Promoting Healthy Eating:

An Investment In the

Future

 A Report to Congress

Prepared by:

Food and Nutrition Service

3101 Park Center Drive

Alexandria, Virginia

December, 1999
Promotiing Heallthy Eatiing::

An Investment iin the Future

A Report to Congress

Table of Contents

Executive Summary.............................................................................................................................i

Introduction.......................................................................................................................................1

Development Process.........................................................................................................................2

The Importance of Nutrition Education...............................................................................................3

State of Current Nutrition Education Services in FNS Programs..........................................................4

The Food Stamp Program (FSP)....................................................................................................4

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)....................4

Child Nutrition Programs (CN).......................................................................................................5

The Food Distribution Program on Indian Reservations (FDPIR).....................................................6

The Commodity Supplemental Food Program (CSFP)....................................................................6

Funding Disparities.............................................................................................................................7

The Foundation for Coordinated Nutrition Education..........................................................................9

Facing Challenges, Breaking Down Barriers, Building on Strengths....................................................12

Legislative Authority.....................................................................................................................13

Resources....................................................................................................................................13

FNS Nutrition Education: Creating a Healthier America ....................................................................15

Creating an Environment for Change.................................................................................................18

Potential Solutions........................................................................................................................18

A Sustained Nutrition Education Effort is Needed .............................................................................23
i

Executive Summary

Promoting

Healthy Eating:

An Investment in

the Future

A Report to

Congress

This report fulfills a Congressional request for the Food and Nutrition

Service (FNS) to report on “a comprehensive, integrated approach to

nutrition education as a complement to the various nutrition assistance

programs.” FNS reviewed its current nutrition education efforts, and

consulted with a wide range of nutrition education experts and

stakeholders.

Our findings are clear: While the nation’s investment in nutrition assistance

is a vitally-important and effective tool in fighting hunger, food insecurity,

and related health problems, improving the quality of the American diet

remains a major challenge. The prevalence of poor nutrition and lack of

physical activity in the FNS target populations exacts a heavy toll in

morbidity, mortality, and economic costs due to disease and lost

productivity.

Fortunately, nutrition education holds great potential to promote good

health and prevent disease. Research confirms that well-designed,

behavior-focused interventions can effectively improve diets and nutritionrelated behaviors. Federal nutrition assistance programs offer a special

opportunity to deliver nutrition and healthy lifestyle messages to those

they serve, particularly children. However, critical changes are needed to

make program-based nutrition education fully effective in improving

nutrition and promoting good health.

Our review of the current state of nutrition education in FNS programs

identified the following barriers and opportunities to change that will

enhance effectiveness.

Authority and funding levels for nutrition education vary widely by

program. Each FNS program has a different nutrition education

legislative authority and funding stream. It is important to make nutrition

education an integral benefit of all FNS programs.

Flexible authority and a dependable funding stream for nutrition

education are needed to support planning, program delivery, integration

of services and the ability of the Federal government to provide

leadership and technical support.
ii

State and local infrastructures must be developed to deliver

integrated, comprehensive programs. The long-term success of Team

Nutrition depends on a stable infrastructure for nutrition education

delivery; this infrastructure was provided by the Nutrition Education and

Training Program (NET) before its funding was eliminated. More

generally, there is no assurance of a central coordinating point at the State

level for nutrition education across and among FNS programs; such

coordination is vital for long-term development of an integrated approach.

The evaluation system for FNS nutrition education is fragmented

and minimal, and lacks outcome measures. Adequate and reliable

data to determine which program components are successful in improving

nutrition and food behaviors and related outcomes is essential to permit

FNS and its partners to plan effective nutrition education interventions.

The external environment has a fundamental impact on efforts to

influence diet-related behavior. Advertising and fast food enterprises,

coupled with financial and time constraints in family life, have a powerful

effect on the eating and physical activity habits of the American

population. It is unrealistic to expect consumer behavior to be consistent

with healthy eating goals in an environment that promotes the opposite,

unless positive nutrition messages are communicated using similarly

effective approaches.

Dietary behaviors are complex, and are motivated by the combined

influence of many factors, including personal factors (attitudes and values)

and environmental influences (family, workplace, school, grocery stores,

community and mass media). Nutrition interventions must deal with the

full range of these complex influences. In addition, nutrition education,

like other kinds of education, requires a commitment to sustained,

consistent and reinforcing messages that can be delivered in multiple ways

to an audience over the long term, and with sufficient breadth and depth

to compete effectively with countervailing messages and influences.

FNS is working toward a comprehensive nutrition education approach

that fulfills its objective of nutrition education that “is fully integrated into

all FNS Programs and provides consistent nutrition messages that

encourage and motivate target groups to make healthy food and nutritionrelated choices throughout the life cycle.”

Stakeholders who provided input for this report identified WIC nutrition

education, Food Stamp matching grants to States, and Team Nutrition as
iii

promising pieces of this approach. However, they clearly indicated that

NET or a NET-like State program must be fully and consistently funded

in order to provide the infrastructure that makes Team Nutrition effective

at the local level. The internal review and external input highlight the value

of a strengthened policy foundation for nutrition education, and more

sustained resource commitments for nutrition education throughout all

programs. These discussions identified:

1. Develop a Funding Mechanism that Supports Sustained

Nutrition Education for All Programs. Adequate infrastructure

and capacity is critical to equip Federal, State and local agencies to

plan, develop and implement effective interventions. One component

of an adequate funding structure is to restore the appropriation for

NET, and increase its authorization level to reflect inflation since the

1977 authorization.

2. Authorize Funding for Cross-Program Coordination. By using a

small portion of Federal program resources for cross-program

initiatives, FNS could better reach target populations. This flexibility

would give FNS an opportunity to structure a cross-program effort to

motivate partners to maintain high-quality, better coordinated nutrition

education across FNS programs. Grants to State agencies should be

used to support development of long-term nutrition education plans

and foster better national, state, and local coordination.

3. Clearly authorize use of FNS program nutrition education

funds for efforts directed to FNS target populations. Eligible

individuals cycle in and out of program participation, making

sustained efforts offered to participants alone problematic. FNS

should be authorized to use some funding for nutrition education

directed at the FNS target population, rather than restrict efforts to

active program participants.

4. Expand Reach of Nutrition Education by Offering State

Incentives. Federal-State-local funding partnerships can increase

investment in nutrition education and spur private contributions. FNS

should be permitted to provide incentives to expand nutrition

education services, and to reach FNS target populations.

5. Authorize Grants for Nutrition Education Focusing on Special

Populations. While integrated cross-program strategies are

necessary to improve diets across eligible populations, some

populations, such as Native Americans, face dietary problems and
iv

needs that require more specialized intervention; special investments

are required in these areas.

6. Leverage Federal Resources with Public-Private

 Partnerships. With the authority to enter into financial partnerships

with business and private non-profit entities, FNS can take advantage

of the potential connections between encouraging healthy dietary

behaviors and such efforts as promotion of American agricultural

products, mutually reinforcing both endeavors.

7. Invest in Improved Evaluation and Reporting for Nutrition

Education. A system for routinely collecting useful data to improve

the planning, management, and outcomes of nutrition education

activities should be developed and implemented. USDA should also

make ongoing investment in studies to supplement this reporting, and

should evaluate social marketing strategies and nutrition education

outcomes.

8. Invest in Nutrition Education for the General Population. FNS’

target populations are unlikely to improve their nutritional lifestyle if

the general population is not also making improvements. Federal

structures, in particular USDA’s Center for Nutrition Policy and

Promotion (CNPP), the Human Nutrition Coordinating Committee,

and HHS’s Nutrition Policy Board, are in place to provide

leadership; funding should be adequate to ensure that these efforts

make an impact in the context of broad environmental influences on

nutrition and physical activity.

Enhancing the nation’s investment in nutrition education represents a

prime opportunity to improve diets and promote good health. The

needed changes in nutrition behaviors can best be achieved through a

sustained, integrated, long-term nutrition education effort that:

• ensures program infrastructure and capacity to support delivery of

ongoing and multifaceted nutrition education to program

constituencies;

• makes nutrition education an integral component of all FNS

programs; and

• allows flexibility for integrated, cross-program interventions.
1

Promoting Healthy Eating: An Investment in the Future

A Report to Congress

Introduction This report fulfills the request from Congress accompanying

the Agriculture Appropriations Act for fiscal year 2000, P.L.

106-78, which directs the USDA Food and Nutrition Service

(FNS) to provide a report on a comprehensive, integrated

approach to nutrition education. In the request from

Congress, the Appropriations Committee:

“Directs the agency to prepare and submit a report to the

Committee no later than January 1, 2000 that describes a

comprehensive, integrated approach to nutrition

education as a complement to the various nutrition

assistance programs. Such a report should highlight the

aspects of current programs such as Team Nutrition, the

Nutrition Education and Training Program (NET) and

other school-based nutrition programs to be included in an

integrated program. The report should also identify gaps

in current programs and approaches as well as potential

funding sources and solutions. This report is to be

developed in close consultation with other government

agencies such as the Department of Education, Health and

Human Services, Centers for Disease Control and

Prevention and other organizations including the

American Dietetic Association, the Society for Nutrition

Education, the National Association of State NET

coordinators and the American School Food Service

Association.”
2

Development Process In accordance with Congressional direction, FNS consulted with

Federal health agencies and professional nutrition organizations in

developing this report. On November 4, 1999, FNS convened a

Nutrition Education Consultation Meeting to solicit input from the

government agencies and professional nutrition organizations

specified by Congress, as well as other partners. Background

materials on FNS nutrition education funding and activities were

provided to each attendee prior to the meeting. Attendees were

asked to identify :

• Opportunities for better coordination and integration of

nutrition education within and across programs;

• Needed improvements in the overall approach to nutrition

education for the FNS target populations;

• Barriers to implementing the improvements or capitalizing on

opportunities (include administrative, regulatory, funding and

other barriers); and

• Ideas for practical, innovative solutions.

This process provided excellent input on FNS nutrition education

issues from a range of experts in the field. Their ideas helped the

Agency in assessing the barriers and framing potential solutions,

as presented in this report.
3

The Importance of

Nutrition Education

The nation’s investment in nutrition assistance has been a critical

tool in fighting undernutrition and related health problems. Today,

it is well established that good nutrition is fundamental to proper

growth, development, health and performance. Diet is widely

recognized as a central component of health promotion and

disease prevention.

But while we have made progress in promoting food security and

fighting hunger, we face a continuing challenge in improving the

quality of the American diet. Poor nutrition and lack of physical

activity account for 300,000 deaths per year, second only to

tobacco as a cause of preventable mortality.1 The economic cost

of poor nutrition contributing to coronary heart disease, cancer,

stroke and diabetes—four of the ten leading causes of death—is

now $71 billion per year, and the growing childhood obesity

epidemic is likely to result in a dramatic increase in this cost over

time.1 Research also suggests that diets during pregnancy and

early childhood can have long-term impacts on child and adult

health. Consumption of a healthy diet in the early years is

essential for normal growth and development, and to prevent a

variety of nutrition-related health problems, such as irondeficiency anemia, growth retardation, malnutrition, compromised

cognitive achievement, obesity, dental caries, and chronic

diseases later in life.

Nutrition education is a key strategy for changing behaviors that

lead to reaching health goals. Research also confirms that

properly designed and implemented nutrition education

interventions, focusing on achieving behavioral change, can be

effective at improving diets and nutrition-related behaviors.3

Healthy People 2010 recognizes nutrition as an important factor

in the prevention of premature deaths from the chronic diseases

described above and sets numerous nutrition objectives including

an increase in the proportion of schools that provide nutrition

education in school curricula2.

 

1 McGinnis, MJ. and Foege, WH. Actual Causes of Death in the United States. JAMA, 270:2207-2212, 1993.

1

Frazao, Elizabeth. “High Costs of Poor Eating Patterns in the United States,” in E. Frazao (ed.) America’s Eating

Habits: Changes and Consequences. USDA Economic Research Service, 1999.

3 Contento, Isobel, “The Effectiveness of Nutrition Education and Implications for Nutrition Education Policy,

Programs, and Research: A Review of Research,” Journal of Nutrition Education, July, 1996.

2 Healthy People 2010 Objectives: Draft for Public Comment September, 1998.
4

State of Current

Nutrition Education

Services in FNS

Programs

FNS nutrition assistance programs touch the lives of one in six

Americans each year, making a tremendous difference in the lives

of children and low-income populations by promoting food

security and reducing hunger. These programs also represent an

extraordinary opportunity to reach participants with nutrition and

healthy lifestyle messages, particularly children who participate

during their formative years. As FNS programs successfully

increase the amount of nutritious food available to at-risk-groups,

they also hold a great, but largely untapped, potential to influence

food choices and support healthy eating and related nutrition

behaviors.

FNS has developed a variety of materials using the principles of

the Dietary Guidelines for Americans and the Food Guide

Pyramid for delivery of consistent, up-to-date messages to

support State and local efforts. Although materials may be made

available at cost across program lines, the materials have

generally been developed for use in specific programs. Resource

constraints limit the Agency’s ability to assure appropriate use of

the materials or integration into cross program efforts.

The Food Stamp Program (FSP) The Food Stamp Program enables low income families to

purchase nutritious foods at retail stores with coupons or

electronic-based benefits. There is no legislative mandate for

nutrition education, but States are encouraged to provide nutrition

messages that focus on reinforcing the link between food security

and a healthy diet by providing nutrition training, information and

material to eligible at-risk-households. States that have an

approved nutrition education plan can be reimbursed for 50

percent of State and local expenditures. Since fiscal year 1993,

the number of States with approved plans has risen from 7 to 46,

but programs vary widely in content and intensity. Most States

contract with USDA’s Cooperative Extension System for actual

delivery of nutrition education.

The Special Supplemental Nutrition

Program for Women, Infants, and

Children (WIC)

The WIC Program provides supplemental food, nutrition

education, and health care referrals to low-income pregnant,

breastfeeding and postpartum women, infants and children up to

age five who are at nutritional risk. Nutrition education services

are legislatively mandated, requiring that each State expend at

least 1/6 of its Nutrition Services and Administration funding on

nutrition education. An additional spending target is required for
5

breastfeeding promotion and support. States are required to

ensure that nutrition education is made available to all

participants. Federal and State program managers are currently

seeking to reinvigorate basic WIC nutrition education services

which did not receive as much developmental emphasis during the

rapid expansion of program participation and breastfeeding

promotion in the 1990’s.

Child Nutrition Programs (CN) The Child Nutrition Programs provide meals and snacks to the

nation’s children through the National School Lunch, School

Breakfast, Special Milk, Summer Food Service, After School

Snacks, and Child and Adult Care Food Programs. Nutrition

education in the Child Nutrition Programs is designed to be

supported through two complementary, integrated mechanisms --

the Nutrition Education and Training Program (NET) and

Team Nutrition. NET has provided support for the State and

local infrastructure to deliver nutrition education at schools and

child care settings participating in the Child Nutrition Programs.

Team Nutrition is a strategy for incorporating behavior-based

messages into new materials for use in NET and other

community-based initiatives that target children.

Team Nutrition develops the messages and materials, and

provides training to States. The NET Program funds the

State and local infrastructure to use these materials to

deliver nutrition education for children at the local level.

Team Nutrition establishes a national model that encourages

use of multiple, reinforcing channels of communication to reach

children and their caregivers with targeted nutrition education

messages. The NET staff and infrastructure have used

materials designed by Team Nutrition and begun to follow the

Team Nutrition communications strategy. Without the NET

Program, there is no delivery mechanism for either national

Child Nutrition initiatives like Team Nutrition or more localized

approaches and projects. Although NET continues to be

authorized at 50 cents per enrolled child to provide State

grants for the infrastructure needed to coordinate nutrition

education activities in CN Programs, no federal funding is

currently provided. A NET-like infrastructure continues to

exist only to the extent that States provide the funding.
6

The Food Distribution Program on

Indian Reservations (FDPIR)

The FDPIR Program provides supplemental foods to lowincome households living on Indian reservations and in

designated areas near reservations. FNS has identified

nutrition education as a high priority for FDPIR, given the high

incidence of diet-related health conditions among Native

Americans. Since 1993, a modest level of funding for FDPIR

nutrition activities has been established and used primarily to

hire and train nutrition education aides.

The Commodity Supplemental Food

Program (CSFP)

The CSFP provides pregnant women, new mothers, infants,

children up to age 6, and elderly people with nutritious USDA

commodity foods. CSFP has authorization to use

administrative funds for nutrition education, and such activities

are mandatory. In actual practice, the intensity and content of

nutrition education vary widely by locality.
7

Funding Disparities Figure 1 illustrates the wide variation in funding for nutrition

education between the various nutrition assistance programs.

The 1998 funding for FNS nutrition education totaled $324

million.

The varying level of program commitment and expenditure for

nutrition education per person is demonstrated in Figure 2.

Figure 2: FNS Nutrition Education Expenditures, 1998

Annual Average Per Person Federal Expenditures

2.11 1.60

24.34

15.94

0.18

$0

$5

$10

$15

$20

$25

Food Stamp

Program

Child Nutrition

WIC Nutrition

Education

WIC

Breastfeeding

Education and

Promotion

FDPIR

Dollars per person per year

Figure 1: Federal Funding for Nutrition Education by 

Program, 1998

Food Stamp State 

Administrative 

Expense- Nutrition 

Education**

13%

School Nutrition 

Programs (Team 

Nutrition + NET) 

3%

WIC Breastfeeding 

Promotion

18%

WIC (State nutrition 

education estimate)

66%
8

These funding disparities reflect the level of support for service

to the millions of participants served by the FNS programs.

Table 1 shows participation in major FNS programs in fiscal

year 1999. FNS estimates that approximately 1 out of every 6

Americans participates in at least one FNS program.

Table 1 : Fiscal Year 1999 Participation in Major

FNS Programs

 FNS Program Participation

(millions)

 Food Stamp Program (FSP) 18.2

 Child Nutrition Programs:

 National School Lunch Program

 (NSLP)

26.9

 School Breakfast Program (SBP) 7.3

 Child and Adult Care Feeding

 Program (CACFP)

2.6

 Summer Food Service Program

 (SFSP)

2.2

 Special Milk Program (SMP) 0.5

 Special Supplemental Nutrition

 Program for Women, Infants, and

 Children (WIC)

7.3

 Commodity Supplemental Food

 Program (CSFP)

0.4

 Food Distribution Program on Indian

 Reservations (FDPIR)

0.1

 Nutrition Program for the Elderly

 (NPE)

0.5
9

The Foundation for

Coordinated Nutrition

Education

USDA has long recognized the importance of nutrition

education and the need to develop new strategies as food

products, life styles and eating habits change. The 1996 State

of Nutrition Education at USDA: A Report to the

Secretary describes a comprehensive approach to nutrition

education for the Department.3 It states USDA's overall goal

for nutrition education as :

"To provide an integrated nutrition

education program that contributes

to a nutritionally knowledgeable

public, motivated to make

behavioral change(s) to promote

optimal health and nutritional

status."

While all 14 recommendations from the 1996 report are

applicable to FNS efforts (see Figure 3), the third is the most

directly relevant to this report: "Put Nutrition Education into

All USDA Food Programs." To respond to the

recommendations, FNS has expanded work with its State

partners in five major areas:

• It has reframed the FNS programs as "nutrition assistance

programs" to emphasize the importance of nutrition as an

essential component of the programs.

• It has strengthened nutrition services within the agency by

placing at least one qualified nutritionist in each of the four

major program areas (Food Stamps, Child Nutrition, WIC

and Food Distribution), and restructuring a technical

nutrition group into a core nutrition unit located in a staff

office that reports to the agency head. This core nutrition

unit has responsibility for coordinating nutrition education

policy across all FNS programs, and coordinating FNS

nutrition education with other nutrition education providers.

 

3

The State of Nutrition Education in USDA: A Report to the Secretary. Submitted to the Secretary by the State of Nutrition

Education in USDA working group. Facilitator/Coordinator: Center for Nutrition Policy and Promotion. October 1996.
10

• It has revised its strategic plan to consolidate nutrition

objectives for all FNS programs under a single goal, with

measurable indicators of nutrition improvement by FNS

target populations.

• It has worked actively with State partners and the

Cooperative Extension System to leverage Federal funding

with increased State contributions for nutrition education

for the Food Stamp-eligible low-income population.

• It has encouraged adoption of the Team Nutrition

behavior-based strategies in the Child Nutrition Programs

by developing new materials, providing training grants to

states, evaluating pilot communities, and developing a

multi-state demonstration project.
11

Figure 3: State of Nutrition

Education in USDA: A Report to the Secretary

Recommendations for Consideration

1. Make nutrition education a priority.

2. Reach out to all Americans.

3. Put nutrition education into all USDA food programs.

4. Link with constituencies.

5. Nurture partnerships and coalitions.

6. State behavioral change as an objective.

7. Evaluate all projects.

8. Refocus training.

9. Refocus research.

10. Make information on USDA’s nutrition education

activities electronically accessible.

11. Follow-up with reports.

12. Publish and share project information.

13. Sponsor cross-program meetings.

14. Explore alternative financing.
12

While the critical advances in nutrition education described

above represent necessary prerequisites for a comprehensive

integrated approach, more needs to be done to achieve the

integration necessary to realize the desired health outcomes.

Facing Challenges,

Breaking Down

Barriers, Building on

Strengths

Drawing upon the input from a wide range of nutrition

education experts, FNS identified a set of gaps and barriers

that, if properly addressed, could make significant progress in

promoting healthy eating and other nutrition-related behaviors

among the FNS target populations. In general, these key gaps

and barriers relate to two broad areas: 1) legislative authority

designating nutrition education as a benefit in all nutrition

assistance programs, and 2) the need for stable resources to

maintain infrastructure and update program activities in

response to changes in technology and client needs.

It is important to recognize in any discussion of challenges, the

fundamental impact of the external environment on any social

marketing effort, particularly a nutrition education strategy.

Advertising and fast food enterprises, coupled with the

financial and time constraints in family life, have a very

powerful effect on the eating and physical activity habits of the

American population. Food manufacturers now invest more in

a single year on commercial promotions of sales of food

products, $7 billion6 , than the government has invested in

nutrition education since creation of the Dietary Guidelines

for Americans in 1980. It is unrealistic to expect consumer

behavior to be consistent with national nutrition goals in an

environment that provides a barrage of messages that

encourage behavior inconsistent with these goals.

No combination of demonstration projects or transient

interventions can succeed in achieving and sustaining the

lifelong behavioral changes needed to ensure good nutrition.

An ongoing investment that reinforces the importance of

nutrition education is essential to counter the external

environment, and lessen the impact of constraints in people’s

personal lives that have been moving the general population

 

6 Gallo, Anthony. “Food Advertising in the United States,” in E. Frazao (ed.) America’s Eating Habits: Changes and

Consequences. USDA Economic Research Service, 1999.
13

towards a less nutritious eating pattern and less active lifestyle.

Legislative Authority Nutrition education should be clearly incorporated into

the legislative requirements for each FNS program.

Each FNS program has a different nutrition education

legislative authority and funding stream. WIC is the only major

program that authorizes nutrition education as an actual

program benefit. It is important to make nutrition education an

integral benefit of all FNS programs. Such a change would

have particular impact on the Food Stamp, Child Nutrition and

household commodity program participants, and could result in

declines in health care costs.

Resources Flexible funding authority and a dependable funding

stream for nutrition education are needed to support

planning, program delivery, integration of services and

the ability of the Federal government to provide

leadership and technical support.

Stable funding holds great potential to support and strengthen

an effective long-term comprehensive, integrated approach to

nutrition education, and is essential to fostering partnerships at

the State and local levels. The Child Nutrition Programs serve

more participants than any other FNS program, but uneven

funding and severe drops in funding from year to year,

particularly in the NET Program, have decreased the capacity

of USDA, States, and local agencies to deliver effective

nutrition education to children.

State and local infrastructures must be developed to

deliver integrated, comprehensive programs.

Without dependable or sustainable funding for NET, the

Federal, State, and local infrastructure necessary for the

delivery of Team Nutrition strategies for children, their parents,

teachers, food service personnel, school administrators,

community partners and local media, is left to the discretion

and expense of State agencies. The effectiveness and longterm success of Team Nutrition depends on a stable

infrastructure for nutrition education delivery.

In addition, a central point is required in each State with
14

responsibility for cross–program coordination of nutrition

education efforts. Because FNS nutrition assistance programs

are administered by various State agencies, coordination and

collaboration among agencies is a vital requirement for longterm development of an integrated approach.

The evaluation system for FNS nutrition education is

fragmented and minimal, and lacks outcome measures.

Planning of effective nutrition education interventions in the

short- and long-term depends on adequate and reliable data to

determine which program components over time are successful

in producing improvements in nutrition and food behaviors and

related outcomes. The importance of strong evaluation to

nutrition education success was a key conclusion of a 1995

FNS conference, “Charting the Course for Evaluation: How

Do We Measure the Success of Nutrition Education and

Promotion in Food Assistance Programs?”. The ability to

conduct evaluations is continually challenged by limits on funds

allocated for that purpose.
15

FNS Nutrition

Education: Creating a

Healthier America

Promoting healthy eating and nutrition-related behavior is the

central goal of improved nutrition. The programs administered

by the FNS represent a vitally-important mechanism for

improving the Nation’s nutrition practices. These Programs are

targeted to populations experiencing a disproportionate share of

diet-related problems, and often facing disadvantages, including

barriers to the educational resources that support behavior

change, Federal nutrition assistance offers one of the Nation’s

best opportunities to improve dietary practices in ways that

promote health and well-being.

FNS Nutrition Education Objective

“Nutrition Education is fully integrated into all FNS

Programs and provides consistent nutrition messages that

encourage and motivate target groups to make healthy food

and nutrition-related choices throughout the life cycle.”

Achieving success in this area, however, is not easy. FNS and

its partners must identify and support the most effective

educational strategies available, and must recognize the unique

role and structure of these programs in improving the nutritional

status of those they serve. FNS’s objective for nutrition

education is to make use of the programs’ ability to reach those

most in need, and to reach them with state-of-the-art nutrition

education interventions that can effectively change behavior.

Making this objective a reality requires attention to the following

principles:

Successful education interventions are based on models of

behavior change that recognize the influence of multiple

factors—personal factors (attitudes and values), and

environmental influences (family, workplace, school, grocery

stores, community and mass media)—on behavioral choices.

Nutrition intervention can be successful only by taking into

account the complexity of these influences, and using a

combination of strategies from each level of influence to produce

lasting behavior change.

Team Nutrition is an example of an FNS nutrition intervention

strategy targeted for school-aged children based on these

behavior-oriented strategies. The approach encompasses six

communications channels, including: 1) food service initiatives
16

which provide training and technical assistance for CN food

service professionals to help them serve healthier meals, 2)

classroom activities which incorporate nutrition education into

the school curriculum, 3) reinforcing messages sent home to

parents, 4) involvement of the entire school and school

environment in healthy, active events, 5) involvement of the

community in nutrition-related events, and 6) media coverage

and message development.

The Evaluation of the Nutrition Education and Training Program

indicated that NET was successful in increasing children’s

acceptance of nutritious foods, improving teachers’ knowledge

of the principles and practices of nutrition education and using

the school dining room as a learning laboratory for nutrition

education. The area where NET was found to fall short was a

continuing need for curricula and materials with a

multidisciplinary focus involving teachers, food service personnel

and administrators.7 Team Nutrition has allowed FNS to

address this shortcoming. The multidisciplinary strategy of Team

Nutrition has recently demonstrated positive impacts on

students’ eating behavior.8

Team Nutrition develops messages, materials, and policies

consistent with current scientific theories on nutrition

communication and behavior change. These are made available

to the NET staff and other partners for delivery to the target

audiences throughout the country. Institutionalization of Team

Nutrition to reach schools and communities depends on training

and support at the State and local levels through infrastructure

provided by the NET program.

Successful efforts must reach their target populations with

sustained interventions over the long-term. Nutrition and

health specialists recognize that the development, maintenance,

and change of eating patterns are determined not only by

individual factors but also by many social, cultural, and

environmental influences.9

Therefore, achievement of a comprehensive, integrated nutrition

education approach requires long-term efforts. Nutrition

 

7

St. Pierre, Robert. An Evaluation of the Nutrition Education and Training Program. Abt Associates, 1981.

8 USDA Food and Nutrition Service. The Story of Team Nutrition: Pilot Study Outcome Report. 1998.

9

 Owen, A.L.; Splett, PL; Owen, GO; Nutrition in the Community: The Art and Science of Delivering Services; 4

th

Edition, McGraw-Hill. 1998.
17

education, like other forms of education, must be ongoing,

continuous and sustainable as nutrition science changes and the

target population evolves.

Key among the components of a comprehensive approach is

sustained and sufficient funding. In addition to the current

funding of FNS nutrition education (including the School Meals

Initiative/Team Nutrition), a continued flow of sufficient funding

is needed to support State infrastructure, program development

and a social marketing campaign disseminating consistent

messages. To be effective, the investment must support longterm repeated exposure through multiple channels to reinforce

behaviorally-focused messages at an intensity that can

reasonably compete in the marketplace. Partnerships with

private industry can help leverage the investment, and an

organized structure of agencies (Federal, State and local) is

required to foster interagency collaboration and partnerships to

ensure adoption and continued application of these strategies.

To be successfully integrated into nutrition assistance

programs, nutrition education efforts must take advantage

of the layered structure of these programs.

Educational activities must be designed to take full advantage of

the differing roles of local, State, and Federal agencies in

administering and delivering quality programs. States are

positioned to identify State and local needs, foster interagency

collaborations, and support local service capacity and quality

assurance. Since FNS programs are administrated by various

agencies within each State, coordination is vital to promoting an

integrated approach.

Support of statewide planning and coordination would facilitate

development of long-term, coordinated nutrition education plans,

and sustainable infrastructures, for FNS programs that carry

messages from the national level to the community level and

address unique State and local issues. State officials, and/or

State Coordinating Councils, should be identified to provide

leadership and a process for cross-program coordination among

FNS-sponsored programs, as well as foster cooperation and

collaboration with other Federal and State initiatives.
18

Creating an

Environment for

Change

Improving the design and delivery of nutrition education holds

great potential for achieving significant improvement in dietary

practices for FNS program participants. The consultations

FNS initiated with key stakeholders generated many creative

and practical ideas that we can and will incorporate into our

current program strategies. However, the most meaningful

changes and improvements must come through strengthening

the policy foundations for nutrition education, and securing

more sustained resource commitments. Therefore, the

potential solutions in this report focus on these areas.

Potential Solutions 1. Develop a Funding Mechanism that Supports

Sustained Nutrition Education for all Programs.

Adequate infrastructure and capacity at the Federal, State and

local levels is critical for agencies to plan, develop and

implement comprehensive and integrated nutrition education

interventions. These efforts must go beyond organizational

issues to build fiscal, technical, programmatic and structural

capacity. Of the four major FNS program categories--Food

Stamps, WIC, Child Nutrition and Commodities-- the latter

two would particularly benefit from increased nutrition

education funding relative to the size of the food benefits

provided and populations served.

One important component of an effective funding structure is

to restore the appropriation for NET, and increase its

authorization level to reflect inflation since the 1977

authorization. Over the last 10 years, the inconsistency of

NET funding levels has complicated the coordination and long

term planning of nutrition education services. While Team

Nutrition has made available many creative nutrition education

resources to State and local government, implementation is

limited. Stakeholders have indicated that full implementation of

these programs requires restoration of stable NET Program

funding needed to support State and local infrastructure.

Without the infrastructure supported by NET, States face

diminished capacities to conduct programs and to perform the

vital leadership functions of assessment; policy development

and quality assurance needed to promote implementation.

2. Authorize Funding for Cross-Program Coordination.
19

Authorize funding and allow flexibility at the Federal level for

pooling a small portion of program resources to support crossprogram, integrated initiatives. Such flexibility would give FNS

an opportunity to structure a cross-program framework for

nutrition education including support materials, technical

assistance and training. This funding and flexibility would

facilitate effective cross-program coordination to reach the

target population where they live, work, learn, and play, and

motivate partners to maintain high-quality nutrition education

components within and across FNS-sponsored programs for

children and families.

Authorize and fund FNS to provide grants to State agencies,

including Indian Tribal Organizations (ITOs) and Territories, to

facilitate development of long-term coordinated nutrition

education plans (5 years), and to permit ongoing coordination

of messages from the national effort to the State and local

agencies and their partners.

3. Clearly authorize use of FNS program nutrition

education funds for efforts directed towards the FNS

target populations.

Eligible individuals cycle into and out of program participation,

making sustained efforts offered to participants alone

problematic. Accordingly, legislation should clearly authorize

use of a limited amount of the FNS program funds for nutrition

education directed at the FNS target population, rather than

restrict efforts to active program participants. This flexibility

would allow State and local agencies to employ multilevel and

multifaceted nutrition education approaches directed to the

children and low-income groups served by FNS programs.

Furthermore, such flexibility would foster more

comprehensive, community-based approaches that could have

a multiplying effect by generating local and private support.

The current authorizing legislation for nutrition education in

FNS programs varies in specific wording and intent across the

programs. For example, WIC legislation requires that at least

1/6 of the funding for nutrition services and administration be

spent on nutrition education for the WIC-eligible population

and requires offering of nutrition education to participants.
20

CSFP mandates nutrition education, but does not specify a

minimum funding level. In other programs the provision of

nutrition education is discretionary. Child Nutrition Programs

allow use of the funding for State Administrative Expense

(SAE) for nutrition education, and authorize funding for the

Nutrition Education and Training Program (NET) and the

School Meals Initiative (SMI). However, with limited SAE

funding and without an appropriation for NET, actual

expenditures are largely limited to the SMI funding. Food

Stamp Program (FSP) legislation allows for FNS to reimburse

State and local expenditures at 50% of their cost for nutrition

education for the FSP target population.

A review of the existing legislative authority and program

performance history of interactions with State and local

partners indicates that funding incentives and increased

flexibility in using authority to support an integrated approach

can greatly foster the commitment and support needed for

nutrition education.

4. Expand Reach of Nutrition Education by Offering

State Incentives.

Authorize FNS to reimburse 50% of State and local

expenditures for targeted nutrition education (50:50

Federal/non-Federal match) to provide incentives to expand

nutrition education services above and beyond current State

and local initiatives. Experience demonstrates that FederalState-Local funding partnerships can increase the investment in

nutrition education and spur private contributions as evidenced

by the growth of State agency Nutrition Plans with the Food

Stamp Program shared Federal/non-Federal investment.

Matching funding would also help to expand the reach of

nutrition education services to effect behavior change in the

FNS target populations.

5. Authorize Grants for Nutrition Education Focusing

on Special Populations.
21

While integrated cross-program strategies are necessary to

improve diets across eligible populations, some populations

face dietary problems and needs that require more specialized

intervention. This investment would represent a commitment

to a healthier America in the Twenty- First Century and the

National Healthy People 2010 goal of eliminating health

disparities in ethnically, economically, and culturally diverse

special populations.10 In addition, these resources would

promote development of innovative approaches, provide

additional support for capacity building activities, as well as

ongoing operational and evaluation costs required to ensure

delivery and coordination of high quality approaches.

6. Leverage Federal Resources with Public-Private

 Partnerships.

By offering opportunities for collaboration and multiplying the

impact of scarce Federal resources, partnerships with the

business and private non-profit communities hold great

potential to broaden the reach and increase the effectiveness

of Federal nutrition education efforts.

Providing FNS with the authority to enter into financial

partnerships with business and private non-profit entities can

allow the Agency to take advantage of the potential

connections between encouraging healthy dietary behaviors

and such efforts as promotion of American agricultural

products, mutually reinforcing both endeavors.

7. Invest in an Improved System of Evaluation and

Regular Reporting for Nutrition Education.

FNS should take the lead in working with the State and local

agencies in all of the FNS programs and other experienced

partners to develop and implement a system for routinely

collecting useful data to improve the planning, management,

and outcomes of nutrition education activities. USDA should

plan for ongoing investment in studies to support and improve

the reporting effort, and to evaluate social marketing strategies

and the outcomes of FNS nutrition education.

 

10 Healthy People 2010 Objectives: Draft for Public Comment: September, 1998
22

8. Invest in Nutrition Education for the General

Population

Stated simply, people tend to “go with the flow.” The target

population of the FNS programs cannot reasonably be

expected to improve their nutritional lifestyle if the trend for

the general U.S. population is not also towards significant

improvement. Federal structures, in particular the USDA

Center for Nutrition Policy and Promotion (CNPP), the

USDA Human Nutrition Coordinating Committee and the

HHS Nutrition Policy Board, are in place to provide

leadership in this effort. However, adequate Federal funding

for nutrition education for the general population is an

essential component of an overall strategy that supports

dietary improvements for those served by FNS programs.

Such funding should be provided at a level that can make a

real impact in the context of today’s food marketplace and

other broad environmental influences on nutrition and physical

activity.
23

A Sustained

Nutrition Education

Effort is Needed

Enhancing the nations investment in nutrition education

represents a prime opportunity to promote food security,

avoid preventable deaths, eliminate nutrition-related health

disparities, and reduce the potential societal cost of the

obesity epidemic. The needed changes in nutrition behaviors

can only be achieved through a sustained, integrated, longterm nutrition education effort that:

ß ensures program infrastructure and capacity at all levels

to support delivery of ongoing and multifaceted nutrition

education to program constituencies;

ß makes nutrition education an integral component of all

FNS programs; and

ß allows flexibility for integrated, cross-program

interventions.