Guidelines for School Health Programs to Promote Lifelong Healthy Eating
Summary
Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors.
This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies.
The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training, family and community involvement, and program evaluation.
INTRODUCTION
School-based programs can play an important role in promoting lifelong healthy eating. Because dietary factors “contribute substantially to the burden of preventable illness and premature death in the United States,” the national health promotion and disease prevention objectives encourage schools to provide nutrition education from preschool through 12th grade (1). The U.S. Department of Agriculture’s (USDA) Nutrition Education and Training (NET) Program urges “nutrition education {to} be a major educational component of all child nutrition programs and offered in all schools, child care facilities, and summer sites” by the year 2000 (2). Because diet influences the potential for learning as well as health, an objective of the first national education goal is that children “receive the nutrition and health care needed to arrive at school with healthy minds and bodies” (3).
The recommendations in this report are intended to help personnel and policymakers at the school, district, state, and national levels meet the national health objectives and education goals by implementing school-based nutrition education policies and programs. This report may also be useful to students, to parents, and to personnel in local and state health departments, community-based health and nutrition programs, pediatric clinics, and training institutions for teachers and public health professionals. These recommendations complement CDC guidelines for school health programs to prevent the spread of acquired immunodeficiency syndrome (AIDS) (4), to prevent tobacco use and addiction (5), and to promote physical activity (6).
In this report, nutrition education refers to a broad range of activities that promote healthy eating behaviors. The nutrition education guidelines focus largely on classroom instruction, but they are relevant to all components of a comprehensive school health program — health education; a healthy environment; health services; counseling, psychological, and social services; integrated school and community efforts; physical education; nutrition services; and school-based health promotion for faculty and staff (7). Although the meals served by school food service programs are an important part of a school health program, this report does not provide specific recommendations related to purchasing and preparing food for school meals. Detailed information on this topic is available from many other publications (8-19) and information sources (see Appendix A). These guidelines also do not address the specific nutrition education and counseling needs of pregnant adolescents (20,21) or young persons with special needs (22-28).
These guidelines are based on a synthesis of research, theory, and current practice and are consistent with the principles of the national health education standards (29), the opportunity-to-learn standards for health education (29), the position papers of leading voluntary organizations involved in child nutrition (30), and the national action plan to improve the American diet (31). To develop these guidelines, CDC convened meetings of experts in nutrition education, reviewed published research, considered the recommendations of national policy documents (1,32-35), and consulted with experts from national, federal, and voluntary organizations.
EFFECTS OF DIET ON THE HEALTH, GROWTH, AND INTELLECTUAL DEVELOPMENT OF YOUNG PERSONS
School-based nutrition education can improve dietary practices that affect young persons’ health, growth, and intellectual development. Immediate effects of unhealthy eating patterns include undernutrition, iron deficiency anemia, and overweight and obesity.
Undernutrition
Even moderate undernutrition can have lasting effects on children’s cognitive development and school performance (36). Chronically undernourished children attain lower scores on standardized achievement tests, especially tests of language ability (37). When children are hungry or undernourished, they have difficulty resisting infection and therefore are more likely than other children to become sick, to miss school, and to fall behind in class (36,37); they are irritable and have difficulty concentrating, which can interfere with learning (38); and they have low energy, which can limit their physical activity (38). Some reports have estimated that millions of children in the United States experience hunger over the course of a year (39), but no scientific consensus currently exists on how to define or measure hunger (1).
Skipping breakfast can adversely affect children’s performance in problem-solving tasks (40-42). A study of low-income elementary school students indicated that those who participated in the School Breakfast Program had greater improvements in standardized test scores and reduced rates of absence and tardiness than did children who qualified for the program but did not participate (43). Twelve percent of students reported skipping breakfast the day before one national survey was taken (44); 40% of 8th- and 10th-grade students in another study reported having eaten breakfast on less than or equal to 2 days the week before the survey (45). Strategies to encourage adequate nutrition among young persons include the following:
- Promote participation in USDA food assistance programs (e.g., the School Breakfast Program and School Lunch Program, the Summer Food Service Program, and the Child and Adult Care Food Program).
- Advise parents and guardians about community-based food supplementation programs (e.g., food stamps; local food pantries; and the Special Supplemental Nutrition Program for Women, Infants, and Children {WIC}).
- Educate students and their families about the importance of eating breakfast.
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