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54–565 PDF 2009

S. HRG. 111–241 

IMPROVING NUTRITION FOR AMERICA’S 

CHILDREN IN DIFFICULT ECONOMIC TIMES 

HEARING 

BEFORE THE

COMMITTEE ON AGRICULTURE, 

NUTRITION, AND FORESTRY 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

MARCH 4, 2009 

Printed for the use of the 

Committee on Agriculture, Nutrition, and Forestry 

( 

Available via the World Wide Web: http://www.agriculture.senate.gov 

COMMITTEE ON AGRICULTURE, NUTRITION, AND FORESTRY 

TOM HARKIN, Iowa, Chairman 

PATRICK J. LEAHY, Vermont 

KENT CONRAD, North Dakota 

MAX BAUCUS, Montana 

BLANCHE L. LINCOLN, Arkansas 

DEBBIE A. STABENOW, Michigan 

E. BENJAMIN NELSON, Nebraska 

SHERROD BROWN, Ohio 

ROBERT P. CASEY, Jr., Pennsylvania 

AMY KLOBUCHAR, Minnesota 

KIRSTEN GILLIBRAND, New York 

MICHAEL BENNET, Colorado 

SAXBY CHAMBLISS, Georgia 

RICHARD G. LUGAR, Indiana 

THAD COCHRAN, Mississippi 

MITCH MCCONNELL, Kentucky 

PAT ROBERTS, Kansas 

MIKE JOHANNS, Nebraska 

CHARLES E. GRASSLEY, Iowa 

JOHN THUNE, South Dakota 

MARK HALVERSON, Majority Staff Director 

JESSICA L. WILLIAMS, Chief Clerk 

MARTHA SCOTT POINDEXTER, Minority Staff Director 

VERNIE HUBERT, Minority Chief Counsel 

(II) 

(III) 

C O N T E N T S 

Page 

HEARING(S): 

Improving Nutrition for America’s Children in Difficult Economic Times ......... 1 

Wednesday, March 4, 2009 

STATEMENTS PRESENTED BY SENATORS 

Harkin, Hon. Tom, U.S. Senator from the State of Iowa, Chairman, Committee on Agriculture, Nutrition, and Forestry ................................................. 1 

Bennet, Hon. Michael F., U.S. Senator from the State of Colorado .................... 4 

Casey, Hon. Robert, Jr., U.S. Senator from the State of Pennsylvania .............. 23 

Chambliss, Hon. Saxby, U.S. Senator from the State of Georgia ........................ 3 

Klobuchar, Hon. Amy, U.S. Senator from the State of Minnesota ...................... 16 

Panel I 

Bartlett, Susan, Senior Associate, ABT Associates, Cambridge, Massachusetts ....................................................................................................................... 7 

Boldt, Connie, School Food Director, Knoxville Community School District, 

Knoxville, Iowa ..................................................................................................... 8 

Wilson, Katie, School Nutrition Director, Onalaska Public Schools, Onalaska, 

Wisconsin .............................................................................................................. 5 

Panel II 

Hecht, Kenneth, Executive Director, California Food Policy Advocates, Oakland, California ..................................................................................................... 30 

Nolan, Lucy, Executive Director, End Hunger Connecticut, Hartford, Connecticut .................................................................................................................. 33 

Paige, David, M.D., Professor, Johns Hopkins Medical School, Baltimore, 

Maryland ............................................................................................................... 27 

APPENDIX 

PREPARED STATEMENTS: 

Harkin, Hon. Tom ............................................................................................ 50 

Bennet, Hon. Michael F. .................................................................................. 52 

Roberts, Hon. Pat ............................................................................................. 53 

Bartlett, Susan ................................................................................................. 54 

Boldt, Connie .................................................................................................... 72 

Hecht, Kenneth ................................................................................................. 76 

Nolan, Lucy ....................................................................................................... 84 

Paige, David ...................................................................................................... 92 

Wilson, Katie ..................................................................................................... 98 

DOCUMENT(S) SUBMITTED FOR THE RECORD: 

Campaign To End Obesity, prepared statement ............................................ 106 

National Milk Producers Federation, prepared statement ........................... 110 

National WIC Association, prepared statement ............................................. 117 

Oregon Hunger Relief Task Force, prepared statement ............................... 122 

QUESTION AND ANSWER: 

Harkin, Hon. Tom: 

Written questions for Kate Wilson .................................................................. 126 

Page

IV 

Harkin, Hon. Tom—Continued 

Written questions for Susan Bartlett ............................................................. 126 

Written questions for Ken Hecht .................................................................... 127 

Lincoln, Hon. Blanche L.: 

Written questions for Connie Boldt ................................................................ 129 

Written questions for David Paige .................................................................. 129 

Written questions for Ken Hecht .................................................................... 130 

Bartlett, Susan: 

Written response to questions from Hon. Tom Harkin ................................. 131 

Boldt, Connie: 

Written response to questions from Hon. Blanche L. Lincoln ...................... 136 

Hecht, Ken: 

Written response to questions from Hon. Tom Harkin ................................. 139 

Written response to questions from Hon. Blanche L. Lincoln ...................... 144 

Wilson, Katie: 

Written response to questions from Hon. Tom Harkin (with attachments) 148 

Written response to questions from Hon. Blanche L. Lincoln ...................... 151 

Follow on questions for the record, USDA ............................................................ 167 

(1) 

IMPROVING NUTRITION FOR AMERICA’S 

CHILDREN IN DIFFICULT ECONOMIC TIMES 

Wednesday, March 4, 2009 

U.S. SENATE, 

COMMITTEE ON AGRICULTURE, NUTRITION, AND FORESTRY, 

Washington, DC 

The committee met, pursuant to notice, at 9:36 a.m., in room 

216, Hart Senate Office Building, Hon. Tom Harkin, Chairman of 

the committee, presiding. 

Present or submitting a statement: Senators Harkin, Casey, Klobuchar, Bennet, Chambliss, and Thune. 

STATEMENT OF HON. TOM HARKIN, U.S. SENATOR FROM THE 

STATE OF IOWA, CHAIRMAN, COMMITTEE ON AGRICULTURE, 

NUTRITION, AND FORESTRY 

Chairman HARKIN. The Senate Committee on Agriculture, Nutrition, and Forestry will come to order. 

We welcome everybody here. It looks like there is a little bit of 

interest maybe in the topic we are on this morning. 

Today’s hearing continues this committee’s ongoing efforts to address issues in child nutrition and health. In our first hearing in 

December of last year, I spoke very bluntly about the real and 

damaging long-term health problems that we face in this country. 

Overweight, obesity, even among our children have reached epidemic levels in America, raising the specter that our children will 

have shorter life spans than we have for the first time in history. 

Compounding these problems is a health care system that is illequipped to prevent disease. I feel we must reorient our health care 

system so that it focuses on preventing diet-related illnesses and 

promoting good nutrition and wellness. 

As the witnesses in our last hearing outlined very clearly, 

USDA’s Child Nutrition Programs are a tremendous opportunity to 

make a lasting impact on the nutrition and eating habits of our 

children. A stronger targeted investment in those programs must 

be a part of a comprehensive Federal response to poor nutrition 

among our children. 

Our witnesses today will present us with some of the particular 

challenges and opportunities that we face in improving child nutrition, both when kids are in school and when they are not. 

Again, I emphasize that we must start early. The WIC Program 

has long been one of our nation’s most effective public health programs and has proven itself time and time again. Our child care 

settings also present us with a unique and often overlooked opporVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
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tunity to reach children before they enter kindergarten and expose 

them to the right kinds of foods and eating habits. 

With over 30 million kids eating federally assisted lunches, the 

National School Lunch Program is perhaps our best opportunity to 

improve child nutrition and health. Research has shown that children who eat school lunches have higher intakes of a range of essential vitamins and minerals than children who consume lunches 

from other sources. 

However, while the quality of school meals has gradually improved over the years, much work remains to be done to bring 

them in line with the dietary guidelines. We know, for example, 

that two-thirds of elementary schools offer meals that exceed the 

standards for saturated fat, which is commonly linked to heart disease. 

One of the solutions is to improve school meals, offering foods 

that have more of the kind of what I call the good stuff, the vitamins and minerals, less of the bad stuff, less sugar, sodium, fats. 

That means more low-and no-fat milk, leaner meats, whole grain 

products, fruits and vegetables, particularly fresh fruits and vegetables. 

Now, while that may seem like an easy recommendation in principle, many school districts will tell you that it is much more difficult to put this into practice for a variety of reasons, one of them 

being cost. Fresh fruits and vegetables and whole grains tend to 

cost more than the less-healthful alternatives, so it is not surprising that some school food service directors find it difficult to 

offer these foods given their limited budgets, budgets which are 

stretched thin, and especially in an economic downturn. 

That being said, there are school districts out there that are 

working within their current budget and still going the extra mile 

for their kids by creating an overall nutrition environment. This 

teaches kids the importance of eating healthy, provides more 

healthful meals for them to eat, encourages healthy living by requiring regular physical activity and education. We will hear testimony today from one of those from my home State of Iowa, in 

Knoxville. 

Perhaps the most important question that it raises for this committee is how Congress can best help places like Knoxville to continue their good work and to help other districts to emulate what 

they are doing. One welcome sign of help came in the President’s 

recently released budget in which the President proposed $1 billion 

per year in additional funding for child nutrition. This is a strong 

indication of how serious the new administration is about ending 

childhood hunger and teaching healthy eating habits at an early 

age. Now Congress must make good on this proposal by dedicating 

real resources in our budget. 

A significant investment in the Child Nutrition Reauthorization 

by Congress would be its own downpayment on comprehensive 

health care reform that would acknowledge the very real budget 

difficulties that school districts, day care centers, and other providers face while also ensuring that kids are getting the most balanced, nutritious meals possible. I have said many times, and I will 

keep saying it, that if we are going to have meaningful health reVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
3 

form in this country, what our kids eat and how they exercise and 

whether they exercise is a big part of health reform in this country. 

So I look upon our challenge this year in this committee to reauthorize the child nutrition bill as being a part of the whole health 

care reform in America by getting to these kids early in life and 

making sure they get the best possible foods and exercise. 

So I look forward to working with my Ranking Member and good 

friend, Saxby Chambliss, and all the members of this committee to 

get a good child nutrition bill that both does the right funding levels, but also perhaps does some redirection and guidance and support for healthier meals in our schools, in our child care centers, 

in our adult care facilities, and also in the Women, Infants, and 

Children Supplemental Feeding Program. 

[The prepared statement of Hon. Tom Harkin can be found on 

page 50 in the appendix.] 

Chairman HARKIN. With that, I will turn to our Ranking Member, Senator Chambliss. 

STATEMENT OF HON. SAXBY CHAMBLISS, U.S. SENATOR FROM 

THE STATE OF GEORGIA 

Senator CHAMBLISS. Thank you very much, Mr. Chairman. 

Let me first of all thank our witnesses for being here to help us 

deal with this critical issue of reauthorizing our Child Nutrition 

Program. I want to particularly welcome my school nutrition folks 

from Georgia who are here and who do such a great job of making 

sure that Georgia’s children are prepared to be educated. 

Mr. Chairman, I want to thank you for holding this hearing 

today and I appreciate the bipartisan approach that we have taken 

on nutrition issues in the past and look forward to continuing to 

work together as we reauthorize the Child Nutrition Programs. 

I would like to thank today’s witnesses for their thoughtful testimony regarding school meals, the Summer Food Service Program, 

the Special Supplemental Feeding Program for Women, Infants, 

and Children, and the Child and Adult Care Feeding Program. 

These programs have a proven track record of not only alleviating 

hunger in the United States, but also improving the nutritional intake of children and their families. 

Given the current state of our nation’s economy, we are seeing 

increased demand for these programs. Many times, the School 

Breakfast and Lunch Programs are the only source of food for 

many students. Today’s witnesses will shed important light on the 

challenges that that program faces in providing healthy meals on 

a day-to-day basis. 

As we strive to improve the country’s nutrition safety net, the 

committee values and depends on the testimony from experts on 

the front lines of the fight against hunger. I know from the schoolteachers in my family of the importance of good nutrition. Good nutrition is not only important for good health, but also for proper 

cognitive development. 

According to the Georgia Department of Education, over 

1,177,000 lunches and 499,000 breakfasts are served each day in 

Georgia schools. I applaud the dedication of school nutrition providers and their efforts to feed kids healthy meals and recognize 

4 

the very early and significant influence they have in developing 

good nutrition habits in school children. 

As the Agriculture Committee moves forward in the reauthorization process, my goal is to ensure that all eligible children can easily access these important nutrition programs. I believe that all of 

us on the committee also share the goal of better utilizing these 

programs as tools to improve nutritional intake as well as combat 

hunger. 

And just in closing, let me say that we made a number of 

changes in the School Lunch Program in our farm bill and we tried 

to make sure that we could take advantage of a lot of local situations in providing fruits and vegetables at the local level for our 

school nutritionists. We hope that with the implementation of that 

program, that all of our child nutrition folks across the country, 

both in schools and out of schools, are going to be able to take advantage of that and make sure that not only children benefit, but 

when the children benefit from that program, farmers benefit from 

it. So it is simply a win-win proposition that we inserted in the 

farm bill and we look forward to seeing the implementation of that 

as we move ahead. 

Mr. Chairman, I look forward to hearing from our witnesses. 

Thank you. 

Chairman HARKIN. Thank you very much, Senator Chambliss. 

Did you have anything, Senator Bennet? 

STATEMENT OF HON. MICHAEL F. BENNET, U.S. SENATOR 

FROM THE STATE OF COLORADO 

Senator BENNET. Mr. Chairman, thank you. I just want to say 

thank you to you for holding this hearing. Thanks for having me. 

I am telling you, as a former school superintendent and the father 

of three school-age kids, I know how important this is. Kids can’t 

learn if they are hungry during school. So I feel like it is very appropriate that this is my first hearing with you and I would just 

ask that the remainder of my opening statement be included in the 

record. 

[The prepared statement of Hon. Michael F. Bennet can be found 

on page 52 in the appendix.] 

Chairman HARKIN. Thank you very much, Senator Bennet, and 

welcome to the committee. It is going to be a good year and we are 

on something that you can help us a lot on because of your experience as being a former superintendent, on this whole issue of 

school lunches and school breakfasts, so we look forward to your involvement in the development of this reauthorization bill. 

We will turn to our first panel. Dr. Katie Wilson has been a 

School Food Service Director for 21 years, has a Bachelor’s degree 

in dietetics, a Master’s degree in food science nutrition, and a Ph.D. 

in food service. Katie recently served as the Chair for the School 

Nutrition Association Nutrition Standards Task Force, developing 

nutrition standards for reimbursable meals and foods sold outside 

the meal program throughout the school day. Dr. Wilson is presently serving as President of the School Nutrition Association and 

she hails from Onalaska, Wisconsin. 

Next will be Dr. Susan Bartlett, a Senior Associate with Abt Associates, a public policy research and consulting firm. Dr. Bartlett 

5 

has over 30 years of experience conducting policy research on national and State programs designed to assist low-income individuals and families. She has directed numerous studies of USDA’s 

Food and Nutrition Assistance Programs, including the National 

School Lunch and School Breakfast Programs, Supplemental Nutrition Assistance Program, the Food Stamp Program, and the WIC 

Program. Dr. Bartlett holds a Ph.D. in urban and regional studies 

from MIT. 

Next will be Connie Boldt, who has served as the School Food 

Service Director for the Knoxville Community School District in 

Knoxville, Iowa, for the past 12 years. Prior to joining that school 

district, she was the Director of Catering Services at Central College in Pella, Iowa. She graduated from Central College and received her graduate degree from Iowa State University in 1986. 

We welcome you here. Your statements will be made a part of 

the record in their entirety and we would ask if—the clock probably 

says 5 minutes, but if it goes to seven or eight, that is fine, but 

if you keep it between five and 10 minutes, I would certainly appreciate it so we can kind of have a give and take. 

We will go in the order in which I just announced, so we will 

start with you first, Dr. Wilson. Welcome and thank you for your 

service as President of the School Nutrition Association. 

STATEMENT OF KATIE WILSON, SCHOOL NUTRITION DIRECTOR, ONALASKA PUBLIC SCHOOLS, ONALASKA, WISCONSIN 

Ms. WILSON. Thank you. Chairman Harkin, Senator Chambliss, 

and members of the committee, I am Dr. Katie Wilson, President 

of the School Nutrition Association and a School Nutrition Director 

in Onalaska, Wisconsin. With me today is our SNA executive team, 

our legal counsel, Marshall Matts, and as you see, a number of my 

colleagues. 

We are meeting here at a time of unprecedented economic challenge for our country. School food programs are a key part of the 

vital safety net for a growing number of our school children. For 

some students, school breakfast is the first meal they have eaten 

since the day before. There are students who come to school on 

Monday not having eaten since Friday. 

As a country, we have gone from discussing millions to billions 

to trillions of dollars, simply overwhelming for most of us, yet at 

the same time, each of us in a Child Nutrition Program sit at our 

desks and struggle to balance pennies. The average cost of producing a school lunch is $2.92, based on our internal study. Currently, local schools receive a Federal reimbursement of $2.57 for 

every lunch provided to a child with income below 130 percent of 

the poverty line. On average, our reimbursement for a free meal is 

35 cents less than it costs to produce that meal. It is hard to believe, but many families cannot afford the 40 cents for lunch or the 

30 cents for breakfast that is charged for a reduced-price meal. We 

see checks for just a few dollars that are returned due to insufficient funds. 

While we have dramatically improved the appeal and nutritional 

quality of school meals, there are no Federal guidelines for foods 

and beverages sold by schools outside the cafeteria. This can take 

the emphasis off nutrition. We are adding more fruits, vegetables, 

6 

and whole grains to both reimbursable and competitive food offerings, but this further increases the cost of preparing those meals. 

We need the money to offset these costs. 

School administrators are also short of funds and are therefore 

charging School Nutrition Programs more and more of the overhead costs of running the entire school. This is called an indirect 

cost of the program. In short, money that you appropriate for 

school meals may be used for energy, telephones, or even personal 

costs in a principal’s office. Neither the statute nor the regulations 

put any cap on indirect costs, and some districts pay as much as 

15 to 18 percent of their budget. 

Free and reduced-price meal certification is used for many services provided in the school, including Title I funding, yet the school 

food service account pays the full cost of collecting and keeping 

that information. 

Mr. Chairman, as you approach reauthorization, we ask the Congress to take a comprehensive look at the Federal Child Nutrition 

Programs and realize that we are struggling with competing needs 

and policy goals. 

We support a consistent national interpretation of the dietary 

guidelines for two reasons: Science and cost considerations. All children need the same nutrients to grow no matter where they live 

in this country—Iowa, Georgia, or California. Why would we allow 

50 or more different interpretations of the dietary guidelines when 

it comes to the National School Lunch and Breakfast Programs? 

When USDA changes the meal guidelines, all vendors change their 

specifications to accommodate the latest science. If, however, there 

are 50 different markets and not just one, it greatly increases the 

cost of doing business. This increased cost is passed on to my program. We also would like to see, first and foremost, the increased 

reimbursement for all lunches served by 35 cents and 20 cents for 

breakfasts. We need the Federal reimbursement rate to be updated 

twice a year to keep pace with inflation, as opposed to the current 

annual adjustment. Many vendors escalate their prices monthly. 

The free meal program should be expanded to include all children who fall below the WIC income guidelines, or 185 percent of 

the poverty level. If the family qualifies for WIC, they should qualify for free meals. 

Lastly, ten cents in USDA commodities for each Breakfast Program is needed. We receive about 20 cents in commodities for each 

school lunch, but there is no commodity support for breakfast. 

Considering nutrition standards, whatever that standard is, it 

must be applied consistently throughout the school environment. 

Students must not be allowed to be able to buy something in the 

gym that we cannot sell in the cafeteria. This is a conflicting message about what is healthy. 

In addition, we ask that you require USDA to implement the Dietary Guidelines for Americans in a practical and consistent manner all over the country. We know we are asking for a lot, and we 

realize that it makes your life more complicated, but our children 

need this in order to be well nourished and prepared to learn. 

In closing, we would like to thank the Senate for its leadership 

in providing recent equipment assistance funding. While school nutrition personnel are great innovators in serving wholesome foods, 

7 

they cannot efficiently serve meals if our equipment is obsolete or 

in need of repair. 

Mr. Chairman, we have attempted to outline a few funding 

issues and other priorities today. We will provide staff with a list 

of administrative changes that could make the programs more effective and easier to administer. We greatly appreciate this hearing 

and your commitment to our children and child nutrition. The time 

to act is now and the funding is imperative. Thank you. 

[The prepared statement of Ms. Wilson can be found on page 98 

in the appendix.] 

Chairman HARKIN. Thank you very much, Dr. Wilson. 

Now we will turn to Dr. Bartlett. Dr. Bartlett, welcome. Please 

proceed. 

STATEMENT OF SUSAN BARTLETT, SENIOR ASSOCIATE, ABT 

ASSOCIATES, CAMBRIDGE, MASSACHUSETTS 

Ms. BARTLETT. Thank you, Mr. Chairman, for the opportunity to 

address this committee. My name is Susan Bartlett and I am a 

Senior Associate at Abt Associates, headquarters in Cambridge, 

Massachusetts. Abt Associates is a public policy research and consulting firm that applies scientific research, consulting, and technical expertise to a wide range of issues in social, economic, and 

health policy. 

Under contract to the Food and Nutrition Service in the Department of Agriculture, Abt carried out the School Lunch and Breakfast Cost Study II, which was designed to estimate the national average cost of producing reimbursable meals in the National School 

Lunch Program and the School Breakfast Program. The study, 

which was carried out during the school year 2005 to 2006, provides a detailed examination of the cost of producing reimbursable 

meals in the school meals program and was designed to allow FNS 

to assess the adequacy of reimbursement rates. Today, I would like 

to present key findings from this study. 

The study was carried out in a nationally representative sample 

of 120 school food authorities across the United States. Within 

these districts, we selected a representative sample of approximately 350 schools and collected extensive data on the costs and 

revenues associated with producing school meals through reviews 

of financial statements, meal production records, recipes, invoices, 

observations of meals taken by students, and interviews with SFA 

and school district officials. 

The study examined the costs of meals charged to the SFA’s accounts, or the reported cost. It also examined the unreported costs, 

which are the costs incurred by the school district in support of 

SFA operations but not charged to the SFA account. Together, the 

reported costs plus the unreported costs represent the full costs of 

meal production. 

I think one point about the methodology that should be noted 

here, because I think we may discuss it more later, is that the 

methodology allocates the SFA administrative costs and overhead 

to all production, so including lunches, breakfasts, and non-reimbursable meals, which includes competitive foods. 

So key findings from the study. No. 1, in most SFAs, the reported 

costs of producing lunches were less than the Federal subsidy for 

8 

free lunches. The national mean cost of producing a reimbursable 

lunch in the 2005 to 2006 school year was $2.36 and the subsidy 

for free lunches at the time, which includes the cash as well as 

commodity assistance, was $2.51. As a result, in almost 80 percent 

of SFAs, the reported cost was less than the Federal subsidy. 

However, in contrast, in most SFAs, the reported costs of producing reimbursable breakfasts were greater than the Federal subsidy. The national mean cost of a reimbursable breakfast was 

$1.92, again in 2005 to 2006, compared to the severe need reimbursement rate of $1.51. As a result of this, in almost two-thirds 

of the SFAs, the cost of producing breakfast exceeded the reimbursement. In only a third of the SFAs the costs were less than the 

subsidy. 

For the average SFA, revenues from reimbursable meals exceeded the reported costs of producing those meals. On average, revenues exceeded costs by about 15 percent. In contrast, revenues 

from non-reimbursable meals fell short of the cost of producing 

those meals by approximately 30 percent. While reimbursable 

lunches and breakfasts taken together generated a surplus, this is 

due entirely to the surplus generated by reimbursable lunches. 

Consistent with the relationship between the subsidy rate and 

the reported meal costs, revenues from reimbursable lunches exceeded costs of producing them by an average of 16 percent. Revenues from breakfasts fell short of the cost of producing those meals 

by an average of 4 percent. 

If we look at the full cost of producing school lunches, we come 

to somewhat different findings. Nearly all school districts provide 

in-kind goods and services to SFAs that are not charged to school 

food service accounts and therefore go unreported. In most SFAs, 

the full cost of producing reimbursable lunches, including these unreported costs, exceeded the costs. In 68 percent of the SFAs, the 

full cost of a reimbursable lunch was more than the subsidy. 

Looking across all school meals programs, the SFA revenues fell 

considerably short of covering these full costs. On average, revenues covered just over 80 percent of full costs. Costs exceeded revenues for reimbursable lunches, breakfasts, as well as competitive 

meals programs. 

Those are the key findings on our cost findings. Thank you very 

much, and I would be happy to answer any questions on methodology or results. 

[The prepared statement of Ms. Bartlett can be found on page 54 

in the appendix.] 

Chairman HARKIN. Thank you very much, Dr. Bartlett. 

Now we will turn to Ms. Boldt. 

STATEMENT OF CONNIE BOLDT, SCHOOL FOOD DIRECTOR, 

KNOXVILLE COMMUNITY SCHOOL DISTRICT, KNOXVILLE, 

IOWA 

Ms. BOLDT. Good morning, Chairman Harkin, Senator Chambliss, and members of the committee and other guests. Thank you 

for giving me the opportunity to tell you about the Knoxville Community School District’s experience with the HealthierUS School 

Challenge. 

9 

I am Connie Boldt, the Food Service Director for the district, located in Knoxville, Iowa. Knoxville is located in south-central Iowa 

with a population of approximately 10,000. The school district has 

five buildings and serves about 1,600 lunches daily. 

Knoxville’s elementary schools, East, West, and North Star, each 

receive the HealthierUs School Gold Award. The Knoxville School 

District, supported by the Board of Education and the administration, promotes healthy lifestyles for students, staff, and families. 

The district feels this is a part of the total learning environment 

and will contribute to academic achievement as well as positive 

lifestyles. 

Serving healthy meals that students will eat isn’t the easiest 

thing to do. It requires money and time. But the benefits for classroom achievement and healthy lifestyles are more than enough to 

make the effort. 

When mandated, the district developed a wellness policy by convening a committee with strong convictions to improve students’ 

lifestyles. It addressed many areas, including physical and nutrition education, support for parents’ efforts toward healthy lifestyles, staff health and wellness, National School Lunch and 

Breakfast Programs, and competitive foods. Written into our 

wellness policy were specific requirements for all food in all grades, 

K through 12, including a la carte, breakfast, and lunch. 

The Wellness Committee’s requirements for school meals included, but were not limited to, offer a variety of fruits and vegetables, with an emphasis on fresh, and serve whole grains whenever 

possible, with a goal of at least half by 2008–2009. Even though I 

was a member of the committee, as a Food Service Director, I was 

concerned that these requirements were challenging and too vague. 

I was also concerned about the overall cost to the program and how 

I was going to do this. 

The wellness policy went into effect for the 2006–2007 school 

year. Implementation of the wellness requirements was phased in. 

We started by adding one fresh fruit or vegetable to every lunch 

menu. We used common fruits and vegetables, like apples, oranges, 

and carrots. Popularity of the fresh foods increased over time and 

we now include more seasonal produce, such as melons, kiwis, 

green peppers, and cucumbers. These additions were welcomed by 

our kids and staff. 

Then came our School Meals Initiative Review in December of 

2006. Our Department of Education consultant, Jane Heikenen, introduced me to the HealthierUS School Challenge. This certification program recognizes elementary schools that take a leadership role in helping students learn to make healthy eating and active lifestyle choices. Given our district’s commitment, these guidelines appeared to be the missing link to our wellness policy. 

To achieve the Gold Award, a number of criteria had to be met, 

including school lunches that demonstrate healthy menu planning 

practices and principles of the Dietary Guidelines for Americans; 

nutrition education activities in at least two grades; physical activity opportunities at every grade level; student average daily participation of 70 percent or greater; and competitive foods could not be 

sold on the elementary campus during the school day. 

10 

So in early 2007, we started working toward the guidelines by 

testing whole grain recipes that we could produce. Second, we 

modified our current school recipes to include more grains. These 

changes were well accepted and possibly some not even noticed. 

During the past 2 years, we also found that we must handle these 

products differently. The whole grain does not seem to have a long 

shelf life and quickly becomes stale, thus encountering more waste 

and increased costs. 

Also in the fall of 2000, we increased legume menu items. In 

other words, this meant more beans. We now offer baked beans, 

refried beans, kidney beans in chili, and commodity pinto beans in 

taco meat at least once a week. We started with about 5 percent 

choosing more legumes and now have increased to about 15 or 20 

percent of our students making that choice. 

While food service was working on food served, the principals 

and elementary teachers worked on the physical and nutrition education requirements. I was pleased to learn that our district had 

met these requirements without modification. 

The final criterion to be met was 70 percent average daily participation, and in October of 2007, the elementary schools averaged 

81 percent. 

We did it. In July of 2008, we learned we had achieved the Gold 

Award. Even though we have a Gold Award, we continually look 

for new ways to incorporate the foods that support the HealthierUS 

School Challenge into our menus, curriculum, and daily lives of our 

students. 

However, increased food costs will make reapplying for the 

HealthierUS School Challenge more difficult in the future. In fact, 

the implementation of the HealthierUS School Challenge criteria 

came with an increased cost. Some items were as high as 76 percent more than the traditional item we were purchasing. In addition, not only has the cost of fresh fruits and vegetables increased, 

the labor to prepare them has also increased. I now figure about 

ten to 20 cents more per serving. 

Finally, the banner in the hall we received is really awesome and 

the plaque in the school is quite impressive, but we didn’t do it for 

the plaque or the banner. We did it for the sake of the kids, and 

I am proud of the Knoxville Elementary Schools for having 

achieved this. But as I said before, serving healthy foods is not 

without a cost and my budget is suffering. 

Please help us implement this great opportunity to serve children nutritious foods in more schools throughout the Nation by 

supplementing reimbursement. It costs more money to prepare and 

serve the meals at Knoxville Schools than what we receive in reimbursement. I support the SNA’s request for an additional 35 cents 

for all lunches and 20 cents for all breakfasts served. In addition, 

I think the HealthierUS School Challenge should receive money to 

support their commitment to fresh fruits and vegetables and whole 

grains. 

Thank you for giving me this opportunity to share our experience 

with the HealthierUS School Challenge. It has made a difference. 

[The prepared statement of Ms. Boldt can be found on page 72 

in the appendix.] 

11 

Chairman HARKIN. Ms. Boldt, thank you very much for the testimony and for great leadership. I am sure we will have some questions for you. 

I would like to start this round of questioning by looking at the 

cost and reimbursement. This is something we grapple with a lot 

here, too, and I think all of us here are interested in making sure 

that we adequately reimburse schools, but we have to have a better 

handle on what that means. So I am struck by the very different 

testimony here between you, Dr. Wilson, and Dr. Bartlett, with respect to the costs of producing a reimbursable meal. 

Dr. Bartlett suggests that, by and large, the Federal reimbursement for a free meal is sufficient to cover its cost—correct me if I 

am wrong on that. Dr. Wilson concludes the opposite finding, a 35– 

cent gap between reimbursement and production costs. So I would 

like to try to see if we can figure out why we have such a significantly different conclusion from two very qualified individuals. 

That is one thing. 

And then on competitive foods, with respect to non-reimbursable 

meals, such as a la carte lines, again, the testimony concludes very 

different things. Dr. Wilson, you say that you need the money from 

competitive foods to cover gaps in the school food service budget. 

Dr. Bartlett, your study found that such foods such as a la cartes 

are actually the reason for those budget gaps and that Federal reimbursement for free lunches are subsidizing food provided through 

a la carte lines. 

I would like to try to examine this and see if we can get to the 

bottom of this because it has very significant policy ramifications 

here for us. So, again, without trying to pick one or the other, I 

don’t know, I am just trying to figure out why we have such different conclusions here. 

Dr. Wilson, how do you square your testimony on the costs of 

competitive and a la carte foods in light of the fact that the testimony from Dr. Bartlett arrives at conclusions that are almost totally different from your own? And I am going to ask Dr. Bartlett 

the same question, too. 

Ms. WILSON. OK. Well, thank you for the chance to answer that 

question. First of all, I think that in the reimbursement rate for 

the reimbursable meal and the 35 cents that we are talking about, 

I do have some State statistics, one from Minnesota in itself that 

shows overall in the State of Minnesota, it is $2.99 average to prepare and serve that meal. 

I think sometimes what happens is the data—for instance, from 

2005–2006 is when the study was done and the data may have 

been from that year or even a year later, I will cede to Dr. Bartlett 

to let us know that, but just from the year 2005–2006 to today’s 

environment, I see a drastic increase in costs in my program, the 

whole grains, the fruits and vegetables, my labor costs, which Ms. 

Boldt referred to. Labor costs have gone up also considerably in our 

programs, and so the gap continues to rise. Even from 2005–2006 

to the 2008–2009 school year, the gap is getting bigger and bigger 

and bigger. 

This year is the very first year many of us saw fuel costs on our 

invoices, saw bread and milk bids that said, you know what? We 

can raise your prices within a 30–day notice, and that is a bid, so 

12 

based on the price of commodities the bid price can go up. I have 

been in the business 21 years and have never seen those things on 

bids before or on invoices. 

Chairman HARKIN. Tell me, what was the reimbursement rate in 

2006 and 2007 when this study was done and what is the reimbursement rate today. 

Ms. WILSON. In 2005–2006? 

Chairman HARKIN. Yes. 

Ms. WILSON. Do you have the numbers or rate? 

Chairman HARKIN. What was the reimbursement rate? 

Ms. WILSON. The reimbursement rate was $2.51, which was cash 

of about $2.37 and commodities of, like, 17 or 18 cents. 

Chairman HARKIN. So two-fifty—— 

Ms. WILSON. One, including cash and commodities, yes. 

Chairman HARKIN. Two-fifty-one. And today it is what? What is 

the reimbursement rate? 

Ms. WILSON. Well, we have $2.57 plus about 20 cents, 21 cents 

in commodities. 

Chairman HARKIN. So it is $2.77—— 

Ms. WILSON. Mm-hmm. 

Chairman HARKIN [continuing]. Is the reimbursement rate. So 

the reimbursement rate has gone up, so even though your costs 

have gone up, the reimbursement rates have gone up, too. 

Ms. WILSON. But I don’t think they have kept pace with labor, 

particularly labor and food costs. 

Chairman HARKIN. What you are saying is that this snapshot, 

this study that was done in 2006–2007, is that when it is? Is that 

the basis? 

Ms. BARTLETT. Five-six. 

Chairman HARKIN. Two-thousand-five and 2006. What your point 

is is that since that time—we are talking about 2 years, three 

maybe, 3 years—that the increase in the costs have far exceeded 

the increase in the reimbursement rate? 

Ms. WILSON. Yes, sir, that is—— 

Chairman HARKIN. So the reimbursement rate went up about 10 

percent, just my back-of-the-envelope figuring, 10 percent. Do you 

have any data on how much the other associated costs have gone 

up in those 3 years, that period of time? 

Ms. WILSON. Well, I know some of the studies—we studied the 

top 100 districts in the country and some of those costs—and we 

can get you exact data, but I know even from my own personal experience, it is anywhere from 11 to 14 percent in costs that I have 

experienced in the 2008–2009 school year, and that includes labor 

and food costs. 

And then the indirect costs, also, as schools have begun to—I 

know we talked about in-kind costs that school districts provide for 

the Food Service Program. In 2005– 2006, schools weren’t as 

pinched as they are now overall, and so as school districts themselves see their budgets shrinking and needing to do more and 

more with less, they are looking to the Food Service Program to 

provide more and more indirect costs to help them run the entire 

school program rather than just food service. So there are not so 

many of those in-kind gifts anymore as we see in our programs. 

13 

Chairman HARKIN. Dr. Bartlett, I will ask you the same question. How does your data that you have are really different than 

what the data I have heard from Dr. Wilson? 

Ms. BARTLETT. Sure. Indeed, the study was based on 2005 to 

2006 data, so things could have changed over time, all the things 

that we have talked about. 

A couple of points. One, the study that we did was a nationally 

representative sample, so we sampled districts across the country 

and when things are weighted up, it looks like the entire country, 

not just restricted to, say, the largest districts. 

I think I can tell you what we did, and I think this, though, is 

probably the main point of difference, is that—and it has to do with 

allocating the administrative and overhead costs of meal production. When we look at reported costs, we look at all the expenses 

that are on an SFA’s expense statement. Some of those costs are 

directly related to food production, the costs of the food, the costs 

of the cooks to prepare the meals. So those get directly allocated 

to the meals that they are attributable to. 

But then there are costs like the SFA director, secretary, things 

like that, warehousing of foods, those kinds of administrative costs 

that are part of food service, or belong to food service, but not directly attributable to any one given meal. So the question is how 

to allocate those. 

We followed what are considered generally accepted accounting 

practices and we allocate those non-production costs across lunches, 

breakfasts, and non-reimbursable foods. So they each pay a share 

based on the food and labor that—the direct production labor. So 

I think that kind of loading of the overhead costs across all meals 

may be one of the major differences. 

Chairman HARKIN. So it seems to me that the real, I don’t want 

to say culprit here, but the real question we have to get at is these 

indirect costs. Is that right or not? Is that the main difference we 

are seeing here, is how you allocate those indirect costs? 

Ms. WILSON. Well, I think that, if I could answer that, the thing 

is that when we set up our budget, and if we are warehousing our 

food or if we are working my salary, for instance, is also set up 

across—the budget is separate. The competitive foods or a la carte, 

breakfast, and school lunch all have separate line items in my 

budget, the costs and the revenues, and so that is broad-based. My 

secretary is broad-based over those. 

And when we talk about some of the indirect costs, I am talking 

about all of a sudden, because you store your food in the warehouse 

and you have a quarter of that warehouse, the district, because 

they are so pinched for finances, decides the Food Service Program 

can just pay for the entire cost of the warehouse and everybody 

who is running the warehouse, whether it stores desks or paper or 

supplies for the school building, and then a quarter of it might 

store some food over in the corner. 

We know people that pay for maintenance people that really 

have nothing to do with food service. They might mop the building 

that the kitchen is attached to. And so as these costs are pinching 

districts, they are looking. Electricity, all garbage pick-up—instead 

of charging the Food Service Program just for what the food service 

does in garbage pick-up, you might be charged for all the garbage 

14 

pick-up in the district. And so those are some of the indirect costs 

that we are seeing, and there is no cap in the statute to prevent 

some of that from happening. 

Chairman HARKIN. Have you seen over your experience that 

schools are shifting more and more of these indirect costs to the 

School Lunch Program? 

Ms. WILSON. Yes, sir, they definitely are. 

Chairman HARKIN. Did you pick any of that up in your studies 

at all, Dr. Bartlett? 

Ms. BARTLETT. We did look at indirect costs, which we—most districts have indirect cost rates that they apply to school food service 

as well as other Federal grant programs, and indeed to pick up 

costs of—I mean, different districts obviously have different rates 

that include different things. We did not find—we found that while 

most districts had indirect cost rates, that only about 16 percent 

of the districts actually charged the school—— 

Chairman HARKIN. About 16 percent? 

Ms. BARTLETT. Sixteen percent charged indirect costs as a line in 

their expense statement. So while that gets applied to some, it did 

not get applied to most. So in terms of those kinds of costs. 

Chairman HARKIN. Well, I just raise the question, if 16 percent 

is the mean on this, then I raise the question of why other school 

districts can’t meet the mean if they are higher than that. 

Ms. BARTLETT. In terms of—no, this is just what percent of districts are charged at all for the indirect costs. When you look—— 

Chairman HARKIN. When you are saying 16—tell me what the 16 

percent is now. I thought that was the—— 

Ms. BARTLETT. No. Sorry. 

Chairman HARKIN [continuing]. Of the total that was—— 

Ms. BARTLETT. If you looked at school districts, what percent of 

the districts themselves get charged these kind of indirect costs on 

their expense statement. 

Chairman HARKIN. Oh, I see. I see. 

Ms. BARTLETT. We only found that those kinds of indirect costs 

showed up on 16 percent of the budgets. The rest of them were not 

charged for those. Again, we also have to make sure—partly when 

we talk—be clear about talking about what we mean by indirect 

costs, because we also talk about the overhead costs of the school 

food, the manager, the SFA director, and those. Those are kind of 

costs that are on the expense statement of the SFA. 

Chairman HARKIN. I have taken more than enough time. Senator 

Chambliss? 

Senator CHAMBLISS. That actually is an area that I wanted to address, too. I think Senator Harkin has pretty well covered it, but 

it looks like, Dr. Wilson, that in your particular case, there are 

some charges being assessed against the program that ought not 

to be assessed. We don’t need to put you at odds with your school 

board and the other folks who are assessing these costs, so I think 

this is an area that we need to address in this legislation and your 

testimony this morning on that has been very valuable. 

Ms. Boldt, I am just curious, do you know what happens in your 

system? Do you know whether these indirect costs are charged to 

your program? 

Ms. BOLDT. No, I really can’t answer that. 

15 

Senator CHAMBLISS. I think that is something that all members 

of the committee are going to need to look very closely at from a 

State-by-State standpoint, but certainly, Mr. Chairman, it is something that we need to address in the reauthorization. 

Ms. WILSON. We have one example from Georgia, if you would 

like to just hear some numbers. 

Senator CHAMBLISS. Yes. 

Ms. WILSON. This is from, in Georgia, quite a large district said to me they pay $1,140,000 in indirect costs, $395,000 for six maintenance people that work throughout the entire district, $220,000 

for utilities that are used in the buildings that they are housing 

kitchens in, and $84,000 are from uncollected meal costs. So that 

just gives you some numbers of a district in Georgia. 

This has truly been—the difference is that it has exploded since 

2005–2006, these kinds of costs, because school districts are also 

really in trouble as far as finances are concerned. Thank you. 

Senator CHAMBLISS. These are obviously very difficult economic 

times and every area of our economy, and I know school districts 

are looking for every way they can to try to recoup the tremendous 

overhead that they are seeing because they have got the same fuel 

cost and labor cost increases that you alluded to that you are being 

charged with. But that is not right. I expect I will get a call from 

that nutritionist, probably the chairman of that school board. 

[Laughter.] 

Senator CHAMBLISS. But it is something we need to look at. 

Dr. Wilson, if USDA were given the authority to regulate food 

sold in competition to the National School Lunch Program, do you 

see a need to continue the requirement for all school districts to 

have local wellness policies? 

Ms. WILSON. That is a very interesting question. We really truly 

believe that USDA needs the authority to regulate everything in 

the district, because then we can all conform to dietary guidelines. 

While wellness policies were really a good idea and everybody 

meant well, we have some very excellent policies in this district 

that were done well with good committees, and then we have some 

policies where it was somebody who was pestering the superintendent and they needed something to do, and so they are now— 

we just heard a speaker yesterday, that he talked about the philosophy of nutrition rather than the science of nutrition, and many of 

these local wellness policies are not dealing with the science of nutrition. They are dealing with the philosophy of food or eating or 

a personal philosophy and how someone eats because they became 

the chair of that wellness policy. 

So even though they were intended to do good, they didn’t always 

do what they were intended to do across this country, and so, yes, 

we truly believe that with USDA, just like the National School 

Lunch Program and Breakfast Program, we have national standards, a meal pattern that we all need to follow. And so if USDA 

had the jurisdiction over everything, from bell to bell during that 

school day, that then we would all follow dietary guidelines irregardless of what our philosophy of what nutrition might be. 

Senator CHAMBLISS. Ms. Boldt, I first of all applaud your accomplishment of receiving that Gold Award for HealthierUS School 

Challenge, especially since you incurred additional cost for some of 

16 

the products that you provided. We oftentimes talk, when we talk 

about education in general, about the fact that, really, good education starts at home. If you don’t have strong support from parents, then it makes it much more difficult to educate a child. Did 

you find that same experience with trying to achieve this goal that 

you were successful in achieving, that you had great support both 

from your PTA or other parental organizations as well as your 

school board, and how big a factor was that in achieving this 

award? 

Ms. BOLDT. We did have pretty good support across the board. 

We also had in our wellness policy that we make efforts to encourage the parents and support for them, like with information, different kinds of things that we can do to help them at home, also. 

So we have included that in our wellness policy. 

Senator CHAMBLISS. Dr. Bartlett, did your study look at the impact of school policies regarding a la carte or vending sales and 

how the volume of such sales may influence the resources available 

to school food service personnel? 

Ms. BARTLETT. We really just focused on looking at the costs of 

those different components of the program and collected data on 

that at the point in time, 2005 to 2006. 

Senator CHAMBLISS. OK. Thank you, Mr. Chairman. 

Chairman HARKIN. Thank you, Senator Chambliss. 

We welcome Senator Klobuchar, both for questions and if you 

have an opening statement you want to give. 

STATEMENT OF HON. AMY KLOBUCHAR, U.S. SENATOR FROM 

THE STATE OF MINNESOTA 

Senator KLOBUCHAR. Well, thank you very much, Senator Harkin. Thank you to the witnesses. 

I have spoken on this issue a bit before from my perspective, 

being a mother with a 13–year-old and really seeing a tale of two 

schools, one, the school she attended in Minneapolis that was 90 

percent free and reduced lunch for a number of years, and now in 

Arlington, Virginia, two public schools, which is a little different 

demographic make-up, and just seeing the differences in the school 

with less free and reduced lunch kids in terms of their fitness and 

their moms packing them carrots and things like that, and then 

seeing in the inner-city school just the vending machines being 

used a lot, I think a lot of kids going for maybe the less healthy 

alternative when there were choices and then some healthy food 

given out, as well. 

Minnesota, as you have noted, has put a lot of emphasis on this. 

But even despite our State’s emphasis to see the difference between 

the schools and the nutrition these kids are getting is very stark, 

and also see the huge obesity problem with some of these kids. I 

am worried it is going to get worse as our economy gets worse because oftentimes it is cheaper to go out, as we all know, and buy 

less nutritional food. And so I am very concerned about this obesity 

issue. 

The other reason I am interested in this is we have a lot of food 

that is produced in Minnesota. We have a lot of food that is processed in Minnesota. I have gotten some information about the 

need, as you have talked about, Dr. Wilson, for some national 

17 

standards and how this is contributing to cost, the fact that we 

don’t have these national standards, and I wanted to lead with that 

and I know you were referencing it in your questions with Senator 

Chambliss, but how you think this could work to give the Secretary 

of Agriculture this discretion. 

I personally think it sounds like a good idea to me, sort of seeing 

this patchwork of things going on, and as we look at how to reduce 

costs. But at the same time, my whole focus is to make these meals 

as healthy as possible and to limit some of the—and I don’t know 

what you are calling them here—bad competitive choices, and then 

also how we work that with the States, because I could see some 

of them would want to be doing—they might have different kinds 

of food that they have available in their States that are healthy. 

So a long question. 

Ms. WILSON. OK. Well, thank you. I think, first of all, the whole 

idea of standards is that—and let me, if I could, just give you an 

example. If you are a manufacturer in the school market and you 

make a small bag of graham crackers and you make it for 1.5 

ounces, but five miles down the road, their standard, their wellness 

policy says, no, you can have up to two ounces. And then the next 

one says, well, we are going o do 2.5 ounces. Well, now I go back 

to that manufacturer and I say, well, my district just said one 

ounce. So now there are four different bags of the exact same graham crackers, and to me, that is very costly. 

Most of our school districts are smaller. We aren’t all metropolitan districts. So when you can’t buy hundreds of thousands of them 

at the same time, the manufacturer is not going to make them just 

for you. So, first of all, without standards, we are eliminating a 

number of products that all of us could potentially use, because the 

manufacturer will make the product if we have a standard that a 

snack has to be two ounces or whatever we come up with as standard. That product will be made for all of us and we will all buy 

it at a much lesser cost than if we first—it would eliminate some 

things for smaller districts, and I am talking about the majority of 

districts in this country, but it would also cost most of us more if 

we are asking a manufacturer to make three and four and five different sizes of the same product. 

As far as nutrition is concerned and doing local kinds of things, 

I truly encourage local produce, local kinds of things that maybe 

are made in your community. But there, too, when we looked at 

our standards, we are looking for a range of things. It is very difficult to hit a sugar number, for instance, in milk and say, this is 

the number. We are not going anywhere else. This is the number. 

It is much better to do things in ranges because you and I both 

know that 1 day we do really well, and last night I was at a gala 

that had a fabulous dessert and I enjoyed every minute of it. So, 

you know, we can’t do that every single time—— 

Senator KLOBUCHAR. We have a lot of those problems in our occupation. 

[Laughter.] 

Ms. WILSON. Absolutely. 

Senator KLOBUCHAR. There is a lot of too many choices. 

Ms. WILSON. So we look at choices. We have a range for fiber in 

our standards. We have a range for sodium, so that we can, over 

18 

the period of a week, look at things. And if I have something that 

is local in my district or made in my State that I want to use, it 

will fit within a range because I will balance that throughout the 

rest of the week. So I think it very nicely fits into standards if you 

have some ranges and some standards, though, that we all need to 

meet. And again, it is not based on somebody’s philosophy. It is 

based on the science of nutrition. 

Senator KLOBUCHAR. And how would it work with these a la 

carte choices, because I have seen myself they go for the fries—— 

Ms. WILSON. And the standards do work. The standards are—if 

the USDA Secretary has the opportunity to eliminate the time and 

place rule and they have the authority to say that here are the 

standards for the entire school during the school day—— 

Senator KLOBUCHAR. Right. 

Ms. WILSON [continuing]. You all need to meet them, whether it 

is in my a la carte line or in the school store or the young person 

that is selling to keep their club afloat and they have a little table 

outside the cafeteria—— 

Senator KLOBUCHAR. You might have limited my ability to sell 

Life Saver lollipops for the high school prom? 

Ms. WILSON. Perhaps, because—— 

Senator KLOBUCHAR. OK. That is what I did. 

[Laughter.] 

Senator KLOBUCHAR. I mean, on the student council. 

Ms. WILSON. Sell recycled wrapping paper. It is much better. 

Senator KLOBUCHAR. All right. So what about the vending machines and how would they fit into this—— 

Ms. WILSON. They all fit within. Within the school building, 

under the authority of the USDA Secretary, everything within that 

building for the school day would have to meet the standard. And 

now there, too, I am not competing against the football coach, because if I have the most wonderful program, even my a la carte 

meets the standard, and a football coach, they are going to go to 

State, so they need to raise money to get on that nice bus and get 

down to State, we all support that. And if the football coach is 

going to sell something out there in the hallway, I guarantee you 

students will come and purchase it. They want to support their 

team. That is part of being in school. We don’t want to be the adversary to that and that is what becomes—that is where the problem becomes a problem, because they take their $1.50 or their 

$2.50 and they are going to support that football coach, and they 

all mean well. They all have good meaning, but it is not always in 

the best interest of the science of nutrition. So the standard needs 

to be bell to bell in every area of that building for us all to be in 

the same thing for kids. 

Senator KLOBUCHAR. Ms. Boldt, what do you think of that? 

Ms. BOLDT. I agree 100 percent. That is exactly what happens in 

school districts. 

Senator KLOBUCHAR. Dr. Bartlett, any thoughts on how we can 

do this? I just want to fix this, because I think people are so well 

intentioned here and they want to have healthier kids, but somehow these things keep falling through, and these kids are smart 

and they find ways to find this food. That is what I have seen. 

Chairman HARKIN. They find what? 

19 

Senator KLOBUCHAR. They find unhealthy food wherever they 

can find it. It is a true fact. Also, sometimes their parents don’t 

have the money to give them, or they are not at home learning 

some of this nutrition, so when they get to school, they are looking 

for the vending machine that has the—I am not going to say a 

brand name, just like when I brought up American Girl at the 

Commerce Committee, I got letters. But they find something that 

is very non-nutritional and that is what they eat for lunch, so—— 

Ms. BARTLETT. I have to say it certainly seems right. Our study 

didn’t particularly focus on—we did not look at the nutritional 

quality of the different foods, but certainly my experience as a parent shows that there is a lot of unhealthy stuff going on. 

Senator KLOBUCHAR. OK. Well, thank you very much and we 

look forward to working with you. 

Chairman HARKIN. Dr. Wilson, you talked about the plethora of 

different wellness policies all over this country. In the last reauthorization of the child nutrition bill, I had offered an amendment 

that would have had a wellness policy developed by the Institute 

on Medicine that would have applied to all schools all over America. I lost that amendment. 

Then we decided, well, we will just have a wellness policy that 

each school would develop. I think we thought that at least, that 

way, at least schools would have to start thinking about what is 

a wellness policy. But you are right. They differ, as school districts 

differ all over the country. So I am glad to hear you say that not 

based on science. Of course, it is not based on Institute of Medicine 

guidelines. 

And then now, I am just delighted to hear you now advocating 

for the Secretary to have the authority for all schools. I have often 

said, what sense does it make if you have the authority for school 

lunches in the lunchroom or in the cafeteria, but you can go right 

outside the door and there are all the vending machines. I also like 

your testimony when you said that the signal, the message we send 

to kids if you have all these sugary drinks and candies and stuff 

in the gym but not in the rest of the school, are we saying to kids 

that is the healthy thing to eat in the gym? So I really appreciate 

your testimony on that. 

I think we have to come to grips with this in terms of having the 

dietary guidelines be standardized for the whole country and for 

every school. The only thing that I would think about in terms of 

a wellness policy beyond that is for the physical activity of kids and 

making sure that we have some wellness policies that develop in 

accordance with that so that kids get adequate exercise and that 

type of thing in a school setting. That is a little bit outside of your 

purview, but I am just saying that that should be also a part of 

the wellness policy. 

But I want to delve into one other thing and that is the idea that 

on this increasing the reimbursement, we have the inflation thing 

standard in there now that goes up with inflation. But I think 

what I am beginning to see is that we don’t have a real good grip 

on these indirect costs, and there is no cap on them. There is no 

inflationary guideline on them whatsoever. And I think it would 

probably be fairly easy for a school district to think, well, if I have 

got to cut corners, I will just shift it over to that School Lunch ProVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
20 

gram. After all, they are going to get more money because they 

have got an inflationary increase. I think somehow we are going to 

have to take a look at that and how we might want to address it. 

I don’t have a formula or anything in my head, but somehow, we 

have got to address how much of that shifting can go on from the 

indirect costs. 

But I also want to address a question to you, Ms. Boldt, about 

what you have done in your school. I read your testimony and in 

listening to you and what you have done, you were able to do it 

within these guidelines, right, and within the reimbursement that 

you have, you were able to do all of this. 

Ms. BOLDT. I truly don’t have the bottom line yet. I do suspect 

that our costs were higher, but I am not quite sure yet where the 

bottom line is. 

Chairman HARKIN. Well, you have been doing this for 2 years? 

Ms. BOLDT. We are in our second year. 

Chairman HARKIN. Two years now, and you have gotten all the 

healthier foods. But somehow, you have been able to do that within 

the reimbursement that you have been getting. 

Ms. BOLDT. I am not quite sure if we are within reimbursement 

or if we have tapped into some, you know, savings, so to speak. We 

also have an a la carte competitive foods that fit our wellness policy that also supplement total program costs. 

Chairman HARKIN. But you have control over that, too, right? 

Ms. BOLDT. Yes. 

Chairman HARKIN. Yes. You have control over that a la carte 

line, so—— 

Ms. BOLDT. Yes. 

Chairman HARKIN [continuing]. You are also putting good foods 

and fresh vegetables and things like that in the a la carte line. 

Ms. BOLDT. Yes. It is also regulated, the 35 percent fat and saturated fats and—— 

Chairman HARKIN. I just wonder if—I am proud of what you 

have done. You have got the certificate. You have got the banner 

hanging in the hallway. But if we want to replicate what you are 

doing around the country, I wonder if we need to have some more 

financial incentives or bonuses. For example, do you think that 

more schools would become HealthierUS Gold Schools if they received not only a plaque and a commendation, but a significant financial bonus at the end of the year for maintaining those strong 

standards? 

Ms. BOLDT. It would definitely be of assistance for the budget. 

Chairman HARKIN. Well, I think that is something that we ought 

to—— 

Ms. BOLDT. Because I did do—— 

Chairman HARKIN [continuing]. We ought to think about. If they 

meet these, they get some kind of a bonus or some kind of an incentive, to give some kind of a financial incentive for this at the 

end of the year. And I think maybe that is something that we could 

look at. I don’t know, Dr. Wilson, if you have thoughts on that. 

Ms. WILSON. Well, I think there are a lot of possibilities and it 

certainly is worth exploring, Senator Harkin. I do—again, will go 

back to the indirect costs, and if that would be something that 

would be decided upon, then we have to have the other piece that 

21 

says that that stays within the Food Service Program to continue 

to do those activities and increase the healthy environment in that 

program. As long as that money isn’t looked upon from the school 

district as a school district bonus but maybe it is used to do 

healthy things in the cafeteria and increase physical education, it 

has to be tied to that award, then, so they can’t—but it is certainly 

something to explore, yes. 

Chairman HARKIN. All right. Well, Ms. Boldt, I think you point 

out that it is very difficult to do what you have done in figuring 

out this 51 percent of whole grain items, bringing in more fresh 

fruits and vegetables. I think the important part of your story is 

that you did it and you didn’t give up and you kept at it and you 

made it work without any extra money, at least as I understand 

it, for the meals. So I think that is a tremendous achievement and 

you ought to be very proud of it. I just again am thinking about 

how we replicate what you have done around the country, and I 

think maybe some financial incentives and bonuses might be a 

thing that we could do. 

Now, I am told that there are, Dr. Bartlett, OMB guidances on 

indirect costs. Do you know what those are? Can you address that 

at all, that there is OMB guidance on indirect costs and what can 

be assessed to the School Lunch Program. 

Ms. BARTLETT. Indeed, sort of their restricted rates and unrestricted indirect cost rates that have to be approved, so—— 

Chairman HARKIN. By whom? 

Ms. BARTLETT. I believe by the school district. 

Chairman HARKIN. By the—— 

Ms. BARTLETT. Or the education—I am not 100 percent certain 

who sort of finally approves them, but I do believe that they do 

have to—I don’t believe that a school district can just say, we are 

going to charge X percent and put all these things in it, but sort 

of exactly what goes in those rates is—— 

Chairman HARKIN. But Dr. Wilson just read what was going on 

in Georgia—— 

Ms. BARTLETT. Right. 

Chairman HARKIN [continuing]. And all that. I mean, I don’t 

know if that is within OMB guidelines or not. 

Ms. BARTLETT. It seems odd, doesn’t it. I don’t know the answer 

to that question. 

Chairman HARKIN. Do you know that, Dr. Wilson? 

Ms. WILSON. I don’t believe there is any kind of—there is some 

minor language, and I am not familiar exactly, but it doesn’t put 

any kind of a cap or what it can be or how often. And I was just 

handed a note that a director here at this conference told us, reported to us 2 days ago that they were not assessed indirect costs 

for quite a—until this year, so the district decided to go back 8 

years to recap what they considered indirect costs on the Food 

Service Program—electricity, garbage—— 

Chairman HARKIN. Is this the school you were talking about earlier, or is that a different school? 

Ms. WILSON. No. They said they don’t remember what school district it is, but the director reported out to us at the conference that 

their district is going back 8 years to what they have assessed as 

indirect costs that should have been charged—garbage, electricity, 

22 

and somebody mopping the floor in the cafeteria, those kinds of 

things. 

So there is no cap to it, as to what can be done or how much or 

what it could, you know, what indirect costs are allowable that 

have to do with food service, so—— 

Chairman HARKIN. This is all very interesting. I mean, not interesting, kind of alarming in a way. You said it is like 15 to 18 percent? I forget which one of you said that. 

Ms. WILSON. That was in our testimony. 

Chairman HARKIN. Fifteen to 18 percent of the costs are indirect 

costs. 

Ms. WILSON. Of their budget. 

Chairman HARKIN. Of their budget. 

Ms. WILSON. They are taking 15 to 18 percent—— 

Chairman HARKIN. Did you have a figure on that, Dr. Bartlett? 

Ms. BARTLETT. I don’t have an exact figure on that. When we 

look at reported costs, we see that about 45 is labor, 45 is food, and 

there is 10 percent other, of which the indirect costs would be included in that. So on average—— 

Chairman HARKIN. In the ‘‘other’’? 

Ms. BARTLETT. Correct. So on average, it would be less than 10 

percent. 

Chairman HARKIN. So they are saying 10 percent. You are saying 

15 to 18 percent. 

Ms. BARTLETT. Again, I—— 

Chairman HARKIN. Do you have a methodology for how we could 

look at that? I would like to get to kind of the bottom of this, also. 

Ms. WILSON. Well, we definitely can send you our statistics in 

the study that we did to get to that number. But again, I think not 

that the data is skewed in any way from either place, it is just that 

the time has changed. And from 2005–2006 to 2007–2008 and 

2008–2009, my costs have drastically—and I am going to use the 

word ‘‘drastically’’. 

Chairman HARKIN. Well, that would be 50 percent. I mean, if it 

went from 10 percent to 15, that is a 50 percent increase in 2 

years. 

Ms. WILSON. And many districts have just recently decided to 

start charging these indirect costs. You know, also, we can have 3 

months of operating budget in a fund balance, and that is to purchase equipment. I want to start cooking from scratch, reopen my 

bakery, do fresh fruits and vegetables. I need equipment to do that. 

And so we sometimes will build a month or two of a fund balance 

so that when the dishwasher breaks down, I can repair that or replace it. I have now replaced—you know, in the State of Texas, 

they took out all their deep fryers, but they had to use their fund 

balances, if they even had them, to try to replace that equipment 

with cooking equipment. But a district might look at that 2 

months’ worth of money and say that that could be used for indirect costs. 

Chairman HARKIN. Well, I think we are going to have to look at 

these OMB guidelines and take a look at them. The only concern 

I have about putting a cap on something, that becomes a ceiling, 

too. In other words, everybody goes to that—— 

Ms. WILSON. It has to go there, right. 

23 

Chairman HARKIN. If the mean is ten or 12 or 14 percent, whatever it is, there are some obviously way below that, and if all of 

a sudden they can say, gee, now we can shift all these costs over, 

then we will find that happening. That is the only problem I have 

with putting a cap on it. 

Senator CHAMBLISS. I think the problem we have got, Mr. Chairman, is that with the cost of fuel particularly increasing, skyrocketing in such a fast manner, all school boards had a significant 

issue all of a sudden that they didn’t anticipate at the beginning 

of the year and they were looking for pots of money—— 

Chairman HARKIN. Yes. 

Senator CHAMBLISS [continuing]. And for other folks to help them 

defray expenses, and with the cyclical nature of fuel costs, or my 

son-in-law is a produce farmer and cabbage can cost anywhere 

from $3 to $12 a box, it makes it difficult from a cookie cutter approach to try to figure out how we cap them, or maybe we can figure out a way to look at the food consumed away from home provision, which I understand is the index we use, not the CPI, that 

maybe we can look at that and try to use a factor in there that is 

maybe a little more reasonable and will help both ends of this 

issue. But it is something we have got to look at. 

Chairman HARKIN. Yes, we are going to have to look at it. If you 

have the answer, let me know, will you? I don’t know that I have 

the answer. 

[Laughter.] 

Ms. WILSON. Could you let us all know? 

Chairman HARKIN. What is that? 

Ms. WILSON. We would like all to know if you find the answer. 

Chairman HARKIN. Yes, I don’t know. This is something definitely we are going to have to have our staffs work on and stuff. 

Senator Casey has joined us from Pennsylvania. Senator Casey? 

STATEMENT OF HON. ROBERT CASEY, JR., U.S. SENATOR 

FROM THE STATE OF PENNSYLVANIA 

Senator CASEY. Mr. Chairman, thank you very much, and I want 

to commend you on presiding over this hearing and highlighting 

this important issue. 

Very few issues we confront in Washington have as much importance, I think, not only to the life of a child and his or her family 

but to the family of America and for our long-term economic security. We can’t divorce or separate the issue of child nutrition and 

what happens to children in our schools and our communities, we 

can’t separate that from job creation and skill development and 

economic growth and all of those issues. 

I do want to thank those in the audience and, of course, our 

panel for the work you have done over many, many years, laboring, 

literally laboring in this vineyard for so long and so passionately. 

We are in a time period now where a lot of these issues can be addressed, but we are in a time of tight budgets and economic difficulty, so it is not going to be easy to do what we hope to do. 

But I do want to thank Dr. Wilson especially. We met the other 

night, along with many of your colleagues. You all look well rested, 

so apparently people didn’t stay up too late. But Dr. Bartlett and 

Ms. Boldt, we want to thank you, as well, for your testimony. 

24 

I know that we are running late, we are on the second round, 

and I apologize for being late. I just wanted to present one question 

for the panel before we conclude, just to get your sense of some of 

the practices that are working, some success stories, so to speak. 

We have heard from a number of experts in school nutrition that 

one of the biggest problems with administering the various meal 

programs is that you have different paperwork, you have got different eligibility and oversight requirements. And I just wanted to 

ask a broad question for each or all of you. What would you recommend as to addressing this problem to make the programs easier to administer? You may have covered this already, but I just 

wanted to get a sense from the experience we have had in Pennsylvania, and we have some Pennsylvanians in the crowd. We won’t 

ask you to stand up. But if there are best practices that you have 

identified that would help on these questions of administration. 

Ms. WILSON. Well, thank you, and I think that we can get some 

wonderful examples from districts across this country that are 

doing really great things, that have become innovative, and I know 

we have to be very creative. But if I could say one thing administratively, and we haven’t even talked about it here, but it could be 

another way to really help our programs, and it was in our testimony, and that is that we collect all the income data in every individual school district and then everybody in the district uses that 

income data for all different Federal programs. But all of that cost 

is in our program, in the School Nutrition Program, and that is a 

cost when you are collecting all of this income data. 

The other thing is that then we do verification, and we have to 

go through that whole process. But everybody uses that information. And so if we could look at another way somewhere else to collect this income data to be accountable. 

And then the other big piece is that the free category, if we could 

eliminate free—I am sorry, eliminate reduced category and make 

those children all free, because they qualify in WIC and then they 

come to school in kindergarten and they don’t qualify for free meals 

at the same level. So to eliminate that reduced-price category 

would really also help streamline our programs. These are ways 

that we can streamline the spending and the administrative burden that is on these programs that are very well audited and very 

well accounted for. Thank you. 

Senator CASEY. Anyone else? 

Ms. BARTLETT. I have to say, I defer to my colleagues since they 

have more direct experience. But just a couple of points. Abt is 

doing another study that is trying to ease some of—looking at how 

to ease some of the administrative burden in terms of the 

verification that has to be done for school lunches and working 

with States to help them use Medicaid data to directly verify income. So certainly moving in that direction is a way to streamline 

that would be useful. That is one idea. 

Senator CASEY. Thank you very much. 

Mr. Chairman, thank you. I know my time is up, but we are 

critically concerned about this issue and I think these issues that 

involve children, just like we made progress recently on children’s 

health insurance, this issue, as well, I think is a matter of basic 

25 

justice for children and for families. We have got to do everything 

possible to get this right. Thank you very much. 

Chairman HARKIN. Thank you. 

I have just one last question I wanted to follow up with Dr. Wilson, and that is this difference in the competitive budget. Are reimbursements—for example, Dr. Bartlett said their study found that 

a la carte lines are actually the reason for the budget gaps, that 

Federal reimbursements for free lunches are subsidizing food 

through a la carte lines. But you say you need the money from 

competitive foods to cover gaps in the school food service budget, 

and that is still something I am trying to wrestle with and trying 

to figure out. Are reimbursements subsidizing the competitive 

foods? 

Ms. WILSON. Well, I really think that—I don’t know a district— 

I don’t know a State department that would allow that to occur, because we have to keep our a la carte budget separate from our reimbursable budget. And so when we are reviewed once every 5 

years, that is one of the things they check, and so some of those 

districts may not have been reviewed correctly or something because we are not allowed to use any money from the reimbursable 

program to subsidize a la carte. If they see that there is a problem 

in budget there, if you don’t bring even your labor that is doing the 

a la carte over to that side of the line item, our State department 

would say to us, we need to see labor here, because it has to account for the exact cost. 

So I am not sure where they were at or what districts they were 

in, but we absolutely have a la carte to subsidize the rest of my 

programs. You know, we are not all in this to keep increasing the 

number of programs that we have in our School Nutrition Program 

and we have two reasons for a la carte. One is that it does definitely subsidize my Breakfast and Lunch Program. The second is 

that I am trying to meet the needs of all children, and I want those 

children to stay in school and obtain their nutritional foods from 

me. And so I, too, have very strict restrictions on what I sell in that 

a la carte line. It is not a bunch of stuff that they can go to the 

gas station and buy. I am very, very restrictive. But it is definitely—it is priced accordingly so that if you buy a la carte items, 

that money is being used to subsidize the rest of my program. 

Chairman HARKIN. So the money flows one way, but not the 

other way. 

Ms. WILSON. Our State wouldn’t allow it. It is not allowed. 

Chairman HARKIN. But it allows it the other way, from competitive foods to the school lunch—— 

Ms. WILSON. It is part of the entire food service fund, but we 

can—and that is why I started a la carte in the district I am in. 

Chairman HARKIN. Dr. Bartlett, when I read your testimony, it 

seemed to indicate that actually the school lunch Federal reimbursements are subsidizing the a la carte lines. I am trying to 

wrestle with this. 

Ms. BARTLETT. Right. I do think that the main difference has to 

do with the allocation of the overhead kind of costs. We certainly 

recognize the SFA director, things like that, how that gets allocated 

to the different meals. Our methodology which we applied this 

study and which we applied—we did a similar study—the same 

26 

study 14 years ago—found the same results of a cross-subsidization. And it is these sort of overhead costs that get allocated to 

lunch, breakfast, and competitive foods, arguing that those programs, those products should bear some of those kind of overhead 

costs. As I said, we had the same finding before and the practice 

that we follow are generally accepted accounting practices, to allocate those kind of costs that come up with the average costs of 

meals. 

And in terms of the districts, it was a nationally representative 

sample. I think it is sort of—it is not due to peculiarities in the districts that we studied. 

Chairman HARKIN. I will have to think about that. I will have 

to think about that. I think I understand what you are saying, is 

that if you have the set-up for the School Lunch Program, School 

Breakfast Program, then you introduce a la carte lines, they are 

utilizing the space and the overhead and all that kind of stuff, so 

that really does subsidize the a la carte line, not in kind of a money 

flow, it is just that you are saying that the whole arrangement 

then covers any costs of the a la carte line—— 

Ms. BARTLETT. Right. 

Chairman HARKIN [continuing]. Is my way of thinking about it, 

anyway. 

Ms. BARTLETT. Exactly. 

Chairman HARKIN. But again, if a la carte lines have to meet dietary guidelines and meet all the dietary guidelines and stuff, well, 

I guess I am not so worried about it then. It is just the problem 

there are a lot of the a la carte lines that don’t do that right now. 

I don’t much care how that food gets out there as long as it is good 

food. 

Well, that is really all I have. Senator Chambliss, do you have 

any follow-ups at all? 

Senator CHAMBLISS. Thanks, ladies. 

Chairman HARKIN. Great panel. Thank you all very much. Thank 

you, Dr. Wilson and Dr. Bartlett. Thank you, Connie. Thanks for 

what you did in Knoxville. It is a great example. 

We will call our second panel up. That is Dr. David Paige, Mr. 

Kenneth Hecht, and Ms. Lucy Nolan. 

[Pause.] 

Chairman HARKIN. We welcome our panel. Dr. David Paige, Professor of Population and Family Health, with a joint appointment 

in International Health and Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, and a joint appointment 

in pediatrics at the School of Medicine. Dr. Paige is a recognized 

expert in the area of community health and maternal and child nutrition. His groundbreaking studies of lactose intolerance in children, his pioneering effort in establishing a Supplemental Feeding 

Program for Disadvantaged Women, Infants, and Children, and his 

design and implementation of community-based programs define 

the scope of his interest. 

Mr. Kenneth Hecht is Executive Director and one of the cofounders of California Food Policy Advocates. Begun in 1992, CFPA 

is California’s State-wide nutrition policy and advocacy organization whose mission is to improve the health and well-being of lowincome Californians by increasing their access to nutritious, affordVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
27 

able food. Upon completion of law school, Mr. Hecht worked for 15 

years as a public interest attorney, first at San Francisco Neighborhood Legal Assistance Foundation and then as Executive Director 

of the San Francisco Legal Aid Society. Right away, you are a 

friend of mine. That is how I started my whole career, is as a legal 

aid attorney, Mr. Hecht. We are glad you are here. 

And Lucy Nolan, the Executive Director of End Hunger Connecticut, a nonprofit organization dedicated to ending hunger in 

Connecticut. Their goal is to raise awareness of hunger in the State 

of Connecticut, promote funding for and access to nutrition assistance programs, and to speak out to help eliminate the root causes 

of hunger. She received her B.A. from Ohio Wesleyan University 

and her Juris Doctorate from the University of Connecticut School 

of Law. 

We welcome you all here to this discussion on the reauthorization of the child nutrition bill. Your testimony will be made a part 

of the record in its entirety and if you would just summarize in several minutes, we would appreciate it. 

Dr. Paige? 

STATEMENT OF DAVID PAIGE, M.D., PROFESSOR, JOHNS 

HOPKINS MEDICAL SCHOOL, BALTIMORE, MARYLAND 

Mr. PAIGE. Yes. Thank you, Mr. Chairman, Senator Casey, other 

members of the committee. As you noted, I am at the Johns Hopkins School of Public Health and in the School of Medicine. I am 

a member of the Maryland State WIC Advisory Panel and direct 

a WIC Program out of Johns Hopkins and I am also testifying 

today on behalf of the National WIC Association and a copy of their 

testimony will be appended, and I acknowledge my good colleague, 

Reverend Douglas Greenaway, who is the Executive Director of 

that fine association. 

My comments this morning will focus on the critical role of the 

WIC Program, the role that it plays in securing the nation’s health. 

The past 36 years with respect to the program has demonstrated 

that it is a potent force in improving the health, nutrition, and 

well-being of women, infants, and children living in poverty. And 

it is really poverty that we are talking about with respect to the 

problems of under nutrition and poor nutrition. 

Today, over 13 million children below 18 years of age, 18 percent 

of the population, is living below the Federal poverty level, which 

for 2009 is set at $22,000, and the number rises to 21 percent when 

we look at children below 5 years of age, the population that WIC 

serves, and even higher in the African-American population, Hispanics, and children living in female-headed households. So we 

have a considerably large number of children and families at risk. 

Moreover, between 2000 and 2007, the number has risen considerably, a 15 percent increase, another 1.7 million children that we 

are dealing with. The Census Bureau estimates that over 12 million children are food insecure as measured by generally accepted 

standards. Of course, we know the number will escalate in the current economic situation. 

WIC is very effective in reaching this population. Seventy-five 

percent of all of the WIC enrollees are below 100 percent of poverty 

28 

level, with about 35 percent below 50 percent of poverty and another 35 to 40 percent between 50 to 100 percent of poverty. 

I would like to focus briefly, if I can, on some of the risks that 

exist within this population and the role that WIC plays. I will try 

to do this briefly. Poverty in general, the overarching issue, results 

in poor health. Among pregnant women, 60 percent who enter the 

WIC Program have a clinical or medical condition at certification. 

Thirty-eight percent have obstetrical problems, 27 percent are anemic, and about the same number have low weight gain during 

pregnancy. These are critical issues, critical determinants with respect to low birthweight and pre-term birth. 

The WIC Program is very effective in reversing these conditions, 

these negative outcomes. There have been multiple studies, independent studies, that show clearly that WIC has been very successful in increasing birthweight as well as reducing pre-term birth. I 

won’t go into all of the specifics. They are in the testimony. 

There is supporting all this a comprehensive review by GAO 

which clearly indicates that WIC is effective in lowering the incidence of low birthweight and pre-term birth, and also at the same 

time extraordinarily cost effective. There have been multiple studies showing the cost effectiveness of the program. Even a simple reduction of one or two nights in the neonatal intensive care unit or 

1 day in terms of a woman’s extra stay in the hospital will more 

than compensate for the WIC benefits. So this has been an extraordinary accomplishment on the part of the program. 

I would like to identify one other risk factor and that is infant 

mortality. Infant mortality in the U.S., as we all know, is lamentably very high and is among the highest among industrialized 

countries, even the highest, depending on some parameters that 

may be used. Reducing low birthweight and reducing pre-term 

birth is an effective way of reducing infant mortality. A number of 

studies validated by the GAO speak to the reduction of infant mortality. Our own work in the mid–1990’s further reinforces that particular issue with reduction to infant mortality. 

I would like to briefly discuss the preschool population, and that 

indicates that there are more subtle problems that exist in this 

population and we need to be very clear and we need to reach out 

to increase the enrollment of this population at risk. 

I also want to mention that the Centers for Disease Control has 

done multiple studies in this area which show the effectiveness of 

the program regarding improved weight gain, improved overall 

health, as well as a sharp reduction in anemia in the preschool 

population. 

I would like to address two other areas briefly, obesity, which I 

know is an interest of the committee and of yours, Senator Harkin. 

We need to think of obesity as poverty induced, resulting in food 

insecurity and obesity as part of this continuing spectrum of issues 

that we are dealing with in populations in poverty. Of course, obesity is not limited to only the population in poverty. Nevertheless, 

this is a very important population group that is suffering from the 

epidemic of obesity as a result of the inadequate food purchasing, 

calorie-dense foods that are available, inadequate numbers of supermarkets and other choices that exist in many of our poor communities, both urban as well as rural throughout our country. And 

29 

we need to do a great deal in this area and perhaps a question and 

answer can address this even more fully. 

Breastfeeding is another crtical area that I would like to speak 

to very briefly. When we talk about addressing obesity, we need to 

start pre-conceptionally, peri-conceptionally and during the conceptional period. But the first time we can really introduce a remedy 

is postnatally providing breastfeeding. Human milk is the most important nutritional head start that we can provide to our newborns. 

Human milk is species-specific. It is a living tissue that provides 

both the anti-infectious agents, the antibodies, the other elements 

that we need to improve the well-being, and WIC is very dedicated, 

as you well know, to trying to improve the number of individuals 

who do elect to breastfeed. Nevertheless, in the lower economic 

tiers, this has become very difficult. Socio-economic factors are the 

major impediment in this population and we need to do a great 

deal, and perhaps we can explore this further in question and answer. 

I would just like to move to some recommendations very quickly 

with regard to the administration of the WIC Program. I would 

argue that we enroll all infants, women, and children below 185 

percent of the poverty level. This is cost effective, it is smart policy, 

and we will set the tone and the health infrastructure to help this 

population move out of poverty, become well educated, and move 

forward in eliminating this problem. 

Enroll all Medicaid recipients. I think this makes sense and is 

comparable with enrolling everyone below 185. 

I would like to argue the fact that we give the States the option 

to certify children up to 1 year, which this will maximize program 

effectiveness. This is also a very smart, cost-effective measure that 

combines remediation and prevention, because we need to be more 

efficient and clever about integrating the remediation arm and the 

preventive arm that is implicit in the WIC Program. 

I would also argue that we establish linkages with the social 

services community, more direct linkages, in a coordinated and collaborative manner, and this will improve communication and better 

target nutrition. 

Streamline uniform qualifying application, as we addressed earlier. 

Expansion of the WIC for electronic benefits, MIS and EBT funding. 

I would like to point out one area that doesn’t get attention, if 

I may, and that is the military families who an individual of that 

family serving in the combat zone gets extra pay, but that then 

counts against them in terms of the WIC. And it is a small matter, 

but for that subgroup of individuals, they really deserve to not be 

thrown off the WIC Program. And since this has been brought to 

my attention, I thought that I would bring it to a higher authority 

with respect to improving on that. 

The other issues, I will leave for discussion, and they are in the 

written testimony, but we also need to address the obesity epidemic 

and move forward on this, and I thank you very much for the opportunity to testify before you today. 

[The prepared statement of Mr. Paige can be found on page 92 

in the appendix.] 

30 

Chairman HARKIN. Thank you very much, Dr. Paige. 

Mr. Hecht? 

STATEMENT OF KENNETH HECHT, EXECUTIVE DIRECTOR, 

CALIFORNIA FOOD POLICY ADVOCATES, OAKLAND, CALIFORNIA 

Mr. HECHT. Good morning. Thank you, Chairman Harkin and 

other members of the committee for this opportunity. I am from 

California Food Policy Advocates, a State-wide nutrition policy organization where we work to increase access for low-income Californians to nutritious, affordable food. 

As with much of the conversation this morning, our focus has 

been on school programs, but we have recently come to realize that 

by the time kids come to school, it may be too late to stop them 

from becoming obese. And as the studies show, obesity is exceedingly difficult to reverse, so that an obese preschooler is very likely 

to go on to be an obese adolescent and then an obese adult, with 

all of the disastrous consequences that that holds for the individual 

and really for the country. It seems to us absolutely indispensable 

to health care reform that we get it right when the kids are first 

starting out in our preschools and our schools. 

We had the opportunity at California Food Policy Advocates to 

participate in two studies, which has taught me all I know as a 

lawyer about nutrition. One was in Los Angeles, where we did observations in child care homes and centers, and another was done 

by mail to about 500 randomly sampled centers and homes 

throughout the State of California. The results were remarkably 

consistent and each fortified the other, and I would like to talk 

about those results. 

We have also had an opportunity to participate in two State-convened panels on child care nutrition generally and on the Child 

Care Food Program specifically and our recommendations come 

also from those two panels and are consistent with those two panels. 

First, just a moment on obesity. One in four children in the two 

to five age bracket is obese or overweight before ever reaching kindergarten—one in four. And as I said, this is exceedingly difficult 

to reverse, so it is the beginning of a long, long problem. 

At the same time, we still have concern for hunger and food insecurity. I think the number mentioned so far was 12 million children in that preschool bracket, and that turns out to be almost 20 

percent, almost one in five, children is living in a household that 

is deemed by the government to be either food insecure or hungry. 

A few moments on the Child Care Food Program. It is a big program. It is serving three million children throughout the country. 

About a third of them are in family child care homes, very small 

operations, and about two-thirds are in child care centers, which 

tend to be a bit larger. The program is now spending about $2 billion a year. 

In addition to providing reimbursement, which, of course, is critical to the agencies, the Child Care Food Program also provides 

three monitoring visits every year, which is more than licensed 

child care homes and centers will receive in any State, I believe. 

It provides nutrition education, training, technical assistance, or at 

31 

least it used to until the reimbursement went away and the money 

had to be focused on other things and away from these important 

services. 

The Child Care Food Program is based on a very simple concept 

of meal patterns, which are really the food groups. There is milk, 

fruit and vegetables, grains, proteins, and that sets—there are a 

minimum which set the quantity of those foods so that children 

should get enough nutrients, but what it doesn’t address at all is 

the quality of those foods and it doesn’t limit the numbers of calories. In other words, the Child Care Food Program set-up at the 

moment is not responsive to obesity. The meal patterns were set 

in place before we were aware of the obesity epidemic and they 

have not been changed since. 

USDA has commissioned a study from the Institute of Medicine, 

which is to start next year, and I think it is a safe estimate that 

the results of that study will not be implemented for another 4 

years, 5 years, and our recommendations are what we believe are 

sort of consensus, unarguable changes to the program that don’t 

interfere with but actually work well with meal patterns. 

A moment on our studies. Our two studies found that the child 

care facilities that participated in the Child Care Food Program 

had better nutrition than the facilities that did not. We found that 

Head Start was at the top of the pack and that food brought from 

home—I am glad there are no mothers left on the panel at the moment—was the worst. It had the least good nutrition to it. But 

within that, there was a range of nutrition that was better in the 

Child Care Food Program than not. 

Even in the Child Care Food Program, there are problems, which 

is what my recommendations will go to. For example, whole milk 

is being served in 50 percent of the Child Care Food Program sites, 

and I think it is absolute consensus scientifically that from the age 

of two on, children should not be receiving whole milk. They should 

be receiving either non-fat or low-fat milk. Similarly, only 27 percent, about a quarter, of the homes and centers that were on the 

Child Care Food Program were serving any whole wheat at all. So 

there is room for improvement. 

Our recommendations follow the following principles. One, we 

want it to be consistent with the WIC Program, which is serving 

roughly the same population. The WIC Food Program, as you 

know, has recently experienced a real transformation in its food 

package and it is terrific, based on lots of study, lots of input from 

scientists and nutritionists all over the place, and we really try to 

borrow from that. 

Second, we are trying to make the recommendations simple, because in the homes particularly, there is not much time to fuss 

with complicated nutrition requirements. 

Third, we are trying to make it inexpensive so that the nutrition 

reimbursement goes as far as possible. 

Some recommendations on the nutrition. First, we urge that the 

reimbursement be increased. As we heard in the first panel, really, 

the costs have run away from all of the nutrition programs, and in 

the Child Care Food Program, where there is intensive paperwork, 

the reimbursement has been lost. 

32 

But with the increase in reimbursement we are asking that nutrition improvements within the meal patterns be linked, and we 

are asking for the things that we all know are good, and I think 

there is plenty of science to back it up—low-fat milk, more fresh 

fruits and vegetables, more whole grains, less sodium, less sugar, 

less fats. Not rocket science. 

Second, as I mentioned, we would like the nutrition as well as 

the messages, the nutrition education, to be absolutely consistent 

with the WIC Program, which is doing a great job and we ought 

to grab onto it. 

Third, we are proposing that there be some changes in the health 

environment in these facilities in order to maximize the benefit of 

the Federal reimbursement. Every program ought to have water 

easily accessible to the kids. We ought to have limits on screen 

time. We ought to get those kids outside and moving, and if it is 

bad weather, they ought to be moving inside. So physical activity 

is important. 

In the school programs, we have a concept called foods of minimal nutritional value. We would import some of that into child care 

to be sure that the kids aren’t having sodas, candies, the things 

that we all know they shouldn’t be having. And finally, we need to 

devise some strategies to work with the moms and dads who are 

sending food from home and don’t know better. 

In order to have these benefits make any difference at all, we 

need to grow these programs. There are two ways in which we 

would recommend opportunities for growth. One has to do with access and participation. There ought to be categorical eligibility into 

these programs so it is easy to get in for the kids who have already 

been means tested or their families have been means tested. 

Second, there are areas of our State, I suspect other States, 

where there cannot be family child care homes because there is no 

sponsoring organization in that portion of the State, and we would 

recommend that where there is no sponsoring organization that the 

State be the sponsor of last resort, or the State might delegate that 

responsibility, so that children won’t be deprived of a family child 

care home on CACFP simply because there is not a sponsor in the 

neighborhood. 

Finally, there are ways to simplify and streamline this program. 

When the Child Care Food Program operates on a school campus, 

it ought to operate under the school lunch rules and regulations. 

We ought to defeat these kinds of silos that make administration 

complicated and expensive. 

Finally, we need money to train. The Federal money to train, the 

State money to train has really dried up and is not coming back 

any time soon at the State level. I think it has to be Federal reimbursement so that the sponsors are trained, the providers are 

trained, the providers are in a position to provide indispensable nutrition education to the kids and to their families so that we really 

spread the right obesity prevention strategies throughout our communities. 

Thanks a lot. 

[The prepared statement of Mr. Hecht can be found on page 76 

in the appendix.] 

Chairman HARKIN. Thank you very much, Mr. Hecht. 

33 

And now we will turn to Ms. Nolan. 

STATEMENT OF LUCY NOLAN, EXECUTIVE DIRECTOR, END 

HUNGER CONNECTICUT, HARTFORD, CONNECTICUT 

Ms. NOLAN. Good morning. Thank you, Mr. Chairman and members of the committee, for inviting me to present testimony today 

on behalf of meals served to children out of the school day. These 

meals are one of the best ways to improve nutrition for America’s 

children in tough economic times, as you all know. 

I am here today to talk specifically about the After-School Programs and Summer Nutrition Programs. These programs are designed to provide nutritious meals and snacks to children when 

school is out. We know that when children participate in Federal 

food programs that they do better with their weight, and that children when they are out of school gain weight. We have science behind that. 

We really need to make sure that we can provide these children 

with these meals and snacks that are nutritious, and sponsors are 

trying to increase the quality of the food that they served. We have 

worked with a community in Middletown where they really worked 

hard to have better food that the kids will eat, but also increase 

their fresh fruits and vegetables. They need funds to do this. They 

can’t do it with the funds that they have now. 

I just very quickly would like to say, in Connecticut with our 

School Nutrition Program, we have schools that certify as healthy 

schools, and when they certify as a healthy school, they are given 

ten cents extra per meal served from the prior year. I suggest this 

would be a great way to incentivize other Summer Nutrition or 

After-School Nutrition Programs, as well, and give them the funds 

to be able to get the healthier foods. 

These programs are really great because they combine food with 

activity. We see a lot of kids that go in and they swimming because 

they can get a meal, or they can do arts or after school they can 

do their homework, they can play basketball. They get some of the 

physical activity that they might not get if they are sitting at 

home. 

So it is key to us. We really feel that it is really imperative that 

we keep these programs as activity-based, as well, because as you 

say, it helps us look at the whole child and look at the future of 

our children and look at them as both health and as psychological 

health of our kids and getting them food and activity. 

I would suggest that we need to increase access to these programs. Right now, the Summer Nutrition Program nationally 

serves one in five eligible children. In Connecticut, we served one 

in four. We are No. 8 in the country. I mean, that is pretty terrible. 

It is great because we are No. 8, but it is really pretty terrible. 

So right now, the area eligibility is at 50 percent. We suggest 

that we go to before 1981 standards of 33 percent, and at the very 

least, we use the current and non-food Federal funding for programs such as the 21st Century Learning Grants of 40 percent so 

that we have at least the same basis in that way and we can grab 

more children. 

I also think that we can create partnerships with farmers and 

farms on these programs. Again, in Middletown, we had a partnerVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
34 

ship with a CSA, Long Lane Farm that is part of Wesleyan University, and they came in every week and taught the kids. They planted something with the kids. They taught them about farming. They 

taught them where their food came from. They brought them foods 

that they could try. As anyone with kids knows, if other kids are 

going to eat something, they might try it, whereas they might not 

at home if it is their siblings or their mother goading them. 

Nutrition education is key. The expanded Food and Nutrition 

Education Program, we can work with them, FNEP. Again, using 

the healthy food incentives would be really helpful as a way we 

can—we have these programs. Let us use the nutrition and the 

program together to increase nutrition. 

Outreach is absolutely necessary. We have found in Connecticut, we give out in End Hunger Connecticut five grants of $750 to communities, to sponsors, as a way to buy things that are non-food related. So maybe they raffle off bikes. A kid would come every day, 

and every time they get a raffle ticket. At the end of the summer 

session, they would raffle it off and somebody would win the bike. 

It would have them come. They would want to come. They would 

tell their friends. They would have smoothie days, things like that. 

We increased last summer alone, with those, just those five sites, 

we served an 18,000 additional meals and over 400 kids daily in 

those sites, and that is a $3,000 investment. 

We really do need to get people out there and do outreach because we can get to families. We can hang door knockers. We can 

get out flyers to schools before school is over. But it is really key 

that we let people know that these programs are happening. We 

also need funding for startup and expansion and transportation 

funds. 

And finally, the summer meals and also the after-school snacks 

and breakfast should receive commodity support, and in the rural 

areas perhaps cash in lieu of commodities because it is more cost 

effective. 

After-school snacks, there is really not enough food for an afterschool snack. I have a son who eats lunch at 10:30 in the morning 

and then goes off and plays football. I know he is not in an afterschool program, but I worry about him practicing football until 6. 

Kids need something in between, particularly if they are eating 

early. 

You guys last year, excuse me, with the Economic Stimulus Plan, 

we added two more States to the supper programs and we would 

like to see that all over the country because they are really just key 

programs. We can feed kids all year long. They can feed them during the weekends. They can feed them after school, families who 

get home late. It is just enough food for our children. We need to 

feed them what they really need. And then we can also do that 

through the National School Lunch Program, which would be great. 

The final thing that I would like to add is that we would really, 

really like to see this as a year-round seamless program, the Child 

Nutrition Programs. When you have a sponsor doing Summer Nutrition and them somebody else doing After-School, the rules are all 

different, CACFP, they are all different. People don’t do they because they are just so difficult to navigate. We would put all the 

out-of-school meal programs together, create one program with 

35 

identical eligibility procedures, identical reimbursement, and administration. It could really streamline these programs, save 

money, and feed kids at the same time. We don’t need a mishmash 

of programs right now. We need one whole program that will do 

the best thing and would be the best economically, as well. 

So those are my recommendations. Thank you very much. 

[The prepared statement of Ms. Nolan can be found on page 84 

in the appendix.] 

Chairman HARKIN. Thank you very much, Ms. Nolan. 

Let me pick up on what you were just saying there. You are saying that we ought to put together the Summer Feeding Program, 

After-School Programs, the supper programs—what else am I missing here—— 

Ms. NOLAN. CACFP. 

Chairman HARKIN. Right, the Adult and Child Care Programs, 

put them all together sort of under one guideline, one operational 

kind of a program. Is that what you are saying, that they should 

all be together? 

Ms. NOLAN. I am saying that we are at a position now where 

kids aren’t eating on weekends. They are not eating during school 

vacations. And so if we can put them all together and have one 

common program where kids can then get these meals during the 

year and everything is—right now, we have sponsors who—with 

the After-School Program, and I know in CACFP with shelters, I 

have talked with people in homeless shelters and it is just too difficult for them to keep all the—to make sure that they have all the 

little things that they need to have to give to our State Department 

of Education to get the funding. And so if we can have something 

that is just everybody could have it together, I think the administration would be easier, kids would eat, and more people would be 

sponsors. 

Mr. HECHT. May I add an example to that? 

Chairman HARKIN. Sure. 

Mr. HECHT. We have a private program in California that has 

operated since the last reauthorization in which sponsors of summer food are permitted to go on serving snacks during the school 

year to children under the summer food rules so they don’t have 

to grapple with two sets of rules and regulations and reimbursements. The numbers of sponsors has gone up enormously. The 

number of kids participating has gone up enormously. If we had a 

community-based program and a school-based program, just two 

programs instead of as many as we have, it would be enormously 

better and cheaper with money that could then get poured into nutrition. 

Chairman HARKIN. Hmm. 

Mr. HECHT. It was a recommendation that was made several administrations ago but didn’t go anywhere, but it is terrific. 

Chairman HARKIN. I will take a look at that. Also, you mentioned about in the Summer Feeding Program that a lot of times, 

what attracts kids is not the food, it is the other ancillary activities, swimming and games and things like that. I am sure you are 

not saying that the food doesn’t have some part of it, but there is 

another aspect to this. If that is so, then what kind of suggestions 

would you have that we might institute that would draw kids in 

36 

for the Summer Feeding Programs? I mean, we have the Ys, for example, YMCAs all over the country that are really involved in 

wellness programs. They have embarked on this several years ago. 

So would that be something that could be a part of this? Maybe 

churches could be involved in this, too? I am just kind of searching. 

How do you promote all these activities that then you can get food 

to these kids? 

Ms. NOLAN. Our grant program is called ‘‘Operation Participation’’ as a way—because we want kids to participate, and what we 

found is that if you get this little—something to get them, they will 

tell their friends who will then come. And simple things like in one 

community, we had police officers and firefighters come every Friday and read to them, and there was this big trunk and it was the 

mystery of what was in the trunk. And at the last day, they would 

read some clues as to what was going on and the kids would have 

to guess. And at the last day of the feeding program, they opened 

up the trunk and they all got T-shirts that said, ‘‘I participated in 

the Summer Feeding Program.’’ 

The raffle that I talked about, we got kids who came because 

they wanted that bike so badly. There were two bikes and they 

wanted them so badly that they came to make sure that their 

names were in the raffle. 

We have had art supplies that have come, and so we have really 

been able to—kids will come and do art because they know that 

that is there. And we can streamline eligibility with the Federal 

funding for the summer programs using the 21st Century, you 

know, doing the 21st Century Program. So we can use that as a 

way to get kids. 

But what we found is, and I think you are right, the food is certainly a pull, but they want a whole experience, and this is a way 

we—what we have done is been able to build the community into 

these summer sites, so we have the police officers come, the firefighters. We have had raffles where kids come and they are able 

to do a raffle. 

Chairman HARKIN. I guess what is on my mind is I am thinking 

that since we are limited in what we can do here, we can provide 

the funding and we should increase the funding for the Summer 

Feeding Program, the Child and Adult Care Program, After-School 

Programs, but should we somehow link it to certain activities that 

the local community has to engage in to be able to participate, in 

other words, providing those kinds of sports, activities, things like 

that for kids rather than just setting up, as I have seen in some 

places where they just go to a park and they bring a lot of food and 

kids come to the park and they can have a lunch or something, 

which I don’t think works very well. In other words, encouraging 

local communities to think about how they do the things you are 

talking about, getting the local firefighters, police, and stuff like 

that involved. 

Mr. HECHT. Let me sharpen the question just a minute. In California, over 80 percent of the children who eat summer food meals 

eat them at school, during summer school generally, and we are 

starting to see that beleaguered school districts aren’t going to be 

able to offer as much summer school as they have in the past, so 

there are going to be more children unanchored to a program or a 

37 

school that gives them a summer food meal. So there is a serious 

problem, I think increasing this coming summer, at least in California, of children who are not going to be close by some activity, 

either academic or recreational, where we can plop a Summer Food 

Program. 

Ms. NOLAN. I also—I think that if we could do—if there is some 

kind of a pilot that we could do to try this out, maybe State by 

State and having where they are connected, it would be helpful. I 

think that it would be something that you would see some more 

significant usage of the program. 

Chairman HARKIN. And I also want to see what role we have for 

the Ys around the country, because they are really into wellness 

and promoting wellness, and perhaps this is something that we 

ought to be looking at as part of this. 

Ms. NOLAN. Boys and Girls Clubs, I think. 

Chairman HARKIN. And Boys and Girls Clubs, too. Yes, Boys and 

Girls Clubs, too. 

Senator Chambliss? 

Senator CHAMBLISS. Thanks, Mr. Chairman. 

I like your idea, Ms. Nolan, of trying to create some sort of umbrella out there. What we tend to do as policymakers here in Washington all too often is that we create these programs and they are 

all great programs. You all have talked about your individual ones. 

All of a sudden, somebody comes in with another idea and we create a fourth panelist on this panel all of a sudden who has a great 

program and we throw money at it. 

Mr. Hecht, you make a great point that throwing money at it is 

not necessarily the answer to it. Certainly everybody can use more 

funding, but if you had them all under one umbrella and you restructured the programs so you don’t have the overlap, you are 

going to wind up saving a lot of money to be able to be spent on 

additional meals and what not. So I think are some very good ideas 

that you all have tossed out there. 

Ms. Nolan, it is pretty obvious that what you are doing with kids 

in your program is you are letting them have fun. If kids have fun, 

they are going to show up. 

Ms. NOLAN. Right. 

Senator CHAMBLISS. There is probably a lot of peer pressure 

bringing in other kids, too, if they know they are having fun. So 

obviously you are doing a lot of the right things. 

Dr. Paige, I was curious about in your statement that everybody 

at 185 percent of poverty level ought to be automatically enrolled. 

What you are saying there is that all of those folks are eligible 

now. They are just not enrolling. And you are not talking about an 

expansion, you are just talking about making sure that folks that 

are eligible do get enrolled again, which I am sure there are probably some of those parents who, when they leave the hospital, 

maybe they don’t know about the program or some of them want 

to do it on their own rather than depending on the government. 

But that is an interesting concept you throw out there, that it will 

save us money in the long run if you do have more families participating in the program. 

Mr. PAIGE. Currently, Senator Chambliss, there is not a sufficient appropriation to meet the entire need were we to be successVerDate Nov 24 2008 02:35 Mar 02, 2010 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6633 C:\DOCS\54565.TXT SAG2 PsN: SAG2
38 

ful through our outreach efforts to bring all of the eligibles into the 

program. So my own view is that not only will the nutritional risks 

be addressed, but we will have the opportunity to develop a more 

comprehensive preventive program. It is hard to measure the prevention, but when we are talking about newborns and we are talking about pregnant women, there is a strong, compelling case to be 

made that prevention is as important as the remediation that we 

attempt to do by identifying nutritional risk. 

So it is from that perspective, that broad-based public health preventive perspective, and it is not simply empty rhetoric. We know 

through the data that when we can begin to provide a nutritional 

infrastructure, we can start with a comprehensive program prenatally. We can deal with the range of obstetrical and behavioral 

problems. We can start this nutrition education. We are talking 

about obesity and we are talking about where to start, as I mentioned quickly in my prepared comments. 

But my own view is that we need a vertical, comprehensive, integrated, coherent program of all of the nutritional programs, not 

just WIC. What we have now is a fractured system. It is a good 

system. WIC is a wonderful system. But it needs to be integrated 

with Head Start and it has to have a linkage into the schools. We 

have to have, as was mentioned earlier, a standard, unified approach with regards to qualifying as well as reducing the burden 

on the client to continue to qualify for many of these programs. We 

can be much smarter about it. We can integrate it. We can move 

to a streamlined approach. 

We can locate these programs with health programs so that we 

are dealing in a more comprehensive, unified approach to deal with 

the nutritional risks that exist within the population that we are 

serving. We can make effective use and economical use of the personnel back and forth between this, an electronic system that 

would communicate back and forth in terms of immunizations, in 

terms of social services. 

We have complex problems here. We have poverty that feeds, if 

you will take the metaphor, the malnutrition that exists and we 

have to be clever about it. It was mentioned by my colleagues here 

that we must have a more comprehensive, effective system, particularly as money becomes less available, we have to be smarter 

about the way we run these programs. We have to start preconceptionally in the schools with our young women and young 

men in terms of health issues, and we have to address the—obesity 

is not an isolate. Low birthweight is not an isolate. These are part 

of a continuum that exists within the community and we keep looking at it. 

We are the best country in the world. We really have the best 

programs in the world. But we are not clever about the way we 

apply them in our lower-tier population that needs a consistent, coordinated message that moves over time, because after two or 3 

years, we have our children graduating from WIC and they are 

going into school and they get a different message, and they get a 

different message in every State and in every community with respect to good nutrition. It is a more amorphous concept than simply 

saying good nutrition. 

39 

So we need Federal standards and guidance with regard to a unified message. We need a streamlined, integrated approach. We 

need a vertical, coherent, logical approach that is built on sound 

nutrition science with a core that is, I would say, federally suggested with the embroidery around it in terms of the expression of 

the communities and the States that we are dealing with and we 

have not been clever enough to accomplish that, and it is very cost 

inefficient. We are losing tremendous amounts of money. 

The client burden—forget even the client burden. Going from one 

doctor to get a hematocrit and then going to—a blood count, and 

then going to another place to get another blood count, and then 

having to carry that information, that is not an efficient system 

and it doesn’t lead to good care, either. 

Senator CHAMBLISS. Mr. Hecht, your comment about one in four 

children are obese before entering kindergarten is an interesting 

statistic, because child obesity obviously is a problem that all of us 

are concerned about now, and the fact that it does go up rather 

than going down is also pretty alarming. Is there a direct correlation between that statistic and the economic strata which those 

children come out of? 

Mr. HECHT. Yes and no. I wish I could give you a simpler answer. There is no question but that it costs more to have healthier 

food and that the families with less money are having a hard time 

helping their children have healthy diets. On the other hand, as 

Dr. Paige mentioned, there is obesity at every income stratum and 

it is not isolated to the low-income areas, but the causes of it seem 

clearer at lower incomes and the consequences seem much more severe. 

Senator CHAMBLISS. Last, Mr. Hecht, you mentioned in your testimony and in your written statement that this paperwork in your 

program is a real problem. Is there any way for your providers to 

go online to do this versus having all this paperwork to complete? 

And second, what can we do to eliminate that paperwork? I have 

no idea what it is or what all the requirements are, but what can 

we do about it? 

Mr. HECHT. That is a very welcome question. Yes, there are ways 

that our providers can begin to use computers to go online to file 

some of the information that they need to. The next group up, the 

sponsoring organizations, are doing that much more. Some of the 

providers, particularly if they are in the family child care homes, 

have difficulty either owning or being adept at some of the computer technology. 

The paperwork is extremely burdensome in the family child care 

homes and in the centers. There has been a Paperwork Reduction 

Task Force meeting. Some of those recommendations have been 

met, some have not. It ought to be carried on. There are some questions that are asked of providers, if they serve the same number 

of children day after day, is that real or are they making that up, 

which is sort of a blunt instrument for trying to make sure that 

there are no fraudulent claims being made in child care. But the 

paperwork requirements that have been put in place to try to stop 

that are really very blunt and are burdensome to the providers and 

to the sponsors and not very adept at catching any problem if there 

is a problem. 

40 

Senator CHAMBLISS. Thanks, Mr. Chairman. 

Chairman HARKIN. Thank you very much. 

Senator Casey? 

Senator CASEY. Mr. Chairman, thank you very much, and I want 

to thank Senator Klobuchar for letting me jump the line here. I am 

grateful for that. 

I was looking at some of the particulars, Dr. Paige, of your testimony as well as both of our other witnesses and some of the numbers in here are just staggering and worthy of repetition many, 

many times, even though it is bad news, because we need this information to focus us on the urgency of this. 

The 13 million American children below the age of 18 living in 

families with incomes below the poverty level is a stunning number 

in and of itself. The percent of children in poverty increases to 21 

percent in children below the age of five. The section on low birthweight, where you are highlighting that problem, but you also have 

some good news there. Based upon the data, the WIC Program reverses many of the negative outcomes that we are talking about. 

And then, of course, under the section on infant mortality, this 

line I have never seen before and it really—we know it is true, but 

we don’t see this very often, that the disease burden among the 

survivors is lifelong. 

Mr. PAIGE. Yes. 

Senator CASEY. And it is just staggering what our challenge is. 

So it leads to my question on the WIC Program. We have, as we 

know, we are in the midst, I should say, of a terrible economic crisis, a lot of families living through that trauma and we have limited budgets and limited resources. But I guess I would ask you, 

Doctor, if you could, and I know it is difficult to do this, but to rank 

some of the recommendations that you make in terms of the three 

most urgent or the few that are most urgent in light of the need 

and the gravity of the problem, but also in the context of the budget realities we have. 

Mr. PAIGE. Thank you, Senator Casey. Thank you for highlighting those very significant numbers. I might add that those 

numbers that you have just read escalate dramatically in our minority populations. In female-headed households in Baltimore or in 

Washington, we are looking at 60 percent poverty. So these are extraordinary problems that we are dealing with nationally. 

I would also like to comment briefly, if I may, and I will be very 

brief, regarding the lifelong burden. Over the last eight to 10 years, 

the research has been prolific in the area of fetal growth restriction 

and low birthweight, the result thereof, and adult disease burden. 

The adult disease burden is in terms of shifts in the internal physiology—anatomy and physiology of the fetally growth restricted that 

results in heart disease at age 50 and 60 and results in diabetes 

and results in a number of disease burdens that up until very recently we thought were very isolated, circumscribed, age-specific 

problems, and we are much wiser now. 

So when we quote statistics regarding the dollars saved in the 

neonatal intensive care unit, that really is just the beginning. We 

have the disease burden just moving through time. And underpinning that are the congenital anomalies that exist as a result of the 

41 

inadequate nutrition and environmental hardships that exist that 

are continuing. 

So now to your question. I really can’t answer the question entirely. I can just say philosophically, my own view is to start at the 

beginning to try to maximize and optimize the embryo, where we 

have many, many problems. We don’t think of the embryo. We 

think of the fetus and we think of 30 weeks and 34 weeks, where 

there is a more tangible human experience. But the embryo is undergoing enormous development and requires the best nutrition. So 

we have to get our women into the program very early. 

We have to increase education, not just for our poor women, but 

for our population in general. These are not problems unique to 

this population, they are just escalated in this population. 

So my own view is to start peri-conceptionally, move through 

pregnancy and infancy into childhood. But you note in my testimony, I try to make the point that in the one-to 4–year-old, these 

are youngsters who are already walking. They are cute, but they 

no longer have that intense position in the household as a newborn, so it is easy to forget them and the risks that they face in 

terms of the nutritional factors that are required for interaction, for 

cognitive development. So we pay a penalty if we sacrifice our oneto 4–year-olds and only concentrate. 

So it is a complex question. There is a hierarchy. My own view 

is to maximize, optimize fetal growth, pregnancy, and the early infant period, and I think we need to address the preventive elements of the WIC Program in this in terms of now only the food, 

which is absolutely critical, it is the substrate that makes it all 

work, but the education and the continuing education that exists, 

and you heard in my earlier response, I see it as a vertical issue. 

I see that we have to protect this newborn right through the oneto 4–year age, right through Head Start, right into school. We need 

it in a coherent manner and that would be an attempt at answering your question, Senator. 

Senator CASEY. Thank you, and I know I am over time, so I will 

just present this to Ms. Nolan as something we will be sending to 

you. I have worked hard on the Summer Food Program. In our 

State, we have a large portion of our State which is rural, and I 

will ask you a question for the record that I will preview now. I 

just ask for your recommendations about how to make that program more effective in rural areas, the Summer Food Program in 

rural areas. But we are about a minute-and-a-half over, so we will 

submit that for the record. Thank you very much. 

Chairman HARKIN. Thank you. 

Senator Klobuchar? 

Senator KLOBUCHAR. Thank you very much. 

Thank you to all of you for your good work. I was very interested, 

Mr. Hecht, and kind of shocked at the statistic that you put out 

there on the two-to 5–year-olds with 25 percent of them being 

obese or overweight. Could you explain, and I know you talked a 

little bit demographically earlier, but could you explain, just take 

a little time to explain why you think this is happening? 

Mr. HECHT. Well, I think there are two parts to it. One is calories in and one is calories out. I think it is as simple as that, that 

the children are not getting movement either at child care or at 

42 

home. There is a tremendous amount of screen time, as I am sure 

you know, and every reputable body says there shouldn’t be any before a child is one, one or two, and then there should be perhaps 

an hour of limited quality education type of TV if there is any. But 

in so many homes, the TV is just on all day. 

And on the food side, as we all know, Adam Jernowski [ph.] has 

done good studies, others, as well, that show that healthier food is 

more expensive to purchase, and so it is—and in some cases, less 

accessible. So it is both access and affordability that makes it very 

difficult for low-income families to feed their children the kinds of 

food they would like or for child care providers to have the kinds 

of food they like. 

On the other hand, we found a very interesting thing which we 

are still developing, but I think it is solid, is that the families that 

paid more for child care got less in terms of nutrition because they 

weren’t always going to the programs that had the Child Care Food 

Program with the Federal reimbursement. So for all the bashing, 

the Child Care Food Program is a good program. It needs to get 

better, but it is a good program. 

Senator KLOBUCHAR. Very good. Thank you. You know, speaking 

of that program, are you recommending that we change the law to 

mandate that—because you were talking about some of the issues 

with it—that the changes for child care sites, that these changes 

for child care sites you have suggested, that it should be a mandate 

in terms of receiving the nutrition dollars? 

Mr. HECHT. Yes, I do. 

Senator KLOBUCHAR. And what do you think would be the best 

recommendations to try to change the program? 

Mr. HECHT. I would go in two directions. One are the, what I 

think are modest recommendations with regard to the quality of 

food, that we really borrow from the WIC food package change and 

increase fresh fruits and vegetables, whole grains, get water into 

those kids, low-fat milk, and limit sodium, salt—sodium and sugar 

and fats. And then the surrounding environment, which includes 

some of the screen time, physical activity, not having certain kinds 

of food around where the children are, what we now referring to 

as foods of minimal nutrition value in the schools. There are just 

some things everybody knows kids shouldn’t have and those ought 

not be there. I think those are practical, implementable suggestions, in addition to increased reimbursement, of course. 

Senator KLOBUCHAR. On the other thing, when you were talking 

about the early childhood on and the mothers and whether or not 

some of these kids are just preprogrammed, which is a scary 

thought, based on the nutrition they have received before they 

were born, I listened to that because I think that is an issue that 

we see that just makes it so hard for these little kids. 

Dr. Paige, you wanted to—— 

Mr. PAIGE. I was just going to jump in and say, paradoxically, 

many of the low birthweight infants are at risk for obesity because 

given their reduced size, organ size and shifts in hormones and so 

on—I have lectures here that I won’t bore you with—given those 

shifts, when they are born into a calorie-abundant environment, 

they tend to increase weight more quickly and their feedback systems with respect to satiety and control are also in many ways 

43 

interfered with. And as a result, we have this paradox of low birthweight, and it may account—the question was asked earlier why 

demographically would we see a tilt perhaps in this population of 

economically disadvantaged, and this is arguably an important 

issue that is being pursued scientifically. But there is enough evidence at the moment to at least underpin the logic of it, yes. 

Senator KLOBUCHAR. When you talked, Dr. Paige, about how you 

can make it easier for people, and clearly how we do a better job 

here is to get this nutrition information and get it out there and 

make it easily as accessible as possible to low-income families from 

the very beginning, so you talked about how difficult it is to access 

the information and trying to do it on a site basis. Could you just 

elaborate a little on that in terms of making it—what would be 

your dream of how to make this accessible to low-income mothers? 

Mr. PAIGE. Well, we have been very clever about doing this internationally in terms of providing star power and other agents of 

change within a community with regard to musicals and other elements that are quickly identifiable by many of us in the population. We need also that for attention. But then a consistent message, as well. We have a very fractured message across the spectrum of services that we provide. 

So we need that reinforcement, and then my dream—I am coming back to the same theme, though—is that we are working in a 

cooperative, integrated manner with the food programs that are out 

there, with the school program, in a consistent message, as well. 

There are conflicting information. We see in the newspaper frequently, even for us on an upper-tier, maybe, suddenly the scientific information or the food information has changed and the 

sands have shifted under us. It is both proper, but this is happening on a continuing basis in terms of the, I will say it again, 

the fractured message that exists out there. 

I think I will stop there and get your response. 

Senator KLOBUCHAR. OK. Well, I am out of time to do my response. Could I just ask one more question, Senator Harkin? It was 

actually the question that Senator Casey was going to ask you, Ms. 

Nolan, about how you would replicate this idea on a rural basis. 

Ms. NOLAN. Well, there—one wouldn’t believe it, but we do actually have a fair amount of rural poverty in Eastern Connecticut 

and one of the things that has been an issue is the transportation. 

I think that if there is a way that we can increase transportation 

to those places, some people say that we can increase the time in 

which—or lessen the time that the food has to be there so that 

maybe somebody can drop it off and then have the kids come in, 

or have it for a longer time. There are a number of things. There 

are a number of people who have worked on this and I will be 

happy to get you something really written up that explains it fully. 

Senator KLOBUCHAR. Thank you very much. 

Ms. NOLAN. You are welcome. 

Mr. PAIGE. May I just add, Reverend Greenaway reminds me 

that the National WIC Association is launching on Tuesday a partnership with Sesame Workshop, which is specific to my general 

comment regarding utilizing the various outlets of communication 

and advertising and—— 

44 

Senator KLOBUCHAR. So how are they doing that? Are they showing Sesame characters eating spinach? 

Mr. PAIGE. Well, we will both watch on March 10. 

[Laughter.] 

Senator KLOBUCHAR. That is good. 

Mr. PAIGE. But whether that is or is not successful, we need an 

approach that addresses it in the language, in the venue that people are comfortable and operate with. 

Reverend, do you want to answer? Are they going to eat spinach? 

Rev. Greenaway. Well, we have a partnership with Sesame 

Workshop which will provide Healthy Habits for Life kits, which 

are a combined video and reading material, educational tool for 

WIC families that emphasizes ‘‘eat a rainbow,’’ so all of the fruits 

and vegetables. Talking Broccoli will be there and Cookie Monster 

tomorrow. Cookie Monster will be talking about sometime and anytime food. And those who have little children know that when they 

go to the grocery store, they go, ‘‘Oh, no, Mommy, that is sometime 

food, but carrots are anytime food.’’ 

It is that kind of nutrition message that we are trying to reinforce with Sesame Workshop that we have been communicating 

within the WIC clinic all along, but now we have a great collaborative partnership to do that. We are putting in the hands of WIC 

families already five million of these Healthy Habit kits, which include a DVD that they can play at home and they are already a 

big hit. 

Senator KLOBUCHAR. OK. 

Mr. PAIGE. I would add that within the WIC Program, as well, 

we are looking for ways to use internet-based education and other 

efficient methods that use modern technology to reinforce the message, provide DVDs and a range of information so that there can 

be an interactive chat room on the internet. These are—each one 

will not solve the problem, but in a coordinated effort that provides 

this broad-based approach, we can make progress. 

And as I said, we have been very successful, the U.S. has, in 

achieving this internationally, but we haven’t been clever enough 

to apply it consistently here in our own homes and our own country. 

Senator KLOBUCHAR. Thank you very much. 

Chairman HARKIN. Thank you all. I just have one other area that 

I would like to cover with you, Dr. Paige, and that is the area of 

breastfeeding. Twenty-eight years ago this year, when I was a 

member of the House, I was one of the honorary co-chairs of the 

National Breastfeeding Coalition. That group had formed to protest 

the activities then of the Nestle Corporation in terms of their provisions of infant formula to not only poor families around the world, 

but also how they were providing it to mothers in hospitals. As 

soon as they gave birth, they got a nice package of infant formula. 

That coalition was, I think, fairly successful at that time in 

terms of the boycott and Nestle agreed to change a lot of its practices at that time, in the mid–1980’s, although I understand that 

now it has crept back in, that there are still these packages given 

to mothers in hospitals as soon as the child is born. They get these 

packages of infant formula and things like that. I don’t know how 

45 

extensive that is, but I have heard that it has kind of crept back 

in. 

And since that time, even in my own family, we have been heavily involved in promoting breastfeeding. But we found, as you kind 

of alluded to, I think, and that is among low-income women, the 

incidence of breastfeeding is the lowest. Among higher-income 

women, it is the highest. So what are the barriers? What are the 

barriers getting low-income women focused more on breastfeeding? 

Mr. PAIGE. What is interesting is that if you look at the data in 

the 1960’s and 1970’s—and let me also say I have not only been 

aware but a strong supporter of yours at arm’s length in terms of 

everything you have done in this regard. In the 1960’s and 1970’s, 

through the early 1970’s, the level of breastfeeding among the lowincome population was quite high. In the course of a generation, a 

generation and a half, we have reversed this. 

It is the attraction of formula, and this attraction starts in the 

hospital when there is a discharge pack. Our colleagues in the infant formula business are clever about this. They say, yes, breast 

is best, but when you need to go out for an evening or so, and slowly both the commitment as well as the lactation begins to erode 

and you have a quick move to formula. 

Yes, in the hospitals they are now giving out infant formula 

packs. Our own data shows clearly that there is a marked difference between those who receive the pack versus those who do 

not in terms of the rapid decrement in breastfeeding. This is a 

problem that has resurfaced. 

I am all for enterprise and entrepreneurial activity, but I do 

think we have a responsibility here to our newborns to eliminate 

that practice. 

Chairman HARKIN. You talked about peer counseling. I think 

that is extremely important—extremely important. 

Mr. PAIGE. We have been—thank you for raising that, Senator 

Harkin. We at Hopkins have been working aggressively in this 

area and the data shows clearly that the—not just the individuals, 

but the clinics that have peer counselors present do much better 

in terms of initiation and duration. 

Chairman HARKIN. Yes. 

Mr. PAIGE. This program is an extraordinarily strong program. 

Chairman HARKIN. The other thing, Dr. Paige, is that there has 

been a shift. In the 1960’s and 1970’s, fewer women in the lower 

economic strata were employed. They were at home. That shifted 

because of the erosions of the economy and their husbands’ pay, 

things like that. There are more and more women in the workforce. 

And what has happened is—let me take an example. 

My oldest daughter has a very nice job in California. Her company provides all kinds of benefits for breastfeeding. They have a 

room. They have refrigeration. You can pump. They just provide all 

that kind of stuff. But she doesn’t have a minimum-wage job. See, 

most of the low-income women, they go to work at 7–Eleven or 

Casey’s or in a department store, things like that. They just don’t 

provide that kind of help, so they are caught. They may want to 

breastfeed, but they don’t have the ability to do so. 

Mr. PAIGE. Yes. 

46 

Chairman HARKIN. So what I am hoping is that we would—I 

hope this administration, I hope the Obama administration and I 

hope others will start talking about a national effort to provide 

support for new mothers in the workplace so that they are able to 

breastfeed their children. We just don’t have that at all in this 

country and we need that national effort. It is also the workplace 

that we have got to start looking at. So there are a lot of areas. 

I hope you will start looking at that, too, of how we change that 

attitude, that mindset that we have in this country. 

Mr. PAIGE. Yes. 

Chairman HARKIN. I mean, I have seen personally and I have 

heard many stories of women who take their children someplace, 

maybe a restaurant, they are breastfeeding, and they are told to 

stop. 

Mr. PAIGE. Let me just jump in on that. My doctoral student, 

who is now my colleague, Dr. Gross, was at Toys ’R Us. This is in 

the State of Maryland about eight or 9 years ago. She was 

breastfeeding in Toys ’R Us, of all places, and she was asked to 

leave. She then went on a tear. She was angry and educated and 

she got the law changed in the State of Maryland that someone can 

discretely or appropriately breastfeed in appropriate establishments. 

You have raised the points that have been at the center of my 

concern for many, many, many years in terms of how we begin to 

change the culture, the workplace culture and even the community 

culture, because there is a lack of receptivity to breastfeeding, 

whether it is on a train or at home. Some of the strongest negatives exist within the family itself. So we have a great deal of work 

to do in this particular area. 

The peer counselors have been very effective in breastfeeding and 

I think they can also work in other areas of WIC in terms of even 

the issue of obesity, in terms—our communities tend to respond 

more immediately to the exhortations of folks from the community. 

They are a powerful force. 

Chairman HARKIN. We have got to focus on this, because President Obama has suggested and has supported this visiting nurse 

program and put it into his budget, by the way, for next year, 

which is laudable, and that is visiting nurses to go to homes, lowincome, poverty homes where we have pregnant mothers-to-be and 

to work with them on their nutrition and stopping smoking and 

don’t drink alcohol and that kind of peer counseling. All of that is 

well and good. Hopefully, we can try to expand that beyond that 

to also as an encouragement for them to breastfeed, at least for the 

initial stages of the baby’s life. 

Mr. PAIGE. The decision to breastfeed is really made prenatally, 

usually, the data suggests, in the seventh or eighth month, as the 

realization, recognition of a new life to be born and a responsibility, 

and we need to bring in our obstetrical community, our nursing 

community. As I said several times, we need to be clever about it 

and we need to shape this in a way that is also consistent. 

I would add, not a polemic but just a fact that many of the WIC 

women, while they initiate, the numbers begin to approach Healthy 

People 2010 goals, many—a large number abandon breastfeeding 

within the first three or 4 weeks. So those who do elect do not have 

47 

a—we do not have the structure either in our health system or in 

WIC or in any of the social services to reinforce that decision on 

the part of the mother and she becomes quickly discouraged. There 

is no support internally or externally and there is abandonment. 

Chairman HARKIN. Well, listen, thank you all very much. This 

has been a great panel and I thank you for your leadership in this 

area, all of you, in this whole area. We invite your continued input 

and advice to us as we develop this reauthorization of the child nutrition bill. 

I thought the two panels were very good. We focused on the 

school-based programs and we focused on the non-school-based programs, Child and Adult Care, WIC Programs, After-School, Summer Feeding Programs, and we have to think about how we 

streamline them, make them more effective. And one word I would 

add is how we leverage, leveraging money. In other words, if we 

are putting things out there, what can we get communities then to 

add on to in terms of leveraging those dollars a little bit better out 

there. 

But thank you all very much and the committee will stand adjourned until the call of the Chair. 

[Whereupon, at 12:07 p.m., the committee was adjourned.] 

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DOCUMENTS SUBMITTED FOR THE RECORD 

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