Comprehensive School Wellness Program

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Comprehensive School Wellness Program
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WHY the Focus on Local Wellness Policies?

• The prevalence of overweight among children aged
  611 has more than doubled in the past 20 years
• Overweight children and adolescents are more
  likely to remain overweight or become obese
  adults and develop chronic disease
• One in three American children born in 2000 will
  develop diabetes in their lifetime

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DID YOU KNOW????

• Overweight children miss an average of 1 day per
  month more of school than their average weight
  counterparts.
• National School Boards Association

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The National Picture

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Overfed But Undernourished
Children Consuming Daily Recommended Intake
Critical Age
Iron
Phosphorus
Zinc
Vitamin C
Vitamin A
Magnesium
Folate
Calcium
Data compiled by Dr. John Lasekan, Ross
Labs NHANES 1999-2000 and the Continuing Food
Survey 1994-96, 1998
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Percentage of students who attended physical
education class daily.
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Percentage of students who ate five or more
servings of fruits and vegetables per day during
the past seven days
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Effects of Improving Nutrition on Learning

• Improved behavior.
• Improved attendance (A single-day absence by just
  one student can cost a school district anywhere
  from 9 to 20).
• Less visits to school nurse.
• Increased attention, creativity and test scores.
• Essential for growth and development.

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• Nearly two-thirds of parents support restricting
  access to high-calorie, low-nutrient snack foods
  in schools, and half of parents feel their
  childs 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
  childs 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

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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 schools power
• Open lunches promote fast-food

French, Am J Pub Health 2003 931161
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Competitive Foods

• 90 of schools offer a la carte lunch
• Vending machines for students
• 76 of high schools
• 55 of middle schools
• 15 of elementary schools
• School stores, snack bars or canteens
• 41 of high schools
• 35 of middle schools
• 9 of elementary schools
• School Nutrition Dietary Assessment Study, 2001

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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 94463
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Plan The Menu

• Policy must include the following
• 1a. Nutrition education goals
• 1b. Physical activity goals
• 1c. Other school-based activities
• 2. Nutrition guidelines/standards
• 3. Assurances that USDA school meals guidelines
  are being met
• 4. Plan for measuring implementation
• Designation of 1 or more people to ensure
  wellness policy is being met at all school
  buildings
• We recommend having a specific workgroup
  designated to work on each of the above sections.

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1a. Nutrition Education Goals

• The primary goal of nutrition education is to
  influence students' eating behaviors. The
  following should be considered when establishing
  nutrition education policy language
• Students in grades pre-K -12 receive nutrition
  education that is interactive and teaches the
  skills they need to adopt healthy eating
  behaviors.
• Nutrition education is offered in the school
  dining room as well as in the classroom, with
  coordination between the foodservice staff and
  teachers.
• Students receive consistent nutrition messages
  throughout the school, classroom, cafeteria,
  home, community and media.
• http//www.fns.usda.gov/tn/Healthy/policy_componen
  t1.html

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1a. Nutrition Education Goals

• State and district health education curriculum
  standards and guidelines include both nutrition
  and physical education.
• Nutrition is integrated into the health education
  curricula or core curriculum (e.g., math,
  science, language arts).
• Schools link nutrition education activities with
  the coordinated school health program.
• Staff who provide nutrition education have
  appropriate training.
• Schools are Team Nutrition Schools and they
  conduct nutrition education activities and
  promotions that involve parents, students, and
  the community.

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Nutrition Education (sample language)

• Nutrition education is offered in the classroom
  and is linked to the school cafeteria, school
  garden and local farms, with coordination between
  teachers and foodservice staff.
• Students receive consistent nutrition messages
  throughout the school environment.

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Sample Categories for Policy

• Nutrition Education
• Physical Activity
• Other School Based Activities
• Nutrition Guidelines for All Foods on Campus
• Eating Environment
• Child Nutrition Operations
• Food Safety/Food Security

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Nutrition Enhances Achievement

• Comprehensive 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.

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Sample Policy Language Nutrition Guidelines

• Foods
• A food item sold individually
• will have no more than 30 of its calories from
  fat (excluding nuts, seeds, peanut butter, and
  other nut butters) and 10 of its calories from
  saturated and trans fat combined
• will have no more than 33 of its weight from
  added sugars8
• will contain no more than 230 mg of sodium per
  serving for chips, cereals, crackers, French
  fries, baked goods, and other snack items will
  contain no more than 480 mg of sodium per serving
  for pastas, meats, and soups and will contain no
  more than 600 mg of sodium for pizza, sandwiches,
  and main dishes.

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Sample Vending Machine Nutritional Guideline
Language

• Vending sales of pop or artificially sweetened
  drinks will not be permitted on school grounds.
• The nonvending sale of pop or artificially
  sweetened drinks will not be permitted on school
  grounds both prior to the start of the school day
  and throughout the instructional day, but will be
  permitted at those special school events that
  begin after the conclusion of the instructional
  day.
• The vending sale of beverages, other than soda,
  with less than 10 fruit juice may begin at the
  conclusion of the instructional day.
• Milk, water, and 100 fruit juices may be sold on
  school grounds both prior to and throughout the
  instructional day. This standard will be
  phased-in over the next three school years in the
  following manner
• o 2003-04 School Year Milk, water, and beverages
  containing 10 fruit juice with artificial
  sweetener may be sold on school grounds both
  prior to and throughout the instructional day.
• o 2004-05 School Year Milk, water, and beverages
  containing 25 fruit juice may be sold on school
  grounds both prior to and throughout the
  instructional day.
• o 2005-06 School Year Milk, water, and beverages
  containing 100 fruit juice may be sold on school
  grounds both prior to and throughout the
  instructional day.

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Sample Policy Language Nutrition Education Goals

• The primary goal of nutrition education is to
  influence students' eating behaviors.
• Consider the following
• Grades pre-K -12 receive nutrition education that
  is interactive and teaches the skills they need
  to adopt healthy eating behaviors.
• Nutrition education is offered in the school
  dining room as well as in the classroom, with
  coordination between the foodservice staff and
  teachers.
• Students receive consistent nutrition messages
  throughout the school, classroom, cafeteria,
  home, community and media.
• Nutrition is integrated into the health
  education curricula or core curriculum (e.g.,
  math, science, language arts).
• Staff who provide nutrition education have
  appropriate training.
• http//www.fns.usda.gov/tn/Healthy/policy_componen
  t1.html

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Physical Education, Too

• Students 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

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Physical Activity(sample language)

• Students are provided opportunities for physical
  activity during the school day through daily
  recess periods, elective physical education (PE)
  classes, working in the school garden, walking
  programs, and the integration of physical
  activity into the academic curriculum.

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• Physical Activity
• Is time provided during the school day for all
  children to participate in a structured physical
  education program?
• Are adults and parents encouraged to engage in
  physical activity programs with students?
• Do teachers provide time for unstructured
  physical activity during recess?
• Is recess scheduled before lunch or other meal
  periods to encourage better consumption of meals?
• Do children have access to recreational
  facilities before and after school hours and
  during vacation periods?
• Are physical activities coordinated with
  community agencies?
• Is the school setting safe for walking and/or
  biking to and from school?

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1b. Physical Activity Goals

• The primary goal for a school's physical activity
  component is to provide opportunities for every
  student to develop the knowledge and skills for
  specific physical activities, maintain physical
  fitness, regularly participate in physical
  activity, and understand the short- and long-term
  benefits of a physically active and healthful
  lifestyle.
• The following examples of policy language should
  be considered when setting goals for physical
  activity.
• At a minimum, students should have 60 minutes of
  physical activity on most, preferably all, days
  of the week.

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1b. Physical Activity Goals

• Students should be given opportunities for
  physical activity during the school day through
  daily recess periods, elective physical education
  (PE) classes, walking programs, and the
  integration of physical activity into the
  academic curriculum.
• Students should be given opportunities for
  physical activity through a range of after-school
  programs including intramurals, interscholastic
  athletics, and physical activity clubs.
• Schools should work with the community to create
  an environment that is safe and supportive of
  students' physically active commute to and from
  school.

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Sample Policy Language Physical Activity

• At a minimum, students have 60 minutes of
  physical activity on most, preferably all, days
  of the week.
• All elementary school students will have at least
  20 minutes a day of supervised recess, preferably
  outdoors, during which schools should encourage
  moderate to vigorous physical activity verbally
  and through the provision of space and equipment.
  
• All elementary, middle, and high schools will
  offer extracurricular physical activity programs,
  such as physical activity clubs or intramural
  programs.

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Practical Suggestions

• Extension Activities (outside of PE)
• Low-equipment weight training
• Stretching

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Other School Based Activities

• Policies established under this category
  create an environment that provides consistent
  wellness messages and is conducive to healthy
  eating and being physically active. Some examples
  of policy language include
• Provide a clean, safe, enjoyable meal environment
  for students.
• Provide adequate time for students to enjoy
  eating healthy foods with friends, scheduled as
  near the middle of the school day as possible.
• Prohibit use of food as a reward or punishment.
• Provide enough space and serving areas to ensure
  student access to school meals with a minimum of
  wait time.
• Prohibit denial of student participation in
  recess or other physical activity as a form of
  discipline, or cancellation of recess or other
  physical activity time for instructional make-up
  time.

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Other School-Based Activitiesto Address

• Involving parents KIDS IMITATE PARENTS
• Adequate time and pleasant surrounding for meals
• Classroom parties and special events
• Fundraising events
• Using food as a reward or punishment
• School environment (composting, water etc.)
• School gardens
• Connections with local farms for fresh food and
  educational opportunities (Farm to School)
• Community resources/alliances

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1c. Other School Based Activities

• Policies established under this category create a
  school environment that provides consistent
  wellness messages and is conducive to healthy
  eating and being physically active. Examples of
  policy language include
• Provide a clean, safe, enjoyable meal environment
  for students.
• Provide adequate time for students to enjoy
  eating healthy foods with friends, scheduled as
  near the middle of the school day as possible.
• Prohibit use of food as a reward or punishment.
• Provide enough space and serving areas to ensure
  student access to school meals with a minimum of
  wait time.
• Prohibit denial of student participation in
  recess or other physical activity as a form of
  discipline, or cancellation of recess or other
  physical activity time for instructional make-up
  time.

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1c. Other School Based Activities

• Ensure fundraising efforts are supportive of
  healthy eating.
• Provide on-going professional training and
  development for foodservice staff and teachers in
  the areas of nutrition and physical education.
• Provide student access to physical activity
  facilities outside school hours.
• Schedule recess for elementary grades before
  lunch so that children will come to lunch less
  distracted and ready to eat.
• Develop strategies for parents, teachers, school
  administrators, students, foodservice
  professionals, and community members to serve as
  role models in practicing healthy eating and
  being physically active, both in school and at
  home.

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• Step 4 Other School-Based Activities
• This section of the template is designed to help
  you select specific Other School-Based Activities
  policy statements for your school district. A
  list of suggested policy statements is included.
  Here are the tasks for step 4
• Prepare for the project. Prior to starting the
  project you will need to do some homework
• Read background information. At the end of the
  Other School-Based Activities section youll find
  a page describing some of the current issues on
  the topic. Read this information to get ready
  for the project.
• Research the topic. A list of helpful Internet
  links is also at the end of the section. Check
  these out to be prepared for the project.
• Gather district information. Team members will
  need to know what current practices are in place
  in the District. Find out about snack and soft
  drink sales, fund-raising activities. Research
  food reward practices.
• Conduct a team discussion. Using the Discussion
  Guide, talk about the important issues under each
  topic area.
• Review the Suggested Policy Statements. Select
  policy statements that are suitable for the
  district.

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• Other School-Based Activities
• Select the policy statements which are
  appropriate for the District. After you check
  the policy statements you should copy them into
  the District Wellness Policy, Action Steps, the
  Implementation Timeline and the Assessment Tool.
• If you wish to modify a policy statement, you can
  do so on this page or on the District Wellness
  Policy page. Additional policy statements may
  also be added.
• School dining areas have sufficient space for
  students to sit and consume meals.
• School dining areas are clean, safe and pleasant
  environments that reflective the value of the
  social aspects of eating.
• Enough serving areas are provided to ensure
  student access to school meals with a minimum of
  wait time.
• Meal times are scheduled near the middle of the
  day.
• Students are given adequate time to enjoy eating
  healthy meals with friends.
• Food or physical activity is not used as a reward
  or punishment.
• Recess or other physical activity is not denied
  as a form of discipline.
• Recess or other physical activity time is not
  cancelled for instructional make-up time.
• The District has adopted nutrient standards for
  all foods sold on school campuses.
• Pouring-rights contracts soft drink companies are
  not allowed.

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• Section 204 of Public Law 108-265??June 30, 2004
• Child Nutrition and WIC Reauthorization Act of
  2004

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Child Nutrition and WIC Reauthorization Act

• Signed by President Bush on June 30, 2004.
• Section 204 of this Act requires each district
  participating in the USDA School Meal Program to
  have established a local school wellness policy
  by the school year beginning July 2006.

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2. Nutrition Guidelines/Standards

• Students' lifelong eating habits are greatly
  influenced by the types of foods and beverages
  available to them.
• Standards must be established to address all
  foods and beverages sold or served to students,
  including those available outside of the school
  meal programs.
• The following items should be considered when
  setting nutrition standards for all available
  foods during the school day. These standards
  should focus on increasing nutrient density,
  decreasing fat and added sugars, and moderating
  portion size.
• Set guidelines for foods and beverages in a la
  carte sales in the food service program on school
  campuses.
• Set guidelines for foods and beverages sold in
  vending machines, snack bars, school stores, and
  concession stands on school campuses.
• Set guidelines for foods and beverages sold as
  part of school-sponsored fundraising activities.
• Set guidelines for refreshments served at
  parties, celebrations, and meetings during the
  school day.

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School Wellness Policy Provisions

• Requirement 2
• Nutrition guidelines for all foods available
  during the school day
• school meals
• a la carte foods,
• vending machines,
• snack bars, school stores, concession stands
• any school-sponsored fundraising activities

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School Wellness Policy Provisions

• Requirement 3
• Assurance that nutrition guidelines for school
  meals will not be less restrictive than federal
  regulations.

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3. Assurance that School Meals Meet USDA Standards

• Schools must ensure that reimbursable school
  meals meet the program requirements and nutrition
  standards set forth under the 7 CFR Part 210 and
  Part 220.

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4. Plan for Measuring Implementation

• Establish a plan for measuring implementation of
  the local wellness policy
• Including designation of 1 or more persons within
  the local educational agency or at each school,
  as appropriate, charged with operational
  responsibility for ensuring that the school meets
  the local wellness policy.
• Recommendation - periodically assess how well the
  policy is being managed and enforced, and
  evaluate any financial impact to vending
  policies. Evaluation and feedback are very
  important in maintaining a sound, school wellness
  policy.

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School Wellness Policy Provisions

• Requirement 4
• A plan for measuring the effectiveness of the
  wellness policy, including the designation of at
  least one person to oversee the activities and
  maintain responsibility for program operation.

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• (a) IN GENERAL - Not later than the first day of
  the school year beginning after June 30, 2006,
  each local education agency participating in a
  program authorized by the Richard B. Russell
  National School Lunch Act (42 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
  wellness policy for schools under the local
  educational agency that, at a minimum
• 1) Includes goals for nutrition education,
  physical activity and other school- based
  activities that are designed to promote student
  wellness
• 2) Includes nutrition guidelines selected by the
  local educational agency for all foods available
  with the objectives of promoting student health
  and reducing childhood obesity
• 3) Provides an assurance that guidelines are
  being met
• 4) Establishes a plan for measuring
  implementation of the local wellness policy
• 5) Involves parents, students, and
  representatives of the school food authority, the
  school board, school administrators, and the
  public

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School Wellness Policy Provisions

• Requirement 5
• The policy development team must include
• Parents
• Students
• Child nutrition staff
• Representatives of the school board
• School administrators
• Members of the public
• CDE encourages Teachers, School Nurses,
  Dietitians and others

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Action Plan to Create Implement a Local
Wellness Policy

• Step 1 Initial Homework
• Review the federal and state legislation
• Step 2 - Identify a Policy Development Team
• include members required by the legislation.
• Step 3 Assess the Districts Needs Create a
  Plan for Improvement
• Identify areas of your school environment that
  need improvement.
• Step 4 Draft a Policy

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Action Plan to Create Implement a Local
Wellness Policy

• Step 5 Build Awareness and Support
• Once you have a draft policy, put in motion a
  plan to spread awareness of the districts needs
  and proposed solutions. Build support and create
  buy-in within schools
• Step 6 Adopt the Policy
• Have the school board or the administration
  approve the policy. A public hearing or
  presentation may be necessary.
• Step 7 Implement the Policy
• Implementation requires good planning and
  management. It may occur immediately or may be
  phased in over time.
• Step 8 Maintain, Measure Evaluate the Effort
• Evaluate your annual progress

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Possible Components

• Physical Education
• Health Education
• Nutrition
• Family/Home Involvement
• Technology
• Brain Primers (Interdisciplinary methods on how
  to incorporate exercise and PE into other
  classes)
• Intramural
• School Nurse
• Wellness Adventure

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Why Wellness Programs
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Recommended Assessment

• School Health Index
• Offered free online
• Comprehensive, objective technical
• Physical activity nutrition in 1 model
• Measurable outcomes (hard data numbers)
• http//apps.nccd.cdc.gov/SHI/pdf/MiddleHigh.pdf
• Changing the Scene
• Subjective (answer YES or NO)
• User friendly
• Geared to parents community

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Evaluation Tool

• School Health Index (CDC)
• Changing the Scene (USDA)
• Collect BMIs
• Action For Healthy Kids Website
• State profiles assessment tools
• CDCs health obesity trend data
• School Nutrition Associations Keys to
  Excellence

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Assessment Tools

• USDA Team Nutrition Changing the Scene, a
  tool kit designed to address improvements in the
  school nutrition environment. The State of
  Michigan modified this improvement checklist (a
  link is available from this website) to help you
  measure progress as you take action.
• http//www.fns.usda.gov/tn/Resources/changing.htm
  l
• Centers for Disease Control/Healthy Youth
  School Health Index, a self-assessment and
  planning guide that enables schools to identify
  strengths and weaknesses of their health policies
  and programs, develop action plans for improving
  student health, and involve teachers, parents,
  students, and the community in improving school
  policies, programs, and services. This
  assessment tool is now available to schools
  online and includes online tools for summarizing
  results.
• (Recommended by the Collaborative)
• http//apps.nccd.cdc.gov/shi/

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School Health Index
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http//apps.nccd.cdc.gov/shi/default.aspx
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SHI Format

• ? No Cost
• ? Completed by school health teams
• Meets Section 204 requirement
• Members should represent each school in district
• Involving youth in the process is highly
  desirable
• ? Two separate versions
• Elementary School
• Middle School/High School

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SHI Format

• ? Self-Assessment
• Consists of 8 modules which follow the
  Coordinated School Health Program model
• 4 of 8 relate to Local School Wellness Policy
• ? Worksheets lead to development of a Plan for
  Action for improvements
• ? Well tested and frequently used

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Sample Section of SHI
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• Use One of These Checklists to Assess your
  District
• Michigan Healthy School Assessment Tool (HSAT)
• School Health Index from the Centers for Disease
  Control and Prevention
• Changing the Scene Improvement Checklist
• Marketing Assessment Tool, CA Project LEAN

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Action Plan
http//www.actionforhealthykids.org/wellnesstool/i
ndex.php
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Group Work

• Pick one of the wellness policy components and

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Sample Wellness Policies

• http//www.ag.ndsu.edu/k12wellpolicy/policies.html
  
• Image

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Resources

• http//www.schoolwellnesspolicies.org/WellnessPoli
  cies.html
• http//www.schoolwellnesspolicies.org/WellnessPoli
  cies.html
• http//www.schoolnutrition.org/uploadedFiles/Schoo
  lNutrition.org/Child_Nutrition/Local_School_Wellne
  ss_Policies/SNALocalWellnessPolicyGuidelinesFinal.
  pdf
• http//departments.oxy.edu/uepi/cfj/resources/heal
  thy_school_food_policies_05.pdf
• www.mihealthtools.org/schools
• The CDC's data on obesity trends
• http//www.cdc.gov/nccdphp/dnpa/obesity/trend/
• The CDC's Youth Risk
• Surveillance System http//www.cdc.gov/HealthyYo
  uth/yrbs/index.htm
• Action for Healthy Kids'
• State Profiles for Action http//www.actionforhea
  lthykids.org/state.php

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Resources

• www.actionforhealthykids.org
• Team Nutrition
• www.fns.usda.gov/tn/healthy/wellnesspolicy.html
• National Alliance for Nutrtion and Activity
• www.schoolwellnesspolicies.org/
• School Nutrition Association
• www.asfsa.org/childnutrition/fsoperations/policies
  /index.asp
• Making it Happen School Nutrition Success
  Stories
• www.fns.usda.gov/tn/resources/makingithappen.html

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Questions Comments