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Childhood Nutrition Facts
Download the edition of America After 3PM , or learn about special topics on afterschool, such as health and wellness in afterschool and the top 10 states for afterschool. Where are snacks and beverages being sold to students in your school? Each of the nine guidelines is accompanied by a series of strategies for schools to implement. Healthy food preparation methods play an important role in providing nutritious and appealing meals and include practices such as substitution techniques i. Public hearings or other meetings that gather wider input from the school and community might be beneficial or required. Health in the Balance.

Population surveys

Project EAT

Who is responsible for sale at each of these locations? Is the district business office responsible for vending machines? Does a student entrepreneurial class run the school store? Does the band have a snack cart? Are the sports teams responsible for spirit days to raise money at school?

The Venue Survey Tool will help you inventory the people and places that sell foods impacted by the Smart Snacks standards. Keep everyone responsible for selling snacks and beverages across campus informed about the Smart Snacks standards. Make this an ongoing educational process with your school community. Or use the Smart Snacks…Just Enough presentation to provide Smarts Snacks basics to staff and students that may change over time. Use the Beverage Inventory and Food Inventory to help you document and stay organized.

Find out who talks with vendors and manages contracts. Ask them to identify contracts that may need to be amended based on your product inventories. Use the Vendor Contact Tool to inventory vendors, collect contact information and indicate when they have been contacted about new or updated contracts. Consider organizing a meeting with neighboring schools or districts to explore combining purchasing power and learn from one another. Use our sample invitation and sample agenda to generate interest for the collaboration.

Hold taste testing events and focus groups to get their feedback…and make sure you incorporate that feedback. Remember, when students are part of the decision-making process, they are much more likely to embrace the changes and contribute to Smart Snacks success.

Now let's talk school fundraising! By contacting her, you can ask questions, learn best practices and get started creating a healthier school environment.

Furthermore, the CDC staff members identified enough scientific evidence to support the inclusion of two additional guidelines: After identifying each guideline, the CDC staff members reviewed the scientific reports again to identify common strategies and actions within each guideline that resulted in positive associations with student knowledge, attitude, behavior, or health outcomes related to physical activity, diet, weight, or chronic disease risk factors.

Expert statements also were reviewed for strategies and actions that are supported by opinions, commentaries, or consensus statements from public health and education organizations or agencies about youth nutrition, physical activity, or obesity prevention. Ultimately, research and evaluation studies and expert statements were rated as presenting evidence of sufficient relevance for a strategy or action to be included in the revision of the guidelines. An additional descriptive articles were included in the document to support the background information e.

In addition to the literature search and rating the sufficiency of the evidence, CDC convened a group of 10 experts in youth nutrition, physical activity, school health, school food service, education, and public health to review the scientific evidence and to provide individual input on proposed revisions of the guidelines.

Input from the individual experts on the nine guidelines and corresponding strategies and actions were reviewed and integrated into the guidelines. CDC also garnered input from 53 federal and state education and public health agencies, as well as from nongovernmental organizations that represented policy makers, educators, parents, students, school nurses, physicians, and other health-care providers.

Each of the 53 agencies provided a review of the guidelines and proposed revisions. The revised version was sent for review and revision to three experts in the field of school-based nutrition and physical activity who had not previously reviewed the document.

This report was developed in response to the long-term and intermediate outcomes associated with inadequate physical activity and unhealthy eating. Healthy eating and physical activity have been associated with increased life expectancy, increased quality of life, and reduced risk for many chronic diseases 9, Healthy living through healthy eating and regular physical activity reduces the risk for the top three leading causes of death in the United States heart disease, cancer, and stroke , as well as for certain chronic conditions, such as high blood pressure and type 2 diabetes 1,2, Cardiovascular disease CVD includes coronary heart disease, myocardial infarction, congestive heart failure, stroke, and other diseases and illnesses of the heart and blood vessels.

Heart disease is the leading cause of death in the United States, and stroke is the third leading cause Adult population subgroups disproportionately affected by CVD and its related risk factors include blacks, Hispanics, Mexican-Americans, and persons of low socioeconomic status A healthy diet and regular physical activity can prevent and reduce metabolic risk factors that cause CVD, including hyperlipidemia e. For example, dietary fiber can decrease the cholesterol concentration in the blood 21 , and physical activity can help maintain normal blood glucose levels 9.

Studies indicate that CVD risk factors occur more frequently in obese children. Some types of cancer can be prevented through regular physical activity and a diet consisting of various healthy foods with an emphasis on plant sources e. A diet rich in plant foods is associated with a decreased risk for lung, esophageal, stomach, and colorectal cancer Dietary factors that influence cancer risk include food type, variety, preparation, portion size, and fat content 17, Excess consumption of processed and red meats is associated with an increased risk for colorectal and prostate cancer Physical activity might contribute to cancer prevention through its role in regulating the production of hormones, boosting the immune system, and reducing insulin resistance 9.

Regular physical activity can reduce the risk for developing cancers of the breast and colon, and some evidence indicates that physical activity can reduce the risk for developing endometrial and lung cancers 9. Healthy eating and physical activity also can contribute to cancer prevention by preventing obesity 9.

Overweight and obesity are associated with increased risk for numerous types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin's lymphoma Diabetes, a disease characterized by high blood glucose levels 26 , was the seventh leading cause of death in the United States in Diabetes is the leading cause of kidney failure, nontraumatic lower-extremity amputations, and new cases of blindness among adults and can affect the nervous system and oral health Persons with diabetes have a two to four times higher risk for dying from CVD than those without diabetes 27, Diabetes is a result of defects in insulin production, insulin action, or both and is classified as either type 1 insulin-dependent diabetes or type 2 usually non--insulin-dependent diabetes Although diet and physical activity can help control blood glucose levels and reduce complications from both types of diabetes, type 1 diabetes is an autoimmune disease of the pancreas, and little is known about prevention In , the prevalence of type 1 diabetes among a sample of U.

Type 2 diabetes is the most common form of diabetes in adults Healthy eating and regular physical activity can help prevent this type of diabetes 29,31, Type 2 diabetes was previously observed primarily among adults but has become more common among children and adolescents 26, In , the prevalence of type 2 diabetes in a sample of U. In the Pima Indian community, type 2 diabetes in children and adolescents aged years increased significantly from 0.

Poor diet and physical inactivity are risk factors for numerous conditions that affect overall health and quality of life, and many of these conditions can lead to chronic diseases.

Intermediate outcomes such as obesity, metabolic syndrome, inadequate bone health, undernutrition, iron deficiency, eating disorders, and dental caries can begin in childhood, leading to earlier onset of disease and subsequent premature death. Healthy eating and physical activity control body weight through a balance of energy expenditure and caloric consumption Weight gain occurs when persons expend less energy through physical activity than they consume through their diet As this imbalance continues over time, the risk for overweight and obesity increases Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors Obesity is the condition of excess body fat In adults, weight status is determined directly by BMI.

Weight status in persons aged years is determined by comparing their BMI to other persons of the same sex and age in a reference population. BMI is calculated and plotted by age on a sex-specific growth chart to determine a BMI-for-age percentile.

Poverty is determined by the poverty-income ratio, which is the ratio of a family's income to the U. Census Bureau's poverty threshold. The threshold varies with the number and ages of family members and is revised yearly. Obesity in children and adolescents is associated with numerous immediate health risks, including high blood pressure, high blood cholesterol levels, type 2 diabetes, metabolic syndrome, sleep disturbances, orthopedic problems, and social and psychological problems, such as discrimination and poor self-esteem 7,35, These immediate health risks can have long-term consequences for children and adolescents, affecting them into adulthood.

Insufficient public health and education efforts to decrease or minimize these health risks will affect both health-care and education systems. Increasing rates of obesity among children and adolescents are of particular concern because those who are obese are more likely to become overweight or obese adults and have related chronic diseases 8. The probability of childhood obesity persisting into adulthood increases as children enter adolescence 46,47 ; even obesity during early childhood ages years increases the risk for adult obesity The findings were consistent for both sexes and all childhood age groups studied in the cohort years, years, years, years, years Obesity in adults is associated with an increased risk for premature death, heart disease, type 2 diabetes, stroke, several types of cancer, osteoarthritis, and many other health problems 8, The risk factors and precursors to these diseases are being detected in obese children 23 , and national concern exists that this trend might lower the age of onset of chronic conditions and diseases and possibly decrease the quality of life or shorten the lifespan of obese children Metabolic syndrome is a clustering of metabolic risk factors that increases the risk for prematurely developing CVD and type 2 diabetes Metabolic syndrome is defined as the presence of three or more of the following metabolic risk factors: Physical inactivity and obesity are established risk factors for metabolic syndrome, and a poor diet can accelerate the risk for developing CVD among persons with metabolic syndrome In , metabolic syndrome was significantly more prevalent among obese persons than among those of normal weight Adequate calcium and vitamin D intake, along with weight-bearing physical activity e.

Physical activity places a mechanical load on the skeleton, and the body responds by strengthening bone mass to support the activity. In addition, both vitamin D and regular physical activity enhance the positive effects of calcium Bone growth during adolescence is particularly crucial for achieving optimal bone health because bone mass peaks in late adolescence 56, Adolescents who do not achieve optimal bone mass during this period will lack the adequate support to sustain normal losses of bone mass later in life.

Low body weight, weight loss, physical inactivity, and dieting among children and adolescents can lead to low bone density. Low bone density leads to osteoporosis, which is the most common cause of fractures among adults.

In older adults, fractures lead to physical disabilities, depression, reduced quality of life, and potentially death 56, In , approximately 10 million U. These conditions disproportionately affect women In addition, obesity in children and adolescents is associated with orthopedic complications such as fractures, musculoskeletal pain, impairment in mobility, and abnormal lower extremity alignment Reduced food intake and disrupted eating patterns because a household lacks money and other resources for food is referred to as food insecurity.

In , approximately Blacks and Hispanics have the highest prevalence of undernutrition 60 , and food insecurity and hunger might be associated with lower dietary quality and undernutrition in children and adolescents, especially in adolescents Undernutrition can have lasting effects on overall health, cognitive development, and school performance Children and adolescents in food-insecure households have poorer health status and experience more frequent stomachaches and headaches than those from food-secure households In addition to poor health outcomes, behavioral and psychosocial problems also have been associated with food insecurity and hunger in children and adolescents , Those who are food insecure have lower physical functioning and quality of life Children and adolescents experiencing hunger have lower math scores and are more likely to repeat a grade in school and receive special education services or mental health counseling than those not experiencing hunger 62, Children and adolescents experiencing hunger also are more likely to be absent and tardy from school than other children and adolescents Schools have a long history of seeking out and developing strategies to address these concerns.

The National School Lunch Program and School Breakfast Program were initiated, in part, as a way to reduce undernutrition among children and adolescents Iron deficiency is a condition resulting from too little iron in the body Iron deficiency hampers the body's ability to produce hemoglobin, which is needed to carry oxygen in the blood.

This deficiency can increase fatigue, shorten attention span, decrease work capacity, impair psychomotor development, affect physical activity, and reduce resistance to infection 70 , Iron deficiency ranges from depleted iron stores without functional or health impairment to iron deficiency with anemia, which affects the functioning of several body systems To prevent iron deficiency, children and adolescents need to consume adequate amounts of foods containing iron e. Among school-age children and adolescents with iron deficiency, anemia is associated with poor cognition and lower academic performance 72, Whether this association exists among iron-deficient children and adolescents without anemia is unclear A Healthy People national health objective strives to reduce iron deficiency among young children aged years and females of childbearing age aged years objective NWS 21 In a national sample, children and adolescents who were overweight or obese were approximately twice as likely to be iron deficient than those of normal weight Eating disorders are psychological disorders characterized by severe disturbances in eating behavior.

Anorexia nervosa is characterized by a refusal to maintain a normal body weight. Bulimia nervosa is characterized by repeated episodes of binge eating followed by compensatory behaviors such as self-induced vomiting Disorders that do not meet all criteria for either anorexia nervosa or bulimia nervosa are referred to as eating disorders not otherwise specified. Eating disorders are more common in females than males.

Among females, the lifetime prevalence of anorexia nervosa is approximately 0. The prevalence of anorexia nervosa and bulimia nervosa in males is approximately one tenth that in females. According to the American Psychiatric Association, the prevalence of anorexia nervosa and bulimia nervosa in U. However, children and adolescents report disordered eating behaviors that are clinically severe but do not meet full criteria for an eating disorder.

Eating disorders can cause severe complications, and mortality rates for these disorders are among the highest for any psychiatric disorder Dental caries is the most common chronic condition in children and adolescents, with the greatest prevalence in blacks and Mexican-Americans and in those who live in poverty Pain from untreated caries can affect school attendance, eating, speaking, and subsequent growth and development Dental caries is associated with sugar and full-calorie soda consumption 80, Children who are obese have been found to have higher rates of dental caries than their normal weight peers The Dietary Guidelines for Americans have been published every 5 years since 5.

The guidelines also recommend that children, adolescents, and adults limit intake of solid fats major sources of saturated and trans fatty acids , cholesterol, sodium, added sugars, and refined grains 5. Available data indicate that most children and adolescents do not follow critical dietary guidelines. For example, the guidelines provide guidance on the amount of fruits and vegetables that children and adolescents should consume.

The guidelines also recommend that children aged years drink 2 cups of fat-free or low-fat milk or equivalent milk products per day and persons aged years drink 3 cups per day i.

The guidelines recommend that children and adolescents consume at least half of their daily grain intake as whole grains, which for many people is 2- to 3-oz equivalents, depending on age, sex, and calorie level 5. Whole grains are an important source of fiber and other nutrients. Persons aged years do not eat the minimum recommended amounts of whole grains. During , the median intakes of whole grains in this age group ranged from 0.

Sodium intake, which is associated with increased blood pressure 85 , has increased steadily during the last 35 years, in large part because of increased consumption of processed foods such as salty snacks and increased frequency of eating food away from home The guidelines recommend a maximum daily intake of sodium of 2, mg or 1, mg, depending on age and other individual characteristics.

These groups make up approximately half of the U. However, almost all persons in the United States consume more than the recommended amount of sodium. During , boys aged years and years had an average daily sodium intake of 3, mg and 3, mg, respectively. Girls aged and years had an average daily sodium intake of 2, mg and 3, mg, respectively Although the dietary guidelines do not have a recommendation for the maximum daily intake for added sugar, they do recommend that persons reduce their intake of added sugars 5.

Males aged years consume an average of Because many foods and beverages with added sugar tend to contain few or no essential nutrients or dietary fiber, the guidelines advise that one way to reduce intake of added sugar is to replace sweetened foods and beverages with those that are free of or low in added sugars 5.

Approximately half of these empty calories come from six sources, which include soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk The guidelines recommend that persons in the United States, including children and adolescents, strive to achieve and maintain a healthy body weight. Specifically, children and adolescents are encouraged to maintain the calorie balance needed to support normal growth and development without promoting excess weight gain 5.

During , a significant increase in caloric intake occurred in the United States Changes in energy intake among children and adolescents varied by age. Studies indicate that the overall energy intake among children aged and years remained relatively stable from to the late s and 84,89, However, the energy intake among persons aged years increased significantly during the same period 84,90, Multiple factors, including demographic, personal, and environmental factors, influence the eating behaviors of children and adolescents.

Male adolescents report greater consumption of fruits and vegetables and higher daily intakes of calcium, dairy servings, and milk servings than females 78 , Black adolescents are more likely than white or Hispanic adolescents to report eating fruits and vegetables five or more times per day Children and adolescents from low-income households are less likely to eat whole grain foods Taste preferences of children and adolescents are a strong predictor of their food intake Taste preference for milk, among both males and females, is associated with calcium intake Taste preferences for fruits and vegetables are one of the strongest reported correlates of fruit and vegetable intake among males and females Male and female adolescents who reported frequent fast-food restaurant visits three or more visits in the past week were more likely to report that healthy foods tasted bad, that they did not have time to eat healthy foods, and that they cared little about healthy eating Certain behaviors and attitudes among children and adolescents are related to healthy eating.

For example, behavior-change strategies that are initiated by children and adolescents e. Among female adolescents, self-efficacy to make healthy food choices and positive attitudes toward nutrition and health are significantly related to calcium intake The home environment and parental influence are strongly correlated with youth eating behaviors. Home availability of healthy foods is one of the strongest correlates of fruit, vegetable, and calcium and dairy intakes 92, Family meal patterns, healthy household eating rules, and healthy lifestyles of parents influence fruit, vegetable, calcium and dairy, and dietary fat intake of adolescents The physical food environment in the community, including the presence of fast-food restaurants, grocery stores, schools, and convenience stores, influences access to and availability of foods and beverages A lack of grocery stores in neighborhoods is associated with reduced access to fresh fruits and vegetables 99, and less healthy food intake Low-income neighborhoods have fewer grocery stores than middle-income neighborhoods, predominantly black neighborhoods have half the number of grocery stores as predominantly white neighborhoods, and predominantly Hispanic neighborhoods have one third the amount of grocery stores as predominantly non-Hispanic neighborhoods Furthermore, lower-income and minority neighborhoods tend to have more fast-food restaurants than high-income and predominately white neighborhoods During , approximately three in 10 children and adolescents consumed at least one fast-food meal per day; those who reported eating fast foods consumed more total calories than those who did not Children and adolescents who report eating fast foods tend to consume more total energy, fat, and sugar-sweetened beverages and consume less milk, fruits, and nonstarchy vegetables Children and adolescents are more likely than adults to report fast-food consumption The school environment also influences youth eating behaviors and provides them with opportunities to consume an array of foods and beverages throughout the school day.

The widespread availability of foods and beverages served outside of the federal school lunch and breakfast programs is well-documented , These products, referred to as competitive foods and beverages because they are sold in competition with traditional school meals, often are sold in the school cafeteria and are available throughout school buildings, on school grounds, or at school-sponsored events.

Food advertising and marketing influence food and beverage preferences and purchase requests of children and adolescents i.

Children and adolescents are exposed to many forms of marketing, including television advertisements, advertising on the Internet and advergames i. Physical activity is defined as "any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level" 9. Examples of physical activity include walking, running, bicycling, swimming, jumping rope, active games, resistance exercises, and household chores.

The guidelines indicate that children and adolescents should include vigorous intensity, muscle-strengthening, and bone-strengthening activities at least 3 days of the week. HHS also recommends encouraging children and adolescents to participate in activities that are age appropriate, are enjoyable, and offer variety 9.

Healthy People national health objectives include an objective on increasing the proportion of adolescents who meet current federal physical activity PA guidelines for aerobic physical activity and for muscle-strengthening activity objective PA 3 Despite national guidelines for physical activity, many young persons are not regularly physically active.

Regular participation in physical activity among children and adolescents is related to demographic, personal, social, and environmental factors. Hispanic and non-Hispanic black students are less active than their non-Hispanic white counterparts This difference also is evident during childhood and continues through adulthood, with non-Hispanic white adults having the highest prevalence of activity compared with other ethnic groups Sex is correlated with physical activity levels, with males participating in more overall physical activity than females This trend continues through adulthood, with females remaining less physically active than males Adolescent males also report a greater intention to be physically active in the future than females Children and adolescents who intend to be active in the future and who believe physical activity is important for a healthy lifestyle engage in more activity.

Overall, personal fulfillment influences the motivation both of boys and girls to be physically active Child and adolescent perceptions of their ability to perform a physical activity i. Girls are motivated by physical activities that they prefer and by their confidence in their ability to perform an activity Boys are affected by their ability to perform a particular physical activity, as well as by social norms among both friends and parents Positive social norms and support from friends and family encourage youth involvement in physical activity among all children and adolescents ,, Parent and family support for physical activity can be defined as a child's perception of support e.

Youth perceptions and parent reports of support for physical activity are strongly associated with participation in both structured and nonstructured physical activity among children and adolescents ,, The physical environment can be both a benefit and a barrier to being physically active. Environmental factors that might pose a barrier to physical activity include low availability of safe locations to be active, perceived lack of access to physical activity equipment, cost of physical activities, and time constraints , Youth perceptions of neighborhood safety e.

Parents' perceptions about environmental factors also influence physical activity among children and adolescents. For example, parents rate distance and safety as top barriers for their children walking to school The school environment can also influence the participation of children and adolescents in physical activity.

Although this is a critical opportunity for children and adolescents to participate in physical activity, schools do not provide it daily. In addition, many schools do not regularly provide other physical activity opportunities during the school day, such as recess. When schools provide supportive environments by enhancing physical education , and health education , having staff members become role models for physical activity, increasing communication about the benefits of physical activity, and engaging families and communities in physical activity, children and adolescents are more likely to be physically active and maintain a physically active lifestyle Television viewing, nonactive computer use, and nonactive video and DVD viewing are all considered sedentary behaviors.

Television viewing among children and adolescents, in particular, has been shown to be associated with childhood and adult obesity Potential mechanisms through which television viewing might lead to childhood obesity include 1 lower resting energy expenditure, 2 displacement of physical activity, 3 food advertising that influences greater energy intake, and 4 excess eating while viewing , Overall, persons aged years spend an average of 7 hours and 11 minutes per day watching television, using a computer, and playing video games The home environment offers children and adolescents many opportunities for television viewing, including eating meals while watching television or having a television in their bedroom The presence of a television in a child's bedroom is associated with more hours spent watching television 0.

The likelihood of having a television in the bedroom increases with a child's age , Eating meals in front of the television is associated with more viewing hours Children and adolescents are more likely to engage in unhealthy eating behaviors when watching television ,, and are exposed to television advertisements promoting primarily restaurants and unhealthy food products , Increased television viewing among children and adolescents is associated with consuming more products such as fast food, soft drinks, and high-fat snacks ,,, and consuming fewer fruits and vegetables ,, Healthy People national health objectives include a comprehensive plan for health promotion and disease prevention in the United States.

Healthy People includes objectives related to physical activity and healthy eating among children and adolescents and in schools Appendix B Schools have direct contact with students for approximately 6 hours each day and for up to 13 critical years of their social, psychological, physical, and intellectual development The health of students is strongly linked to their academic success, and the academic success of students is strongly linked with their health.

Therefore, helping students stay healthy is a fundamental part of the mission of schools School health programs and policies might be one of the most efficient means to prevent or reduce risk behaviors, prevent serious health problems among students, and help close the educational achievement gap , Schools offer an ideal setting for delivering health promotion strategies that provide opportunities for students to learn about and practice healthy behaviors.

Schools, across all regional, demographic, and income categories, share the responsibility with families and communities to provide students with healthy environments that foster regular opportunities for healthy eating and physical activity.

Healthy eating and physical activity also play a significant role in students' academic performance. The importance of healthy eating, including eating breakfast, for the overall health and well-being of school-aged children cannot be understated.

Most research on healthy eating and academic performance has focused on the negative effects of hunger and food insufficiency 62 and the importance of eating breakfast 65,, Recent reviews of breakfast and cognition in students 73,, report that eating a healthy breakfast might enhance cognitive function especially memory , increase attendance rates, reduce absenteeism, and improve psychosocial function and mood.

Certain improvements in academic performance such as improved math scores also were noted 65, A growing body of research focuses on the association between school-based physical activity, including physical education, and academic performance among school-aged children and adolescents.

A comprehensive CDC literature review that included 50 studies synthesized the scientific literature on the association between school-based physical activity, including physical education, and academic performance, including indicators of cognitive skills and attitudes, academic behaviors e.

The review identified a total of associations between school-based physical activity and academic performance. Therefore, the evidence suggests that 1 substantial evidence indicates that physical activity can help improve academic achievement, including grades and standardized test scores; 2 physical activity can affect cognitive skills and attitudes and academic behavior including enhanced concentration, attention, and improved classroom behavior ; and 3 increasing or maintaining time dedicated to physical education might help and does not appear to adversely affect academic performance Schools can promote the acquisition of lifelong healthy eating and physical activity behaviors through strategies that provide opportunities to practice and reinforce these behaviors.

School efforts to promote healthy eating and physical activity should be part of a coordinated school health framework, which provides an integrated set of planned, sequential, and school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students.

A coordinated school health framework involves families and is based on school and community needs, resources, and standards. The framework is coordinated by a multidisciplinary team such as a school health council and is accountable to the school and community for program quality and effectiveness School personnel, students, families, community organizations and agencies, and businesses can collaborate to successfully implement the coordinated school health approach and develop, implement, and evaluate healthy eating and physical activity efforts.

Ideally, a coordinated school health framework integrates the efforts of eight components of the school environment that influence student health i. The following guidelines reflect the coordinated school health approach and include additional areas deemed to be important contributors to school health: This report includes nine general guidelines for school health programs to promote healthy eating and physical activity.

Each guideline is followed by a series of strategies for implementing the general guidelines. Because each guideline is important to school health, there is no priority order. Then, guidelines pertaining to nutrition services and physical education are provided, followed by guidelines for health education, health, mental health and social services, family and community involvement, staff wellness, and professional development for staff. Although the ultimate goal is to implement all guidelines recommended in this report, not every guideline and its corresponding strategies will be feasible for every school to implement.

Because of resource limitations, some schools might need to implement the guidelines incrementally. Therefore, the recommendation is for schools to identify which guidelines are feasible to implement, based on the top health needs and priorities of the school and available resources. Families, school personnel, health-care providers, businesses, the media, religious organizations, community organizations that serve children and adolescents, and the students themselves also should be systematically involved in implementing the guidelines to optimize a coordinated approach to healthy eating and regular physical activity among school-aged children and adolescents.

The guidelines in this report are not clinical guidelines; compliance is neither mandatory nor tracked by CDC. However, CDC monitors the status of student health behaviors and school health policies and practices nationwide through three surveillance systems. These systems provide information about the degree to which students are participating in healthy behaviors and schools are developing and implementing the policies and practices recommended in the guidelines.

YRBSS includes a national, school-based survey conducted by CDC and state, territorial, tribal, and district surveys conducted by state, territorial, and local education and health agencies and tribal governments.

YRBSS data are used to 1 measure progress toward achieving national health objectives for Healthy People and other program and policy indicators, 2 assess trends in priority health-risk behaviors among adolescents and young adults, and 3 evaluate the effect of broad school and community interventions at the national, state, and local levels.

In addition, state, territorial, and local agencies and nongovernmental organizations use YRBSS data to set and track progress toward meeting school health and health promotion program goals, support modification of school health curricula or other programs, support new legislation and policies that promote health, and seek funding and other support for new initiatives. SHPPS data are used to 1 identify the characteristics of each school health program component e. The School Health Profiles i.

State, local, and territorial education and health officials use Profiles data to 1 describe school health policies and practices and compare them across jurisdictions, 2 identify professional development needs, 3 plan and monitor programs, 4 support health-related policies and legislation, 5 seek funding, and 6 garner support for future surveys.

Results from the surveys are described throughout this report. Physical education, health education, and other teachers; school nutrition service staff members; school counselors; school nurses and other health, mental health, and social services staff members; community health-care providers; school administrators; student and parent groups; and community organizations should work together to maximize healthy eating and physical activity opportunities for students Box 1.

Coordination of all these persons and groups facilitates greater communication, minimizes duplication of policy and program initiatives, and increases the pooling of resources for healthy eating and physical activity policies and practices Establish a school health council and designate a school health coordinator at the district level.

Each district should have a school health council to help ensure that schools implement developmentally appropriate and evidence-based health policies and practices. The school health council serves as a planning, advisory, and decision-making group for school health policies and programs.

School health councils should include representatives from different segments of the school and community, including health and physical education teachers, nutrition service staff members, students, families, school administrators, school nurses and other health-care providers, social service professionals, and religious and civic leaders The school health council provides input on decisions about how to promote health-enhancing behaviors, including healthy eating and physical activity among students.

Some roles of school health councils include Each district also should designate a school health coordinator who manages and coordinates health-related policies and practices across the district, including those related to healthy eating and physical activity. This person serves as an active member of the district-level school health council and communicates the district school health council's decisions and actions to school-level health coordinators and teams, staff, students, and parents , A district school health coordinator also should.

Establish a school health team and designate a school health coordinator at the school level. Each school should establish a school health team, representative of school and community groups, to work with the greater school community to identify and address the health needs of students, school administrators, parents, and school staff. A school health team. Every school also should designate a school health coordinator to manage the school health policies, practices, activities, and resources, including those that address healthy eating and physical activity.

School health coordinators might. An assessment of current school-based healthy eating and physical activity policies and practices is necessary to provide baseline information about strengths and weaknesses. An assessment can also identify how district-level policies are being implemented at the school level and in the development of community-specific strategies.

An assessment enables the school health council, school health coordinator, parents, school administrators, and school board members to develop a data-based plan for improving student health. A Self-Assessment and Planning Guide available at http: Schools and school districts can refer to the School Health Index for a comprehensive list of policies and practices that promote healthy eating and physical activity in schools.

The School Health Index guides schools through the development of an action plan to improve their school health policies and practices , Results from the School Health Index assessment and action plan can help schools determine where, what, and how to incorporate health promotion programs and policies into their overall school improvement plan.

Inclusion in the school improvement plan helps ensure that health is a regular item on agendas of district school board meetings and school-based management committees.

Completing the School Health Index can lead to positive changes in the school health environment. For example, after completing the School Health Index, some schools have hired a physical education teacher for the first time, added healthier food choices to school meal programs, and incorporated structured fitness breaks into the school day An assessment might also involve collection of data on current eating and physical activity behaviors of students, community-based nutrition and physical activity programs, and student, staff, and parent needs School health policies are official statements from education agencies and other governing bodies e.

They identify what should be done, why it should be done, and who is responsible for doing it. School health policies can School health policies should comply with federal, state, and local laws and mandates.

School health councils, teams, and coordinators can lead the development, implementation, and monitoring of policies , The Child Nutrition and WIC Reauthorization Act of required that each school district participating in the federally supported meal program establish a local school wellness policy for the first time by school year By , most school districts had a local wellness policy; however, the quality of policies varied across school districts.

In addition, many of the policies lacked plans for implementing and monitoring the status of the wellness policy The Healthy, Hunger-Free Kids Act of updated requirements for local school wellness policy to include, at a minimum,. The act also requires that the U. Department of Agriculture USDA , in conjunction with the CDC director, "prepare a report on the implementation, strength, and effectiveness of the local school wellness policies" States, districts, and schools should use a systematic approach when developing, implementing, and monitoring healthy eating and physical activity policies.

They can use the following strategies throughout the policy process. Identify and involve key stakeholders from the beginning of the policy process. One person, such as the school health coordinator at the district or school level, depending on the level at which the policy is to be implemented , should assume or be designated with overall responsibility for coordinating and implementing healthy eating and physical activity policies.

This person also can help identify and involve key stakeholders, including the school health council or team. Key stakeholders in district- and school-level policy processes include students, families, school nutrition service staff, physical education teachers, health education teachers, school nurses, school principals and other administrators, staff from local health departments, health-care providers, and staff from local community organizations and businesses.

This group of stakeholders will contribute to the development, implementation, and monitoring of healthy eating and physical activity policies. Draft the policy language. Policy language should be specific, simple, clear, and accurate; avoid education, health, and legal jargon; and be easy for readers with diverse backgrounds to understand and apply.

Policy language should be consistent with state, district, and school visions for student learning and health and other policies in the same jurisdiction. A written policy should describe NASBE's state school health policy database includes a comprehensive set of laws and policies from 50 states on approximately 40 school health topics available at http: Adopt, implement, and monitor healthy eating and physical activity policies.

After the draft policy is completed, the process of adopting the policy begins , To ensure greater support for policy adoption, school health council members or other policy makers should be given time to share the draft policy with their partners and gather reactions.

Public hearings or other meetings that gather wider input from the school and community might be beneficial or required. Such hearings allow every interested person or organization to provide input on the policy.

Policy adoption typically requires that the drafted policy be presented to the policy-making body e. The presentation should include background information about why the policy is needed e. Policies likely will require final approval by the school board, the district superintendent, or both.

Implementation of policies should be a cooperative effort that includes the school health coordinator, school health council, and school staff members. All school staff members and teachers, in particular, need sufficient time to implement the policy and make agreed-on changes in the school environment to support the policy Those responsible for implementation should be prepared to address challenges, such as perceptions that the policy is low priority, limited resources for full implementation, changes in school administrators and school staff members, and concerns such as lost revenue from certain food and beverage sales and resolving scheduling conflicts for use of physical activity facilities because of increasing numbers of physical activity programs Parental and community concerns might be mitigated by making incremental changes and ensuring that the media receive positive stories about the response to the policy.

Monitoring policy implementation allows school staff members to determine whether the policy yielded the expected results and which changes could be made to improve the results. Establishing policy is an important component of many of the nine guidelines. Following is a list of key healthy eating and physical activity policies that are described in the remaining guidelines:. Evaluation can be used to assess and improve policies and practices that promote increased physical activity and healthier eating among students and faculty members.

All groups involved in and affected by school efforts to promote lifelong physical activity and healthy eating should have the opportunity to contribute to evaluation. Education agencies and schools should designate a person to take the lead on evaluation activities.

Schools may choose to enlist local universities, the health department, or the education department to assist with the evaluation of school policies and practices.

Important information