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Eat Smart: NC’s Recommended Standards For All Foods Available In School grewout of a recommendation from the NC Healthy Weight Initiative’s 100-

member task force. “Set state standards for all foods and beverages availablein school” was one of four policy and environmental recommendationspresented in the task force report, Moving Our Children Toward A HealthyWeight: Finding The Will And The Way.1 Several other North Carolina groupshave also examined the issue. The following efforts were valuable in thedevelopment of the Eat Smart School Standards.

• The School Policy Work Group convened by the American HeartAssociation (AHA)—issue papers on nutrition standards and financialgoals that promote optimal nutrition

• NC Prevention Partners—policy briefs based onthe aforementioned issue papers

• NC Action for Healthy Kids—a working paper onnutrition standards for foods and beveragesavailable in schools, developed with input from anumber of school nutrition directors andnutritionists

In December 2003, North Carolina’s ConsensusPanel To Recommend Standards For All FoodsAvailable In School* convened. The Panel ofeducators, nutritionists, physicians and public healthprofessionals developed this document as a tool forparents, community leaders, educators, industryrepresentatives and policy makers to help move theconversation and stimulate change around theimportant role of sound nutrition in a healthy schoolenvironment.

This document is one of many tools that support Eat Smart, Move More...North Carolina, a statewideinitiative that promotes increased opportunities forhealthy eating and physical activity. The Eat Smart School Standards document is available atwww.EatSmartMoveMoreNC.com.

This publication is in the public domain and may be reprinted without permission. Permission to adapt must be requested from [email protected].

Suggested citation: Andersen K, Caldwell D, Dunn C, Hoggard L, Thaxton S, Thomas C.Eat Smart: NC’s Recommended Standards For All Foods Available In School. North CarolinaDHHS, NC Division of Public Health, Raleigh, NC; 2004.

*Panel members listed on inside back cover

PartnersNC Department of Public InstructionDivision of School Business and Finance

Child Nutrition Services SectionNC Healthy Schools

NC Division of Public HealthChronic Disease and Injury Section

Physical Activity and Nutrition BranchWomen’s and Children’s Health Section

Nutrition Services BranchNutrition Education and Training Program

Children and Youth BranchSchool Health InitiativeNC Healthy Schools

NC Cooperative Extension ServiceDepartment of Family and ConsumerSciences

Acknowledgements

1

Childhood overweight and adult obesity have reached epidemicproportions nationally and in North Carolina, and are increasing in all

age groups, among all races and ethnicities.2 Between 1995 and 2000, theprevalence of overweight in North Carolina’s children increased 40 percentin 5 to 11 year olds. More than one in five 5 to 11 year olds (23 percent) isoverweight, while more than one in four 12 to 18 year olds (26 percent) isoverweight.

The human, societal and economiccosts of the overweight and obesityepidemic are staggering. Left unabated,this epidemic will soon overtake tobaccouse as the leading cause of death in theUnited States.3 Currently, more than400,000 deaths annually are attributed tounhealthy eating and physical inactivity,which are highly correlated withoverweight and obesity. This representsan increase of 30 percent from 1990.Overweight and obesity increase the risk for chronic diseases such as heartdisease, stroke, diabetes and some cancers. Centers for Disease Control andPrevention (CDC) scientists recently predicted that 30 percent of childrenborn in 2000 will develop diabetes in their lifetimes.4 The socialstigmatization and low self-esteem often associated with childhoodoverweight is another serious consequence not to be overlooked.5

Childhood overweight is costly. The CDC reports that in one two-yearperiod, U.S. taxpayers spent $127 million on hospital costs associated withcaring for overweight children and adolescents.6 This represents a three-fold increase in two decades. Together, childhood overweight and adultobesity cost North Carolina and its taxpayers $2.14 billion annually in directmedical costs, which excludes lost productivity, disability and death.7

The epidemic of childhood overweight is a complex, multi-facetedproblem that requires multi-level approaches to reverse the upward trend.8

Poor eating patterns and inadequate physical activity play a role in the rise ofoverweight and obesity. The Eat Smart School Standards are one strategy forimproving the eating habits of North Carolina’s children and teens in schools.

Ask North Carolinians what needs to be done to address the overweightand obesity epidemic and you will often hear, “Get the vending machines

and fries out of schools.” NC’s Consensus Panel members agreed thatvending machines and “fast foods” such as fries are a very importantconcern. However, the Panel concluded that the Eat Smart School Standards

Eat Smart: NC’s Recommended Standards For All Foods Available In School

Figure 1. Prevalence of Overweight in NC’s Children and Youth

12-18 year olds>1 in 4 overweight

NC-NPASS 2003.* See Glossary

5-11 year olds>1 in 5 overweight

How do we slow the trend?

must be considered in a broader context that includes all foods available inschool as well as feasible fiscal policy change that reduces reliance onprofits from snack foods and beverages to supplement local school budgets.

The Consensus Panel’s recommendations reflect the understanding thatobesity prevention requires a comprehensive approach. Schools cannot beexpected to solve the problem alone, but they do have a strategic role to play.8

Providing a healthy school nutrition environment will not only influencestudents’ eating patterns, but will also influence families and communities.This multi-level change will help to prevent overweight, obesity and associatedchronic disease, as well as reduce future health care costs.

Eat Smart: NC’s Recommended Standards For All Foods Available In School wasdeveloped within this context. The Eat Smart School Standards are voluntary,sequential and flexible. The Eat Smart School Standards outline fourachievement levels consistent with the language used in the existing localschool improvement process. Schools or school systems may choose theirstarting point and the achievement level they wish to pursue:

The Eat Smart School Standards are also grade specific, reflecting theincreasing level of knowledge and decision making skills that students mayhave as they mature. Standards are provided for Grades PreK-5, Grades 6-8and Grades 9-12. The Eat Smart School Standards do not preclude the serviceof foods prescribed for students with special health needs. Neither do theyapply to foods brought from home for an individual student’s consumption,although parents are encouraged to consider the value of healthy foodchoices, and schools are encouraged to address foods brought from outsidesources in local policy.

The Eat Smart School Standards are consistent with reports from the NationalAcademy of Sciences, Healthy People 2010, the CDC, the US Department

of Agriculture (USDA), and other state and national organizations, whichstate that providing healthy food choices and wholesome meals for studentsshould not be compromised by lack of funds, for-profit practices orfundraising.9, 10, 11, 12, 13, 14 There are, however, significant barriers toimplementation. An examination of local and state policies and a debateabout priorities are needed.

The Child Nutrition Program is an important part of the instructional day,providing a wholesome breakfast, lunch and after school snack for many ofNorth Carolina’s more than 1.3 million students. However, many ChildNutrition Programs are expected to be financially self-supporting and operateas a separate business within the school system. Child Nutrition Programsmust generate revenue to cover the cost of food, supplies and equipmentneeded to prepare and serve meals, the cost of salaries and benefits forpersonnel, and any other costs needed to operate a non-profit program. In

2 Eat Smart: North Carolina

“By the time you getthrough the line, you only have 5 minutes to eat.”

—Patrice, 5th grade

The competitionbetween food,

nutrition andfinances

• Needs Improvement: Requires compliance with statutory requirements • Basic: Requires adoption of a local policy with minimal standards • Proficient: Requires a higher level of effort and outcome• Superior: Requires what the Consensus Panel described as the best schools can achieve in the foreseeable future

Recommended Standards For All Foods Available In School 3

the last two decades, many districts have begun requiring the Child NutritionProgram to pay a proportion of the district’s overhead expenses in indirectcosts, totaling more than $18 million annually statewide.15

The primary source of funds that support local Child NutritionPrograms is reimbursement provided by the USDA through the school’sparticipation in the School Breakfast Program (SBP), National SchoolLunch Program (NSLP) and the After School Snack Program (ASSP).These federal funds provide approximately half the revenues needed tooperate local programs in North Carolina.15 Students and adults who payfor school meals provide another source of revenue.

In North Carolina, there are no permanent state or local mandatedfunds to support the Child Nutrition Program on a per meal basis, and thecombination of federal funds and meal sales is not sufficient for programoperations. To generate additional revenues, most programs makesupplemental items, often called “a la carte,” available for students andadults on the cafeteria line and in vending machines.

All of North Carolina’s public schools sell “a la carte” foods, which providea significant portion of the child nutrition budget—approximately $54

million annually statewide—to support program operations.15 In addition,some snack food and beverage companies provide free menu boards,signage and other materials. Without these sales and incentives, additionalrevenues from state or local sources, grantfunding, or increased student meal prices, ChildNutrition Programs could not operate.

Federal law prohibits the sale of foods ofminimal nutritional value in the cafeteria duringmeal times.16 Foods of minimal nutritional valueinclude soft drinks, hard candy, water ices andchewing gum. Beyond this limited number ofregulated foods and beverages, the myriad of a lacarte foods available to students is not federallyregulated, and state regulations are inadequate. Asa result, students’ preferences, time available to eatand profit margins determine which a la cartefoods will be sold.

This shift to a la carte foods and beveragesaffects nutrient and calorie intakes, and increasescosts for students and their families. The price of aschool lunch that meets NSLP standards rangesfrom $1.15 to $2.00.15 On the other hand, it is notuncommon for a high school student to choose tospend $4 for an a la carte lunch of a chicken filetsandwich, French fries and a 16-ounce sugarsweetened juice drink in the cafeteria, or $3 to $4for a candy bar, chips and a 20 oz. soft drink fromvending machines outside the cafeteria.

The shift to a la carte

Figure 2. Nutrition for the dollar

Percentages based on 2200 calories per day

High School lunch: $2.00 (chicken filet sandwich, lettuce and tomato, baked beans, raspberry applesauce, low-fat chocolate milk)This menu provides 16% of calories from protein and 21% of calories from fat.

High School a la carte purchases: $4.00(chicken filet sandwich, large french fries, 20-oz. sports drink)This menu provides 8% of calories from protein and 38% of calories from fat.

“There are cookies,chips, pizza and friesand some drinks....”

—Sarah, 6th grade

Source: Wake County Public Schools Child Nutrition Services, 2004.

Child Nutrition Programs may offer a la carte foods in vending machinesinside the cafeteria, but many school districts also have vending outside

the cafeteria. Some school boards are opting to enter into exclusivecontracts with soft drink companies, which impact what can be sold bothinside and outside the cafeteria. These “pouring rights” contracts may offerlarge, up-front cash incentives, guaranteed profit margins and other non-monetary incentives to schools such as athletics scoreboards and freerefreshments for meetings.17 The contracts tie revenue to total sales, puttingpressure on schools to promote increased consumption by students. Fundsgenerated from vending machine sales outside the cafeteria accrue to schoolorganizations or departments other than Child Nutrition Programs and areused to supplement shrinking operating budgets. Many of the items andactivities funded by these revenues and incentives are valuable additions tostudents’ learning opportunities. However, schools often operate these softdrink vending machines during meal periods, in violation of state statute.NC Statute 115C-264 prohibits the sale of soft drinks in elementary schoolsbut allows their sale in secondary schools after the end of the last lunchperiod, with approval by the local board of education. Currently, the onlypenalty for violation of this statute is the federal authority to withholdfederal funds for all meals served on the day an infraction is cited. Thispenalizes the Child Nutrition Program rather than the organization orschool entity violating the statute.

School meals that are planned to meet federal guidelines promote health.They are nutrient rich in age appropriate portion sizes. School meals

provide the best nutritional value for the dollar. Overall, students who eatschool lunch have higher intakes of key nutrients than students making anyother noontime choice, even meals brought from home.18 In 1995 Congressmandated nutrition regulations for the NSLP and SBP to reduce theamount of fat and saturated fat in school meals eligible for full or partialfederal funding.19 A 1999 study showed that schools have madeextraordinary progress in meeting the standards.20 Students have theopportunity to choose a school lunch with less than 30 percent of itscalories from fat in 82 percent of elementary schools and 91 percent ofsecondary schools. The study found that students who eat the school luncheat more vegetables and grains, and drink more milk, while eating fewersweet and salty snacks and drinking fewer sweetened beverages. Yet, thenumber of students eating the school lunch has declined dramatically inNorth Carolina as students increasingly choose other options that areavailable on the serving line or in vending machines. North Carolina’sNSLP participation rate has dropped 20 percentage points in the last twodecades—the highest decline in the nation.21

Over the past 25 years, schools in North Carolina and throughout thenation have developed an over reliance on the revenues from a la carte

sales to financially support the non-profit Child Nutrition Program. Inaddition, school organizations and academic departments are increasingly


Vending outside of the cafeteria

Why should students choose

school lunch?

The bottom line

“I see a lot of studentswalk by all day with a soda in their hand.”

—Sandy, 10th grade


dependent on revenues and incentives from the sale of foods and beveragesof limited nutritional value. In the absence of state or local support, schoolshave had few options other than to offer supplemental sales or cease tooperate a Child Nutrition Program.

As North Carolina’s schools transition to implement the Eat Smart SchoolStandards, there is potential for a loss of revenue, particularly in the shortterm. Other state and/or local funds will be needed to offset the financialloss and keep Child Nutrition Programs in the business of preparing andserving healthy meals to children. On the other hand, there is opportunityto work with food and beverage companies to alter the foods and beverageofferings in vending machines and on the cafeteria line to be consistentwith the Eat Smart School Standards. And, encouraging more students toparticipate in school breakfast and lunch would increase federalreimbursement, helping to offset lost revenues.22

The Consensus Panel is fully cognizant of the financial pressures thathave led to decisions in some schools that create substantial barriers tohealthy eating opportunities for students. However, the Panel believes thatthe consequences of overweight on children’s health and self-esteem faroutweigh any short-term financial gains. The Panel recommends that amechanism for enforcing existing statutes and policies be developed, andthat the Eat Smart School Standards be used to raise the level of publicdiscourse and action surrounding these nutritional and fiscal decisions.

Ideally, schools will begin to work immediately to develop and implementlocal policies that support the implementation of the Eat Smart School

Standards. Such policies should consider all aspects of implementing the Eat Smart School Standards, including, but not limited to, availability of funds,personnel and food products; staff and community involvement; classroomand community nutrition education; and strategies for monitoringcompliance with the policy.

While some schools may quickly implement many of the recommendedEat Smart School Standards, others will need to make gradual changes inorder to achieve long-term success. The Panel agreed to adopt a voluntarytimeline for implementation by schools and school systems. However thePanel recommends:

• Grades PreK-5 achieve the Superior rating by no later than 2009 • Grades 6-8 achieve the Superior rating by no later than 2011 • Grades 9-12 achieve the Superior rating by no later than 2014

This timeline will enable all school systems to realistically address andresolve potential barriers to implementation.

The Eat Smart School Standards are also available for consideration bypolicy makers and policy advocates as they address overweight and obesityissues. Financial incentives tied to particular levels of performance willenhance the speed and the quality of implementation.

Proposed implementation

“There should behealthier choices,more fruit.”

—Jeanne, 10th grade


Needs Improvement Basic Proficient Superior

VENDINGBeverages

Not in compliance with NC Statute115C-264 that prohibits the sale ofsoft drinks in elementary schools

In compliance with NC Statute 115C-264 that prohibits the sale of softdrinks in elementary schools

No beverage vending available tostudents

No beverage vending available tostudents

VENDINGSnack Foods

Not in compliance with USDAregulation 7CFR 210 and 220 thatprohibit the sale of foods of minimalnutritional value where school mealsare served or eaten during mealperiods

In compliance with USDA regulation7CFR210 and 220 that prohibit thesale of foods of minimal nutritionalvalue where school meals are servedor eaten during meal periods

No snack vending available tostudents

No snack vending available tostudents

AFTER SCHOOLPROGRAMS

All beverages and snacks in afterschool programs meet the minimumNSLP component guidelines,regardless of funding source

In addition, snacks on 2 days of theweek meet the following standards:≤ 35% total calories from fat,

excluding nuts and seeds≤ 10% total calories from saturated

fat≤ 35% added sugar by weight




In addition, snacks on all days of theweek meet the following standards:≤ 35% total calories from fat,



SCHOOL EVENTSClassroom Events, Celebrations,Class Snacks, Meetings,Parties, Concessions,Intramural Events, Fundraisers,Extracurricular

No local policy Local policy developed by school/community committee guided bysound nutrition principles*implemented for 2 event categories

Local policy developed by school/community committee guided bysound nutrition principles*implemented for 4 event categories


SCHOOL MEALSNational School LunchProgram

School Breakfast Program

Not in compliance with USDA SchoolMeals Initiative 7CFR 210 and 220

In compliance with USDA SchoolMeals Initiative 7CFR 210 and 220. Inaddition, school meals will include:Three fruits (some fresh) and/orvegetables (not fried) offered forlunchFoods containing whole grainsoffered 3 days a weekOne reimbursable lunch andbreakfast offered daily has no morethan 30% of calories from fat andless than 10% of calories fromsaturated fat Milk choices meet requirements of7CFR 210

In compliance with USDA SchoolMeals Initiative 7CFR 210 and 220. Inaddition, school meals will include:Four fruits (some fresh) and/orvegetables (not fried) offered forlunchFoods containing whole grainsoffered 4 days a weekTwo reimbursable lunches andbreakfasts offered daily have no morethan 30% of calories from fat andless than 10% of calories fromsaturated fatAll milk choices, except whole milk,allowed

In compliance with USDA SchoolMeals Initiative 7CFR 210 and 220. Inaddition, school meals will include:Four fruits (some fresh) and/orvegetables (not fried) offered forlunch—at least one is rawFoods containing whole grainsoffered dailyEvery reimbursable lunch andbreakfast offered daily has no morethan 30% of calories from fat andless than 10% of calories fromsaturated fatMust serve unflavored low fat milkMay serve flavored low fat milkMay serve unflavored and flavorednon fat milk

A LA CARTEAll other food and beverageitems sold in school cafeteriaor in other locations whereSchool Meals are served oreaten

No local policy If local policy allows a la carte foodsales, the following options may besold:The same portion size of any fooditem served that day in the NSLP or SBP

Fruit (some fresh) or vegetables (not fried)YogurtAny milk offered in NSLP/SBP mealsthat dayWater50-100% juice with no addedsweeteners ≤ 8 oz.

If local policy allows a la carte foodsales, the following options may besold:The same portion size of any fooditem served that day in the NSLP or SBP

Fruit (some fresh) or vegetables (not fried)YogurtAny milk offered in NSLP/SBP mealsthat dayWater

If local policy allows a la carte foodsales, the following options may besold:The same portion size of any fooditem served that day in the NSLP orSBP that meets the following:≤ 35% total calories from fat,


fat≤ 35% added sugar by weightFruit (some fresh) or vegetables (not fried)YogurtAny milk offered in NSLP/SBP mealsthat dayWater

Eat Smart Nutrition Standards: GRADES PreK-5

*See Glossary



VENDINGBeverages

Not in compliance with USDAregulation 7CFR 210 and 220 thatprohibits the sale of foods of minimalnutritional value where school mealsare served or eaten during mealperiods and/or NC Statute 115C-264that prohibits the sale of soft drinksduring meal periodsNo local policy

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories50-100% juice with no addedsweeteners ≤ 12 oz

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—required, any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories50-100% juice with no addedsweeteners ≤ 8 oz

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—required, any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories

VENDINGSnack Foods


50% of choices are items that haveno more than 200 calories per portion



AFTER SCHOOLPROGRAMS

All beverages and snacks in afterschool programs meet the minimumNSLP component guidelines,regardless of funding source


excluding nuts and seeds≤ 10% total calories from saturated fat≤ 35% added sugar by weight



In addition, snacks on all days of theweek meet the following standards:≤ 35% total calories from fat,


SCHOOL EVENTSClassroom Events, Celebrations,Class Snacks, Meetings, Parties,Concessions, Intramural Events,Fundraisers, Extracurricular


Local policy developed by school/community committee guided bysound nutrition principlesimplemented for 4 event categories

Local policy developed by school/community committee guided bysound nutrition principlesimplemented for 6 event categories




In compliance with USDA SchoolMeal Initiative 7CRF 210 and 220.In addition, school meals will include:Three fruits (some fresh) and/orvegetables offered for lunch—atleast 2 are not fried Foods containing whole grainsoffered 3 days a weekOne reimbursable lunch andbreakfast offered daily has no morethan 30% of calories from fat andless than 10% of calories fromsaturated fatMilk choices meet requirements of7CFR 210.

In compliance with USDA SchoolMeals Initiative 7CFR 210 and 220.In addition, school meals will include:Four fruits (some fresh) and/orvegetables offered for lunch—atleast 3 are not fried Foods containing whole grainsoffered 4 days a weekTwo reimbursable lunches andbreakfasts offered daily have no morethan 30% of calories from fat andless than 10% of calories fromsaturated fat All milk choices, except whole milk,allowed

In compliance with USDA SchoolMeals Initiative 7CFR 210 and 220.In addition, school meals will include:Four fruits (some fresh) and/orvegetables offered for lunch—noneare fried Foods containing whole grainsoffered dailyEvery reimbursable lunch andbreakfast offered daily has no morethan 30% of calories from fat andless than 10% of calories fromsaturated fat Must serve unflavored low fat milkMay serve flavored low fat milkMay serve unflavored and flavorednon fat milk

A LA CARTEAll other food and beverageitems sold in school cafeteriaor in other locations whereSchool Meals are served or eaten

No local policy If local policy permits a la carte itemsto be sold, they are limited to thefollowing every dayThe same portion size of any fooditem served that day in the NSLP orSBP

Fruit (some fresh) or vegetables (notfried)YogurtNuts and seeds ≤ 1 oz.Water50-100% juice with no addedsweeteners ≤ 12 ozAny milk offered in NSLP/SBP mealsthat day

If local policy permits a la carte itemsto be sold, they are limited to thefollowing every dayThe same portion size of any fooditem served that day in the NSLP orSBP

Fruit (some fresh) or vegetables (notfried)YogurtNuts and seeds ≤ 1 oz.Water50-100% juice with no addedsweeteners ≤ 8 oz.Any milk offered in NSLP/SBP mealsthat day

If local policy permits a la carte itemsto be sold, they are limited to thefollowing every day The same portion size of any fooditem served that day in the NSLP orSBP that meets the following:≤ 35% total calories from fat,


fat≤ 35% added sugar by weightFruit (some fresh) or vegetables (notfried)YogurtNuts and seeds ≤ 1 oz.WaterAny milk offered in NSLP/SBP mealsthat day

Eat Smart Nutrition Standards: GRADES 6-8

*See Glossary



VENDINGBeverages

Not in compliance with USDAregulation 7CFR 210 and 220 thatprohibits the sale of foods of minimalnutritional value where school mealsare served or eaten during mealperiods and/or NC Statute 115C-264that prohibits the sale of soft drinksduring meal periodsNo local policy

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories50-100% juice with no addedsweeteners ≤ 12 ozSports drinks that contain no morethan 100 caloriesIf sodas are allowed outside of mealperiods, they are no larger than 12 oz.

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—required, any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories50-100% juice with no addedsweeteners ≤ 12 ozSports drinks that contain no morethan 100 calories

In compliance with USDA regulation7CFR 210 and 220 and NC Statute115C-264In addition, if local policy permitsvending to students, contents mayonly include the following:Water—required, any sizeLow fat or non fat milk, flavored orunflavored—any size ≤ 360 calories50-100% juice with no addedsweeteners ≤ 8 ozSports drinks that contain no morethan 100 calories

VENDINGSnack Foods





SCHOOL EVENTSClassroom Events, Celebrations,Meetings, Parties, Concessions,Intramural Events,Fundraisers, Extracurricular







In compliance with USDA SchoolMeal Initiative 7CRF 210 and 220.In addition, school meals will include:Three fruits (some fresh) and/orvegetables offered for lunch—atleast 2 are not fried Foods containing whole grainsoffered 3 days a weekOne reimbursable lunch and breakfastoffered daily has no more than 30% ofcalories from fat and less than 10% ofcalories from saturated fat Milk choices meet requirements of7CFR 210

In compliance with USDA SchoolMeal Initiative 7CRF 210 and 220.In addition, school meals will include:Four fruits (some fresh) and/orvegetables offered for lunch—atleast 3 are not friedFoods containing whole grainsoffered 4 days a weekTwo reimbursable lunches andbreakfasts have no more than 30% ofcalories from fat and less than 10%of calories from saturated fatAll milk choices, except whole milk,allowed

In compliance with USDA SchoolMeal Initiative 7CRF 210 and 220.In addition, school meals will include:Four fruits (some fresh) and/orvegetables offered for lunch—noneare friedFoods containing whole grainsoffered dailyEvery reimbursable lunch andbreakfast offered daily has no morethan 30% of calories from fat and lessthan 10% of calories from saturated fat Must serve unflavored low fat milkMay serve flavored low fat milkMay serve unflavored and flavorednon fat milk

A LA CARTEAll other food and beverage items sold in schoolcafeteria or in other locationswhere School Meals areserved or eaten

No local policy If local policy permits a la carte itemsto be sold, they are limited to thefollowing every dayThe same portion size of any fooditem served that day in the NSLP orSBP

Fruit (some fresh) or vegetables (notfried)Yogurt50% of snack choices are items thathave no more than 200 calories perportion Water50-100% juice with no addedsweeteners ≤ 12 ozSports drinks that contain no morethan 100 caloriesAny milk offered in NSLP/SBP mealsthat day

If local policy permits a la carte itemsto be sold, they are limited to thefollowing every dayThe same portion size of any fooditem served that day in the NSLP orSBP

Fruit (some fresh) or vegetables (notfried)Yogurt75% of snack choices are items thathave no more than 200 calories perportion Water50-100% juice with no addedsweeteners ≤ 12 oz.Sports drinks that contain no morethan 100 caloriesAny milk offered in NSLP/SBP mealsthat day

If local policy permits a la carte itemsto be sold, they are limited to thefollowing every dayThe same portion size of any fooditems served that day in the NSLP orSBP that meet the following:≤ 35% total calories from fat,


fat≤ 35% added sugar by weightFruit (some fresh) or vegetables (notfried)Yogurt100% of snack choices are items thathave no more than 200 calories perportion Water50-100% juice with no addedsweeteners ≤ 8 ozSports drinks that contain no morethan 100 caloriesAny milk offered in NSLP/SBP mealsthat day

Eat Smart Nutrition Standards: GRADES 9-12

*See Glossary


Moving the Eat Smart School Standards from paper to practice will not beeasy and it will not happen overnight. Families, school and community

leaders as well as policy makers bring different perspectives to this issue.However, all share the common goal of providing a healthy future forchildren. All can work together to create change.

Healthy eating patterns do not just happen—they are developedthrough a lifetime of exposure to foods and eating experiences. Providingenvironments that support healthy choices—from policies to role-modeling—is a challenge for schools. However, it is also an opportunity topromote change toward more supportive environments at home and otherplaces families eat away from home. Two recent national polls showremarkable agreement between parents and teachers on what schoolsshould do to be part of the solution to obesity.23 More than 90 percent ofparents and teachers surveyed favor converting the contents of vendingmachines in schools to healthy foods and beverages. North Carolinaparents said in a recent study that they prefer nutrition education be taughtin the classroom.24 Teachers, parents, students, school nutrition staff,educators, business and industry, and community leaders can collaborate toassess the school’s eating environment, develop a shared vision and actionplan, evaluate the plan’s success and problem-solve to find solutions thatwork for the good of all students.

Schools have an opportunity to provide classroom health and nutritioneducation supplemented by learning laboratories in the many venues

where food is offered or served. Cafeterias, school stores, vending, partiesand after school events offer opportunities for schools to reinforce themessage that making healthy food choices means a healthier body and asharper mind.

Fun, interactive, culturally-sensitive, age-appropriate nutrition educationtaught as part of a comprehensive, K-12 health education curriculum suchas the Healthful Living Standard Course of Study, provides opportunities toteach the value of making healthy choices.25 Integrating nutrition educationand physical activity into all curriculum areas can maximize theeffectiveness of teaching these important life skills. The cafeteria-classroomconnection allows elementary students the opportunity to be exposed tonew foods and begin developing skills in making healthy food choices. Thisconnection also allows middle and high school students the opportunity todeflect negative social pressure and practice personal responsibility anddecision-making skills in a positive, supportive environment. Whilenutrition education is part of the Healthful Living Standard Course ofStudy, it is not consistently taught across the curriculum in all schools.

From paper to practice

Learning and practicing healthy eating

Training opportunities for teachers, staff and parents would raise the levelof knowledge and commitment these groups share in supporting a

healthy school environment. Teacher and staff training should focus oninnovative teaching strategies in the classroom and the cafeteria. Trainingshould also equip adults with the skills to evaluate and improve their owneating habits, enhancing their ability to serve as role models. Likewise,parental and community involvement through School Health AdvisoryCouncils (SHACs)26 participation in school activities, parent-teacherorganizations or local board of education meetings can ensure thatconsistent messages about the role of good nutrition and active lifestyles inhealth and learning are provided and reinforced at home and at school.

School personnel who are committed to their own health and well beingare a valuable asset to the school, both as role models and as advocates.

When school personnel embrace health, they act as role models forhealthful living, reinforcing the “Eat Smart, Move More” message forchildren and families.27 “Adults as positive role models for children” is arecommendation of the NC Healthy Weight Initiative’s Task Force.1 Schoolpersonnel who make healthy choices are likely to advocate for schoolenvironments that promote healthy eating and increased physical activity forstudents. This role as advocate can take many forms. Seeking alternativerevenue for projects and activities currently funded by vending sales, voicingsupport for adequate time to eat school breakfast and lunch, speaking outagainst violations of current statutes and policy, and advocating for nutritioneducation in classrooms may be appropriate. Healthy adult role models mayalso seek alternatives to food as a reward and work with peers to developother options for celebrations and special events.

Schools are places of extraordinary influence on student behavior and thedevelopment of lifelong eating patterns. The support of healthy eating

patterns cannot, however, stop with the school. Families have a large role toplay. Families are the foundation of the solution to childhood overweightand adult obesity. They provide the child’s first learning environment andhave the potential to make that environment supportive of healthy eatingand physical activity. Families can influence children’s eating practices byensuring availability and accessibility of foods in appropriate portion sizes.They can influence children’s eating patterns by establishing mealstructures that reflect the importance of eating away from TV or otherdistractions and learning to enjoy the social aspects of eating together as afamily as often as possible. They can learn to avoid feeding practices thatmay encourage overeating or eating disorders. And they can commit to“walking the talk”—eating healthy meals and snacks, and balancing foodintake with physical activity to improve their own health and provide anexample for children. Families can also influence opportunities forchildren to make healthy choices by being advocates for environmental andpolicy change to support healthy eating outside the home and by makingthoughtful decisions when selecting places to eat away from home.


Adults learning to lead

School personnelas role models

Families as thefoundation


Eat Smart: NC’s Recommended Standards For All Foods Available In Schoolrepresents the best thinking of the Consensus Panel on how schools can

help change eating patterns of students in school and influence change infamilies and communities. The Eat Smart School Standards do not address allthe important contributors to eating patterns in schools. Among theseother important issues are:

• Universal availability of school breakfast• Adequate time to eat • Lunch periods scheduled as near the middle of the school day as possible• Appropriate supervision and pleasant and comfortable eating environments • Nutrition education of sufficient quality and quantity to enhance decision-

making skills• Marketing and advertising to students • Stigma and peer pressure for students who eat the school meals while their

friends choose expensive a la carte foods

The Consensus Panel did not make specific recommendations for foodsserved at special school events. Instead, the Panel recommends that acommittee of school and community members, including parents andstudents, develop a local policy. Such involvement may promote greaterunderstanding and implementation of the Eat Smart School Standards. Thepolicy may include such issues as:

• Alternatives to using food as an individual reward • How often food will be part of a group celebration• What other celebration options are available• What kind and amount of foods will be provided for all special school events

Finally, the Consensus Panel chose to keep the Eat Smart School Standardsas simple as possible, using measures such as portion size, calories, types offood and preparation methods that will make significant differences in thedevelopment of healthy eating patterns. The Eat Smart School Standards buildon other efforts, including the USDA’s School Meal Initiative19 and NCPrevention Partner’s Winner’s Circle Healthy Dining Program,28 which havebeen accepted by many child nutrition directors. The schools’ success inmeeting the School Meal Initiative’s standard for meals averaged over aweek will be a strong foundation for moving toward the availability everyday of meals that have no more than 30 percent of calories from fat andless than 10 percent of calories from saturated fat. The promotion ofWinner’s Circle options will give schools a head start on implementing theEat Smart School Standards, and Winner’s Circle marketing will strengthenacceptance of increasing numbers of healthy foods. The Eat Smart SchoolStandards may be thought of as “Winner’s Circle Plus,” building on thestrength of Winner’s Circle criteria for meals, side dishes and snacks.

Beyond the Eat Smart School Standards

“We have to split ourlunch time and activitytime. We only get 21 minutes to eat and 21 minutes for activity.”

—Antonio, 7th grade

The Eat Smart School Standards do not use an “all or nothing” approach.Rather, they call on schools and communities to assess current practicesand evaluate the school and community’s level of readiness to change, theircommitment to investing in children’s short and long term health, andtheir willingness to find fiscal solutions.

Tools addressing ways to implement specific standards will be developedto assist local implementation. Partners in the Eat Smart School Standardsproject will develop some of the tools; however other organizations andindividuals concerned about the health and well-being of children areencouraged to also provide their expertise and support. Implementation ofthe Eat Smart School Standards has not been pilot tested. It is recommendedthat an expert panel be convened at the end of three years to study thesuccess and the difficulties of implementation and to make anymodification that may be deemed necessary.

Childhood overweight is a health crisis in North Carolina and throughoutthe United States. The epidemic begins with unhealthy eating and

physical inactivity patterns, established when children are very young. All segments of society have a role to play in solving this extraordinarilycomplicated health issue. Eat Smart: NC’s Recommended Standards For All FoodsAvailable In School is only one part of the solution. However, these Eat SmartSchool Standards can become a highly visible part of the solution and havefar reaching effects on what students eat in school and how change occursin families and communities. Students and families who improve eatingpatterns are also likely to increase physical activity, another importantcontributor to obesity prevention. Effective action will require vigoroussupport by families, school and community leaders, and policy makers.


CALL TOACTION


Be Part OF THE Solution

• Eat smart and move more to look, feel and do your best• Get informed and involved• Set goals for yourself• Serve as a role model to younger students• Eat the school breakfast, school lunch and healthy snacks

• Eat smart and move more—children are watching you• Support school meal programs—eat breakfast and lunch at school• Learn how Child Nutrition Programs are financed and discuss it with others• Advocate for healthy school meals and nutrition education• Provide healthy snacks or fun physical activity for parties and events

• Teach and role model good nutrition and physical activity• Coordinate nutrition education with cafeteria staff• Teach life skills—not just the facts• Eat with students—support school meal programs• Use non-food rewards

• Provide tasty, appealing and healthy meals• Market healthy meals well• Coordinate classroom and cafeteria activities• Eat smart and move more—children are watching you • Provide nutrition information to students and families

• Support a healthy eating environment and tell others about your commitment• Establish school policy and enforce district and state policy• Seek alternative sources of revenue for your school• Schedule recess before lunch and adequate time to eat• Provide continuing education opportunities for staff on nutrition and health

• Support a healthy eating environment and tell others about your commitment• Make funds available to support healthy eating• Establish and enforce policy for foods available in schools• Require comprehensive skill based nutrition education for PreK-12• Support school meal programs—eat breakfast and lunch at school

Students, families, teachers, child nutrition staff,superintendents and school board members each play a rolein making school a place that supports healthy eating.

Students:

Families:

Teachers:

Child NutritionStaff:

Principals:

SchoolSuperintendents/

School BoardMembers:


1. Caldwell D, Lebeuf J. eds: AmmermanA, Cooke C, Dunn C, Longenecker J,Matthews B, Ngui E, Samuel-Hodge C,Schwartz R, Ward D. Moving Our ChildrenToward a Healthy Weight: Finding the Willand the Way. North Carolina DHHS,Division of Public Health, Raleigh, NC:2002.

2. North Carolina Nutrition and PhysicalActivity Surveillance System (NC-NPASS).Division of Public Health, Women’s andChildren’s Health Section, NutritionServices Division. Available athttp://www.NCHealthyWeight.com.Accessed April 10, 2004.

3. Mokdad A, Marks J, Stroup D,Gerberding J. Actual causes of death inthe United States, 2000. JAMA. 2004;291:1238-1245.

4. Narayan K, Boyle J, Thompson T,Sorensen S, Williamson D. Lifetime riskfor diabetes mellitus in the United States,JAMA. 2003;290:1884-1890.

5. Dietz W. Health consequences ofobesity in youth: Childhood predictors ofadult disease. Pediatrics. 1998;101(3)Suppl:518-525.

6. Centers for Disease Control andPrevention. Preventing obesity and chronicdiseases through good nutrition and physicalactivity. Available at http://www.cdc.gov/nccdphp/pe factsheets/pe pa.htm.Accessed April 10, 2004.

7. Finklestein E, Fiebelkorn I, Wang G.State level estimates of annual medicalexpenditures attributable to obesity.Obesity Research 2004;Vol 12 No. l:1-7.

8. U.S. Department of Health andHuman Services. The Surgeon General’sCall to Action to Prevent and DecreaseOverweight and Obesity, U.S. Departmentof Health and Human Services. PublicHealth Service. Office of the SurgeonGeneral; Rockville, MD: 2001.

9. Allensworth D, Lawson E, Nicholson L,Wyche J, eds. Schools and Health: OurNation’s Investment. Washington DC.Institute of Medicine, Washington, DC:National Academy Press; 1997.

10. Caldwell D, Nestle M, Rogers W.School nutrition services. In Marx E,Wooley S, Northrop D. Health is Academic,New York, NY: Teachers College Press;1998:195-223.

11. Bogden J. Fit Healthy and Ready toLearn: A School Health Policy Guide.National Association of State Boards ofEducation. Alexandria, VA: 2000.

12. U.S. Department of Agriculture.Changing the Scene: Improving the SchoolNutrition Environment. Alexandria, VA;2000.

13. Centers for Disease Control andPrevention. School Health Index for PhysicalActivity and Healthy Eating: A Self-Assessment and Planning Guide. Atlanta,GA; 2000.

14. U.S. Department of Agriculture. Foods Sold in Competition with School MealPrograms: A Report to Congress. Alexandria,VA; 2000.

15. North Carolina Department of PublicInstruction, Division of School Businessand Finance, Child Nutrition ServicesSection. Unpublished data. Raleigh, NC2004.

16. U.S. Department of Agriculture.Competitive Foods (7CFR 210.11, 220.12)Federal Register; Washington, DC; January1, 1986.

17. Nestle M. Food Politics: How the FoodIndustry Influences Nutrition and Health.Berkeley and Los Angeles, CA: Universityof California Press; 2002.

18. Burghardt J, Devaney B. The SchoolNutrition Dietary Assessment Study: Summaryof Findings. Submitted to the U.S.Department of Agriculture, Food andNutrition Service. Princeton, NJ:Mathematica Policy Research, Inc.; 1993.

19. U.S. Department of Agriculture.National School Lunch Program and SchoolBreakfast Program Nutrition Objectives forSchool Meals (7CFR 210, 220) FederalRegister; Washington, DC; 1994; 30218-30251.

20. Fox M, Crepinek M, Conor P,Battaglia M. School Nutrition DietaryAssessment Study II. Final report submittedto the U.S. Department of Agriculture,Food and Nutrition Service, Cambridge,MA: Abt Associates, Inc.; 2001.

21. U.S. Department of Agriculture.Making the Grade: A comparison of programdata from 1979 and 1998. For Food,Nutrition and Consumer Services Forum,Promoting Healthy Eating Behaviors: The Roleof School Environments. Washington, DC:1999.

22. Brownell K, Horgen K. Food Fight: TheInside Story of the Food Industry: America’sObesity Crisis, and What We Can Do About It.New York, NY: The McGraw HillCompanies: 2004.

23. The Robert Wood JohnsonFoundation, Active Living: Healthy Schoolsfor Healthy Kids. Available at: http://www.http://www.rwjf.org. Accessed April 10,2004.

24. Dunn C, Kelsey K, Matthews W,Sledge M. Body image, self esteem andnutrition concerns of parents of 6th and7th grade students. Journal of Extension“In Press.”

25. Centers for Disease Control andPrevention. Guidelines for School HealthPrograms to Promote Lifelong HealthyEating. MMWR, Atlanta, GA: 1996.

26. NC State Board of Education. HealthyActive Children Policy. Available athttp://sbepolicy.dpi.state.nc.us. AccessedApril 10, 2004.

27. NC Department of Health andHuman Services, Division of PublicHealth. Eat Smart More More: NC Blueprintfor Changing Policies and Environments inSupport of Increased Physical Activity/HealthyEating. Raleigh, NC: 2002.

28. North Carolina Prevention Partners.Winner’s Circle: Where Nutritious MeetsDelicious. Available at http://www.winnerscirclehealthydining.com.Accessed April 10, 2004.

References


A la carte: Any individual food sold inschool cafeterias. Also known assupplemental sales.

Added sweeteners: Sweeteners addedduring processing or packing.

After School Snack Program: Federallyfunded program that offers cashreimbursement for serving snacks tochildren in after school activities aimed atpromoting the health and well being ofchildren and youth.

Body Mass Index (BMI): An index ofbody weight for height used to classifyoverweight or obesity in adults. BMI,adjusted for age and gender, is also usedto identify children and adolescents whoare overweight or at-risk for overweight.

Child Nutrition Program: The schoolfood service program operated under theauspices of the NC Department of PublicInstruction, Division of School Businessand Finance, Child Nutrition Services.

Childhood overweight: A gender- andage-specific Body Mass Index at or abovethe 95th percentile for children andyouth aged 2 to 20 years, based on 2000Centers for Disease Control andPrevention (CDC) growth charts. Neithera separate definition for obesity nor adefinition for overweight based on healthoutcomes or risk factors is defined forchildren and youth.

Class snacks: Snacks brought into aschool classroom for all students to shareand enjoy.

Classroom events: Events occurring in aschool classroom for all students toparticipate in or enjoy.

Concessions: Food sold at events onschool property, during the school day oroutside school hours.

Competitive foods: Any foods sold incompetition with the School Breakfast,National School Lunch or After SchoolSnack Programs.

Extracurricular: Outside the regularcourse of study but under the supervisionof the school.

Foods of Minimal Nutritional Value:Foods and beverages that do not provideat least 5 percent of the Reference DailyIntake (RDI) for any one of several keynutrients. Soda water (carbonatedbeverages), water ices, chewing gum andcertain candies are included.

Fundraisers: Activities in which studentsor others sell products to raise money forthe school.

Healthy People 2010: Healthy People2010 is the prevention agenda for theNation. It is a statement of nationalhealth objectives designed to identify themost significant preventable threats tohealth and to establish national goals toreduce these threats.

Intramural events: Events occurringbetween students in the same school.

Juice, 100%: Undiluted liquid fraction ofwhole vegetable, fruit or fruit blendswithout added sweeteners.

Juice drink: Diluted, sweetened fruit orvegetable juice or fruit or vegetable juiceblend.

MilkSkim Milk: Pasteurized, homogenizedfluid cow’s milk containing less than.5% milk fat.Low fat milk: Pasteurized, homogenizedfluid cow’s milk containing 1% milk fat.Reduced fat milk: Pasteurized,homogenized fluid cow’s milkcontaining 2% milk fat.Whole Milk: Pasteurized, homogenizedfluid cow’s milk containing 3.5% milk fat.

National School Lunch Program:Program under which participatingschools operate a nonprofit lunchprogram authorized by 7CFR210 of theNational School Lunch Act.

Obesity: A Body Mass Index of 30 orgreater in adults. There is no definitionfor obesity in children and youth. Referto “childhood overweight” for adefinition that applies to children andyouth aged 2 to 20 years.

Overweight: A Body Mass Index between25 and 29.9 in adults. Refer to“childhood overweight” for definitionthat applies to children and youth aged 2to 20 years.

Policy: A principle plan or course ofaction as pursued by an organization.

Portion size: A quantity of food orbeverage intended for consumption byone individual.

Pouring rights contract: A contract with avendor for the sale of one brand, alsoknown as an exclusive beverage contract.

Regulation: Rules that implement laws.

Reimbursement: Federal cash assistancepaid to participating schools for lunches,breakfasts and after school snacks thatmeet USDA requirements.

School Breakfast Program: Programunder which participating schoolsoperate a nonprofit breakfast programauthorized by 7CFR220 of the NationalSchool Lunch Act.

School Health Advisory Councils:Advisory group of individuals whorepresent segments of the school andcommunity. The group acts collectively toprovide advice to the school system on allaspects of school health. The NC StateBoard of Education’s Healthy ActiveChildren Policy requires a Council in eachschool district.

School lunch: Noontime meal that meetsthe requirements of the National SchoolLunch Program.

Sound nutrition principles: Principles ofhuman nutrition based on thepreponderance of scientific evidence todate. For example, the Dietary Guidelinesfor Americans and the Food GuidePyramid are sound nutrition principles.

Supplemental sales: Foods sold in schoolcafeterias intended to supplement fundsreceived from the federally reimbursedschool meals. Historically, supplementalsales were intended to supplement astudent’s lunch brought from home. Forexample, a carton of milk to accompanya brown-bag lunch.

Vending machine: Cash-operatedmachine that dispenses foods and/orbeverages.

Water: Carbonated and non-carbonatedwater, with no added sweeteners and zerocalories.

Weekly USDA Standard: Congressionallymandated requirement that federallyreimbursed school lunches and schoolbreakfasts average, over the course of aweek, no more than 30 percent ofcalories from fat and less than 10 percentof calories from saturated fat. Eat SmartSchool Standards recommend that schoolsprogress toward using this standard daily.

Glossary


NC STATE BOARD OF EDUCATION Policy # EEO-S-000 1. A la carte sales are limited to foods contributing to

the nutritional well-being of the child and aiding inthe establishment of good food habits. School foodauthorities and sponsoring organizations mayprovide these foods under the following conditions:

A. Sponsors must operate all food and beverageservices during or before the established lunchperiod through the school food servicedepartment.

B. The school food service department retains allreceipts from the sale of these items.

C. Sponsors must use all food service income for thepurpose of the school’s non-profit Child NutritionPrograms.

D. A la carte items may not include food ofminimum nutritional value.

2. Competitive food sales by a school of extra fooditems in the lunchroom or its general environs mustbe on a non-profit basis. “On a non-profit basis”means that the sponsor deposits income from thesale of such food items to the account of the school’snon-profit lunch and breakfast programs and usesthe income solely for these programs.

A. The school may sell extra food items after theestablished lunch hour is over, only with theapproval of the LEA. The established lunch houris over when the last pupil has been served forthe day.

C. The department may deny the opportunity toparticipate in the program to any school foodauthority that operates in violation of state policy.

Complete text available at: sbepolicy.dpi.state.nc.us/

NC GENERAL STATUTE 115C-264.Operation. In the operation of their public school food programs,the public schools shall participate in the NationalSchool Lunch Program established by the federalgovernment. The program shall be under thejurisdiction of the Division of School Food Services ofthe Department of Public Instruction and inaccordance with federal guidelines as established bythe Child Nutrition Division of the United StatesDepartment of Agriculture.

Each school may, with the approval of the local boardof education, sell soft drinks to students so long as softdrinks are not sold (i) during the lunch period, (ii) atelementary schools, or (iii) contrary to therequirements of the National School Lunch Program.

Complete text available at:www.ncga.state.nc.us/Statutes/Statutes.asp

US CODE OF FEDERAL REGULATIONSec. 210.11 Competitive foods means any foods sold in competitionwith the Program to children in food service areasduring the lunch periods. State agencies and schoolfood authorities shall establish such rules or regulationsas are necessary to control the sale of foods incompetition with lunches served under the Program.Such rules or regulations shall prohibit the sale offoods of minimal nutritional value.

Complete text available at: www.access.gpo.gov/nara/cfr/waisidx_04/7cfr210_04.html

US CODE OF FEDERAL REGULATIONSec. 220.12 Competitive food services. State agencies and SchoolFood Authorities shall establish such rules orregulations as are necessary to control the sale of foodsin competition with breakfasts served under theProgram. Such rules or regulations shall prohibit thesale of foods of minimal nutritional value, as listed inappendix B of this part, in the food service areasduring the breakfast periods.

Complete text available at: www.access.gpo.gov/nara/cfr/waisidx_04/7cfr220_04.html

Existing Policy, Law and Regulation

Alice Ammerman, DrPH, RDUNC School of Public HealthDepartment of Nutrition & Medicine

Kathryn Kolasa, PhD, RD, LDNECU Brody School of MedicineDepartment of Family Medicine

Kathy Andersen, MS, RD*NC Division of Public HealthNutrition Education and Training

Evelyn B. MonroeMember, NC State Board of Education

Dorothy Caldwell, MS, RD, LDN*NC Division of Public HealthSchool Health Initiative

Robert Schwartz, MDWake Forest University School of MedicineDepartment of Pediatrics

Shirley Caraway, EdDSuperintendent, Orange County Public Schools

Kim Shovelin, MPH, RD, LDNNC Prevention PartnersUNC School of Public Health

Susan Chase, PhDPrincipal, Gaston County Public Schools

Julie Stewart, MS, RD, LDNFood Service ManagerSAS Institute

Carolyn Dunn, PhD*NC Cooperative Extension ServiceDepartment of Family & Consumer Sciences

Sherée Thaxton, MA, RD, LDN*NC Division of Public HealthHealthy Weight Initiative

Yonni Freemark Student, Durham County Public Schools

Cathy Thomas, MAEd*NC Division of Public HealthPhysical Activity and Nutrition Branch

Joanne Harrell, RN, PhD, FAANUNC School of NursingCardiovascular Health in Children and Youth

Clarie WhitePresident, NC Congress of Parents and Teachers

Patti HeadMember, Wake County Board of Education

Gretchen WilsonPresident, NC School Food Service Association

Lynn Hoggard, MS, RD, LDN, FADA*NC Department of Public InstructionDivision of School Business and Finance, Child Nutrition Services

Carol ZinnTeacher, Henderson County Public Schools

Consensus PanelMembers

*Denotes writing team

Reviewers

For more information contact

NC Healthy Weight InitiativePhysical Activity and Nutrition Branch, Chronic Disease and Injury Section1915 Mail Service Center, Raleigh, NC 27699-1915 • 919-715-0104E-mail: [email protected] • Web address: www.NCHealthyWeight.com

Tracey Bates, MPH, RD, LDNDurham County Health Department andNC Dietetic Association

Byron Lawson, EdD Bladen County Public Schools

Alice Pettitt, MEdNC Cooperative Extension ServiceOrange County Center

Luci Bearon, PhD Parent and Sociologist

Alice Lenihan, MPH, RD, LDNNC Division of Public HealthNutrition Services Branch

Michael Sanderson, MPHNC Division of Public HealthNC Healthy Schools

Paula Hudson Collins, MHDL, RHEdDepartment of Public InstructionNC Healthy Schools

Joanne Moylan, MPH, RD Pitt County Health Department

Cynthia Sevier, MS, RDStokes County Public SchoolsChild Nutrition Program

Consenus PanelFacilitators

Lara Khalil, MPHRebecca Niemitz, MPH, RD, LDN

Anne Hardison, MR

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EAT SMART: NORTH CAROLINA’S Recommended … · Eat Smart: NC’s Recommended ... Recommended Standards For All Foods Available In School 3 the last two decades, ... include soft