healthy meals, healthy food choices, healthy children: usda's team nutrition

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Healthy Meals, Healthy Food Choices, Healthy Children: USDA’sTeam Nutrition1

EILEEN KENNEDY, D.SC., R.D.

Center for Nutrition Policy and Promotion, 1120 20th Street, NW, North Lobby, Suite 200, Washington, DC 20032

INTRODUCTION

Over the past 30 years the chief areas of concern inpublic health nutrition have changed; the major nutri-tion problems in the United States have shifted fromthose of underconsumption and nutrient deficiencies toproblems of excesses and imbalances (1). The typicalAmerican diet is high in fat and saturated fat and lowin fiber and complex carbohydrate (2).Government nutrition policies and programs need to

adapt and respond to the changing nutrition profile ofthe American consumer. The purpose of this article isto review and discuss the U.S. Department of Agricul-ture’s Team Nutrition — a multi-faceted approach toimproving the nutritional status of U.S. children. Thepaper begins with a concise review of what U.S. chil-dren are eating.

WHAT ARE U.S. CHILDREN EATING?

Data from two nationally representative surveys inthe United States indicate that the caloric intakes ofchildren 1 to 15 years of age have been static or declin-ing since the early 1970’s. It is only in the 16- to 19-year-old age group that recent data for 1989–1991 in-dicate that energy intakes have increased (1, 3).These nationally representative data are reinforced

by information from a serial, cross-sectional study inBogalusa, Louisiana (4); results indicate that over a15-year period, 10-year old children have had energyintakes that are stable or declining.Although average energy intakes for some children

have been declining and for many children are lessthan 100% of the Recommended Dietary Allowances(RDA) for energy, consumption of other nutrients arein excess of 100% of the RDA (Table 1). Iron, calcium,and zinc are the nutrients most likely to be consumedby children in amounts less than the RDA(3).How do the diets of low-income children compare

with those of U.S. children in general? The picture that

emerges is similar to that was shown for children in allincome categories. Children’s energy intake varieslittle over the income ranges presented (5). For lower-income children, energy intakes are below 100% of therecommended level (similar to those of U.S. childrenoverall), but the consumption levels for other nutrientsare, on average, well above 100%. Patterns of energyand nutrient intake are similar to those presentedabove in that, although energy intakes are low for chil-dren from low-income households, nutrient intakestend to be above requirement levels on average.The data in Table 1 indicate, however, that children

are consuming diets which do not meet the DietaryGuidelines recommendations for total fat, saturatedfat, or sodium. When one looks at specific food patternsfor children of all income levels it is clear that less than20% of children consume the recommended number ofservings of grains, vegetables, and fruits (6); less thanone-third of children, on average, eat the suggestednumber of servings from the milk and meat group.Obesity has become a significant public health prob-

lem for both adults and children in the United Statesover the past 30 years. The National Health and Nu-trition Examination Survey has collected data sincethe early 1970s and results indicate that obesity hasbeen increasing across all age/gender groups (1).Longer term studies reinforce these national leveldata. Here again, data from the Bogalusa Heart Studyindicate that since 1973 10-year-old children in thesame communities have become progressively heavier.Children are, on average, 1.36 kg heavier than in theoriginal cross-sectional study of the early 1970s (4).Perhaps, somewhat surprisingly, in the Bogalusastudy, this increased overall weight is not accompaniedby an increase in height nor is there an increase inenergy intake. The authors conclude that a major con-tributor to the increasing overweight in these commu-nities is decreased physical activity.Obese children are more likely than normal-weight

children to become obese adults (7). The risk of anobese child remaining obese as an adult increases withthe age of the child. Thus, the predictive value for adultobesity is excellent for 18-year-olds who are obese, good

1 Presented at the symposium The American Health Foundation:A 25th Anniversary Program, Tarrytown, New York, November 16–17, 1994.

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0091-7435/96 $18.00Copyright © 1996 by Academic Press, Inc.All rights of reproduction in any form reserved.


TABLE 1Average Three-Day Dietary Intakes of Children in 1989 by Gender and Age

(1) Targets are 100% for food energy and 75% of RDA for other nutrients.(2) Guidelines are 30% calories from fat, 10% calories from saturated fat, 300 mg cholesterol, 2,400 mg sodium.Source: Based on USDA’s Continuing Survey of Food Intake by Individuals, 1989.

SYMPOSIUM: AMERICAN HEALTH FOUNDATION 25th ANNIVERSARY 57


for obese 13-year-olds, but only moderate at agesyounger than 13 (8). The data would strongly suggestthat the earlier one can prevent childhood obesity, thehigher the likelihood that adult obesity will not occur.The environment in which U.S. children live has

changed dramatically since World War II. As a result,the influences on a child’s health and nutritional statusare now more complex. New directions in nutritionpolicies are needed to respond to the changing nutri-tional needs of U.S. children. USDA’s Team Nutritionis an example of one such innovative approach.

NEW VISIONS FOR IMPROVING NUTRITION

The federal government has a role to play in address-ing the nutritional needs of children. School-based in-terventions offer a number of advantages for effectivelyimproving the consumption patterns and nutritionalstatus of children. First, more than 95% of children inthe United States are enrolled in school. Second, sincechildren eat one or two meals a day at school, the caf-eteria and classroom can serve as a learning laboratoryfor promoting sound dietary habits. This is true forchildren who bring food from home as well as for chil-dren who purchase school meals. Third, schools canoffer regular physical activity.The USDA has a bold new intervention—Team Nu-

trition—which underscores the federal government’snational commitment to improving children’s healthand well-being. The vision of Team Nutrition issimple—improve the health of children through betternutrition. A comprehensive 4-point framework for ac-tion has been established to improve children’s dietsand nutritional status (Fig. 1). The 4 points include:

1. Eating for Health: Ensuring school meals meetthe Dietary Guidelines.

2. Making Food Choices: Nutrition education, train-ing, and technical assistance.3. Maximizing Resources: Getting the best value.4. Managing for the Future: Streamlined adminis-

tration.

Eating for Health

The School Meals Initiative for Healthy Children up-dates the school lunch and school breakfast nutritionstandards for the first time in almost 50 years. Regu-lations that were finalized in June 1995 require thatschool meals meet the Dietary Guidelines for Ameri-cans while maintaining the energy and nutrient goalsbased on the Recommended Dietary Allowances. Thesenew regulations will ensure that the nutrition stan-dards of school meals more closely address the currentnutrition needs of U.S. children.However, ensuring appealing and nutritious meals

are served in the schools is only one part of the multi-faceted strategy to improve children’s diet patternsand nutritional status. The changes in nutrition stan-dards for school meals will be complemented by an in-novative nutrition promotion program.

Making Food Choices

Team Nutrition will support the policy changes innutrition standards in school meals by implementingthe Team Nutrition—Children’s Nutrition Campaign.As shown in Fig. 1, the campaign will involve a com-bination of in-media, in-school, and in-community ac-tivities.The campaign’s mission is to build skills that em-

power children to make food choices for a healthy diet.The campaign uses a variety of approaches to reachchildren in a language they speak and in ways that arelively and entertaining. Activities under this nutrition

FIG. 1.

EILEEN KENNEDY58


promotion effort seek to strengthen support for chil-dren’s food choices for a healthy diet among parents,educators, and school food service personnel.The nutrition promotion campaign brings proven, fo-

cused, science-based nutrition messages to children ina language they understand while strengthening socialsupport for children’s food choices for a healthful diet.The campaign consists of comprehensive, multimediaeducation and information activities aimed at givingchildren the tools they need to choose a healthful diet.As shown in Fig. 1, the campaign is built around aframework of mass media and in-school efforts, with anemphasis on the school setting, to relate to nutritionpolicy changes in school meals. Mass media and in-school efforts are supplemented with materials distrib-uted through partner networks and directly by theUSDA through its regions and state cooperators. Ex-tensive strategic public–private partnerships extendthe campaign’s reach and amplify the message,thereby leveraging the investments of the USDA andits Team Nutrition partners.

Target Audiences

The target audiences for the campaign, in order ofpriority, are as follows:

Primary.

1. Third- to fifth-grade students.2. Prekindergarten to second-grade students.3. Sixth- to twelfth-grade students.

Although the children are the primary target of thecampaign, it is vital to reach the following secondaryaudiences as well:Secondary.

1. Parents.2. Educators.3. School food service professionals.

Parents control most of what children eat and whatthey are exposed to in the home, educators have con-siderable impact on them as well, and school food ser-vice professionals can reinforce our messages at thepoint of purchase—the lunchroom.

Messages

The campaign theme is “Making Food Choices for aHealthy Diet.” Based upon the most recent nutritionaland behavioral research, three specific campaign mes-sages were selected from the Dietary Guidelines forAmericans and Food Guide Pyramid to support thetheme:

● Kids should expand the variety of foods in theirdiet.

● Kids should add more fruits, vegetables, andgrains to the foods they already eat.

● Kids should make lower-fat choices.

The campaign messages are action-oriented and fo-cus on specific skills children need in order to makehealthy choices.While the Dietary Guidelines and the Food Guide

Pyramid communicate a wealth of nutrition informa-tion and guidance, these three specific messages weredeemed most important; they provide children with ac-tions they can take to improve their diet. When chil-dren’s diets are examined overall, their consumption offruits, vegetables, and grains is much lower than rec-ommended, and their consumption of dietary fat ishigher than recommended. These messages also sup-port and reinforce two of the school meal improvementschildren will see as a result of nutrition policy changes.All campaign materials—from public service an-

nouncements to posters to pogs—need to communicatethis theme and the campaign messages. The theme willhelp all of the diverse campaign elements work to-gether and reinforce each other.

TRAINING PLAN FOR HEALTHY SCHOOL MEALS

The mission of the Training Plan for Healthy SchoolMeals is

to ensure that school nutrition and food service personnel havethe education, motivation, training, and skills necessary to pro-vide healthy meals that appeal to the children served and meetthe USDA nutrition requirements. These personnel will alsohave a clear vision of their role in the school community and asan integral team member of comprehensive school health pro-grams.

Three strategic components have been identified forthe Training Plan:

1. Establishing Training Standards and a ResourceSystem.2. Developing a Sustainable Infrastructure: Deliv-

ery Systems.3. Supporting an Incentive Program: Team Nutri-

tion Schools.

1. Establishing Training Standards and aResource System

Training standards will be established and a re-source system will enable instructors and food servicepersonnel to access resources for education and train-ing programs. This will be achieved through the follow-ing activities:

● Recommended training standards to achievehealthy school meals will be identified and orga-nized by content areas for target audiences.

● Resources currently available will be identified,evaluated, and organized by the identified contentareas. Effective materials will be incorporated intoa user-friendly, electronic resource system easilyaccessible by phone, hard copy, fax, or electronicmail.

SYMPOSIUM: AMERICAN HEALTH FOUNDATION 25th ANNIVERSARY 59


● “Anchor” resources will be identified as key, rec-ommended instructional materials in implement-ing education and training programs. For ex-ample, the following have been selected as anchorresources: USDA’s Nutrition Standard TrainingCurriculum Package and National School Lunchand Breakfast Recipes, the National Food ServiceManagement Institute’s Healthy Cuisine Work-shops, and the American School Food Service As-sociation’s “Target Your Market” Program.

● An ongoing effort will be made to identify gaps,i.e., the resources not currently existing andneeded for effective training programs. Plans todevelop or support the development of the identi-fied resources will be implemented.

2. Developing a Sustainable Infrastructure:Delivery Systems

The Training Delivery System will be organized atfour levels:

● National—USDA, Food and Consumer Service.● Regional Office—USDA, Food and Consumer Ser-vice.

● State Educational Agency.● Local Educational Agency.

From USDA at the National level, communicationwill flow through Team Nutrition contacts at the re-maining three levels. At the Regional Office, a TeamNutrition point person will be designated and, in turn,will ask State Educational Agencies to designate aTeam Nutrition contact person. At the State level, thedelivery systems will be integrated with the existingstate training infrastructure. State and local agen-cies will be able to select from a menu of multi-faceted training opportunities and resources de-pending on their unique needs and choices.The following anchor delivery systems have been se-

lected:

● Team Nutrition Training Grants● Nutrition Standard Training Sessions● USDA Electronic Resource System● Promotional Events● Partnership Programs● Healthy Meals Hotline

3. Supporting an Incentive Program: TeamNutrition Schools

Team Nutrition Schools will provide the link to local-level implementation of the Healthy School Meals

Training Plan and will establish a network of local ed-ucational agencies that will

● Model success in achieving Healthy School Meals.● Serve as Centers of Excellence, mentoring andserving as models for other agencies.

● Model the involvement of partners at the grass-roots level.

● Demonstrate results of changes made in schoolmeals and showcase successful outcomes of nutri-tion programs in schools.

● Provide the link between the Children’s NutritionCampaign and the Training Plan.

● Provide recognition for schools implementing ex-emplary programs.

These schools will be supported through the infra-structure described in the Training Delivery Systemcomponent.

CONCLUSION

The Team Nutrition Initiative is an example of ascience-driven, consumer-oriented nutrition promotionintervention. The conceptualization of the paradigmwas influenced by nutrition research and focus groupresearch with children.The regulatory reform in the School Meals Initiative

for Healthy Children and the Team Nutrition Activi-ties provide a comprehensive integrated plan to ad-dress the nutritional needs of children. The USDA be-lieves that this type of comprehensive approach is re-quired to address the nutritional needs of children.

REFERENCES

1. Centers for Disease Control. The National Health and NutritionExamination Survey, 1988–1991. National Center for HealthStatistics, 1994.

2. National Research Council. Diet and health implications for re-ducing chronic disease risk. Report of the Committee on Diet andHealth, Food and Nutrition Board, Commission on Life Sciences.Washington: Natl Acad Press, 1989.

3. U.S. Department of Agriculture, Human Nutrition InformationService. Continuing Survey of Food Intake of Individuals (1989–1991). Washington: USDA, 1995.

4. Nicklas TA, Webber LS, Srinivasan SR, Berenson GS. Seculartrends in dietary intakes and cardiovascular risk factors in 10-year- old children: the Bogalusa Heart Study (1973–1988). Am JClin Nutr 1993;57:930–7.

5. Kennedy E, Goldbery J. What are American children eating?Implications for public policy. Nutr Rev 1995;53 Suppl:111–26.

6. Kennedy E, Ohls J, Carlson S, Fleming K. The healthy eatingindex. J Am Diet Assoc. 1995;95:1103–8.

7. Williams CL, Kimm SYS. Prevention and treatment of childhoodobesity. In: Annals of the New York Academy of Sciences. NewYork: N Y Acad Sci, 1993;699.

8. Guo SS, Roche AF, ChumleaWC, Garner JD, Suervogel RM. Thepredictive value of childhood body mass index values for over-weight at age 35 years. Am J Clin Nutr 1994;59:810–9.

Received April 18, 1995Revision requested August 2, 1995Accepted August 2, 1995

EILEEN KENNEDY60

healthy meals, healthy food choices, healthy children: usda's team nutrition

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