they were selling and we surveyed the principals to find out what kind of policies they had. Then the next year came along. The wellness policies were due at the beginning of the 2006 school year. We then did a follow up assessment, so that first year that those policies would have gone into effect, we again did a food service director survey and a principal survey.

Then we collected all of the policies from the entire state and there are 151 if you ever need to know this — there are 151 school districts in the state of Connecticut. We collected all of those and proceeded to try to evaluate them to see how strong they were. Then we looked at what was called the macro level variable, so the demographic variables of the districts, to see if there was a way of predicting who had a better versus a worse policy. As I said, my hypothesis was at the poorer districts, the more urban districts were going to end up with worse policies, and I imagined that some of the wealthier districts would have stronger policies.

We ended up looking primarily at variables like the population of the district, how big it was, the percentage of kids in that district with free reduced lunch — so that’s sort of an index for income — we looked at the racial and ethnic composition of the district, and then thanks to that parent comment that ‘this is America land of the free’ one, I thought it would be really interesting to look at the political landscape of the district, to think about whether the proportion of Democrats to Republicans actually has an effect at the local level, in terms of that general belief that it’s an appropriate or inappropriate thing for the school district to be setting strong policies.

What we found at baseline was contrary to another thing which I had thought: there was no clear association at baseline, so this is before the policies, between the macro level variables and the food environment. In other words, in Connecticut the food environment was just as bad in Greenwich as it was in Bridgeport. It was basically bad everywhere, and so that was sort of an interesting first thing that we learned.

We also learned that three-quarters of the districts didn’t even have a policy, and very few had things like guidelines for classroom parties. It was only 6%, very few prohibited food as reward — that was only 13% — and the majority 85% said that they currently sell unhealthy snacks. That was kind of the picture going into this.

Then, as I said, we collected the policies and we proceeded to code them. We came up with this sort of complicated coding system where we had these seven domains where we wanted to assess how strong of a policy it was. These were nutrition education, standards for the school lunch program, standards for the competitive foods, physical education, physical activity, a category we called communication and promotion, so that had to do with efforts to engage the parents and to make sure that all the messages in the school were consistent with each other and then evaluation like what type of plans did they have for evaluating their policy.

What we then found was that those macro level variables did predict the policy quality, but in exactly the opposite way that I had thought, so I was completely wrong on this study. Basically the more dense districts, so these were the big city districts, tended to have better policies, not worse. The more free and reduce lunch, the higher those levels were in the district, again the better the policies were. Then my political landscape variable, amazingly, came out to be significant where the proportion of democrats to republicans predicted a stronger policy, so in other words, the more democrats, the stronger the local school wellness policy was. Now one question was there’s a relationship between the political sort of landscape and the income sort of socioeconomic status, so I did control for that in my analysis and found still that that political landscape was a significant predictor.

In the meantime we’re been doing our study, we’ve been funded to do this pre-post thing, and then Senator Williams introduces this new bill that I mentioned before, where after the one that got vetoed by Jodi Rell, he separated the nutrition and the physical activity parts of the bill, he set the super strong beverage standards, and then they created an innovative program where they provided a financial incentive for districts to follow certain food nutrition standards for their foods. It’s a little bit complicated, but instead of requiring all the districts to only sell snacks that met certain guidelines, they basically told districts, you can choose to participate or not to participate in this program, but if you choose to participate we will pay you three times as much money for our reimbursement for your program as we typically would. So it was a pretty nice sort of incentive for them.

Then just from a strategic perspective, I think Senator Williams having gotten his bill vetoed the year before, did a lot of things up front with this bill. He secured a promise from Governor Rell that she would sign it, he got a lot of support from the PTA, CABE is the Connecticut Association of Boards of Education, and the superintendents group, so he was able to really get a lot of support on the ground. What was nice, as Kelly mentioned a lot of our research that we’ve been doing with The Department of Education was really helpful to kind of reassure the food service directors that they would be able to continue to be financially solvent, and that the students would buy the lunches.

The law changed in July. The vending machines were emptied out and filled with only juice and water. This was all great news from Connecticut, but in the meantime, I was still doing my study, so it really messed up my study, because part of my study was to see if these policies were going to actually change what foods were available; how many districts were going, for example, take out soda as part of their policy. Well, I was never able to look at that because they all had to do take it. I was still glad that the law passed, but it did mean that my outcome variables had to be adjusted.

As I said, there was this healthy food certification program, where the districts could agree to participate and get this money. Instead of looking just at what was being sold in the district, I was able to look specifically at the districts that chose to sign up for this program, and those that didn’t.

Luckily from a research perspective, exactly half of the districts signed up in year one for the program, and at baseline or at — in looking at the ones that signed up versus the ones that didn’t there was no significant difference on any of the demographic groups. So it wasn’t as though it was only the wealthy districts that signed up or only the poor districts that signed up, it was really a mix.

What I was able to do — and let me just walk you through this — is I was able to look at the year before the school wellness policies went into effect, how many unhealthy a la carte snacks were being sold, this one’s for elementary schools, and before and then after. I was able to split up the districts that were just using their own personal local school wellness policy, so that’s the local standards yellow line and compare them to the districts that chose to sign up for the healthy snack, or the healthy food certification and that were actually using the state’s standards, so that’s the red line.

This is a significant interaction and what it shows is essentially that local control are sort of leaving it up to the district meant there would be some improvement. I mean the line does go down, so it wasn’t as though the local policies did nothing, but they definitely didn’t do as much as the state policy.

It’s kind of a tricky message to give when people ask, were school wellness policies successful? Well yes and no. They were successful in that they did improve the picture, but they certainly didn’t improve the picture as much as a strong state policy was able too. We found it’s the same thing for the middle schools and for the high schools and you can see that in the middle and high schools, the line did go down but it didn’t go down all that much, so there’s still quite a bit of unhealthy food in the middle schools and high schools that did not participate in this.

Kind of to summarize this: we did see a significant reduction in the sales of all the unhealthy snack categories in all the levels. We also saw that the schools that participated in this voluntary healthy food certification had much greater reductions in their unhealthy snacks.

Finally, we found that the strength of the policies, so this gets back to our coding system, where we looked at how strong the language was. Did it say things like the district shall do such and such, or did it say, the district should do such and such, so we really coded carefully to see how the policy was worded, and whether it was kind of a suggestion or whether it was really requiring change. What we found was that the strength of the policy, so this was how many of their statements were required did significantly predict the reduction in unhealthy snack sales.

The next thing we did is we put together — and this is Guilford’s — is we put together a report card for every district in the state and this is sort of the summary of their scores on each of those domains I mentioned. We divided it into two things — this is a little bit complicated — but if you focus on the strength side, the strength side shows really the proportion of statements that they had that were these really strong statements that set requirements.

The comprehensiveness gives them credit for any statement. If they say something like we recommend that the teachers not use food as reward, they would kind of get a point in terms of comprehensiveness, like they covered that domain. They would not get a point in terms of strength.

We put together these report cards, these were sent out to each of the districts and posted online — and then you can’t really see this very clearly — but we showed them exactly how they scored. We went through every single item — there are 96 of them — of the things we were looking for in these policies and we gave them their exact score and explained how we got — how they got it.

The idea behind this was really it’s almost like an intervention in a way to see if giving this feedback to the districts showing them how they scored would in fact really motivate them to do a better job to rewrite their policy and to resubmit it. Fortunately the Commissioner of Education in Connecticut was — really backed this effort and wrote a letter saying, here’s your score we will be asking for your policies again in a couple years.

So there’s really I think motivation for the districts to take this seriously. One of the biggest criticisms of the school wellness policies was that people felt like the districts would write the policy, they’d stick it on a shelf and nothing would ever really change, so what we’re really trying to do here in Connecticut is make sure that that does not happen. This just shows all their complicated feedback they got.

As a state, this kind of gives you an overview — on average as a state the state didn’t do particularly well. I mean we have a tough coding system, so we really wanted to set the standard as high as possible. As you can see, a lot of these scores are in the 30s, a couple in the 40s, interestingly the highest I mean 49 for our coding system in the state was for the score food and beverages and that was really because the ones that signed up for the healthy food certification got pretty high scores for doing so.

I’m going to just wind down now and review some of the key arguments that have come up in all of this work trying to make changes in the schools, and think about the type of research that we’ve been trying to do to combat these.

One of the key arguments that you’ll hear is these, what I call only statements: students only eat five meals a week at school, students drink only one can of soda a week from the school vending machines. That second one was said about four thousand times when Williams was trying to get the soft drinks out of the schools. They kept saying it’s only one can of soda a week — as if that was a reason not to do anything.

I think when you hear those kinds of arguments you need to come back and say, there are a lot of factors that contribute to childhood obesity, just like the responsibility is really spread among all these different things, but just because one factor is not solely responsible doesn’t mean that they aren’t in part responsible, and so it’s really making the argument that everybody needs to take responsibility instead of always saying, it’s not our product, it’s not our responsibility.

Another thing that comes up a lot is this idea of parents as the gatekeepers, so the people who fight against making changes in schools will say, parents can tell their children not to buy unhealthful foods, or I got an email basically saying, tell your first grader that when somebody comes in to celebrate their birthday in the classroom not to take a cupcake, they should just not take one, they should say no thank you.

Well, that’s kind of ridiculous obviously, but it’s also just this philosophy that it’s really all up to the parents and that parents should really be setting a better example. I think the argument back there is to say, you’re right, parents are responsible; but the role of the school is to back parents up; is to sort of do everything it can in order to provide an environment where parents’ job is easier, and where you’re really supporting parents; as opposed to an environment where you’re forcing parents to essentially teach their children that they have to fight against the environment at school. That’s just making parents’ jobs harder.

There are also arguments about education that we need more nutrition education. You hear that all the time: we need to teach children to make good choices by providing a range of choices. In terms of the education, the argument I typically make is that there’s no evidence that this is being caused by a lack of education. That you don’t see a rise in childhood obesity over this short period of time because suddenly people forgot that they should be eating fruits and vegetables, or forgot that they shouldn’t be eating too much junk food. It’s a pretty easy argument to come back with that people know, even small children know what a healthy — which is a healthier choice but that’s not the — that’s not what is keeping them — not knowing isn’t what’s keeping them from making the healthy choice. It’s really about the environment.

Then this other argument, which is really interesting, that you can’t teach children to make choices unless they have a range of choices. Kelly once said something that really stands out in my head for responding to this one, which is you don’t teach children not to smoke by selling cigarettes in school and then teaching them not to buy them; that you just have to keep it out of the school altogether. So I think that that is a pretty good response.

Then people get kind of personal and start calling you names and say, you’re big brother or that this is the nanny state, and so that sort of gets back into this political ideology of what is the role of the state in making policy about personal things. Sort of going back to what Rogan Kersch was talking about last week. Another big criticism was unfunded mandate that the — whenever a state policy goes into effect it doesn’t provide more money for the schools, the schools get angry and that’s understandable, so I think Connecticut provides a nice model for that and that they did provide a financial incentive.

Finally, there’s just sort of the basic belief that schools should have local control and that parents should have control over what’s happening in their district. The plan at The Rudd Center is to continue to really refute each of these arguments as they come along; to systematically do studies to try to test out some of these ideas and show that the school environment really does make a difference; and then to find ways to frame these messages as we talk about it in public or in testimony, or to the media so that they can really appeal to all the political groups. I mean, one thing I’ve learned is I’m really good at convincing people who think the same way I do that this is a good idea. What I need to get better at, is convincing people who don’t think the same way I do, so that we can really change the — sort of shift social attitudes to support these policies. That’s it, so I’m happy to answer questions or comments.

Student: [inaudible]

Dr. Marlene Schwartz: The question is, it makes sense to do these things sort of K-12, but at the university setting people sometimes have this new freedom and can eat all they want, and are there efforts to change what’s available in the university — is that right? I have not heard of universities looking at this from specifically a nutrition perspective. I mean certainly Yale has done a lot in terms of sustainable food and things like that, and education, which I think is linked.

I mean, I think those will have positive health impacts, but the only thing that I have heard — which wasn’t specifically for eating or weight concerns, but I have a funny feeling might impact it anyway — is, the University of Virginia was getting rid of their trays so that students had to actually carry their plates. This is also sort of a Brian Wansink inspired idea, that when you make it harder for people to carry a lot of stuff they’ll probably end up carrying fewer things. In the end, I would not be surprised if The University of Virginia students were eating less because of that, but the reason for it was all about the environment, it wasn’t about weight. That’s the only thing I’ve heard of.

Professor Kelly Brownell: If anybody has questions, you can come up and talk to Marlene individually. Let’s thank her again for coming here today.

[end of transcript]

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