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IMPROVING CHILDREN’S HEALTH: 

STRENGTHENING FEDERAL 

CHILD NUTRITION PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON 

EDUCATION AND LABOR 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

HEARING HELD IN WASHINGTON, DC, MARCH 2, 2010 

Serial No. 111–47 

Printed for the use of the Committee on Education and Labor 

( 

Available on the Internet: 

http://www.gpoaccess.gov/congress/house/education/index.html 
(II) 

COMMITTEE ON EDUCATION AND LABOR 

GEORGE MILLER, California, Chairman 

Dale E. Kildee, Michigan, Vice Chairman 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Rau ́l M. Grijalva, Arizona 

Timothy H. Bishop, New York 

Joe Sestak, Pennsylvania 

David Loebsack, Iowa 

Mazie Hirono, Hawaii 

Jason Altmire, Pennsylvania 

Phil Hare, Illinois 

Yvette D. Clarke, New York 

Joe Courtney, Connecticut 

Carol Shea-Porter, New Hampshire 

Marcia L. Fudge, Ohio 

Jared Polis, Colorado 

Paul Tonko, New York 

Pedro R. Pierluisi, Puerto Rico 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Dina Titus, Nevada 

Judy Chu, California 

John Kline, Minnesota, 

Senior Republican Member 

Thomas E. Petri, Wisconsin 

Howard P. ‘‘Buck’’ McKeon, California 

Peter Hoekstra, Michigan 

Michael N. Castle, Delaware 

Mark E. Souder, Indiana 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Joe Wilson, South Carolina 

Cathy McMorris Rodgers, Washington 

Tom Price, Georgia 

Rob Bishop, Utah 

Brett Guthrie, Kentucky 

Bill Cassidy, Louisiana 

Tom McClintock, California 

Duncan Hunter, California 

David P. Roe, Tennessee 

Glenn Thompson, Pennsylvania 

Mark Zuckerman, Staff Director 

Barrett Karr, Minority Staff Director 
(III) 

C O N T E N T S 

Page 

Hearing held on March 2, 2010 .............................................................................. 1 

Statement of Members: 

Kline, Hon. John, Senior Republican Member, Committee on Education 

and Labor ...................................................................................................... 4 

Prepared statement of ............................................................................... 5 

Miller, Hon. George, Chairman, Committee on Education and Labor ......... 1 

Prepared statement of ............................................................................... 3 

Questions submitted for the record ......................................................... 55 

Shea-Porter, Hon. Carol, a Representative in Congress from the State 

of New Hampshire, submission for the record: 

Issue brief, ‘‘Federal Child Nutrition Programs Are Important to 

Rural Households,’’ from the Carsey Institute .................................... 50 

Statement of Witnesses: 

Gettman, Lucy, director of Federal programs, National School Boards 

Association ..................................................................................................... 29 

Prepared statement of ............................................................................... 31 

Morrison, Carolyn, president, National CACFP Forum; executive director, 

Child Care Development Services ............................................................... 13 

Prepared statement of ............................................................................... 15 

Rivas, Dora, president, School Nutrition Association (SNA); executive 

director, Food and Child Nutrition .............................................................. 7 

Prepared statement of ............................................................................... 9 

Response to questions submitted for the record ..................................... 56 

Saluja, Kiran, MPH, RD, deputy director, PHFE WIC Program ................. 20 

Prepared statement of ............................................................................... 22 

(1) 

IMPROVING CHILDREN’S HEALTH: 

STRENGTHENING FEDERAL 

CHILD NUTRITION PROGRAMS 

Tuesday, March 2, 2010 

U.S. House of Representatives 

Committee on Education and Labor 

Washington, DC 

The committee met, pursuant to call, at 2:35 p.m., in room 2175, 

Rayburn House Office Building, Hon. George Miller [chairman of 

the committee] presiding. 

Present: Representatives Miller, Kildee, Scott, McCarthy, Wu, 

Holt, Loebsack, Shea-Porter, Fudge, Polis, Sablan, Chu, Kline, 

Petri, and Roe. 

Staff Present: Aaron Albright, Press Secretary; Ali Al Falahi, 

Staff Assistant; Tylease Alli, Hearing Clerk; Andra Belknap, Press 

Assistant; Calla Brown, Staff Assistant, Education; Jody Calemine, 

General Counsel; Carlos Fenwick, Policy Advisor; Patrick Findlay, 

Investigative Counsel; Denise Forte, Director of Education Policy; 

David Hartzler, Systems Administrator; Kara Marchione, Education Policy Advisor; Sadie Marshall, Chief Clerk; Alex Nock, Deputy Staff Director; Lillian Pace, Policy Advisor, Subcommittee on 

Early Childhood, Elementary and Secondary Education; Meredith 

Regine, Junior Legislative Associate, Labor; Alexandria Ruiz, Administrative Assistant to Director of Education Policy; Melissa 

Salmanowitz, Press Secretary; Gabrielle Serra, Detailee, Child Nutrition; Dray Thorne, Senior Systems Administrator; Daniel Weiss, 

Special Assistant to the Chairman; Kim Zarish-Becknell, Policy Advisor, Subcommittee on Healthy Families and Communities; Stephanie Arras, Minority Legislative Assistant; James Bergeron, Minority Deputy Director of Education and Human Services Policy; Kirk 

Boyle, Minority General Counsel; Allison Dembeck, Minority Professional Staff Member; Ryan Murphy, Minority Press Secretary; 

Susan Ross, Minority Director of Education and Human Services 

Policy; and Linda Stevens, Minority Chief Clerk/Assistant to the 

General Counsel. 

Chairman MILLER. A quorum being present, the committee will 

come to order to conduct a hearing on Improving Children’s Health: 

Strengthening the Federal Child Nutrition Programs. 

I want to welcome our witnesses and thank you for taking your 

time to be with us. I am going to introduce you in a moment. But 

first we are going to have opening statements by myself and by 

Representative Kline. 
2 

The statement starts out saying ‘‘This morning,’’ so we will 

change it right away to say, This afternoon, we will examine how 

stronger nutrition programs can help fight the childhood obesity 

epidemic and help improve our students’ learning and health. 

Today, almost one in three children are obese. Childhood obesity 

affects all aspects of children’s lives from their physical well-being 

to their academic success to their self-confidence. The health of our 

children should be the top national priority. 

As many of you know, First Lady Michelle Obama recently announced that ending childhood obesity will be her first major policy 

initiative. Last month she launched the Let’s Move! Campaign to 

ensure that children born today will grow up as healthy adults. Mr. 

Kline and myself were both at the White House when she met with 

the bipartisan group on what contributions we might make as we 

consider the reauthorization. By offering a realistic goal of making 

children healthier and more active within a generation, she has set 

the stage for dramatic improvement. 

To help achieve this goal, her initiative contains four key pillars: 

getting parents more involved and informed about nutrition and 

exercise; making healthy foods more accessible and affordable; increasing attention to physical activity; and improving the quality of 

food in the school meal programs. 

The first lady and I both know that the government alone can 

not curb this epidemic. Individuals, families, communities, and the 

private sector all share responsibility. I welcome her involvement 

and look forward to working with her on this initiative. 

This committee can play a key role in this effort, and today’s 

hearing provides an opportunity to hear from stakeholders. For 

over 60 years, the child nutrition programs have helped families 

who have struggled with the choices of putting food on the table 

or paying another bill. The School Lunch and School Breakfast Programs and the Child and Adult Care Food Program and the WIC 

Program have provided a nutritional safety net for these families, 

serving nearly 45 million individuals across the country. 

Studies show that pregnant women who participate in the Womens, Infants, and Children Program have healthier pregnancies and 

healthier babies. Studies have also shown that low-income women 

are less likely to breastfeed than high-income mothers. Thanks to 

Federal, State and local efforts, the WIC Program has improved 

breastfeeding rates among WIC mothers in this population. 

The Child and Adult Care Food Program also provides critical 

nutritional support to young children. This program helps make 

nutritious meals and snacks possible for 3 million children in childcare centers, family child-care homes, Head Start and after-school 

programs. 

The meals children receive in these programs are more nutritious 

and well-balanced than in other child-care programs. Despite this 

success, the tough economic times, and the paperwork requirements, have forced some sponsors to make the difficult decision to 

stop administering this program. 

In South Central L.A., one of the highest risk areas of hunger 

and obesity in California, no organization was able to sponsor this 

program this year. We will go into some detail on that during the 
3 

question period. As a result, more than 5,000 low-income young 

children lost access to healthy meals and snacks. 

If we are serious about improving children’s health, we will have 

to make these programs and other critical sources of nutrition a 

priority. But the discussion doesn’t end there. 

As the First Lady said, we must also consider the role schools 

play in providing children with nutrition that meets the requirements to promote academic achievement. We expect children to 

come to school prepared to learn, but studies show that hunger and 

poor nutrition can be major barriers to their success. 

Our work to reauthorize the child nutrition programs presents a 

great opportunity to change the way children eat, to expand their 

access to nutritional meals, and to end the child hunger crisis in 

our country. We must ensure that schools have the support they 

need to provide high-quality meals, and safe meals, so that children can make healthy choices. We must ensure that all eligible 

children can access these programs by removing barriers families 

face when enrolling in the school meal programs, like confusing application forms. 

Today we will learn more about the work that lies ahead to provide all children with the healthy, nutritious, and safe meals they 

need to lead healthy and successful lives. I want to thank our witnesses for joining us today, and I look forward to hearing your testimony. 

Now I would like to recognize Mr. Kline, the senior Republican, 

for the purposes of an opening statement. 

[The statement of Mr. Miller follows:] 

Prepared Statement of Hon. George Miller, Chairman, 

Committee on Education and Labor 

Good Morning. 

This morning we’ll examine how stronger nutrition programs can help fight the 

childhood obesity epidemic and help improve our students’ learning and health. 

Today, almost one in three children are obese. 

Child obesity affects all aspects of children’s lives from their physical well-being, 

to their academic success to their self-confidence. 

The health of our children should be a top national priority. 

As many of you know, the First Lady, Michelle Obama, recently announced that 

ending childhood obesity will be her first major policy initiative. 

Last month, she launched the ‘‘Let’s Move’’ campaign to ensure that children born 

today will grow up to be healthy adults. 

By offering a realistic goal of making children healthier and more active within 

a generation, she has set the stage for dramatic improvements. 

To help achieve this goal, her initiative contains four key pillars: 

• Getting parents more involved and informed about nutrition and exercise; 

• Making healthy foods more accessible and affordable; 

• Increasing attention to physical activity; and 

• Improving the quality of food in the school meal programs. 

The First Lady and I both know that the government alone cannot curb this epidemic. 

Individuals, families, communities and the private sector all share responsibility. 

I welcome her involvement and look forward to working with her on this initiative. 

This committee can play a key role in this effort and today’s hearing provides an 

opportunity to hear from stakeholders. 

For over sixty years, the child nutrition programs have helped families who have 

struggled with the choices of putting food on the table or paying another bill. The 

school lunch and school breakfast program, the Child and Adult Care Food Program, 

and the WIC program have been a nutritional safety net for these families—serving 

nearly 45 million individuals across the country. Studies show that pregnant women 

who participate in WIC have healthier pregnancies and healthy babies. 
4 

Studies have also shown that low-income women are less likely to breastfeed than 

higher-income mothers. But thanks to federal, state and local efforts, the WIC program has improved breastfeeding rates among WIC mothers in this population. 

The Child and Adult Care Food Program also provides critical nutrition support 

to young children. This program helps make nutritious meals and snacks possible 

for three million children in child care centers, family child care homes, Head Start 

and after-school programs. 

And we know that that the meals children receive in these programs are more 

nutritious and well-balanced than in other child care programs. But despite its success, tough economic times and paperwork requirements have forced some sponsors 

to make the difficult decision to stop administering this program. 

For example, in South Central Los Angeles, one of the highest-risk areas for hunger and obesity in California, no organization was able to sponsor this program last 

year. 

As a result, more than 5,000 low income young children lost access to healthy 

meals and snacks. If we are serious about improving children’s health, we have to 

make these programs, and other critical sources of nutrition, a priority. 

But the discussion doesn’t end there. 

As the First Lady has said, we must also consider the role schools play in providing children with healthy meals and environments that promote academic 

achievement. 

We expect children to come to school prepared to learn. 

But studies show that hunger and poor nutrition can be major barriers to their 

success. 

Our work to reauthorize our child nutrition programs presents a great opportunity to change the way children eat, to expand their access to nutritious meals 

and to end the child hunger crisis in our country. 

We must ensure that schools have the support they need to provide high-quality 

and safe meals so kids can make healthy choices. 

We must also ensure that all eligible children can actually access these programs 

by removing barriers families face when enrolling in the school meal programs, like 

confusing application forms. 

Today we will learn more about the work that lies ahead to provide all children 

with the healthy, nutritious and safe meals they need to lead healthy and successful 

lives. 

I want to thank our witnesses for joining us today. I look forward to hearing their 

testimony. 

Mr. KLINE. Thank you, Mr. Chairman, and good afternoon to all. 

Welcome to our witnesses. 

Today we will examine Federal child nutrition programs with an 

eye toward improving children’s health. Childhood obesity rates are 

a serious concern for parents and families, and they present a challenge to the health of our Nation as a whole. What children eat at 

school certainly plays a role in their overall nutrition. So I welcome 

this opportunity to look at what parents and local schools are doing 

to promote healthy eating habits. 

The last time we reauthorized the Federal nutrition programs, 

Congress called on school districts to establish local wellness policies as a way to promote good health and engage parents in a discussion about nutrition and physical activity. In fact, it was my 

friend, Mike Castle, who took the lead on addressing children’s 

health with these local wellness policies. Local policies are the most 

direct and responsive strategy for promoting healthy eating habits 

at home and at school. They allow schools to get buy-in and involvement from parents and students. They account for demographic and economic differences as well as local food preferences. 

And they avoid the dangers of a one-size-fits-all Federal approach 

to school menu planning. 

Of course, the School Breakfast and Lunch Programs are not the 

only initiatives to support child nutrition. When Congress reauthor-
5 

izes child nutrition programs, we will also look at the Child and 

Adult Care Food Program and the Women, Infants and Children 

program, commonly known as WIC. Together these programs help 

combat hunger and promote nutrition through meals, education, 

and subsidies to low-income Americans. Our goal in renewing these 

programs should to be strike the appropriate balance between Federal support and local leadership. 

With local wellness policies and other initiatives, school districts 

are exploring a broad range of policies to promote better health and 

combat hunger. I would caution as we prepare to renew and extend 

these programs, that we not confuse support for a healthy school 

environment with Federal mandates for what children and their 

families are allowed to eat. 

One report from the Institute of Medicine concluded that radical 

changes might actually undermine participation in the School 

Lunch Program, saying, ‘‘If school children are not satisfied with 

the taste of food served in school meals, participation in the school 

meal programs is likely to decrease.’’ That is not to say that school 

meals should not be nutritious; but ultimately, good health habits 

begin at home. That is why it is important for local schools to have 

the flexibility to work with parents to develop policies that work for 

their students. 

Local schools also need the flexibility to determine what food is 

sold outside the cafeteria. Many schools are voluntarily including 

healthy snacks in their vending machines or at extracurricular 

events, but ultimately it is local control over food policy that allows 

for innovation while still responding to each school’s unique circumstances. 

We have all heard the outrageous stories in which a piece of banana bread at a bake sale does not meet the nutritional standards, 

but a bag of chips meets the requirements. Clearly, arbitrary nutritional mandates can backfire when they override common sense. I 

hope we will keep these cautionary tales in mind as we explore 

how parents and local schools can improve children’s health. 

Thank you Mr. Chairman. I yield back. 

[The statement of Mr. Kline follows:] 

Prepared Statement of Hon. John Kline, Senior Republican Member, 

Committee on Education and Labor 

Thank you Chairman Miller, and good afternoon. Today we will examine federal 

child nutrition programs with an eye toward improving children’s health. Childhood 

obesity rates are a serious concern for parents and families, and they present a challenge to the health of our nation as a whole. What children eat at school certainly 

plays a role in their overall nutrition, so I welcome this opportunity to look at what 

parents and local schools are doing to promote healthy eating habits. 

The last time we reauthorized the federal nutrition programs, Congress called on 

school districts to establish local wellness policies as a way to promote good health 

and engage parents in a discussion about nutrition and physical activity. In fact, 

it was Representative Mike Castle who took the lead on addressing children’s health 

through these local wellness policies. 

Local policies are the most direct and responsive strategy for promoting healthy 

eating habits at home and at school. They allow schools to get buy-in and involvement from parents and students. They account for demographic and economic differences, as well as local food preferences. And they avoid the dangers of a one-sizefits-all federal approach to school menu planning. 

Of course, the school breakfast and lunch programs are not the only initiatives 

to support child nutrition. When Congress reauthorizes child nutrition programs, we 

will also look at the Child and Adult Care Food Program and the Women Infants 
6 

and Children program, commonly known as WIC. Together, these programs help 

combat hunger and promote nutrition through meals, education, and subsidies to 

low-income Americans. 

Our goal in renewing these programs should be to strike the appropriate balance 

between federal support and local leadership. With local wellness policies and other 

initiatives, school districts are exploring a broad range of policies to promote better 

health and combat hunger. 

I would caution as we prepare to renew and extend these programs that we not 

confuse support for a healthy school environment with federal mandates for what 

children and their families are allowed to eat. One report from the Institute of Medicine concluded that radical changes might actually undermine participation in the 

school lunch program, saying ‘‘If schoolchildren are not satisfied with the taste of 

foods served in school meals, participation in school meal programs is likely to decrease.’’ 

That is not to say that school meals should not be nutritious. But ultimately, good 

health habits begin at home. That’s why it is important for local schools to have 

the flexibility to work with parents to develop policies that work for their students. 

Local schools also need the flexibility to determine what food is sold outside the 

cafeteria. Many schools are voluntarily including healthy snacks in their vending 

machines or at extracurricular events. But ultimately, it is local control over food 

policy that allows for innovation while still responding to each school’s unique circumstances. 

We’ve all heard the outrageous stories in which a piece of banana bread at a bake 

sale does not meet nutritional standards, but a bag of chips meets the requirements. 

Clearly, arbitrary nutritional mandates can backfire when they override commonsense. I hope we’ll keep these cautionary tales in mind as we explore how parents and 

local schools can improve children’s health. Thank you Chairman Miller, I yield 

back. 

Chairman MILLER. Thank you. 

Pursuant to committee rule 7(c), all members may submit an 

opening statement in writing which will be made part of the permanent record. 

And now I would like to introduce our panel of witnesses for this 

hearing. First witness, Ms. Dora Rivas, is currently serving as 

president elect of the School Nutrition Association after serving as 

a member of the membership committee in 2005 to 2006. Ms. Rivas 

has been in food service for 36 years. In January 2005 she took the 

role of food and child nutrition services executive director for the 

Dallas Independent School District. Ms. Rivas is certified with the 

Texas Association of School Nutrition and credentialed as a school 

nutrition specialist with the School Nutrition Association. She also 

is a registered dietitian with the American Dietetic Association. 

Carolyn Morrison is the president of the National Child and 

Adult Care Food Program Forum and the CEO of the Child Care 

Development Services in Gresham, Oregon. In addition to being 

current and past president of the National Child and Adult Care 

Food Program Forum, she has served on numerous national and 

USDA committees and task forces to improve this program. Ms. 

Morrison has served on the advisory board of the National Food 

Service Management Institute, the California Child and Adult Program Roundtable, and California Food Policy Advocates, and the 

Oregon Sponsors Alliance. 

And I believe our colleague, Congresswoman Chu, will introduce 

the next witness. 

Ms. CHU. Today I have the pleasure of introducing one of my 

own constituents, Kiran Saluja, who is the deputy director of the 

Public Health Foundation Enterprises’ WIC in Irwindale, California. This organization is a nonprofit agency that has been pro-
7 

viding WIC services in the Los Angeles and Orange County areas 

for over 34 years. She oversees 54 WIC centers that are throughout 

the two counties, serving 325,000 clients every month. And I am 

pleased to report that in my district, she oversees seven WIC locations who serve over 46,000 people. 

Ms. Saluja first joined the Public Health Foundation WIC in 

1984 as a nutritionist. She is a registered dietitian and a member 

of the National WIC Association, the American Public Health Association, and the American Dietetic Association. She has focused 

much of her work on breastfeeding and is a strong and vocal advocate for healthy babies and families. 

Thank you, Ms. Saluja, for joining us today, and I look forward 

to your testimony. 

Chairman MILLER. Thank you and welcome. 

Our next witness will be Lucy Gettman who is the director of 

Federal programs for the National School Boards Association. Ms. 

Gettman began her career as an advocacy coordinator for the Children’s Hunger Alliance in Ohio. She has held policy and professional positions with the Ohio Attorney General, the Ohio Student 

Aid Commission, and the Interuniversity Council of Ohio. 

Immediately prior to her work with the National School Board 

Association, she was director of Federal relations for the Reading 

Recovery Council of North America. Ms. Gettman currently specializes in early childhood education, child nutrition education technology and literacy issues for the National School Board Association. 

Welcome to all of you. Your prepared testimony will be placed in 

the record in its entirety. You are going to be given 5 minutes to 

explain the highlights of your testimony. And in front of you, you 

see the small boxes. When you begin, a green light will go on. 

When you have used up 4 of your 5 minutes, an orange light will 

go on and you may want to think about wrapping that up. And 

then, when a red light goes on, your time will have expired. 

So, welcome. We look forward to your testimony and the responses you will have to the members of the committee’s questions. 

Ms. Rivas, we will please begin with you. 

STATEMENT OF DORA R. RIVAS, MS, RD, SNS, EXECUTIVE DIRECTOR, FOOD AND CHILD NUTRITION SERVICES, DALLAS 

INDEPENDENT SCHOOL DISTRICT 

Ms. RIVAS. Thank you. Chairman Miller, members of the committee, thank you very much for continuing the extraordinary tradition of this hearing. We deeply appreciate the courtesy. 

Our two highest priorities on our issue paper in general are to 

expand access and improve the nutritional content of the meals in 

the environment of the local school. 

First, we have several suggestions to expand access. We recommend that direct certification and direct verification be a high 

priority, that you continue to expand its use for child nutrition. We 

recommend the statute be amended to allow for community eligibility in high-poverty areas so that children do not have to individually fill out the applications. The Hunger-Free Schools Act, H.R. 

4148, has a provision that embraces this concept. 
8 

We support expansion of the Summer Food Service Program and 

the After-School Child Care Program. We support the Healthy 

Start Act introduced by Representatives Stephanie Herseth Sandlin and Jo Ann Emerson to provide 5 cents in USDA commodities 

per meal for the School Breakfast Program. And that is H.R. 4638. 

We urge the Congress to expand the Free Meal Program gradually over time, to make the income guidelines consistent with the 

income guideline in the WIC Program. H.R. 3705 has been introduced to do this and we support that approach. 

Finally, we ask that you close a major loophole in the statute 

which allows funds that you appropriate for school meals to be 

used for expenses unrelated to providing those school meals. There 

is no provision in the statute or in the regulations that govern 

what expenses can be reimbursed with this funding. Furthermore, 

when a charge is made that we believe to be inappropriate, there 

is no recourse. There is no appeal process to USDA. Our suggested 

amendment is written in the testimony. 

Second, with regard to nutrition integrity, we have a few suggestions. SNA, in partnership with the First Lady, Michelle Obama’s 

Let’s Move! Campaign has committed to further improving healthy 

school meals and advancing nutrition education for America’s children. I encourage you to go to our Web site to learn more about 

that partnership on the First Lady’s Let’s Move! Campaign. 

We urge the committee to increase the reimbursement in all 

meal categories. We urge you to also amend the statute and require 

the Secretary to establish a consistent national application of the 

most recent dietary guidelines for all meals reimbursed by the Department of Agriculture. 

The current statute is defective in two important respects. First, 

it requires meals to be consistent with the goals of the dietary 

guidelines. That is not specific enough. The meals must be consistent with the guidelines, not just the goals of the guidelines. 

Second, someone must be in charge of deciding if the meals, are, 

in fact, consistent with the guidelines. That responsibility must 

rest with the Secretary. If every State and local community can decide if they are meeting the guidelines, then there is no standard 

at all. Children need the same nutrients, regardless of where they 

live. It is basic science. The country is spending a lot of money to 

develop the IOM report and to craft the dietary guidelines. They 

should be followed consistently. 

The time has clearly come to end the so-called time-and-place 

rule and give the Secretary the authority needed to regulate the 

nutritional quality of all foods and beverages sold on the school 

campus during the school day. The Secretary should be required to 

promulgate regulations to guarantee that all foods and beverages 

sold in schools are consistent with the most recent edition of the 

Dietary Guidelines for Americans, taking into consideration the 

recommendations of the Institute of Medicine and SNA’s recommendation for national nutrition standards. 

While it is mostly a matter of science, let me also mention that 

the current multiplicty of nutrition standards across the country is 

driving up the cost of the program. The more product specifications 

that exist in the school market, the higher the cost of production 
9 

and the cost of the program. Again, our specific amendments with 

regard to consistency is included in our written testimony. 

We must finally establish an effective nutrition education program in the school. 

Chairman Miller, members of the committee, thank you again for 

continuing this special tradition. We pledge to work closely with 

the majority and the minority to craft a reauthorization bill that 

is both faithful to our children and responsive to the deficit. 

I would be pleased to answer any questions that you may have. 

Chairman MILLER. Thank you very much. 

[The statement of Ms. Rivas follows:] 

Prepared Statement of Dora Rivas, President, School Nutrition Association 

(SNA); Executive Director, Food and Child Nutrition 

Chairman Miller, Members of the Committee, thank you very much for continuing 

the extraordinary tradition of this hearing. We deeply appreciate the courtesy. 

I am Dora Rivas, the President of the School Nutrition Association (SNA) and the 

Executive Director of Food and Child Nutrition in Dallas, Texas. With me are 1,000 

of my best friends. Each day my 55,000 colleagues in SNA serve over 31 million 

children in 100,000 school districts. Representatives from countries around the 

world now regularly attend our conventions to learn how the American school nutrition programs are operated and implemented. It is a most special American success 

story and this great Committee is very much a part of that history. 

Mr. Chairman, as we meet to craft the 2010 Child Nutrition Reauthorization, we 

do so with the full realization that it will not be easy to reconcile the needs of our 

children with the massive public debt we face as a country. Investing in our children 

and preparing them to learn and compete in a global economy must remain one of 

the country’s highest priorities. However, we appreciate the challenge you will face 

in implementing the President’s proposal to increase funding for this critically important program. 

Given the time of the day, with your permission, I will make the SNA 2010 Issue 

Paper a part of the hearing record and confine my remarks to two of our highest 

priorities: Expanding program access and improving the nutritional content and environment of the local school. 

Program Access 

Extending the reach of the child nutrition programs, while improving their efficiency, is one of the two major themes in our Issue Paper. To this end, we are proposing several changes in the statute: 

• We recommend that direct certification and direct verification be a high priority 

and that you continue to expand its use for child nutrition. The cost of collecting 

and verifying income data for the 20 million children who receive free and reduced 

price meals is significant. Further, it takes our limited personnel away from the 

mission of improving the nutritional quality of the meals. We are nutritionists, not 

accountants, and the more you can do in this area the better. 

• We recommend that the statute be amended to allow for community eligibility 

in high poverty areas so that children do not have to individually fill out the applications. The Hunger Free Schools Act, H.R. 4148, has a provision that embraces this 

concept. 

• We support expansion of the Summer Food Service Program and the After 

School Child Care Program. 

• We support the Healthy Start Act introduced by Representatives Stephanie 

Herseth Sandlin and Jo Ann Emerson to provide five cents in USDA commodities, 

per meal, for the school breakfast program. 

• We urge the Congress to expand the ‘‘free’’ meal program to make the income 

guideline consistent with the income guideline in the WIC program. If the younger 

child qualifies for WIC, the older sibling should qualify for fee school meals. This 

would mean raising the income guideline from 130% of poverty to 185% of poverty. 

The current reality is that many children who qualify for ‘‘reduced price meals’’ simply do not have 40 cents for lunch or 30 cents for breakfast to purchase the meal. 

Each day we are confronted with children who do not have this small amount. At 

the end of each year, there are children who owe the school money for meals that 

have been provided. We see checks for only a few dollars that are returned for insufficient funds. Our anecdotal data indicates that the breakfast fee is actually the 
10 

larger barrier to participation but we urge you to raise the income level for both 

programs. 

• Finally, given the size of the programs and the significant annual appropriation, we ask that you close a major loophole in the statute which allows funds that 

you appropriate for school meals to be used for expenses completely unrelated to 

providing school meals. There is no provision in the statute, or in the regulations 

that govern what expenses can be reimbursed for this funding. As a result, we are 

frequently required by local schools to pay for: sanitation for the entire school; electricity for the school; personnel completely unrelated to the meal program; school 

construction; and a disproportionate percentage of the overhead operating costs of 

the school building, among other expenses. Further, when this happens there is no 

recourse. There is no rule and no appeal process to USDA. 

Therefore, we are asking for an amendment as follows: 

SUGGESTED AMENDMENT

Section 10 of the Richard B. Russell National School Lunch Act is amended by 

adding new subsections as follows: 

‘‘(c) The Secretary shall identify those expenses that are reasonable and necessary 

for providing meals under this Act and the Child Nutrition Act of 1966. 

(d) School food service authorities may reimburse only those expenses identified 

by the Secretary under subsection (c). 

Nutrition Integrity 

As we all know, our country is facing an obesity epidemic. Obesity is now a major 

public health problem that is significantly increasing the cost of health care. While 

the school lunch and breakfast programs are a part of the solution, not part of the 

problem, there are some other changes that must be made within the school. This 

is why SNA, in partnership with First Lady Michelle Obama’s Let’s Move! campaign, has committed to further improving healthy school meals and advancing nutrition education for America’s students. To learn more about SNA’s partnership 

with the First Lady’s Let’s Move! campaign, I encourage you to visit our website 

at http://www.schoolnutrition.org/Blog.aspx?id=13585&blogid=564. 

The time has clearly come to end the so-called ‘‘time and place rule’’ and give the 

Secretary the authority needed to regulate the nutritional quality of all foods and 

beverages sold on the school campus during the school day. The Secretary should 

be required to promulgate regulations to guarantee that all foods and beverages sold 

in school are consistent with the most recent edition of the Dietary Guidelines for 

Americans, taking into consideration the recommendations of the Institute of Medicine and SNA’s recommendations for National Nutrition Standards. This must be 

implemented as soon as is practicable. 

We urge you to also amend the statute and require the Secretary to establish a 

consistent national application of the most recent Dietary Guidelines for all meals 

reimbursed by the Department of Agriculture. The current statute is defective in 

two important respects: 

First, it requires meals be consistent with the ‘‘goals’’ of the Dietary Guidelines. 

That is not specific enough. The meals must be consistent with the Guidelines, not 

just the goals of the Guidelines. 

Second, someone must be in charge of deciding if the meals are, in fact, consistent 

with the Guidelines. That responsibility must rest with the Secretary. If every state 

and local community can decide if they are meeting the Guidelines, there is no 

standard at all. Children need the same nutrients regardless of where they live. It 

is basic science. The country is spending a lot of money to develop the IOM report 

and to craft the Dietary Guidelines. They should be followed consistently. 

While it is mostly a matter of science, let me also mention, that the current multiplicity of nutrition standards across the country is driving up the cost of the program. The more product specifications that exist in the school market, the higher 

the cost of production and the cost of the program. 

We therefore suggest that the following amendment be included in the Committee’s bill: 

SUGGESTED AMENDMENT

‘‘Section 9 (f) (1) (A) of the Richard B. Russell National School Lunch Act is 

amended to read as follows: ‘‘(A) are consistent with the most recent edition of the 

Dietary Guidelines for Americans as prescribed by the Secretary; and’’. 

3. We must finally establish an effective nutrition education program in the 

school. The investment you are making in the school nutrition programs is significant and the country’s health care bill is even bigger. Yet for all of the words about 
11 

obesity we still do not have an effective nutrition education program in the school. 

The Department, with SNA and other stakeholders, must do the research necessary 

to figure out how to communicate effectively with children about nutrition. Some 

schools are attempting to utilize computers that dictate to students the number of 

calories in a food item and the amount of physical activity it will take to burn off 

those calories. 

When the Nutrition Education and Training Program was first enacted in the 

1970s, it was funded with 50 cents per child, per year. That level lasted for only 

one year and then it was reduced over time. We request that a new nutrition education program be established, funded and modernized so it can communicate more 

effectively with children in today’s modern world. The First Lady, with bipartisan 

support, is asking all of us to give greater attention to the obesity challenge. It must 

include a nutrition education program in the schools. 

Conclusion 

Chairman Miller, Members of the Committee, thank you, again, for continuing 

this special tradition. We pledge to work closely with the majority and the minority 

to craft a reauthorization bill that is both faithful to our children and responsive 

to the deficit. I would be pleased to answer any questions that you may have. 

Thank you. 

2010 LEGISLATIVE ISSUE PAPER

President Obama proposed an additional $1 billion for Child Nutrition Reauthorization to eliminate childhood hunger and serve our children. SNA believes every 

penny of this increase—and more—is needed to make additional improvements in 

child nutrition programs. Therefore, SNA urges Congress to increase funding for 

child nutrition. SNA’s priorities for Reauthorization include: 

Top Priorities 

• Expand the ‘‘free’’ meal category from 130% of poverty to 185%, consistent with 

the WIC income eligibility guidelines (eliminating the reduced price meal category). 

• Increase the per meal reimbursement for all meals in order to keep pace with 

rising costs and implementation of the Dietary Guidelines for Americans. The current Federal reimbursement of $2.68 for a ‘‘free’’ school lunch is 35 cents less than 

the average cost of production. 

• Require the Secretary to establish a consistent national application of the Dietary Guidelines for Americans, for all reimbursable meals, in accordance with recommendations of the Institute of Medicine (IOM), which benefited from SNA’s Recommendations for National Nutrition Standards. 

• Grant the Secretary the statutory authority to regulate the sale of all foods and 

beverages on the school campus, consistent with the most recent edition of the Dietary Guidelines for Americans, in accordance with SNA’s Recommendations for National Nutrition Standards and the recommendations of IOM (ending the ‘‘time and 

place’’ rule). 

• Require the Secretary to determine which school expenses and indirect costs 

can be paid for with school food service funds. 

Additional Priorities 

Funding 

• Allow for community eligibility in high poverty areas. 

• Provide USDA commodities for each school breakfast served. 

• Expand after school and summer meal programs. 

• Re-establish entitlement funding for equipment assistance in all schools. 

Administrative provisions 

• Require the Secretary to establish an expedited food safety coordination and recall communication system. 

• Address childhood obesity by establishing an effective nutrition education curriculum and increasing the consumption of fruits, vegetables and whole grains. 

• Utilize technology to simplify program administration and enhance financial accountability. 

• Establish a seamless application and reimbursement process for all school, preschool and child care food programs. 

• Maximize the use of direct certification and direct verification. 
12 

SNA Partners With First Lady Michelle Obama’s 

Childhood Obesity Initiative 

School Nutrition Professionals Commit to New Nutrition Programs and Goals 

NATIONAL HARBOR, MD (February 9, 2010)—The School Nutrition Association 

(SNA), representing 55,000 school nutrition professionals, is proud to support First 

Lady Michelle Obama’s childhood obesity initiative. SNA and its members have 

agreed to a number of key steps to further improve the nutritional quality of school 

meals and advance nutrition education for America’s students. Commitments include: 

Challenge school nutrition programs to achieve US Department of Agriculture’s 

HealthierUS School Challenge Certification, significantly increasing the number of 

schools nationwide meeting the program’s goals: 

• SNA will work with USDA to eliminate current barriers for recognition, ensuring more schools can participate in the program; provide training and mentoring to 

assist school nutrition programs in meeting the HealthierUS School Challenge requirements; and promote the program through conferences and meetings, publications and events 

• SNA’s goal is to increase the number of HealthierUS Schools from the current 

600 to 2,000 in year one, and with the support of other education community partners, reach 10,000 HealthierUS Schools by year five 

Encourage school nutrition directors to partner with the Center for Disease Control’s Coordinated School Health Programs to improve the school health environment. SNA will offer educational programs and training on successfully implementing the Coordinated School Health Program. 

Challenge school nutrition program directors to accelerate the time frame for 

meeting the Institute on Medicine’s (IOM) National Nutrition Standards for school 

meals. To meet this goal, SNA will initiate the following during the 2010-2011 

school year: 

• Develop and promote the LAMP Awards (Leading Advancements in Menu Planning), a recognition program encouraging school districts and industry members to 

use innovative menu plans, recipe and product development, and other tools to 

achieve IOM goals prior to the timeline for implementation 

• Partner with local fruit and vegetable growers through Farm to School Programs to promote consumption of more fresh fruit and vegetables 

• Partner with industry to provide more affordable whole grain products and to 

develop nutrition education campaigns influencing students to consume more nutrient-dense foods at a critical time in their development 

Advance nutrition education opportunities for all students. With the First Lady 

and federal officials, SNA plans to partner with media, technology, and education 

program leaders to bring turnkey nutrition education into the classroom, cafeteria, 

and home. 

‘‘First Lady Michelle Obama recognizes how crucial school meals are to the health 

and academic success of America’s children, and school nutrition professionals are 

proud to support the First Lady’s effort to combat childhood obesity and strengthen 

under-funded school meals programs,’’ said School Nutrition Association President 

Dora Rivas, MS, RD, SNS, and executive director of Food and Child Nutrition Services for the Dallas Independent School District in Texas. 

‘‘Since announcing her initiative, the First Lady has eloquently shared her own 

struggles as a working mom to foster healthy lifestyles for her children,’’ said Rivas. 

‘‘The School Nutrition Association looks forward to working with the First Lady to 

encourage America’s families to get involved in school nutrition programs and promote physical activity and healthy eating at home.’’ 

‘‘The school cafeteria is a classroom for students—an opportunity for them to 

learn about nutrition and well-balanced meals. School nutrition programs need the 

support of parents and families to succeed—whether joining students for lunch or 

making time to talk with them about the food they eat at school, taking an interest 

in a child’s eating habits can lead to a lifetime of good choices. After all, when a 

child has tried new fruits and vegetables at home, he or she is more likely to pick 

up those items when they walk through the lunch line.’’ 

The First Lady’s initiative was launched just as Congress prepares to reauthorize 

the Child Nutrition Act, a critical opportunity for legislators to enhance the National School Lunch and Breakfast Programs for 31 million American children who 

benefit from school meals each day. 

‘‘SNA has been calling on Congress to increase the school meal reimbursement to 

keep pace with rising costs. We hope the First Lady’s activism will encourage legislators to provide school lunch professionals with the support they need to offer an 

even greater variety of fruits, vegetables and whole grains to students,’’ said Rivas. 
13 

The School Nutrition Association is a national, non-profit professional organization representing more than 55,000 members who provide high-quality, low-cost meals to students across 

the country. The Association and its members are dedicated to feeding children safe and nutritious meals. Founded in 1946, SNA is the only association devoted exclusively to protecting and 

enhancing children’s health and well being through school meals and sound nutrition education. 

Chairman MILLER. Ms. Morrison. 

STATEMENT OF CAROLYN L. MORRISON, CHIEF EXECUTIVE 

OFFICER, CHILD DEVELOPMENT SERVICES, INC. 

Ms. MORRISON. Good afternoon, Mr. Chairman and members of 

the committee. My name is Carolyn Morrison, and I am president 

of the National CACFP Forum and a sponsor of the USDA Child 

and Adult Care Food Program in Oregon. Thank you for the opportunity to join you this afternoon to discuss the key role the Child 

and Adult Care Food Program plays in ensuring young children 

have access to good nutrition, and to offer recommendations for reauthorization. 

Program improvements can also help reduce childhood overweight and obesity, a priority about which our First Lady is so passionate. Every day across the country, millions of low-income families rely on the healthy food their children receive in child-care programs because of this USDA program. We all know hunger stifles 

a child’s health, intellect, creativity, capacity to learn and to be at 

their best. This program’s resources support good nutrition and 

prevent childhood obesity by offering healthy food and teaching 

young children, and their caregivers, about healthy lifestyles and 

meal patterns. 

As a middle-class mom who decided to be a child-care provider 

in the early eighties, I learned firsthand from my exposure to lowincome children who were in my care. I will never forget the 4- 

year-old boy who wondered why I cooked and didn’t just go out and 

buy fast food. Johnny’s mom was poor and struggled to make ends 

meet. She loved her kids but hadn’t the resources, knowledge, or 

energy to feed them well. The only nutritious meals her children 

received for many years were those that she received in child care 

or when they were at school. 

Given the crucial role early childhood nutrition plays in supporting the good health, cognitive growth, and development of a 

child, and the lack of knowledge and/or resources of many working 

families, expanding access to the program is vital to ensuring that 

all children in care settings have the opportunity to grow strong 

and live healthy productive lives. 

For many children in child care, like Johnny, the daycare program they attend is their primary source of food. They spend 10 

to 12 hours each day in care and receive most, if not all, of their 

meals while there. Allowing child-care facilities the option of serving a third meal service, as was previously allowed, is an opportunity to improve child nutrition through this reauthorization. 

The program is an essential source of support for family childcare provider centers and Head Start programs. Program resources 

include training and technical assistance, on-site visits, and reimbursement for food and meal preparation costs. The program also 

serves as an important tool in creating and maintaining accessible, 

affordable, quality child care for working families. 
14 

Reducing the program area eligibility test from the current 50 

percent to 40 percent could accomplish, through reauthorization, 

improved access to healthy meals for many more young children. 

Increasing the availability and the consumption of fresh fruits 

and vegetables, whole grains, and lower fat dairy products for 

young children in child care is essential to improve development 

and health, and to prevent obesity at the one-time, early childhood, 

when it can have the most long-term effect. 

Updating the program nutrition standards and meal pattern to 

make them consistent with the most recent Dietary Guidelines for 

Americans could be accomplished through reauthorization. Improving meal quality will require enhanced meal reimbursements. 

The network of program sponsors is breaking down. Sponsors are 

choosing to discontinue offering the service because they cannot afford to continue to operate, given the paperwork and oversight responsibilities. Nationally, 27 percent of sponsors have chosen to 

leave the program. This is an especially serious problem in Los Angeles where a sponsor chose to close, leaving 5,000 children and 

over 700 providers unserved in a very low-income community. 

A large challenge in my State of Oregon is the size and the geography of our State. While 67 percent of all caregivers are concentrated in 6 of our 36 counties, providers in the very rural areas 

deserve to participate as well. 

Sponsor administrative reimbursement rates should be brought 

up to the level necessary to provide quality nutrition and wellness 

education, cover the cost of transportation for serving rural areas, 

cover the cost of additional visits and the time spent in helping 

low-income providers overcome literacy and language issues. 

Retention of caregivers is challenging as they must remain eligible for the program by meeting training requirements. We have 

worked to meet this challenge by developing and offering on-line 

training and healthy nutrition. This positively impacted our retention of child-care providers in the program as they now have access 

to mandatory training, regardless of where they live. 

Among other topics, these trainings focus on serving more fresh 

fruits and vegetables, low-fat milk and whole grains, and have a 

secondary benefit of helping them meet licensing requirements. 

Partnerships with local colleges and universities have enabled us 

to develop these resources, as there simply isn’t enough money 

from the sponsor reimbursement to develop them. 

In closing, we strongly support legislation introduced by Representative Tonko, the Access to Nutritious Meals for Young Children Act, which includes the recommendations I have discussed 

today. And lastly, I would like to invite each of you, when you are 

home in your districts, to visit child-care centers, homes, and sponsoring organization to see firsthand the importance and opportunities available through the program for playing a role in improving 

children’s health, their lives, and reversing the childhood obesity 

epidemic. 

Thank you very much for this opportunity to share this information with you on behalf of all the sponsors. 

Chairman MILLER. Thank you. 

[The statement of Ms. Morrison follows:] 
15 

Prepared Statement of Carolyn Morrison, President, National CACFP 

Forum; Executive Director, Child Care Development Services 

Good afternoon, Mr. Chairman and Members of the Committee, I am Carolyn 

Morrison, President of the National CACFP Forum, an organization that serves to 

promote, protect and perfect the Child and Adult Care Food Program (referred to 

as the CACFP); and Executive Director of Child Care Development Services, Inc. 

(CCDS), an Oregon sponsor of the CACFP. Thank you for the opportunity to join 

you this afternoon to discuss the key role the Child and Adult Care Program plays 

in ensuring young children have access to good nutrition and to offer recommendations for strengthening the program through the Child Nutrition Reauthorization. 

A well-conceived reauthorization bill, focused on the right program improvements 

for CACFP, can help to reduce hunger, childhood overweight and obesity, improve 

child nutrition and wellness, and enhance child development and school readiness. 

Every day, across the country, millions of low-income families rely on the healthy 

food their children receive in child care through the USDA Child and Adult Care 

Food Program. CACFP reimbursements, nutrition requirements and training support high quality nutrition experiences for over 3 million children in child care: more 

than two-thirds of them in child care centers, and the rest in family child care 

homes. Ensuring young children are well-fed in child care promotes their health, 

creativity, capacity to learn and be at their best. 

As a middle class mom who decided to be a child care provider in the early 80’s, 

I learned this first hand from my exposure to low-income children who were in my 

care. I will never forget the 4-year old boy who wondered why I cooked and didn’t 

go get fast food. Johnny’s mom was poor and struggled to make ends meet. She 

loved her kids, but did not have the resources, knowledge or time to feed them well. 

Unfortunately, under the current system healthy CACFP meals and snacks are 

out of reach for millions of young children in child care. Over half the children in 

child care are in centers or family child care homes that do not participate in 

CACFP. Family child care homes’ participation in CACFP, which had been one of 

the fastest growing nutrition programs, has dropped 27 percent since the introduction of a complex two-tiered reimbursement system in 1997. (Thirteen states have 

had a drop of 42% or more.) Given the crucial role early childhood nutrition plays 

in the cognitive growth and development of a child, and the lack of knowledge and/ 

or resources of many working parents, expanding access to CACFP is vital to ensuring that all children in care settings have the opportunity to grow strong and live 

healthy, productive lives. 

For many children in child care like Johnny, the child care program they attend 

is their primary source of food; they spend 10-12 hours each day in care and receive 

most, and some days all, of their meals while there. 

CACFP is a vital source of support for family child care providers, centers and 

Head Start Programs. CACFP sponsoring organizations play a critical role in ensuring child care providers can participate in this program and serve healthful meals 

to children under their care. CACFP resources, including training and technical assistance, on-site visits and reimbursement for food and meal preparation costs, support: 

• providing good nutrition and preventing childhood obesity by teaching children 

and caregivers about healthy lifestyles and meal patterns, and 

• creating affordable, quality child care. 

Numerous studies throughout the years have demonstrated that the CACFP is vitally important to providing young children with the necessary nutritional support 

to have a healthy start in life as well as contributing to an improved overall quality 

of care. (Please see Appendix A for summary of research.) 

The reauthorization of the Child Nutrition Programs provides an important opportunity to make the necessary improvements to increase program access and nutrition quality, and protect the quality of CACFP services for children in child care 

by: 

• Increasing CACFP reimbursements to improve nutrition and stem participation 

declines; 

• Raise program reimbursement to support sponsoring organizations’ nutrition 

and wellness education requirements, reaching and teaching low-literacy providers 

and rural transportation costs; 

• Reducing the CACFP area eligibility test from 50 percent to 40 percent; 

• Allowing child care centers and homes the option of serving a third meal service 

(typically this would be a supper or an afternoon snack), as was previously allowed; 

• Updating the CACFP nutrition standards and meal pattern to make them consistent with the most recent Dietary Guidelines; 
16 

• Streamlining program requirements, reducing paperwork, and maximizing technology. 

Increase CACFP reimbursements to stem participation declines and improve nutrition. Purchasing, preparing and serving more nourishing meals and snacks are 

more expensive. Increasing the availability and consumption of fruits and vegetables, whole grains, and lower fat dairy products for young children in child care is 

absolutely essential to improve development and health and to prevent obesity at 

exactly the time—early childhood—when it can have the most long-term effect. This 

effort needs to be supported by adequate meal reimbursements. At the same time, 

family child care participation declines created by reimbursement cuts need to be 

reversed. Higher reimbursements will assure that more children participate in 

CACFP, both attracting more child care centers and helping to stem the loss of family child care providers. A study done in Oregon found that inadequate reimbursement rates and paperwork were the top two reasons for providers to leave CACFP. 

Raise program reimbursement to support sponsoring organizations’ nutrition and 

wellness education requirements, reaching and teaching low-literacy providers, rural 

transportation costs and sustain family child care providers participation in the food 

program. Access to healthy meals is threatened by the breakdown in the network 

of CACFP sponsors, the non-profit community-based organizations supporting the 

participation of family child care homes in CACFP. Unable to make ends meet due 

to high program costs and the loss of economies of scale as providers dropped out 

of the program, 28 percent of sponsors stopped sponsoring the program in the last 

dozen years. In a 2006 USDA report, researchers reported that ‘‘Costs reported by 

sponsors on average were about 5 percent higher than allowable reimbursement 

amounts.’’ Sponsors’ administrative reimbursement rates should be brought to the 

level necessary to provide quality nutrition and wellness education, cover the transportation costs of serving family child care homes in rural areas, and cover the costs 

of additional visits, and the time spent in helping low-income providers overcome 

literacy and language issues. Due to a recession influenced Consumer Price Index, 

sponsors administrative reimbursement rates were recently reduced by one dollar 

per home per month, forcing the elimination of jobs in these community-based organizations. 

In the worse cases this has created situations such as the crisis in Los Angeles 

where yet another long term dedicated sponsor could no longer remain viable within 

the reimbursement rates. The loss of this sponsor left 5,000 children and over 700 

providers unserved in a very low income community. The cumulative impact of so 

many sponsors dropping out is limited access to CACFP. Limited service can be a 

significant problem in both urban and rural areas. 

In my state over the last 10 years, the number of sponsors dropped from18 to only 

10. A large challenge for serving Oregon is the size and geography of our state. 

While 67% of all caregivers are concentrated in 6 counties, providers in the very 

rural areas deserve to participate as well. 

Retention of caregivers is challenging as they must remain eligible for the CACFP 

by meeting training requirements. We have worked to meet this challenge by developing and offering online courses. Online training in health and nutrition positively 

impacted our retention of child care providers in the CACFP as they now have access to mandatory training, regardless of where they live. Among other topics these 

trainings focus on serving more fresh fruits and veggies, low fat milk and whole 

grains and have a secondary benefit of helping them meet licensing requirements 

Partnerships with local colleges and universities have allowed us to develop resources as there simply isn’t enough money from sponsor reimbursements to develop 

these resources. 

Reduce the CACFP area eligibility test from 50 percent to 40 percent to streamline access to healthy meals for young children in child care. Area eligibility, the 

most successful and inclusive CACFP eligibility mechanism, allows family child care 

homes in low-income areas to automatically receive the highest CACFP reimbursement rates. This ‘‘area eligibility’’ test has proven extremely effective because it substantially decreases the paperwork for providers and families by eliminating the 

need to individually document each child’s household income. 

Currently, family child care homes only qualify for area eligibility in areas with 

50 percent or more low-income children (as defined by local census data or the percentage of children in the local school eligible for free and reduced price meals.) The 

threshold is too high to appropriately target many communities with struggling families. This is especially true in rural and suburban areas which do not typically have 

the same pattern of concentrated poverty seen in urban areas. 

Reducing the area eligibility test to a 40 percent threshold would lead to many 

more child care providers who serve low-income children becoming eligible, and 

many children in need being served healthy CACFP meals and snacks. When con-
17 

fronted with the complex CACFP eligibility requirements to be met outside of the 

areas currently eligible most providers choose not to participate. It is easier just to 

resort to serving cheaper, less nutritious meals and operate without the CACFP 

standards, oversight, and required paperwork. It is not uncommon for providers to 

forgo offering even the less costly meals and simply let children rely on food sent 

from home which is often less than nutritious. 

Allow child care centers and homes the option of serving a third meal service 

(typically this would be a snack or supper), as was previously allowed. As parents 

work longer hours to make ends meet, many more young children are spending 

more of their waking hours in child care on work days. National child care standards, based on the best nutrition and child development science, specify that young 

children need to eat small healthy meals and snacks on a regular basis throughout 

the day. Child care centers and homes used to receive funding for three meals, until 

Congress in 1996 cut out one meal to achieve budget savings. This penny-wise and 

pound-foolish step harms children’s nutrition and health and weakens child care. 

We should restore CACFP support to the full complement of meals young children 

need and stop short-changing young children at a time when they can least afford 

it. 

Improve the nutritional value of the meals and snacks and the promotion of 

health and wellness in child care participating in CACFP. Direct the Secretary of 

Agriculture to issue proposed regulations updating the CACFP meal pattern, including recommendations for the reimbursements necessary to cover the costs of the 

new meal pattern, within 18 months of the publication of the IOM CACFP Meal 

Pattern report. In the interim, USDA should issue guidance, and provide education 

and encouragement for serving healthier meals and snacks consistent with the Dietary Guidelines with an emphasis on increasing consumption of whole grains, fruits 

and vegetables, and lower fat dairy and protein foods. 

Streamline program requirements, reduce paperwork, and maximize technology to 

improve program access. This can be accomplished through the following no or very 

low cost proposals which will improve CACFP’s ability to reach low-income families: 

1) allow CACFP sponsoring organizations to plan multi-year administrative budgets 

using carryover funds, and to keep their earned administrative reimbursement 

using a ‘‘homes multiplied by rates’’ system; 2) direct the Secretary of Agriculture 

to reduce paperwork by eliminating ineffective and poorly targeted requirements including ‘‘block claiming;’’ 3) restore the right to advance funds; 4) allow CACFP family child care providers to facilitate the return of family income forms; 5) eliminate 

a barrier to participation by allowing the use of the last four digits of the social security number; 6) continue the USDA Paperwork Reduction Initiative; and 7) 

streamline program operations, increase flexibility, and maximize technology and innovation to reduce parent paperwork and allow sponsoring organizations and providers to operate most effectively. (Please see Appendix B for more details on the 

paperwork reduction proposals.) 

In conclusion, while the CACFP has been and continues to be an important and 

beneficial child nutrition program, I would encourage the Committee to consider improvements to the program. 

We strongly support legislation introduced by Representative Tonko, the Access 

to Nutritious Meals for Young Children Act. The program improvements in this bill 

will help to improve child nutrition, reduce hunger, and enhance child development 

and school readiness. Program improvements will also help reduce childhood overweight and obesity, a priority about which our First Lady is so passionate. 

I encourage you to visit sponsoring organizations and child care homes in your 

districts. Seeing the program benefits first hand will further underscore the importance and opportunities available through the CACFP for playing a role in improving children’s lives and reversing the childhood obesity epidemic. I am certain sponsors and providers would be thrilled to have you visit their programs personally to 

see the good work of this important program. 

Thank you for this opportunity to share this information with you on behalf of 

sponsors across the country. 

APPENDIX A

Food Research and Action Center 

Child and Adult Care Food Program Benefits 

Research has demonstrated CACFP’s clear role in helping to assure good nutrition 

and high-quality, affordable child care. The program is a well documented success: 

• The U.S. Department of Agriculture’s Evaluation of the Child and Adult Care 

Food Program found that children in the Child and Adult Care Food Program re-
18 

i Improving Children’s Health: Strengthening Federal Child Nutrition Programs 

ceived meals that were nutritionally superior to those served to children in child 

care settings without the Child and Adult Care Food Program. 

• The Journal of the American Dietetic Association published a study, Dietary Intake of Children In Urban Day Care Centers, comparing the intake of children at 

a center using the Child and Adult Care Food Program versus a non-participating 

center and found that children at the participating center had significantly higher 

intakes of many key nutrients, including protein, minerals, vitamins, and consumed 

significantly more servings of milk and vegetables, with fewer servings of fats and 

sweets, than the children at the non-participating center. Children from the participating center also had fewer days of illness than children from the non-participating 

center. 

• The Economic Research Service’s Maternal Employment and Children’s Nutrition Volume 1, Diet Quality and the Role of CACFP reported, ‘‘An association was 

found between program participation and better overall diet quality (more fruit, 

milk and variety, and less total fat); reduced likelihood of food energy consumption 

below 90 percent of the average requirements; and lower levels of soda, other soft 

drinks, and added sugars. These differences especially favor children in low-income 

households.’’ 

• Findings from a recently completed study, It’s 12 O’clock * * * What Are Our 

Preschoolers Eating For Lunch?, found that when comparing the meals and snacks 

children brought from home to eat in child care without CACFP to the meals and 

snacks served in child care with CACFP, meals and snacks brought from home had 

significantly poorer quality than meals and snacks served by CACFP providers. 

(Children were sent to child care with a wide range of foods including items such 

as a McDonald’s McGriddle with sausage.) Meal quality was higher for the CACFP 

meals which generally featured more fruits and vegetables, lean meat and milk. 

• A study conducted by the Midwest Child Care Research Consortium reported, 

that ‘‘participation in the USDA Food Program was associated with quality. This association held true for family child care providers and for infant/toddler center-based 

regardless of the provider’s education level.’’ In the report, Child Care Characteristics and Quality, researchers recommended using CACFP as a way to expand training and educational opportunities because ‘‘the USDA Food Program has been an 

important way to augment the quality of programs serving low-income children.’’ 

• The Families and Work Institute’s Study of Children in Family Child Care and 

Relative Care, cited participation in the Child and Adult Care Food Program as one 

of the major factors associated with quality care, reporting that 87 percent of the 

family child care homes considered to be providing good quality child care participated in the Child and Adult Care Food Program. 

• The U.S. General Accounting Office’s report, Promoting Quality in Family Child 

Care, cited the effectiveness of the program: ‘‘Because of its unique combination of 

resources, training, and oversight, experts believe the food program is one of the 

most effective vehicles for reaching family child care providers and enhancing the 

care they provide.’’ i

APPENDIX B

Improve CACFP’s Ability to Reach Low-income Families by Streamlining Program 

and Paperwork Requirements (No or Very Low Cost Proposals) 

• Allow CACFP sponsoring organizations to plan multi-year administrative budgets, the use of carryover funds (similar to WIC) and the option to keep their earned 

administrative reimbursement using a ‘‘homes multiplied by rates’’ system similar 

to the new system recently enacted in the Summer Food Service Program. Taking 

a lesson from the success of these administrative mechanisms in the WIC and Summer Food Service programs, sponsoring organizations should be given the flexibility 

needed to use their earned reimbursement to provide the best services to child care 

providers in CACFP. This would allow sponsors to make adjustments to budgets to 

account for the level of provider participation which is often difficult to predict. 

Under the current system, if a sponsor saves in an attempt to set aside funding for 

a future purchase, for example to buy needed equipment instead of paying more 

through a lease, they are penalized by the reimbursement structure and lose the 

reimbursement. In addition, sponsoring organizations, which now have to bring 

their budgets to a full and complete stop at the end of the fiscal year, are sometimes 

forced to cut back on necessary spending towards the end of the year to insure their 

costs do not exceed earned reimbursement. 

• Direct the Secretary to reduce paperwork by eliminating the ineffective and 

poorly targeted block claiming requirement. The block claiming requirement has ac-
19 

complished little except to generate an enormous amount of unnecessary wasted 

time spent filling out meaningless paperwork, driving around using up expensive 

gasoline, and alarming child care providers and parents for very little reason. A 

poorly defined edit check, such as the block claiming requirement, defeats the purpose and can actually be counterproductive as it pulls valuable resources away from 

legitimate control functions and programmatic objectives. Because the CACFP block 

claiming lacks specificity it identifies and funnels a large portion of false positives 

(legitimate claims) into higher intensity oversight, overwhelming other effective system of controls. All indications are that the vast majority of providers identified as 

block claiming under the rule are not over-claiming but are accurately recording a 

normal attendance pattern. These normal attendance patterns are reflective of a 

wide range of legitimate situations including homes with a small number of children. 

• Restore the right to advance funds for sponsors and child care centers to cover 

program costs upfront. Some child care centers find it too expensive to pay all the 

CACFP food costs up front for several months before the first CACFP payment arrives. Advance funds, when a state chooses to offer them, can help to bridge that 

initial gap and ease the way for centers serving many low-income children to participate in CACFP. Some sponsoring organizations face similar problems and rely 

on advance funds. Sponsors regularly wait for up to two months before their claims 

for reimbursement are paid by the State. PL 104-193 reversed a long standing provision of the law and allowed states the option to eliminate advance funds. The 

right to advances should be restored to address access problems generated in areas 

where the funds have been removed. 

• Allow CACFP family child care providers to facilitate the return of participating 

children’s family income form. For parents willing to share their forms with their 

family child care providers this option could make participation in the program 

much easier. Parents can just hand their CACFP forms with their provider when 

they bring their child to child care. If the parent forgot to sign the document or 

failed to include other important information, the provider will be able to tell the 

parent right away and explain how to remedy it. 

• Eliminate a barrier to participation by allowing the use of the last four digits 

of the social security number. Many parents are concerned about giving their full 

social security number on CACFP applications because of fears of identity theft. 

Using just the last four digits, like so many receipts and records these days, will 

allay parents fear and make them more willing to return the necessary CACFP 

forms for their children to participate in the program. 

• Continue USDA Paperwork Reduction Initiative. We recommend USDA continue to build on the success of its Paperwork Reduction initiative including reconvening the work group. 

• Streamline program operations, increase flexibility, and maximize technology 

and innovation to allow sponsoring organizations and providers to operate most effectively. There are a wide range of possibilities for accomplishing this goal, a number are listed below: 

• Allow the use of existing attendance records instead of re-counting heads at 

meal time and snack time. Detailed attendance records are kept every day at child 

care programs. These records are sufficient, when coupled with food purchase and 

meal service counts, to determine consumption of meals and snacks each day. 

• Allow total counts of meals and snacks served; stop requiring a name list and 

check-marks to indicate each individual child ate which meal and snack. Total numbers are sufficient for ensuring accountability of public funds to serve nutritious 

meals and snacks. 

• States should also accept electronic print-outs of daily attendance records. Currently, not all states allow this, and instead require providers to manually prepare 

an additional list to document attendance for CACFP records separate from the attendance records they keep for the child care center as a whole. 

• Establish permanent operating agreements for eligible child care programs with 

an annual update only if an update is needed to reflect program changes and to ensure continued compliance. If there have been no changes, there should be no update required. This would alleviate one of the many layers of paperwork involved 

in program participation. 

• Require states that require both income eligibility and enrollment forms to combine the forms into one. Parents should not have to complete two nearly duplicative 

forms. 

• On parent information forms, collect only the last four digits of the Social Security number to prevent identify theft and ensure parent participation in the eligibility process. 
20 

• Allow states to collect scanned documentation in place of duplicate paper copies. 

This would cut down on the need to make multiple copies of documentation, and 

to maintain those copies at the child center (and, for multi-site operators, reduce 

the duplicate paperwork also kept in the headquarters office). This would also reduce the quantity of paper and help CACFP to ‘‘go green.’’ 

• Allow two-year contracts with food vendors where possible. Allowing the opportunity to lock in a good rate for a two-year contract would be better than annual 

reapplications, and would save providers and state and federal agencies valuable 

time and money. 

Chairman MILLER. Ms. Saluja. 

STATEMENT OF KIRAN SALUJA, MPH, RD, DEPUTY DIRECTOR, 

PUBLIC HEALTH FOUNDATION ENTERPRISES, INC. 

Ms. SALUJA. Good afternoon, Mr. Chairman, Ranking Member 

Kline, distinguished members of the committee, staff, and thank 

you so much, Congresswoman Chu, for the very nice introduction. 

I am Kiran Saluja. I am here from Los Angeles. I work with this 

very large organization that Dr. Chu told us about. And I am also 

here as the voice of the National WIC Association, which essentially is an advocacy voice of over 12,000 service agencies that provide WIC services to over 9.2 million participants throughout the 

country. Of these 9.2 million, 7 million are infants and children 

under the age of 5. 

And exactly what we are talking about here today, preventing 

childhood obesity, really needs to start in the WIC program. And 

I am here to tell you that we have a solution. We can actually start 

to prevent childhood obesity from the day the child is born, and the 

way we do it is by ensuring that this child gets exclusively 

breastfed. Not only does he get exclusively breastfed at birth, but 

he gets some duration, because, according to the Centers for Disease Control and Prevention, we can prevent 15 to 30 percent of 

childhood obesity if the child is breastfed. The greatest protection 

happens when the child gets no formula, no solids, and it goes on 

to at least 6 months. 

Now, this is the magic pill. Why haven’t we embraced it? Well, 

it certainly isn’t for lack of effort, because I want to thank all the 

members of this committee. I want to thank Chairman Miller specifically, and Representative Carolyn McCarthy, the chair of the 

Healthy Families Subcommittee. Thanks to all of you, the Ag Appropriations Committee bill provided a major expansion. They 

quadrupled the breastfeeding peer counseling moneys in the last 

bill. They created a new breastfeeding performance bonus, which is 

very unusual and was extremely welcomed by WIC agencies and 

provided new funding for evaluation of program effectiveness. 

The WIC food package was like manna from heaven for all the 

WIC providers. We had been waiting for it to change, and in October of 2009 it did change, and it is a fabulous tool for us to really 

get out there with good nutrition messages. And, it has a little 

extra food for the fully breastfeeding mother, which helps us package exclusive breastfeeding. 

Now, you might say, well, what is WIC doing with breastfeeding? 

Well, our rates are increasing but they are increasing very slowly. 

And we are lagging behind the national data because non-WIC 

moms do better than WIC moms. And so why is that happening? 
21 

Well, I am here to ask you for five things. Everybody is asking you, 

so I am sorry. 

I have five asks. Number one, we would really like you to direct 

Food and Nutrition Services to restore the $2 increment that the 

fully breastfeeding moms had when they had that little extra edge. 

It doesn’t sound like a lot, but that $2, you know that WIC staff 

out in the field can really leverage it when they are working with 

a mom when she is kind of vacillating: I don’t know, what should 

I do? Well, you know you get extra fruits and vegetables. So, we 

would really like to see that put back in. 

We would like you to make us some time, so we can help mothers 

where they need the support. And you might say, well, how I am 

going to do that? I can’t create time. Well, yes, you can. You can 

help us by extending certification for children—that is 40 percent 

of our participants—to 1 year. We do that for breastfeeding moms. 

We do that for infants. We should do it for children. That would 

release precious minutes that breastfeeding mothers need for support. 

Now, what about barriers external to WIC, because everybody 

doesn’t live in the WIC world. If they did, trust me, we wouldn’t 

have childhood obesity and we would have everybody breastfeeding 

because that is how committed your WIC staff is out there. Well, 

the external barriers to breastfeeding really mean comprehensive 

policy changes in the institutions that our mothers go to outside of 

WIC, because we really need to optimize this money that has been 

put into WIC to do what we should be doing. And I am really 

speaking specifically of unsupportive infant feeding policies in 

health care systems. I am speaking of the intense direct marketing 

of infant formula, and I am speaking of poor community and workplace support. 

So what I am asking you all is to really—I hate the cliche, think 

outside the box, but think outside the box and work with Members 

of Congress and figure out how can we tackle this problem, how 

can we pass legislation that says if there are Medicaid births happening in a hospital, that hospital should not sabotage 

breastfeeding, it should support breastfeeding. And you might say, 

how does it sabotage breast feeding? Babies get given formula bottles right at birth. Mothers get separated from their babies. It is 

not that people want to be mean, it is just the policy. It is like an 

archaic policy that needs to be changed and there are hospitals 

now that have embraced policies. Outcomes are different. 

Oregon has some very wonderful hospitals. Northern California 

does. Throughout the country we have some very good models. I 

would love us to have many more of them throughout the country. 

What about marketing of infant formula? You might say, well, 

you know—my time is almost up—moms get very confused with 

marketing messages. They come to WIC and they say, Can I have 

that breast milk in a can? And we are like, there is no such thing. 

And it is because they get free formula when they leave the hospital, they get formula, coupons, and free formula at their doorstep. 

This has to stop. We are spinning our wheels in the WIC program. Our mothers are suffering and our babies are getting fatter 

and none of us really want that. I know my time is up so I will 

not keep that beautiful quote that I had at the end. 
22 

I had two more asks, but they are in my written testimony. 

Thank you for indulging me. I really appreciate your attention. 

Chairman MILLER. Thank you very much. 

[The statement of Ms. Saluja follows:] 

Prepared Statement of Kiran Saluja, MPH, RD, 

Deputy Director, PHFE WIC Program 

Good morning Chairman Miller, Ranking Member Kline and distinguished Members of the Committee. I am honored by this opportunity to address the Committee 

and applaud your commitment to WIC and the Child Nutrition Programs. 

I am Kiran Saluja, Deputy Director of the non-profit Public Health Foundation 

Enterprises WIC Program in Irwindale, California. PHFE WIC is the largest local 

agency WIC Program in the nation serving 326,350 participants every month. In our 

agency, we enroll 60,000 newborns annually, delivered at over 80 birthing hospitals 

in the nation’s most ethnically and culturally diverse, densely populated counties— 

Los Angeles and Orange County, California. 

I am testifying today on behalf of the National WIC Association (NWA), the education and advocacy voice of the over 9.2 million participants and 12,200 service 

agencies of the Special Supplemental Nutrition Program for Women, Infants, and 

Children, known as WIC. A copy of the Association’s 2010 WIC Reauthorization recommendations and statement on WIC’s Role in Preventing Maternal and Childhood 

Overweight and Obesity have been attached to my submitted testimony. 

I am honored to have this opportunity to share some of our breastfeeding promotion, support and advocacy strategies and our successes. 

‘‘Breastfeeding is a natural ‘‘safety net’’ against the worst effects of poverty. If the 

child survives the first month of life (the most dangerous period of childhood) then 

for the next four months or so, exclusive breastfeeding goes a long way toward canceling out the health difference between being born into poverty and being born into 

affluence. * * * It is almost as if breastfeeding takes the infant out of poverty for 

those first few months in order to give the child a fairer start in life and compensate 

for the injustice of the world into which it was born.’’ 

These words by James P Grant, former Executive Director of UNICEF, may well 

have been written for the millions of infants and children served by the WIC Program. This is because WIC, along with AAP, CDC, WHO and many other health 

organization, has long understood that breastfeeding offers far-reaching benefits for 

mothers and babies. These organizations unanimously support exclusive 

breastfeeding as the preferred, normal and species specific way to feed babies for 

at least the first six months of a baby’s life. Increasing exclusive breastfeeding rates 

among low-income women is a key strategy for health improvement in general—and 

particularly for the prevention of childhood obesity. 

The collective efforts of WIC Programs across the country at promoting and supporting breastfeeding have resulted in an increase in breastfeeding rates. According 

to the most recent WIC Participant Characteristics Report, breastfeeding rates are 

at record highs—58% initiation and 28% at 6 months. It is true however that despite the continued rise in breastfeeding rates overall, these rates are lower than 

the Healthy People 2010 goal of 75% breastfeeding initiation and 50% at 6 months. 

At PHFE WIC our comprehensive collective efforts have demonstrated an increase 

in the numbers of infants breastfed at newborn enrollment. The dramatic effect of 

the changes to the WIC food package was most apparent in October 2009 when the 

rate of exclusively breastfed newborns enrolled in the PHFEWIC program jumped 

to a record high of 44.8%. [see graph on next page] 
23 

There is also a slow but definite increase in the DURATION of breastfeeding 

among PHFEWIC’s 60,000 infants as is seen in the graph below. Notice all ages depicted (2, 4, 6, 12 months) show a steady upward trend. 

Last year, in the Agriculture Appropriations bill, Congress created huge opportunities for WIC to make quantum improvements in breastfeeding rates, which the 

WIC community is really excited about. The WIC community is grateful to Representative Carolyn McCarthy, Chair of the Healthy Families and Communities 

Subcommittee, and to Chairman Miller for their vision and leadership in promoting 

increased funding for WIC breastfeeding initiatives through legislation extending 

WIC and the Child Nutrition Programs through September 2010 signed into law 

last year. The bill provided a major expansion of Breastfeeding Peer Counselor (PC) 

programs by increasing funding fourfold, as well as supporting (1) creation of a new 

performance bonus for states that achieve high rates or increased current rates of 

exclusive breastfeeding and (2) new funding for evaluations of program effectiveness. (Aside from the WIC appropriations, coverage for breastfeeding support, including the use of Peer Counselors, was written into all pending versions of health 

care reform legislation, since it has been approved and recommended by the US Preventive Services Task Force.) 

As you know, the increase in PC funding represents a substantial increase, from 

$20 million to $80 million this fiscal year, which should enable state and local WIC 
24 

agencies to assist many, many more WIC mothers with effective support for increased breastfeeding initiation, duration and exclusivity. 

Coupled with the major policies around breastfeeding and infant feeding that 

were a key component of the WIC food package changes we implemented last October, this incredible boost in breastfeeding investment means that a real opportunity 

now exists for the WIC community to achieve—and document—increased rates of 

exclusive breastfeeding in a population that is disproportionately impacted by the 

poor health outcomes including obesity, diabetes, and other chronic disease, which 

breastfeeding can help prevent. 

Robust and well-designed evaluations of peer counseling and other breastfeeding 

interventions are critical in assisting state and local WIC agencies determine the 

most efficient and effective strategies for increasing the rates and duration of exclusive breastfeeding in our diverse population. The new WIC breastfeeding performance bonus can then be used to encourage state and local WIC agencies to adopt 

breastfeeding promotion and support strategies that really work. The performance 

bonus is a groundbreaking policy. For the first time in our history, this new provision challenges WIC to go beyond our important core function of serving all the families we can, to actually beginning to work towards concrete and measurable public 

health outcomes. 

In 2005, the Institute of Medicine (IOM) recommended an enhanced breastfeeding 

food package to encourage and support mothers who choose to fully breastfeed. The 

USDA Food and Nutrition Service (FNS), in publishing its Interim Final Rule on 

the WIC Food Packages correctly emphasized the distinction between the fully 

breastfeeding food package and other food packages for women when it set the fruit 

and vegetable cash value vouchers for this food package at $2 above the value for 

other food packages for women. These changes in the WIC Food Package provided 

WIC staff unprecedented opportunities to market the enhanced food benefits for 

‘‘fully’’ (i.e., exclusively) and ‘‘mostly’’ breastfeeding mothers and babies. The fiscal 

year 2010 Agriculture Appropriations Act directed FNS to increase the fruit and 

vegetable cash value voucher to the IOM recommended value for all women to $10, 

eliminating that important distinction. 

I urge the Committee to: 

A. Maintain the enhanced value of the fully breastfeeding food package, as recommended by the IOM and as proposed by FNS in the Interim Final Rule, and direct FNS to set the breastfeeding fruit and vegetable cash value voucher for the 

breastfeeding package at $12 vs. $10 for all other women. 

B. Maintain funding for robust and strategic evaluations of WIC, including the 

impact of breastfeeding, and food package changes on participant health behaviors 

and outcomes. 

C. Support the Breastfeeding Performance Bonus and provide $10 million in performance bonus payments (to be treated as program income) to State agencies that 

demonstrate the highest proportion of breastfed infants, as compared to other State 

agencies participating in the program; or the greatest improvement in proportion of 

breastfed infants, as compared to other State agencies. When providing performance 

bonus payments to State agencies, FNS should consider a State agency’s proportion 

of participating fully breastfed infants. 

WIC’s breastfeeding education and promotion efforts are well in sync with the enhanced foods of the new WIC food packages for babies as well as mothers. Throughout the nation WIC staff received intensive training in how they would no longer 

be routinely providing infant formula in the first month, instead offering lots and 

lots of breastfeeding support. To reach extended duration and have mothers 

breastfeed fully to one year, the extra foods for babies at six months are expected 

to prove an added bonus. Staff is spending more time counseling new mothers and 

at subsequent visits working with mothers to resolve breastfeeding challenges to 

keep mothers as mostly or fully breastfeeding. All of this takes time. To allow sufficient time for ongoing breastfeeding support we must look at releasing precious minutes from other activities. 

Currently states have the option to certify infants and breastfeeding women for 

one year at a time. However, the current eligibility period for children—who make 

up nearly two-thirds of those enrolled in WIC—remains every 6 months. This simple 

change would allow WIC frontline staff to redirect their focus from costly paperwork 

to the provision of nutrition education, enhanced breastfeeding support and anticipatory guidance. 

I urge the Committee to give States the option to certify children for one year. 

Peer Counseling Funding 

The needs of WIC mothers for breastfeeding support vary greatly with culture, 

age, education, assimilation, employment, family support or lack thereof, and a host 
25 

of other variables. Hospital practices are critical to affect positive or adverse outcomes. At PHFEWIC some of our WIC sites enjoy very high Fully Breastfeeding 

rates; at some sites over 80% of newborns do not use any infant formula and at two 

months over a third of the babies are still Fully Breastfed. However, at some of our 

sites the picture is quite the reverse! 

At the sites with very low breastfeeding rates we have found Peer Counselors to 

be the solution! The additional funding for Peer Counselors was met with roars of 

approval and has infused WIC programs with the hope that they can really step up 

the support for our mothers. We, at PFFE WIC, are excited at the prospect of tripling the number of our Breastfeeding Peer Counselors from 7 to 21 of our 54 sites! 

Peer Counselors are undoubtedly an integral part of a spectrum of breastfeeding 

support however we must be realistic that we cannot provide their level of services 

and support out of regular Nutrition Services funding. The WIC community is grateful that this Committee and our partners at USDA recognize that Peer Counseling 

services are resource and funding intensive and have provide targeted funding for 

expanding the Peer Counseling program. 

The National WIC Association applauds the Committee for its support for Peer Counselors and urges that $83 million be targeted for special nutrition education 

such as breastfeeding Peer Counselors and other evidence based diversified 

breastfeeding related activities. We urge Congress to give WIC agencies the flexibility to work collaboratively with health care partners to find the most successful 

methods for supporting exclusive breastfeeding for six months in each community. 

Breastfeeding Broken Hospitals 

It is my dream to see that every WIC baby gets a fair start in life through exclusive breastfeeding I want them to get the documented benefits, which include significantly reduced risk for infections and for chronic diseases such as diabetes, asthma, and obesity among children, as well as fewer visits to the doctor’s office, fewer 

days of hospitalization, and fewer medications than children who are formula-fed. 

Newer studies from Europe have even demonstrated that breastfed children scored 

significantly higher on cognitive and IQ tests than control group children. 

I have spent the past 25 plus years of my life working to realize my dream of 

seeing every WIC mom and baby breastfeed. WIC is unique in that it is the only 

federal nutrition program with a mandate, backed by serious funding, to promote 

and support breastfeeding. WIC breastfeeding education ensures that all enrolled 

pregnant women learn about the whys and ‘‘how to-s’’ of breastfeeding. They receive 

individual education, share their experiences in small groups, and get consistent 

support and encouragement to exclusively breastfeed. 

Thanks in large part to the WIC Program’s efforts, breastfeeding initiation rates 

among low-income women have increased in the last decade. However, exclusive 

breastfeeding rates remain challenged—indicating widespread supplementation of 

breast milk with formula. Using formula undermines breastfeeding because it interferes with a mother’s ability to establish her breastmilk supply. Duration of 

breastfeeding beyond the first few months is also rare in the WIC population. Data 

from the CDC reported in 2009 in the Breastfeeding Report Card indicated that only 

one in three babies in the country were exclusively breastfed at three months and 

a mere 13.6 percent at 6 months.(1) I can say with a great degree of assurance that 

WIC babies were a very small fraction of those numbers. In California, only about 

18% of WIC mothers are still breastfeeding after the first three months. At my larger agency exclusive breastfeeding drops off rapidly with 41 percent of our mothers 

breastfeeding in the first month to merely 12 percent breastfeeding exclusively at 

6 months. 

Why are exclusive breastfeeding rates so low? In the face of intensified marketing 

of infant formula, inadequate infant-feeding policies in healthcare systems, and poor 

social supports, attempts to increase breastfeeding among WIC mothers to meet 

their self expressed goals can only be successful with comprehensive policy change 

in the institutions serving them. In particular, maternity hospital policies directly 

influence all future breastfeeding behaviors by either facilitating or undermining 

them. Sadly, breastfeeding too often starts—and ends—in hospitals during the first 

few hours of life. While some hospitals throughout the nation work collaboratively 

with breastfeeding professionals to assure a positive in-hospital breastfeeding experience, far too many are breastfeeding-broken hospitals. 

By way of example, I would like to address a situation with which I am most familiar. Los Angeles County has the lowest breastfeeding rates—and the worst disparities—in California. Unless a baby is born in one of four hospitals on the more 

affluent West side of the county, there is less than a 50% chance that a mother will 

breastfeed exclusively, especially if that baby’s mother is low income and non-white. 

Nine out of California’s 15 maternity hospitals with the worst rates of exclusive 
26 

breastfeeding initiation are located in Los Angeles, with Orange County close behind. 

WIC mothers who wanted to breastfeed and were confident that they could 

breastfeed are systematically undermined at every step once they enter 

breastfeeding-broken hospitals. Where mammals should be kept together with their 

young, babies are routinely taken away from their mothers at the very moments 

and hours that the breastfeeding instinct is the strongest and ‘‘skin to skin’’ contact 

is critical. Instead, babies are bundled into warmers and tucked into plastic bassinets with little bottles of infant formula conveniently placed inside. Mothers ‘‘recover’’ alone and babies are brought to them, often after a formula feed, sated and 

sleepy. Mothers feel dejected when the newborns nuzzle lazily at the breast, but 

show no desire to latch on. 

This scene is repeated every few hours and the mother is convinced that her baby 

does not ‘‘like her breast’’. She is unsure of how to hold her baby, hold her breast, 

may be in pain, and further may not speak the language of the hospital staff or be 

intimidated by the system. Many nurses, with busy charting demands and perhaps 

lacking breastfeeding related training, may add to the new mother’s self doubts by 

passing unhelpful comments ‘‘Oh, your breast are so big’’; ‘‘don’t you know how to 

put your baby to the nipple’’? Etc. At other times the baby may instinctively start 

suckling at the breast but, having previously been imprinted by the rubber nipple 

of the formula bottle which has a very different flow pattern, may not know how 

to ‘‘milk’’ the breast. The sucking is ineffective, milk flow slow and this of course 

frustrates the baby; the baby cries and gets off the breast, a caring nurse or relative 

offers another bottle, the baby guzzles hungrily and the die is cast! And another one 

bites the dust! One more WIC mother and baby leave the hospital, at best breast 

and formula feeding or, at worst, fully formula feeding! Their next stop is WIC 

* * * not for breastfeeding support but for infant formula! 

Every day frontline WIC staff experience frustration when they see firsthand how 

breastfeeding-broken hospital policies and practices sabotage a WIC mothers’ desire 

to breastfeed in the critical first few days of life. These moms—who have previously 

indicated their desire to breastfeed—return to WIC for their first post-partum appointment already bottle-feeding, with their milk supply already compromised. 

Until breastfeeding-broken hospital policies change, WIC breastfeeding educators 

and mothers will continue to swim upstream. Until we address the wider issue of 

breastfeeding-broken hospital and healthcare policies and practices through strategic reforms, WIC will not see maximum returns from its huge investment in 

breastfeeding promotion and support: concrete and measurable health improvements for low-income families. Failure to address the stark differences in 

breastfeeding rates in the U.S. will exacerbate the deepening health and social inequities we face, and continue to generate increased public costs we cannot afford. 

An important place to start to help WIC succeed in its breastfeeding support and 

promotion efforts would be to fix the breastfeeding—broken hospitals! While I recognize this may be beyond the purview of this Committee, I am compelled to ask you 

to work collaboratively with your colleagues on the Energy and Commerce Committee and Ways and Means Committee to pass legislation that requires that all 

hospitals that receive Medicaid funds adhere, at a minimum, to a set of model policies that do not sabotage breastfeeding, and at best initiate steps to become a Baby 

Friendly Hospital. 

Formula Marketing 

Families with new babies are in a constant state of learning—feeding, changing, 

bathing, and soothing the baby. This can be a bewildering experience. New mothers 

are insecure about their breast milk supply; whether they are producing enough of 

this elixir that cannot be measured in ounces in a calibrated bottle and which the 

baby wants at very frequent intervals in the first few days. This in a world where 

formula feeding defines the normative model for infant behavior; families expect a 

baby to eat every three hours, sleep in between, and finish 2-3 ounces at a feeding. 

BUT THAT IS NOT THE BREASTFED BABY NORM! This baby eats a little bit 

all the time; newborns have teeny tiny stomachs that get filled up quickly. Moreover, mother’s milk, being the perfect food, is digested quickly! WIC can promote 

breastfeeding to our sincerest heart’s content, but how do we get breasts and apparently always hungry newborn breastfed babies to compete with the images of the 

contented cherubic formula fed babies promoted by Madison Avenue? 

Advertisements about ‘‘comfort proteins’’—there is no such thing—in one type of 

infant formula float around a happy baby on TV, while DHA supplemented formulas 

claim to be just like ‘‘mother’s milk in a can’’ and new ‘‘designer formulae’’ hit the 

market at regular intervals (Lipil today, Premium tomorrow, Lactofree today and 

Sensitive tomorrow!). With smart salespersons who regularly stalk hospital nurs-
27 

eries and pediatrician’s offices, new formulae find willing peddlers in health care 

staff who want to ‘‘help’’ mothers with a can of the latest sample! Can mother’s milk 

compete in this market? 

Coincidently, just when WIC education about the miracles of colostrum (the first 

milk) and the innumerable benefits of breast milk begins to resonate with mothers 

at about two weeks post partum there is an incredibly timed delivery of FREE INFANT FORMULA, or/and coupons for formula at the mother’s doorstep. For the 

family this is like manna from heaven! The formula is given to the baby and the 

mother’s breastmilk, produced by the body in a demand-supply continuum, further 

diminishes. What chance does breastmilk have in this battle for the baby share? Not 

a lot, as is evidenced by the billions of dollars spent by WIC on infant formula. 

Infant formula companies battle for market share against a unique product: 

breast milk, a living food that contains hundreds of active biological substances that 

cannot be manufactured and are not present in infant formula. Truly a ‘‘designer’’ 

food, breast milk varies from woman to woman, from day to day and from hour to 

hour in response to the needs of that particular baby who was birthed by the mother. As breastfeeding rates have slowly and steadily increased, particularly among 

low-income women, the formula industry has grown more aggressive in its attempt 

to regain market share, particularly by pushing formula supplementation (i.e., combining breastfeeding and formula feeding). 

In 1994, the United States signed on to the International Code for Marketing of 

Breastmilk Substitutes of the World Health Organization, which prohibits direct 

marketing of infant formula to mothers and health care providers. However, there 

are increasing reports that U.S. formula companies are violating the WHO Code 

through a number of means: routine and widespread direct marketing, including 

saturation advertising to mothers with billboards and magazine ads; detail marketing to healthcare providers; and provision of free formula to new and expectant 

mothers via discount coupons, direct free shipments of formula, and hospital discharge packs. 

A 2006 Government Accountability Office (GAO) report documented marketing 

practices and how much formula manufacturers spend on them. As the U.S. birth 

rate levels off, growth in the domestic infant formula market is primarily being driven by price increases, not by the quantity of formula sold. To maintain profitability, 

formula manufacturers have raised their prices by creating a dizzying array of new 

product lines and additives that come with attractive—though scientifically questionable—health claims. Examples of claims for more recent formulations tout relief 

for ‘‘fussy babies’’ or ‘‘gas.’’ 

Although these products include FDA-approved ‘‘designer’’ ingredients, which 

have been ‘‘generally recognized as safe’’ according to FDA standards, the direct 

health benefits of these additives have not been proven. The most disturbing direct 

advertising for these more expensive ‘‘new’’ formulas subtly undermines the obvious 

and proven superiority of breastfeeding by positioning formula as more and more 

equivalent to breast milk, as demonstrated by the following text on a company 

website: ‘‘Closer Than Ever to Breast Milk! * * * The first and only infant formula 

that has a unique blend of prebiotics, nucleotides, and antioxidants—nutrients naturally found in breast milk. Plus, it has DHA and ARA, ingredients shown to help 

your baby’s brain and eyes.’’ WIC providers report that this kind of marketing is 

causing confusion among WIC participants using infant formula, who sometimes ask 

if WIC provides ‘‘the breast milk in a can.’’ 

Thus another important way to help WIC promote and support breastfeeding, 

would be for the Committee in collaboration with your partners in Congress to make 

a determined effort to eliminate or sharply curb the blatant direct marketing of infant formula, which violates the WHO code and targets vulnerable low income 

women of color. 

Breastpump Funding 

WIC mothers at 3—4 weeks post partum face a whole new set of obstacles to their 

breastfeeding goals. The few, the determined, those that WIC staff are able to ‘‘rescue’’ and who are still breastfeeding without formula may have to think about returning to work! 

California and twenty-four states, the District of Columbia and Puerto Rico have 

laws related to breastfeeding in the workplace (Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming). 

Many WIC programs advocate for their working breastfeeding mothers and many, 

thanks to the support of this Committee and Congress, have breastpumps that are 

loaned free of charge to WIC participants so they can pump breastmilk while at 
28 

work. Needless to say, at PHFEWIC, we do not have enough breastpumps to support all our working mothers. Pumps are given preferentially to those women whose 

babies are in the Neonatal Intensive Care Units (NICUs) with only the remaining 

pumps going to the WWPP (working women pump program). A study of this program showed that WIC working mothers, who received a pump from the WIC program, exclusively breastfed for 120 days MORE THAN comparable working mothers 

who were not able to get a breastpump from WIC. (JHL, 2008, Meehan et al). 

In 1999, Congress approved a National WIC Association proposal to allow the use 

of food dollars for the much needed purchase of breast pumps to support working 

mothers. In 2005-2008, as the nation began to experience a growth in the numbers 

of women and families in poverty and an increase in the working poor, the Program 

was forced to turn to contingency funds to support rapidly expanding caseload. 

USDA placed restrictions on the use of those funds, preventing WIC agencies from 

purchasing breastpumps with those resources. I urge the Committee to direct USDA 

to allow use of contingency funds for breast pump purchase to guarantee 

breastfeeding mothers the critically necessary feeding aids to support their healthy 

breastfeeding choice in the workplace. 

Federal Breastfeeding Support 

Appreciating the external challenge we face in the WIC Program, Congress has 

recognized the importance of WIC breastfeeding promotion and support and has 

steadily increased the funding available to support this effort. WIC staff has not 

only embraced, but championed breastfeeding personally and professionally. Within 

WIC we have clearly established breastfeeding as the expectation and the norm. 

Like other WIC agencies across the nation, PHFEWIC has embraced the culture 

of breastfeeding and assures a breastfeeding—friendly work environment. The 700 

or so employees at PHFEWIC give birth to 22 to 28 babies every year and largely 

due to an effective employee perinatal support program almost all of our staff 

breastfeeds exclusively in the hospital, at six weeks, and when they return to work. 

Indeed, we have some very long term breast feeders (beyond 2 years) and even have 

staff that have tandem breastfed (2 babies, different ages: 2 months and 17 months). 

Our staff enjoys incredible support from the time they report their pregnancy until 

they stop breastfeeding. They are better counselors for having had such good personal experiences and working in such supportive environments. Staff support for 

breastfeeding is a common thread for WIC programs throughout the nation. For 

staff, WIC is the breastfeeding mecca. 

Our participants, however, live in the REAL world! They make forays into the 

WIC breastfeeding world once a month, but then return to their ‘‘formulagenic’’ 

world and may access other services and programs—many of them federally funded—that are not breastfeeding friendly. As an example, WIC moms who are TANF 

recipients are required to attend trainings after they have delivered their babies. 

They are discouraged to attend with their newborn-3 month old babies; this is NOT 

a breastfeeding friendly policy. Staff at various assistance programs have been 

known to ask women to leave the premises if they breastfeed their babies. This, too, 

is NOT a breastfeeding friendly policy. 

The bottom line here is that we must do everything in our power to support WIC 

in its efforts to make breastfeeding the cultural norm. 

On behalf of the National WIC Association, I urge the Committee to: 

a. Emphasize ‘‘breastfeeding promotion and support’’ as an integral part of nutrition education and add such language (breastfeeding promotion and support) to each 

citation related to WIC for nutrition education in the Child Nutrition Act of 1966. 

b. Ensure that ALL federal programs serving families, in particular, but not limited to the Supplemental Nutrition Assistance Program and the Child Care and 

Adult Food Program are breastfeeding friendly and that the employees have, at a 

minimum, a clear understanding that breastfeeding mothers and babies will be supported. 

WIC-led Collaboratives 

Slightly more than one out of every two infants born in the US participates in 

the WIC program. For the PHFEWIC program this translates into 5000 new babies 

each month. While we can, (and we HAVE) changed WIC policy, procedures, food 

benefit packages, created special funding for Peer Counselors, and recognized the 

need to fund the purchase of breast pumps, the reality is that WIC breastfeeding 

efforts do not exist in a vacuum. Our families live in the REAL world, not the 

breastfeeding utopia that many WIC sites have become. The best news is that we 

have willing and eager partners that are hungry to join hands with us and collaborate to effect the environmental changes that will ultimately lead to the optimal duration of exclusive breastfeeding. 
29 

WIC Programs across the nation work hard to collaborate with all manner of partners to encourage breastfeeding success. In the Los Angeles area the various local 

agencies that provide WIC services came together over 15 years ago and partnered 

with the La Leche League, local lactation professionals, hospital staff and 

breastfeeding moms to form a coalition: The Breastfeeding Task Force of Greater 

Los Angeles. Today this Task Force is a respected national entity, sought out by 

local, state and federal funders to provide a myriad of programs and projects to impact breastfeeding. WIC and the Task Force collaborate on privately funded projects 

to advocate for WIC participants, to make the workplace more breastfeeding friendly, and to keep up the pressure to move hospitals along the path to becoming Baby 

Friendly. 

Exemplifying collaborative partnerships, NWA is hosting a special Breastfeeding 

Summit here in Washington D.C. on Tuesday, March 9, 2010 to shine the spotlight 

on the assortment of successful WIC initiatives throughout the nation and to promote, support and advocate for breastfeeding mothers and babies enrolled in the 

WIC program. As the nation’s premier public health nutrition and prevention program with a clear funded mandate to promote breastfeeding, WIC is staking it’s 

rightful claim as the nation’s breastfeeding support and promotion leader and inviting partners to join hands with us. 

Full engagement and leadership in local or state collaboration efforts focused on 

breastfeeding promotion, while desirable and necessary, present challenges for many 

WIC programs due to resource limitations and staffing constraints. Resources are 

sorely needed to create WIC—led breastfeeding collaboratives which aim to bring 

key stakeholders together to ensure seamless breastfeeding support for low income 

women in their communities. 

WIC mothers and babies need the same opportunities and support to breastfeed 

their babies fully like their wealthier, more educated, mainly white sisters, who are 

outside of the WIC world. Our challenge is to reduce the chasm between the 

breastfeeding rates among WIC and non-WIC populations and have good credible 

sources of data to evaluate our progress. Across the nation, dedicated, creative and 

indefatigable WIC staff roll up their sleeves everyday and get ready to promote and 

support breastfeeding. 

There is a new enthusiasm in the air, the buzz around the supportive food package, the funding for Peer Counseling, the growing recognition that breastfeeding can 

play a major role in improving the health and well-being of an entire new generation of citizens. We are pinning our hopes on you. I want to sincerely thank you, 

members of the Committee, for allowing me to share a bit of my passion with you 

today. 

Chairman MILLER. Ms. Gettman. 

STATEMENT OF LUCY GETTMAN, MA, MSW, DIRECTOR OF FEDERAL PROGRAMS, NATIONAL SCHOOL BOARDS ASSOCIATION 

Ms. GETTMAN. Chairman Miller, Ranking Member Kline, my 

name is Lucy Gettman. I am director of Federal programs for the 

National School Boards Association. As a former child nutrition advocate, and now an advocate for school boards, I thank you for the 

opportunity to address the committee on this important issue affecting children enrolled in our public schools. 

The National School Boards Association represents the Nation’s 

nearly 15,000 local school districts and over 95,000 local school 

board members by working with and through our State School 

Boards Associations. At the organizational level, NSBA’s School 

Health Programs Department assists school policymakers and educators to make informed decisions about health issues affecting the 

academic achievement and healthy development of students and 

the effective operation of schools. 

Services are provided with and through NSBA’s member State 

associations and school boards in partnership with other national 

organizations such as the National Association of State Boards of 
30 

Education, the Alliance for a Healthier Generation, and Action for 

Healthy Kids. 

Additionally, NSBA is very proud of its efforts to promote nutrition in the schools and to prevent childhood obesity through Webbased services, educational programming, and publications. A summary of our efforts is provided as an appendix to our statement. 

Without question, local school districts believe that child nutrition is vitally important to fostering a healthy and positive learning 

environment for children to achieve their full potential. Healthy 

students learn better. Children and youth who eat nutritious foods 

and stay active are healthier, perform better in school, and learn 

behaviors that will keep them healthier throughout their lifetimes. 

School boards are acutely aware of the importance of ensuring 

that children have access to healthy and nutritious food, and many 

have already taken steps at the local and State level to improve 

nutrition and healthy eating. One such example is the State of 

Delaware, where a public/private partnership of education and 

health stakeholders, including the Delaware School Boards Association, established the Edith P. Vincent Healthy School Awards to 

recognize the work of public schools championing children’s health, 

including nutrition. 

NSBA’s Health Programs Department maintains many examples 

of school district efforts to improve student health and nutrition on 

its promising district practices database. Healthy nutrition success 

stories include a district in Kentucky that increased breakfast participation rates to 95 percent; a district in New Jersey that holds 

monthly coordinated health team meetings to discuss increasing 

use of fruits and vegetables, coordinating with food services and 

meeting with the PTA. There is a Pennsylvania district that created its own wellness brand to establish a new culture in the district to promote health. And there is an Arkansas district that implemented a water-only policy for sale in the district’s vending machines. 

There are many other examples of local initiatives because the 

commitment to increasing student access to healthy and nutritious 

food is not unique. What is unique, however, are the circumstances 

of each school district. What is successful at one won’t necessarily 

work at another. The geography, economy, demographics and resources available in the community vary for each district. The challenges, opportunities, and responses to local circumstances will also 

vary. 

Local decision-makers and stakeholders are in the best position 

to understand and meet the needs of each district, including child 

nutrition, with the Federal Government playing an important supportive role. Therefore, I have the following recommendations for 

strengthening nutrition programs in the child nutrition reauthorization. 

Recognize local school district authority and the variance among 

local circumstances and laws or policy addressing child nutrition. 

Next, refrain from imposing additional regulations or mandates 

on schools outside of the federally subsidized School Lunch and 

Breakfast Programs, and adequately reimburse schools for the cost 

of these services. 
31 

In addition, support school districts, local communities and 

States that are assuming greater responsibility for health and nutrition through incentives and grants that enable them to further 

expand their local commitment. 

And finally, ensure that adequate resources are available for 

school nutrition programs, for the meals and administration, the 

equipment and facility improvements, training for staff education 

and other stakeholders, for nutrition education and support of local 

initiatives. 

These recommendations are based on NSBA’s resolutions, which 

are determined by a national 150-member delegate assembly, members of which are selected by their States to collectively establish 

policy representing the perspective of 95,000 local school board 

members. The process is annual and ongoing, and the policy development begins in local communities in the States and culminates 

at NSBA’s annual convention each spring. 

In conclusion, reauthorization of the Child Nutrition Act is an opportunity to celebrate the progress made since the 2004 reauthorization and to envision an even healthier future for our children. 

Improving the quality of and expanding access to school meals is 

important to our children and our Nation. School districts are vital 

partners in the effort to assure a healthy and positive learning environment for children to achieve their full potential. The Child 

Nutrition Act reauthorization is an opportunity to acknowledge and 

support this local leadership and authority. 

Thank you again for the opportunity to comment. NSBA looks 

forward to a continuing conversation and collaboration about this 

critical issue. Thank you. 

Chairman MILLER. Thank you. 

[The statement of Ms. Gettman follows:] 

Prepared Statement of Lucy Gettman, Director of Federal Programs, 

National School Boards Association 

Mr. Chairman: My name is Lucy Gettman, director of federal programs for the 

National School Boards Association (NSBA). As a former child nutrition advocate 

and now an advocate for NSBA, I thank you for the opportunity to address the Committee on this important issue affecting children enrolled in our public schools. The 

National School Boards Association represents the nation’s nearly 15,000 local 

school districts and over 95,000 local school board members by working with and 

through our state school boards associations. 

At the organizational level, NSBA’s School Health Programs department assists 

school policymakers and educators to make informed decisions about health issues 

affecting the academic achievement and healthy development of students and the 

effective operation of schools. Services are provided with and through NSBA’s member state associations of school boards, in partnership with other national organizations, such as the National Association of State Boards of Education, Alliance for 

a Healthier Generation, and Action for Healthy Kids. 

Additionally, NSBA is very proud of its efforts to promote nutrition in the schools 

and to prevent childhood obesity through web-based services, educational programming, and publications. A summary of our efforts is provided as an appendix to our 

statement. 

Without question, local school districts believe that child nutrition is vitally important to fostering a healthy and positive learning environment for children to 

achieve their full potential. Healthy students learn better. Children and youth who 

eat nutritious foods and are active stay healthier, perform better in school and learn 

behaviors that will keep them healthier throughout their lifetimes. 

School boards are acutely aware of the importance of ensuring that children have 

access to healthy and nutritious food and many have already taken steps at the 

local and state level to improve nutrition and healthy eating. One such example is 

the state of Delaware, where a public/private partnership of education and health 
32 

stakeholders including the Delaware School Boards Association established the 

Edith P. Vincent Healthy School Awards to recognize the work of public schools 

championing children’s health, including nutrition. 

NSBA’s School Health Programs maintains many examples of school district efforts to improve student health and nutrition on its Promising District Practices 

database. Healthy nutrition success stories include: 

• A district in Kentucky that increased breakfast participation rates to 95 percent. 

• A district in New Jersey that holds monthly coordinated health team meetings 

to discuss increasing use of fruits and vegetables, coordinate with food services, and 

meet with the PTA. 

• A Pennsylvania district that created its own ‘‘wellness brand’’ to establish a new 

culture in the district to promote health. 

• An Arkansas district that implemented a water-only policy for sale in the district’s vending machines. 

There are many other examples of local initiatives, because the commitment to 

increasing student access to healthy and nutritious food is not unique. What is 

unique; however, are the circumstances of each school district. What is successful 

at one won’t necessarily work at another district. The geography, economy, demographics, and resources available in the community vary for each district. The challenges, opportunities and responses to local circumstances will also vary. Local decision makers and stakeholders are in the best position to understand and meet the 

needs of each district, including child nutrition, with the federal government playing 

an important supportive role. 

Therefore, I have the following recommendations for strengthening nutrition programs in the child nutrition reauthorization: 

• Recognize local school district authority and the variance among local circumstances in laws or policy addressing childhood nutrition. 

• Refrain from imposing additional regulations or mandates on schools outside of 

the federally subsidized school lunch and breakfast programs and adequately reimburse school districts for the cost of those services. 

• Support school districts, local communities and states that are assuming greater responsibility for health and nutrition through incentives and grants that enable 

them to further expand their local commitment. 

• Ensure that adequate resources are available for school nutrition programs, for 

meals and administration, equipment and facility improvements, training for staff, 

educators and other stakeholders, nutrition education and support for local initiatives. 

These recommendations are based on NSBA’s Resolutions, which are determined 

by a national 150-member Delegate Assembly, members of which are selected by 

their states to collectively establish policy representing perspectives of 95,000 local 

school board members. The process is annual and on-going in that the process of 

policy development begins in the states and culminates at NSBA’s annual convention each spring. 

Conclusion: Reauthorization of the Child Nutrition Act is an opportunity to celebrate the progress made since the 2004 reauthorization and to envision an even 

healthier future for our children. Improving the quality of and expanding access to 

school meals is important to our children and our nation. School districts are vital 

partners in the effort to assure a healthy and positive learning environment for children to achieve their full potential. The Child Nutrition Act reauthorization is an 

opportunity to acknowledge and support this local leadership and authority. 

Thank you again for the opportunity to comment. NSBA looks forward to a continuing conversation about this critical issue. 

APPENDIX

Efforts to Improve Child Nutrition 

March 2010 

The National School Boards Association (NSBA), through its School Health Programs department, supports NSBA’s commitment to help school policymakers and 

educators make informed decisions about health issues affecting the academic 

achievement and healthy development of students and the effective operation of 

schools. Services are provided with and through NSBA’s member state associations 

of school boards, and in partnership with other national organizations such as the 

National Association of State Boards of Education, Alliance for a Healthier Generation, and Action for Healthy Kids. NSBA receives funding from the Centers for Disease Control and Prevention (CDC) to support much of its work on health issues. 
33 

Web-based services through NSBA’s School Health Programs webpage 

(www.nsba.org/SchoolHealth) 

• ‘‘101’’ Packets on school health topics such as Wellness, Childhood Obesity, Nutrition, and Physical Activity provide the data, background information, research 

and sample policies to support local school board decision making. ‘‘Promising District Practices’’ website provides the ‘‘stories’’ of how school districts have acted to 

address healthy eating and physical activity. 

• A Childhood Obesity web page launched in January 2010 provides easy access 

to data, research, and tools for making policy and environmental change. 

• ‘‘Updates and Special Announcements’’ alert school officials to new research and 

reports on a wide range of health topics, including nutrition, to inform decision making. Users can sign up to obtain the ‘‘Updates’’ via an RSS feed. 

• Searchable database of research, information and sample policies provides essential information on a wide variety of school health topics including nutrition. 

Educational Programming 

• NSBA’s annual conference (April 4-7, 2009, San Diego, CA): several sessions focused on school nutrition and wellness were presented in partnership with such organizations as the Alliance for a Healthier Generation, Action for Healthy Kids, and 

the School Nutrition Association. The 2010 conference (April 10-12) in Chicago also 

will have multiple sessions on school nutrition and related health issues, including 

a session provided by the California School Boards Association on collaborative leadership for addressing health issues. 

• Symposium on Childhood Obesity (July 2008, Little Rock, AR): 12 state teams 

that included members of state boards of education and local school board members 

convened to develop action plans to drive childhood obesity initiatives/policy change 

in their states. Follow-up technical assistance was provided to these state teams. 

• Webcast: On December 1, 2009, in partnership with the Missouri School Boards 

Association’s Education Solutions Global Network (www.esgn.tv), NSBA hosted a 

webcast on strategies for addressing childhood obesity, which targeted school board 

members and other state and local elected and appointed policymakers. 

Publications 

• Content in the American School Board Journal, including a special report focusing on ‘‘Health and Leadership’’ in addressing childhood obesity (February 2009— 

access online at www.asbj.com). 

• Participation in the development of Leadership for Healthy Communities Action 

Strategies Toolkit, a new toolkit for state and local policymakers to develop policy 

measures addressing issues around childhood obesity, including nutrition in schools 

(in partnership with Leadership for Healthy Communities, a national program of 

the Robert Wood Johnson Foundation). 

Chairman MILLER. Thank you very much to all of you for your 

testimony. 

Ms. Morrison, can you just—I only have 5 minutes, so I need a 

better explanation—not better, but a more expansive explanation 

than you have in your paper of what happened. Why did these 

agencies in Los Angeles decide they could no longer participate? 

Ms. MORRISON. The program was being sponsored by an organization, a multiservice organization, and the CACFP administrative 

compensation for the program did not—it was not financially viable 

for the organization to continue supporting that program. There is 

not enough money for the administrative reimbursement to support 

the program and to be able to accomplish the requirements. 

Chairman MILLER. And that is separate from the food package. 

Ms. MORRISON. That is separate from the food, meals, yes. 

Chairman MILLER. So your understanding is that it is a question 

of the cost of administration. 

Ms. MORRISON. That is true. It is the cost of administration of 

the program that is causing sponsors to discontinue sponsoring the 

program. 
34 

Chairman MILLER. And you would attribute that to what? I 

mean why has that changed all of a sudden? 

Ms. MORRISON. Well, one of the things that happened in the last 

year is the reimbursement for administration was reduced because 

of the tie to the Consumer Price Index, which went down. That 

caused the reimbursement rate for certain level of homes to go 

down. Also, the administrative burdens of paperwork, and the additional block claiming that has become a requirement, caused programs to close because it requires more visits and it can’t be accomplished without increasing the reimbursement for the administration. 

Chairman MILLER. All right. Thank you for that. 

Ms. Rivas, you make two recommendations with respect to the 

dietary guidelines. And one is that it is no longer sufficient to simply try to meet the goals—that it is sufficient that you are attempting to meet the goals of the dietary guidelines. You think that dietary guidelines in and of themselves have to be met. Is that a fair 

statement? 

Ms. RIVAS. Well, currently, we have national guidelines that follow the dietary goals. Recently, USDA contracted with the Institute 

of Medicine to further look into the dietary guidelines in order to 

look at the overall problem of reducing childhood obesity. 

And so, currently, what we want to be able to do is increase our 

reimbursement so that we can go ahead and meet those guidelines. 

But we need the Secretary of Agriculture to be given the authority 

to be able to define those guidelines so we can consistently apply 

the same specific guidelines. 

Chairman MILLER. You need him to define how they apply to the 

school nutrition programs. 

Ms. RIVAS. Pardon? 

Chairman MILLER. You need the Secretary to have the authority 

on how they apply to the school nutrition program and how there 

would be compliance. 

Ms. RIVAS. How the guidelines for the Institute of Medicine’s new 

recommendations are going to be applied consistently throughout 

the country. 

Chairman MILLER. And you have landed that on the Secretary 

of—and you think that is the place. 

Ms. RIVAS. Well, we currently have meal patterns. But we have 

new recommendations from the Institute of Medicine that have 

been offered through the Institute of Medicine, and we are needing 

some additional guidance to be able to implement those guidelines 

nationally so that they are consistent. Currently, many States and 

local districts are making changes to their local standards, and 

that increases costs because there are different versions that are 

being applied nationally. Being able to apply them consistently and 

have the Secretary of Agriculture define what those guidelines are 

will make our programs more consistent and reduce the overall 

cost of our programs. 

Chairman MILLER. Thank you. I am delighted when I read in 

your testimony that, you know, you have joined up with First Lady 

Michelle Obama in this campaign for healthy eating and healthy 

meals, and trying to use, as she explained it to us, trying to use 

these programs as teachable moments, as part of the classroom, as 
35 

she would say; whether it is the school garden or the Lunch or 

Breakfast Program, to do this. 

And I was discussing diabetes with some people yesterday, and 

when you think that 23 million children and adults in the United 

States have diabetes—the number of children under the age of 20, 

it is 186,000 individuals. And so it would seem to me that as we 

talk about obesity and diabetes and diet, that there is a moment 

here to really do an education; that if you are going to have this 

explosion of diabetes in the adult population, some kind of work 

with the children while you have these moments around the school 

nutrition programs could conceivably, if well structured and properly delivered, could conceivably have a lifetime of benefits for 

those individuals. And I don’t know how you are thinking about 

this but—— 

Ms. RIVAS. Absolutely. We see—the School Nutrition Association 

sees this as a wonderful opportunity to utilize the school cafeterias 

as a learning laboratory for healthy eating so that we can improve 

the eating habits of our children. We support coordinated school 

health programs so that we can work together with the total school 

community to be able to promote the School Lunch Program. We 

have healthy meals that provide healthy entrees, more fresh fruits 

and vegetables, more whole grains, and they model what the 

healthy meal is. And if our students participate in their program 

they are able to take that message home. 

And so in partnership with the total school community, I think 

that we can work toward having healthier students and then reducing all of the chronic illnesses that result from unhealthy eating. 

Chairman MILLER. Thank you. Mr. Kline. 

Mr. KLINE. Thank you Mr. Chairman. And again, thanks to the 

witnesses for your testimony, for being here today. 

I was struck that it seems every one of you, you do have something in common out there, that every program does seem to need 

more money. We have heard calls for adequate resources, enhanced 

meal reimbursements, covering the cost of transportation and delivery and so forth. So I do—we have got that message. 

We don’t actually have the money, but we do have the message 

that there is more money required. We have some difference of 

opinion, it seems to me, here about the role of the Federal Government, how much it is going to be, how much it is going to be dictated by the Secretary of Agriculture. 

I think, Ms. Rivas, it was your position there ought to be greater 

input at that level. And I think, Ms. Gettman, you were emphasizing, representing the National School Boards Association, that 

there ought to be more local control and that the Federal Government ought to be careful about how it intrudes in that. 

It does seem to me that the child nutrition initiatives at the 

school or school district, local level, allow for more input and support from parents, which I think we all would agree is very helpful. 

The more parents are involved in education in general, the better 

we are. And not just on nutrition. 

Could you address that, involving parents and how that would 

relate to how much the Federal Government dictates in this process? Ms. Gettman, to you. 
36 

Ms. GETTMAN. Thank you. Mr. Chairman, members of the committee, parents absolutely play an absolutely critical role in the 

success of all of our collective efforts. And to maximize and capture 

the collaborative potential between local school districts, families, 

and communities is absolutely paramount. One thing to keep in 

mind is that local school board members are either appointed by 

or elected by and from their communities. Many of them are parents. Many of them are educators or providers or business leaders 

in the community. And they are the perfect leverage point to optimize the collaborative potential with communities. 

Another dimension that we reflect on with regard to the role of 

parents is that the teachable moments that were brought up earlier 

in this hearing can be maximized at the local school district level, 

either through professional development with in-school staff or 

through PTA, basically the role of local school districts as hubs of 

their communities. Local school district initiatives can absolutely 

magnify parent education, parent engagement, parent involvement, 

ultimately resulting in improved child nutrition. 

Mr. KLINE. Thank you. I know that one thing about the local 

school board is that you can reach out and touch it. I think my 

daughter has been involved in such a battle here lately, as a mother of two children in the public schools. 

I just want a clarification here. I am trying to think, Ms. Rivas, 

whether it was you or not, but I am going to turn to you because 

I think it falls into the realm that you were discussing. I want to 

talk just for a second or have you address the issue of the so-called 

competitive foods, you know, where you have—so often you have 

the athletic organizations of the school and organizations who have 

bake sales and they cook the famous brownies and banana bread 

and that sort of thing. 

Is it your position, or the position of your organization, that this 

should fall into these same guidelines that the Secretary would 

promulgate? 

Ms. RIVAS. That is correct. We support local policy and menu 

planning, but with sound science. However, you know, our role as 

food service directors is to teach children, you know, good basic nutrition. As they go through the cafeteria line, we try to teach them 

what a good balanced meal is. And I think when we are talking 

about, you know, meals served outside of the classroom, very often 

they do not support that same message. 

And so we are urging Congress to eliminate the time-and-place 

rule, because what messages we are trying to send in the cafeteria 

in promoting the recommended dietary guidelines and the Institute 

of Medicine recommendations, they need to be consistent messages 

throughout the whole campus. 

Mr. KLINE. Okay. So you—— 

Ms. RIVAS. And so we—— 

Mr. KLINE. You do want to regulate the bake sale. 

Ms. RIVAS. We want to have the Secretary to determine what 

those guidelines should be so that we are consistent, both in the 

cafeteria and outside of the cafeteria, because what we are trying 

to do is have the students participate in the program. And when 

students are tempted to go outside of the cafeteria, they are not 

drinking their milk, which is a very, you know—which is a real 
37 

critical part of their growth and development. We want to encourage healthy eating. 

Mr. KLINE. My time has long since expired, so thank you. I think 

I have got the answer. We want to regulate the bake sale, and that 

is what I was trying to get at. And I do believe I understand your 

position now so I will yield back. I know there are others who have 

questions. 

Chairman MILLER. Thank you. Congresswoman McCarthy. 

Mrs. MCCARTHY. Thank you. And I want to thank Chairman Miller for having this hearing today. This is something that the committee and the subcommittee have been working on for several 

years now. And I want to thank the panel, for bringing the information to a wider audience. I think that, you know, when we start 

looking at—and obviously with Mrs. Obama speaking about this 

constantly, it has finally moved up the radar, which a lot of you 

have already known for a long time that we need to change these 

things. We have worked here in a pretty hard way on issues that 

we are ready for ourselves, for the child nutrition reauthorization. 

The benefits of breastfeeding are well-recognized, as we discussed 

today. 

And just thinking back, I spent over 30 years as a nurse and a 

lot of times I had to work on the OB-GYN floor. And it is there that 

we need to make sure that our nurses and our doctors are trained 

in this, giving the benefits of what the child could go through by 

breastfeeding. 

That is why last year I worked hard to get the $5 million in the 

Ag appropriations for breastfeeding performance bonuses awards, 

and why I introduced legislation addressing this issue. Aside from 

the bonuses, I am also looking at how we can utilize volunteers 

such as those in the National Service AmeriCorps Programs to assist with meeting the goals of child nutrition programs, especially 

for WIC. 

I guess the question that I would ask is what are the greatest 

hurdles that we are facing on breastfeeding success with the WIC 

mothers? And beyond peer counseling funding, what additional resources would support WIC in its efforts to promote breastfeeding? 

Would additional human resources, possibly through volunteers, be 

helpful in the cause that you are looking at? Ms. Saluja. 

Ms. SALUJA. Thank you for your question. It kind of puts it back 

to where—I mean, I hate for you all to think I am going to keep 

digging up that old tree or barking up the old tree. But the reality 

is we can put a lot of effort into promoting breastfeeding. We can 

put a lot of human resources into supporting it. But until we fix 

the institutions that don’t make it happen right, it is just going to 

be more—throwing more money at the problem and hoping it goes 

away. 

So the way I really, I want to really acknowledge that the peer 

counseling money is phenomenal because that is really what helps. 

You know, the peer-to-peer support, friends working with friends, 

people who look like you, understand your situation. Moms, when 

they go to deliver, though, when they—you know, the human-made 

issue that happens when they get confused by the messaging, when 

they don’t have—when the baby is crying and doesn’t take their 

breast, that becomes very difficult for them. 
38 

So perhaps there is a place for some help that happens, but at 

a community task force collaborative level where we could really 

bring a million people marching the streets saying, Hospitals, you 

need to change. Everybody needs to sing the same tune. 

You know, the other programs that our moms access, for example, the SNAP program where they go to apply for food stamps or 

the Child Care Food Program where they might be leaving their 

children, all these programs need to be in sync that we have the 

same message: We are here to support exclusive breastfeeding and 

long-term breastfeeding as a vehicle to prevent childhood obesity— 

and all the other fabulous things that come along with it. 

Volunteers, there is definitely a place for volunteers. I would 

leave it to local programs to figure out how best they can use them. 

We can never have enough human resources, but what we really 

need is systems change. Perhaps these could be the detail people. 

You know, we know that formula companies have detail people. 

They change the name of a formula, they get to the doctor’s office 

and boom, there is a new thing on the horizon. We don’t have 

breastfeeding detail people. Maybe the volunteers could become the 

breastfeeding detail that go out and do these, you know, luncheons 

with docs. 

I think there is a way to do this. We have to kind of think 

through this; locally and collaboratively working together. But we 

have got to get rid of the problems that have been created by the 

external environment, so that our moms and babies don’t suffer 

needlessly. And WIC doesn’t have to, you know, do conniption fits 

to make this happen. 

Mrs. MCCARTHY. One of the things—and quickly, because my 

time is almost up. We have a couple of programs working in my 

district in the underserved schools where we have brought child 

nutrition back in with an exercise program, working together. One 

of the things that I didn’t hear anybody talk about was the data 

that we have so far for 3 years that this program is in place, is that 

the marks all went up. The children actually started getting higher 

grades across the board. And I think that we are overlooking that 

on nutrition. Exercise, actually increases marks for the children. 

And let’s face it, our young women and boys, at that age, they need 

to move around a little bit more. And we have constrained them 

in so many ways. So I am not saying, you know, a free-for-all. I 

don’t believe in that. But I know 2 or 3 minutes of exercise in between classes or whatever, or subjects, has helped them quite a bit. 

Thank you for your testimony. 

Chairman MILLER. Thank you. Mr. Roe. 

Mr. ROE. Thank you Mr. Chairman. I want to, since this is an 

Education and Labor meeting I want to give you all an A. Since 

I have been here, you are the best panel we have had at staying 

within 5 minutes. Mr. Chairman, thank you for selecting these excellent witnesses today. 

And I want to start at birth, because that is what I did for a living was birth babies. And one of the things that, I totally agree 

with you, I think several things I ran across. We worked in a birthing center. And one of the issues you run across for the mother is 

work, going back to work and breastfeeding. I think that is a huge 

issue, basically your education level and cultural issues. But we 
39 

really emphasized that in our practice, and we delivered about 

1,200 babies a year. And so we emphasized that and had a very 

high percent that breastfed. The problem with it is that many 

moms work now, and it is difficult in the workplace, unless it is 

an unusual work environment, for them to be able to do it. So I 

pitch that out with no solutions, just a point that I think that is 

a problem. 

But, absolutely, what you say is true. And also how we grow up. 

And I think it is extremely important to start in the schools. And 

we, as Congresswoman Slaughter did, we started a program in our 

city in Johnson City, Tennessee, called Up and At ’Em, and we 

weighed all the children in elementary school and found that 39 

percent were overweight or at risk, and 1 percent were underweight. And we began a program called Up and At ’Em where we 

introduced exercise as you were talking about, in the elementary 

school level. And hopefully that will be a lifestyle; because growing 

up, my mother didn’t allow me to stay in the house. I mean you 

had to be outside playing. You had to go out. And we only ate when 

we ate. There weren’t any restaurants. And I was in a very rural 

county, so there were no fast food restaurants where I lived. So we 

ate vegetables and fruits, and that is how we grew up, and that 

is how I continue to eat today. So we are what we eat. And I think 

that is a situation where that is got to begin at birth. 

One of the problems I have with the program, I guess, is that 

when you are—it is $2.68 we pay for a meal and it costs the schools 

$3.03, or approximately that, in our area to produce a meal. So 

they are in the hole already. 

I think you brought that point up, Ms. Rivas, and I certainly am 

sensitive to that. You can’t continue to do that. 

The other thing, where school cafeterias have, I guess, expense 

back to the lunch program, where you are paying for a lot of things 

that don’t have anything to do with food. 

The other thing, I would recommend that you look at what we 

did in our local community, which was very helpful in saving 

money, was we did an energy audit for all our buildings. And we 

found out that one of the biggest energy consumers that we had 

were the old ovens and stuff that you prepared the food with, and 

we were able to go in with a company that actually found enough 

energy savings to replace all of that more modern equipment at no 

cost. So I would look at those opportunities out there. 

The other thing I think, Ms. Morrison, you brought up that was 

interesting, I would like to hear your comment. We did this on the 

VA Committee where we budget now for 2 years, is to budget—can 

purchase over a 2-year period of time. That makes good sense if 

you can use best practices like that. 

And any comments that any of you have about what I have said. 

Ms. Morrison, you are—yes, Ms. Saluja. 

Ms. SALUJA. If I could begin at the birth piece, I really appreciated your comments. I congratulate you on your practice. The 

thing that you mentioned, though, it is a very common misconception that people hold, that well, yeah, you want to breastfeed but 

you are going back to work. The reality is that there again, working women, women of color, lower-income moms, are disproportionately affected by that, and it is seen as a hindrance. It really isn’t. 
40 

And again, WIC comes into play there. We have money for breast 

pumps. The WIC program—I will speak personally. From my experience for the last 10 years, we have been putting pumps out in 

work sites. We have actually legislation in 36 States, I believe—it 

is in my testimony, I may have the number wrong—that actually 

provide lactation accommodation at the work site. 

And in Los Angeles, I am so proud to tell you we have never had 

an employer turn us down. We are the advocates. The mother 

comes to us and says, WIC, I am ready to go back to work. There 

are certain conditions. She is exclusively breastfeeding. She is 

going back to work. We call the employer, we tell them about the 

California law. They welcome them with open arms. We have a 

place, we give the pump for free. They give it back to us when they 

are done. And in fact I want to tell you that this working woman 

pump program in Los Angeles, we have actually done a study on 

it, it gives us 120 extra days of exclusive breastfeeding, just because the mother had the support and the location was provided 

for her at the work site. Having said that, I would really urge that 

we look to see that USDA allows us to use contingency funds if 

needed to buy additional pumps, because that is going to be our 

next challenge, as you so well pointed out. 

And I also want to recognize that Representatives Caroline Maloney and Carolyn McCarthy have introduced legislation to provide 

tax credits for workplaces offering lactation facilities. We do need 

to make this a recommendation that breastfeeding and working are 

not incompatible but should be encouraged, because, as I just told 

you all, and I am sure you knew, it is the duration of exclusive 

breastfeeding that is going to help us put the first line of defense 

against childhood obesity. Thank you. 

Chairman MILLER. Did you also ask for Ms. Morrison to respond? 

If there is no objection, just let her. 

Ms. MORRISON. Do you want me to go ahead and answer the 

question? Okay. Thank you for the question. What we are proposing is that we are allowed to have—well, Business 101, you 

don’t plan a budget without having contingency funds or to try to 

have carryover. And with the Child Adult Care Food Program regulations we aren’t allowed to have carryover. It is very difficult. Is 

that enough of an answer for you? 

Mr. ROE. Thank you, Mr. Chairman. 

Chairman MILLER. Thank you. Mr. Scott. 

Mr. SCOTT. Thank you, Mr. Chairman. Have any of the panelists, 

are any of the panelists aware of any successful Farm to School 

Programs, where you work with local farmers to sell food to the 

local school system? 

Ms. RIVAS. I know that across the country we have a number of 

successful Farm to School Programs, and we work through the 

United States Department of Agriculture through the Commodity 

Program to direct Farm to Schools to our school district in Dallas. 

But there are a number of them across the country. 

Mr. SCOTT. And are they helpful? Should they be encouraged? 

Ms. RIVAS. Absolutely. We are able to get a greater variety of 

fruits and vegetables that students have not been exposed to, and 

so it is a very successful program, and we would be glad to provide 

you with a list of some successful programs. 
41 

Mr. SCOTT. Thank you. 

Mr. HOLT. Would the gentleman yield? 

Mr. SCOTT. Yes. 

Mr. HOLT. Representing the Garden State, I would just like to 

bring to the gentleman’s attention H.R. 4710, introduced by myself, 

Mr. Sestak, Mr. Boyd, Mr. Blumenauer, Mr. Ellison, and Mr. 

Davis, to amend the School Lunch Program for Improving Farm to 

School Programs. 

Mr. SCOTT. Good. 

Chairman MILLER. And I think Mr. Scott wants to be on that 

bill. 

Mr. HOLT. That was my question. 

Mr. SCOTT. I think so. I think so. I thought I was already on it, 

as a matter of fact. 

Ms. Rivas, is it any more expensive to provide healthy meals 

than unhealthy meals? 

Ms. RIVAS. Yes. We currently provide healthy meals, and so I 

kind of want to start with that. Because we currently meet the dietary guidelines and provide no more than—— 

Mr. SCOTT. It is more expensive to provide—— 

Ms. RIVAS. It is significantly more to offer more whole grains and 

more fresh fruits and vegetables. 

Mr. SCOTT. One of the curiosities about this program, as I understand it, is the reimbursement rate is the same all over the country. Low-cost areas and high-cost areas, where the cost of food and 

personnel may be vastly different, the reimbursement rate for the 

school meals is exactly the same. Is that right? 

Ms. RIVAS. That is correct. 

Mr. SCOTT. Does that make sense? 

Ms. RIVAS. Does that make sense? 

We all have different challenges, and school food service directors 

struggle with that. We all do have varying labor costs, food costs, 

and fuel costs, but I think the overall problem is that it is currently 

totally underfunded. So all of us are struggling with a tight budget 

and need increased reimbursement, and we are urging Congress for 

35 cents more across the board both for breakfast and for lunch. 

We are wanting to meet the Institute of Medicine’s new recommendations of offering more fresh fruits and vegetables, and in 

order to do that, we need higher reimbursement. 

Mr. SCOTT. How much of your budget, Ms. Rivas, is used up in 

administration and trying to find out who is eligible and who is not 

eligible? It seems to me in many schools where virtually everybody 

is already eligible, it makes no sense to waste money. You could 

serve everybody for the cost of fooling with the eligibility standards. 

Ms. RIVAS. And that is one of our recommendations. You do 

reach a certain threshold where at a certain point when you have 

certain districts that have certain levels of free and reduced lunch 

participation it is more cost effective to be able to eliminate the 

process of applications. 

Mr. SCOTT. In Virginia, we have a tough budget situation, and 

there is consideration being given to dispensing with school breakfast. Can someone say how important the School Breakfast Program is? 
42 

Ms. RIVAS. I can certainly do that. I have been involved in a 

number of districts where we have had programs that we have expanded breakfast through grab and go breakfast, breakfast in the 

classroom, and our teachers are our best advocates for it because 

what they see is that their students are more attentive in the classroom, there are less students going to the nurse’s office because 

they are hungry, and there is research to show that especially 

when it comes to analytical skills and math and science they are 

able to mentally be able to accept all those concepts a lot easier 

when they have had breakfast. 

Mr. SCOTT. Thank you, Mr. Chairman. 

Chairman MILLER. Thank you. 

Ms. Fudge. 

Ms. FUDGE. I thank you, Mr. Chairman, and thank all of you for 

your testimony today. 

Ms. Rivas, the U.S. health care costs due to obesity is estimated 

to be about $150 billion a year, half of which is paid through Medicaid and Medicare. With nearly $1 of every $6 of our economy 

spent on health care, we cannot afford to continue to sell junk food 

in schools. Too many children in my district which I represent, one 

of the poorest districts in the country, depend on food served in 

schools, most of them. Now I am talking about Cleveland, Ohio, 

which is a part of my district. And I am certainly not willing to 

gamble with their heath. Getting unhealthy food out of schools is 

a no-cost way to address the high cost of obesity. 

My question is, from the perspective of the School Nutrition Association, do you think that a minimum nutrition standard for food 

sold outside of school meals Nationwide is needed to protect the integrity of the School Lunch Program and the health of all of our 

children in all States? 

Ms. RIVAS. Absolutely. The School Nutrition Association totally 

urges Congress to eliminate the time and place rule. Because we 

absolutely believe that the health of our student—that we are investing in the future of our country when we have well-nourished, 

healthy students; and being able to teach that same message of 

healthy meals both inside and outside of the cafeteria is critical to 

them developing healthy eating habits in the future and eliminating chronic illnesses as well. 

Ms. FUDGE. So there should be a minimum standard? 

Ms. RIVAS. Absolutely. We are recommending that the standards 

be set by the Secretary of Agriculture following the recommended 

dietary allowances or guidelines for Americans. 

Ms. FUDGE. Thank you. 

Ms. Morrison, in your testimony, you recommend that Congress 

reduce the Child and Adult Care Food Program area eligibility test 

from 50 percent to 40 percent to streamline access to healthy 

meals. While this reduction will have a positive affect on all rural 

and suburban communities, will it also have a positive effect on 

urban areas? And, if so, how? 

Ms. MORRISON. Certainly. The percentage of low-income children 

or families in urban areas is no different than in the rural areas. 

If you have a district that has 50 percent, in fact, it is going to impact them more in the urban areas because you will have more 

children concentrated in an urban area that would be impacted by 
43 

reducing that eligibility to 40 percent than you would in a rural 

area. So the answer to your question is it would have a greater impact in an urban area. 

Ms. FUDGE. Ms. Gettman, Nationwide, 30 percent of school districts prohibit the sale of unhealthy food in school vending machines. Two-thirds of States have weak or no nutrition standards 

for food sold outside of meals. One of your recommendations is that 

Congress refrain from imposing additional regulations or mandates 

on schools outside of the Federally subsidized school lunch and 

breakfast programs. If Congress adopts your recommendation and 

does not work to create Nationwide nutrition standards for food 

outside of meals, how will we ensure that our children are only offered the healthiest food? 

Ms. GETTMAN. Thank you. 

A couple responses that come to mind include that schools and 

school districts are moving in the right direction. As the information you just shared demonstrates, a fairly significant, although 

certainly not all school districts, are already moving in the direction of making that local determination of what is appropriate for 

students to have access to in their schools. 

I think one thing that we haven’t talked about too much is that, 

in light of the direction that many school districts and States are 

going to with regard to implementing standards for school nutrition, that I am not sure we have asked the question whether national standards would necessarily improve over those which already exist in some States and schools. I think sometimes the flip 

side of uniformity is maybe we haven’t reached quite as high as we 

would like to. 

I think it is also important to honor the fact that long-term solutions are more effective when they are locally initiated and there 

is local engagement and the innovation is coming from the local 

level. And so that is where I think we would recommend some attention and resources being devoted. 

I would also give some thought to any unintended consequences 

to having national standards, and I already mentioned, it is possible that national standards could be weaker than those that already exist in some States or in some school districts. 

And, also, as Mr. Kline brought up, we want to make sure that 

our approach deals with all the environments and climates and 

contacts that children have. So it is not just in school, but it is also 

at home and in the community. So that students who do not have 

access to low-nutrition foods in vending machines, for example, 

aren’t just bringing them in or buying them elsewhere or eating 

differently at home than they do in school. 

So I think it is important to take as comprehensive an approach 

as possible and to recognize that successful solutions to these 

issues need to have strong engagement from the local level. 

Ms. FUDGE. Thank you very much. 

Thank you, Mr. Chairman. I yield back. 

Mr. KILDEE [presiding]. Mr. Polis. 

Mr. POLIS. Thank you, Mr. Chairman. 

I couldn’t agree more that nutritional education is essential for 

our country to tackle the obesity epidemic. 

My first question is for Ms. Rivas. 
44 

Numerous scientific studies have shown the benefit of low-fat, 

high-fiber, plant-based options for adults and children; and several 

organizations have promoted vegetarian or meals with a reduced 

meat as important options for chronic disease prevention. 

For example, the American Heart Association, American Diabetes Association, the American Institute for Cancer Research promote plant-based foods for chronic disease prevention; and the 

American Medical Association and the American Public Health Association have called on Federal food assistance programs to emphasize vegetables, fruits, legumes, grains, and nondairy vegetarian foods. 

Based on the scientific research, it seems that we could be making tremendous progress in improving our children’s health and 

bringing down health care costs by expanding access to healthy 

vegetarian choices and reducing children’s intake of fat, saturated 

fat, and cholesterol. 

Many students also prefer such options for moral, religious, allergic, or other reasons. For instance, many children are allergic to 

milk, are lactose intolerant, as I happen to be, or choose not to 

drink milk for other reasons. But they miss out on vital nutrients 

because they don’t have access to nondairy milk substitutes. 

So my question is two-fold. Should we encourage healthful vegetarian menu items in the national school lunch and breakfast programs by making them more affordable and providing incentives 

for schools, especially low-income schools to provide them; and, secondly, do you believe that schools should offer nondairy milk alternatives that meet nutritional stands established by USDA for 

school lunches for kids that can’t drink milk or won’t drink milk? 

Ms. RIVAS. Currently, and we can make an operations—the 

School Nutrition Association did an operations report on trends in 

menu planning in the last year, and the majority of school districts 

are currently offering vegetarian options as a choice in their menu 

planning. In many cases, some of the vegetarian options, because 

they are not very popular, are more expensive. When we have special diets for our students, some of those substitutions are also 

higher, and so they are more expensive and all the more reason 

why that additional reimbursement is very helpful in being able to 

expand those menu options. 

Mr. POLIS. The second part with regard to the milk? 

Ms. RIVAS. Currently, we offer a variety of milk, and school districts can choose to offer, as well, milk alternate substitutions. The 

cost of a comparable milk substitute is probably about four or five 

times the price of an 8-ounce carton of milk. And so, again, it is 

more expensive to be able to do that, but many school districts are 

absorbing the costs. 

Mr. POLIS. What can be done to bring down those prices of, let’s 

say, soy milk or almond milk or other milk products. 

Ms. RIVAS. I think most students accepting that choice. Because 

when we put the soy milk option on the line, a milk carton might 

cost us 20 cents. A soy alternate is about 75 cents. And so when 

we put that on the line, very few students take that choice. I am 

not really sure how to get industry to be able to reduce those costs, 

but, obviously, the more students that are exposed to it and learn 

to accept that, then that also lowers that cost. But, it is basically 
45 

because it is not a high-volume item that it is going to cost us 

more. 

Mr. POLIS. Finally, can you share with us your recommendation 

on how we can strengthen nutrition education and in particular 

what role the TEAM Nutrition Network can play to promote and 

support healthy eating and physical activity by children? 

Ms. RIVAS. A number of years ago, there used to be funds that 

were designated for nutrition education at the rate of about 50 

cents per student; and those funds were eliminated. Certainly more 

funding for nutrition education would be necessary to be able to expand nutrition education. We are also working with the coordinated school health programs in the school to work on incorporating nutrition education into the classroom curriculum. 

Mr. POLIS. You mentioned earlier a majority of schools have vegetarian options. By majority, did you mean perhaps a slight majority, 50, 60, 70 percent, or do you mean the vast majority? 

Ms. RIVAS. I think it is closer to the 90 percent. I don’t know the 

exact figure, but from what I recall it was between 90 and 96 percent. 

Mr. POLIS. Thank you. Yield back. 

Chairman MILLER [presiding]. Ms. Chu. Congresswoman Chu. 

Ms. CHU. Thank you, Mr. Chairman. 

Ms. Rivas, I understand that school districts bear significant administrative costs in administering the Federal School Lunch Program, and one of those costs has to do with what they pay the 

school district itself for the cost of just being there. And I understand that there isn’t any standardization with regard to what the 

school district can charge. One of my school districts just told me 

about an example where they are charged for the full cost of using 

the multi-purpose room all day long, when, in reality, the children 

only use it half an hour each day. So what can be done about this? 

I know that you talk about eliminating the administrative costs entirely, but could there be some standardization that can be done 

across States? 

Ms. RIVAS. Well, USDA currently allows some costs to producing—or indirect costs that go to producing the meal as an allowable cost. But currently there are no specific guidelines to be able 

to determine what those indirect costs are. So we urge you to have 

the Secretary of Agriculture define those guidelines more clearly so 

that nationally we are able to have more consistent guidance in 

what districts are able to charge school districts. So to prevent 

some of the school districts for charging, like the example that you 

used, for the multi-purpose room that is only used minimally. 

Ms. CHU. Should it be done by the Secretary? Should it be done 

State by State? I am wondering what the best way to go about 

doing this is. 

Ms. RIVAS. The most consistent way is to be able to set some general guidelines. But from—this is a national program. It is funded 

nationally. The guidelines for the menu planning all come from the 

Secretary of Agriculture; and they, I think, would be the best body 

to be able to determine what those guidelines—because they know 

what those expectations are for producing that meal. They established the guidelines for producing that meal. So what would be al-
46 

lowable I think would be best determined by the Secretary of Agriculture. 

Ms. CHU. And there are also the administrative costs of 

verification. I know that you talked about one way of streamlining 

would be to have to whole communities qualify for free lunch programs, but not all communities would be able to qualify in that 

manner. So what are other ways that there could be to streamline 

the verification? 

Ms. RIVAS. I am not familiar with all of the variety of the ways 

that that can be done. But I know that there is a certain threshold 

that a school district begins to achieve that after a certain level of 

percentage of free and reduced or it gets to where it is more cost 

effective to eliminate the whole application process. There is a big 

amount of expense that goes to processing applications and 

verification. 

So there is a threshold, and we just urge you to consider that. 

Because it would be a more cost-effective way for those communities to be able to reduce the cost to the students as well as to 

expand participation. 

I had experience with a Provision 2 program where we had about 

84 percent free and reduced, and when we went to that program 

we were able to eliminate the stigma that students had about the 

program, and we were able to increase breakfast from 30 percent 

to 50 percent. We were able to increase middle school and high 

schools over 10 to 15 to 20 percent at varying schools. So it is a 

very good option, especially in those communities that have—where 

the threshold is to where it costs, you are putting more money into 

file cabinets as opposed to on the plate of children. 

Ms. CHU. And there are relatively high percentage rates of fully 

subsidized students and fully paying students, but I understand 

there is a shockingly low rate of students that are at the subsidized 

level. In my district, we are saying it is only 7 percent versus those 

who are subsidized being from 60 to 90 percent. What would be the 

cost and benefits of allowing students at the reduced lunch level to 

be fully subsidized? 

Ms. RIVAS. That is another area that—or recommendation priority that the School Nutrition Association has. Sometimes there is 

a very small percent of students at that reduced category that are 

having to pay 40 cents. And, frankly, when you get some of those 

students and you have families of four or five children in that 

household, it gets very unaffordable for families. And very often 

our own cafeteria supervisors, even though many of them are 

struggling with their own personal budgets, take money out of 

their own pockets to be able to make sure that the children have 

a meal. 

So our recommendation is that over time we have that scale adjusted to where we begin incorporating the guidelines to include 

the reduced student and expand to where they eventually are also 

fully subsidized like the free students are. 

Ms. CHU. Thank you. I yield back. 

Chairman MILLER. Thank you. 

Mr. Kildee. 

Mr. KILDEE. Thank you, Mr. Chairman. 
47 

Ms. Rivas, several years ago, Bill Goodling and I put a program 

in for fresh fruits and vegetables being made available throughout 

the day in the classroom, various places. I visited one of the programs in my district. It was very, very successful, very popular 

with the teachers and the students. Could you comment on that 

program? 

Ms. RIVAS. That is a wonderful program, and I personally have 

that experience with the Dallas School District. We have over 20 

or 30 programs right now where we receive funding for fresh fruits 

and vegetables. And we have volunteers, they come in, they help 

distribute a variety of fresh fruits and vegetables. 

Again, many of these children are not exposed to some of these 

fresh fruits and vegetables. They have never seen a kiwi fruit or 

star fruit or watermelon because they can’t afford it at home. And 

so our staff, along with parent volunteers, deliver it to the classroom for a midmorning or midafternoon snack; and it is a very successful program. 

Mr. KILDEE. Well, what I noticed in two or three schools I visited, that cuts across the socioeconomic lines. 

Ms. RIVAS. Absolutely. It is available to all students, and so it 

is part of a nutrition education program. And part of that program 

requires that you provide nutrition education as part of that program. 

Mr. KILDEE. I remember I went to a rather wealthy—probably 

the wealthiest school district in my district, and nothing was being 

wasted, very little. You could see very little waste. It was an extremely popular program. So we had a study in a poverty area and 

a study in an area that was not—the opposite of poverty. 

Let me ask you this question, too. I started the first School 

Breakfast Program when I was a teacher in Flint Central High 

School in Flint for a small number of students. Does the School 

Breakfast Program have any affect upon attendance at the school? 

Ms. RIVAS. As I was mentioning the benefits of the breakfast program, attendance was one that I forgot to mention, along with improved attention in the classroom, behavior in the classroom, being 

able to learn certain math and analytical skills, attendance, going 

less often to the nurse’s office, all of these are great benefits of the 

breakfast program. 

Mr. KILDEE. Especially among the poor. Very often, they left 

home in the morning without any breakfast, so quite anxious to get 

to school to get their breakfast. And generally, once they got there, 

they stayed there, not always, but they stayed there. So you do see 

an affect on—— 

Ms. RIVAS. I have had some students having been involved with 

the breakfast program where I had breakfast in the classroom at 

one school and the student happened to be rezoned to another 

school where they did not have breakfast in the classroom, and he 

wanted to go back to the other school because they had breakfast 

in the classroom there because they really needed that breakfast 

in the morning. 

Mr. KILDEE. Thank you very much. I thank all of you very much. 

Chairman MILLER. Thank you. 

Mr. Holt. 
48 

Mr. HOLT. Thank you, Chairman Miller; and I wanted to acknowledge the subcommittee Chair, Carolyn McCarthy, for working 

on the Child Nutrition Program. It is really more important now 

than ever. I am finding in schools in my district in these tough economic times the number of children who need the lunches and the 

breakfasts are—the number is greater than ever. 

As you may have gathered from my interchange with Mr. Scott, 

I have a real interest in the Farm to School Programs. You probably know it is a key priority of Agriculture Secretary Vilsack, and 

First Lady Michelle Obama has planted a garden and so forth. And 

it not only—this program not only provides the fresh—fresher food, 

but it also has an important educational component that I think 

lasts into adulthood. 

So I am pleased that some of us have introduced the Farm to 

School Improvements Act, which provides competitive grant and 

technical assistance for the use of local foods. That improves the relationship between schools and the local providers and provides 

mandatory funding each year for the program. So it does provide 

local economic benefit. But I think—and it provides an important 

educational component, as I say. 

Ms. Rivas, as President of the School Nutrition Association, I 

would like to ask you about a couple of things. 

First, starting with the breakfast program. You recommend providing commodity foods for breakfast, which can be used if you already have them for the lunch program but that are not available 

there. What about Farm to School? Did you see a role for that in 

the breakfast programs? 

Ms. RIVAS. We are urging Congress to consider five additional 

cents for commodity and the Farm to School Program, and that 

value would certainly be a wonderful thing to have. And you are 

absolutely right about the vegetable gardens and providing the nutrition education aspect to the students’ knowledge. Because once 

they see and are exposed to those fruits and vegetables and they 

see it growing in the neighborhood garden or their school garden, 

they are able to see that it isn’t something that you just pick up 

at the grocery store but they can grow it at home, and they take 

those messages home to their parents. 

But any financial assistance for the breakfast program, the Institute of Medicine guidelines have increased the requirements in the 

breakfast category to expand more fresh fruits and vegetables as 

well, and so that funding is very critical to meeting those guidelines as well. 

Mr. HOLT. Despite being authorized, the existing Federal Farm 

to School Program hasn’t been funded. So what would you say 

about making the funding mandatory? 

Ms. RIVAS. Absolutely. 

Mr. HOLT. That is it. That is a softball question. 

Chairman MILLER. I thought it was a trick question. 

Ms. RIVAS. Any funding you can make mandatory we will graciously accept. 

Mr. HOLT. Not a trick question. A key pillar of the First Lady’s 

Let’s Move! campaign to solve the problem of obesity is to serve 

healthier foods. She is encouraging or actually working toward the 

goal of doubling the number of schools that participate in the 
49 

HealthierUS School Challenge. What does it take to become a 

HealthierUS school? How can we help more schools get there? Is 

doubling a reasonable goal? 

Ms. RIVAS. I think it is a reasonable goal, and we at the School 

Nutrition Association have been working closely with USDA. They 

are looking at some of the paperwork criteria to make it easier for 

school districts to be able to apply to it. Because when we used to 

see an application that we had to fill out, it made it more complicated. But the benefits of the HealthierUS schools is that not 

only does it have requirements in the menu planning, which is very 

key to the HealthierUS schools requirements, but it also has a component for physical activity. 

In the First Lady’s Let’s Move! campaign, one of the pillars is 

school meals, but one of the other pillars is physical activity. So the 

HealthierUS schools is a wonderful recognition that school districts 

can achieve that promotes both nutrition and nutrition education, 

and physical activity. 

So it is a wonderful program, and the School Nutrition Association is going to be really encouraging more of our members to participate. We are going to be promoting it at our meetings and conferences and publications and everywhere we can to help school 

districts. 

Mr. HOLT. Thank you, Ms. Rivas. 

And I thank the other witnesses, and I am sorry time doesn’t 

allow for discussion with those excellent witnesses now, too. 

Thank you. 

Chairman MILLER. Thank you. 

Congresswoman Shea-Porter. 

Ms. SHEA-PORTER. Thank you. 

Thank you all for being here. 

Better nutrition creates better health, greater productivity, and 

lowers health care costs; and, right now, we are talking about that 

quite a bit on the Hill. So the work that you do actually makes a 

big difference in the lives of these children and these adults, and 

I want to thank you for that. 

We had a recent report by the Carsey Institute, which is out of 

the University of New Hampshire, which happens to be my alma 

mater. But it had a disturbing note. It said that 55 percent of income-eligible rural households with children did not participate in 

the National School Lunch Program. Can you identify any barriers 

to that? 

Ms. RIVAS. I am not familiar with that community, but I know 

that one of the barriers is that there very often is a social stigma 

related to the application. And so more funding to be able to have 

technology, make applications online and easier to access and reduce that stigma that students might have regarding making 

meals available to them would be helpful. 

But I think in a community where there is a high poverty area, 

the community eligible type of program or community eligibility 

would be very helpful. Because, in that case then, students 

wouldn’t have to fill out an application; and, that would reduce the 

cost of the application process to the school district. 
50 

Ms. SHEA-PORTER. Clearly, it has to be addressed; and, Mr. 

Chairman, I would ask that we submit a copy of the report for the 

committee. 

Chairman MILLER. No objection. 

Ms. SHEA-PORTER. I didn’t think you would mind. 

[The information follows:] 
51 
52 
53 

Ms. SHEA-PORTER. The other thing I wanted to ask is that I 

know that the President’s wife is going to put this terrific program 

into place, and I know that she has shown great commitment for 

children and for nutrition and obesity. And the issue, obviously, of 

obesity and then diabetes, et cetera, is enormous. And Mrs. Obama 

has talked about these pillars. 

I can remember—I think it was last year, when we had Richard 

Simmons here and he was talking about the necessity for exercise 
54 

and how children just weren’t getting enough exercise, and I was 

remembering when my own kids were in school the punishment 

would be, if a child was hyperactive or needed to move around, was 

they weren’t allowed to move around. They had to sit in their seat. 

If they couldn’t stay still, they would miss recess, and they would 

have to sit in their seat. So it seemed like it was the exact opposite 

of what we hoped the result would be. 

So my question is, while we start to integrate these programs 

and we bring in more people, will you all be part of a team if you 

are in a school and in such a setting, a day care setting or wherever, where you will actually be included in some of the decisions 

that are made by principals and teachers as part of the education 

process to say that not only is it about food and good food so that 

children don’t have too much sugar and too much whatever it is in 

the food, too many carbohydrates, but that we also make sure that 

the policies in the classrooms and on the playground make sense? 

Because what Mr. Simmons was talking about was a very real 

problem, that the kids aren’t exercising enough. So will your voices 

be heard? Will you be part of that integrated approach? 

Ms. RIVAS. Yes. And I would suggest that you go to the 

schoolnutrition.org Web site. Because in there we have the press 

release where one of our initiatives in partnering with the First 

Lady was to include working to make coordinated school health a 

concept that is one that more of our members embrace. 

I think very often what we have found is that, when you work 

in partnership with a total school community, we are more successful in improving the total school environment not only from the 

menu planning aspect but to the physical activity as well as even 

the vending programs at the school, because we are all supporting 

each other toward that same effort of reducing childhood obesity 

and improving the health of our students. 

Ms. SHEA-PORTER. Let me indicate that I have great sympathy 

for a principal that is exasperated enough to say, what other tools 

do we have? But it does seem to be counterproductive for what we 

are trying to do here. 

I would suggest that even school boards and others who are involved in budgetary decisions about physical exercise need to be 

part of that. So that it is not just nutrition, it is not just one component, but it is looking at the whole child and all of the different 

issues to really, really change the direction that we have been 

heading in. 

Thank you and thank you all for being here. 

Chairman MILLER. Thank you all so very much for your testimony. 

I would ask—and Mr. Kline may have an additional question— 

but, Ms. Saluja, you made a recommendation I think I can follow 

up on, and that is I was stunned by your description of the 

‘‘breastfeeding broken’’ hospitals. And I will take your suggestion 

to talk to Mr. Waxman and Mr. Rangel about this. 

It is just not acceptable that in the year in which—over a year 

now we have spent discussing how to drive down long-term health 

care costs that the recommendations from the Institute of Medicine 

on breastfeeding would not be incorporated into the birth of those 
55 

children with the mothers in those programs. So I appreciate very 

much that recommendation. 

Thank you all. We look forward to this reauthorization. I think 

you have all made a lot of very good recommendations, some of 

which we have discussed with you previously and some which we 

have yet to follow up on. Be assured they will get the full attention 

of the committee. 

Mr. Kline, do you have anything further than that? 

Mr. KLINE. Again, just thank the witnesses. 

Chairman MILLER. Thank you so much; and, without objection, 

members will have 14 days to submit additional materials or questions for the hearing record. 

Without objection, the hearing is adjourned. Thank you. 

[Questions submitted to Ms. Rivas and their responses follow:] 

[VIA FACSIMILE], 

U.S. CONGRESS, 

Washington, DC, March 16, 2010. 

Ms. DORA RIVAS, MS, RD, SNS, Executive Director, 

Food and Child Nutrition Services, Dallas Independent School District, Dallas, TX. 

DEAR MS. RIVAS: Thank you for testifying at the Committee on Education and Labor’s hearing on, ‘‘Improving Children’s Health: Strengthening Federal Child Nutrition Programs,’’ on March 2, 2010. 

Representative Dave Loebsack (D- IA) has asked that you respond in writing to 

the following questions: 

1. You mention a number of ways that the existing child nutrition programs could 

be improved to increase access. Drawing from your experience, could you give us a 

sense of what it would mean for students and even school administrators if schools 

in Dallas that serve predominantly low-income children could offer free meals to all 

their students? 

2. You also mention a number of ways that the existing child nutrition programs 

could be improved to increase access and streamline administration for schools. In 

your experience, can you discuss how well direct certification has worked and in 

more detail, expand upon what you see as the benefits to expanding the type of income data used to directly certify kids? 

Representative Jared Polis (D-CO) has asked that you respond in writing to the 

following questions: 

In your response to my question during the hearing, you mentioned that 90%-95% 

of schools offered a vegetarian option in the school lunch menu. However, according 

to the School Nutrition Association 2009 Operations Report: 

• About 64% offered a vegetarian option in at least one school in the district. 

• About 20% offered a vegan option in at least one school (9% offered it to elementary students, 12% to middle schools, and 20% to high schools). 

• About 14% of schools offered soy or rice milk in at least one school in the district. 

First, I would like to know if you could comment on whether the above more accurately reflect the availability of vegetarian options in our public schools. Second, I’m 

interested in the availability of healthful (low-fat, high-fiber) plant-based options 

and not in the options such as cheese pizza that might count under the ‘‘vegetarian’’ 

definition, but are nevertheless high in fat, saturated fat, and cholesterol. Thus, I 

would like to reframe the following questions and would appreciate your response: 

1. Do you think that we should educate students about the benefits of low-fat, 

high-fiber, plant-based (vegan) options? 

2. Should we encourage such options in the National School Lunch and Breakfast 

Programs by making them more affordable and providing incentives for schools, especially high-poverty schools, to provide them? 

3. Do you believe that schools should offer nondairy milk alternatives that meet 

nutritional standards established by USDA (be eligible for reimbursement under the 

National School Lunch and Breakfast Programs) with school lunches for those kids 

that don’t want to or can’t drink milk? 
56 

Please send an electronic version of your written response to the questions to the 

Committee by close of business on March 25, 2010. If you have any questions, please 

do not hesitate to contact the Committee. 

Sincerely, 

GEORGE MILLER, 

Chairman. 

3700 ROSS AVE., 

Dallas, TX, April 14, 2010. 

Committee on Education and Labor, 2181 Rayburn House Office Building, Washington, DC 20515. 

Thank you for the opportunity to respond to additional questions following my appearance at the March 2, 2010 hearing before the Committee on Education and 

Labor—‘‘Improving Children’s Health: Strengthening Federal Child Nutrition Programs.’’ I appreciate the opportunity and would be pleased to offer any further clarification on these responses, or to respond to any other school nutrition issues the 

Committee members may have. 

Questions from Rep. Dave Loebsack (D-IA) 

1. Providing universal free school meals to Dallas schools with a high percentage 

of students from low-income families would dramatically increase access to school 

meals, reduce the stigma of participation in the National School Lunch and Breakfast Programs and relieve pressure on the school district’s Child Nutrition Services 

Department. 

Due to current economic conditions, an increasing number of America’s children 

are going without school meals because their families cannot afford the reduced 

price meal charge of 40 cents per child. According to an October 2009 School Nutrition Association survey, 45 percent of school nutrition directors reported an ‘‘increase’’ in the number of unpaid student meal charges in the 2008-2009 school year, 

with 15 percent noting a ‘‘strong increase.’’ 

Some families are unaware that they are eligible for reduced price meals or are 

embarrassed that they cannot afford the full price for school meals and avoid going 

through the application process. This trend of some students going hungry and not 

participating in the program or not being able to pay for their meals is placing a 

financial burden on school nutrition programs nationwide, reducing their resources 

to make further nutritional enhancements to the meals or even meet operational 

costs. 

If Dallas ISD had the opportunity to eliminate the application process, the significant savings in paperwork reduction would result in more students having access 

to healthy schools meals, eliminate social stigma and redirect efforts to increasing 

productivity, and increasing focus on improving quality school meals through more 

staff training on food safety, quality meal production and being able to use the cafeteria as a learning laboratory for nutrition education. 

Universal school meals would ensure no child in an eligible school would miss a 

school meal, would eliminate unpaid meal charges and would lift the substantial 

burden of processing applications for the free and reduced price program. 

2. Eligibility for free meals shares income guidelines with other federal assistance 

programs, such as the Supplemental Nutrition Assistance Program (SNAP), the 

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

and other programs offered by other federal agencies. 

Multiple applications for programs with similar eligibility standards takes time 

unnecessarily, demands resources, and increases the potential for mistakes. Direct 

certification takes advantage of income verification work that has already been 

done, reduces errors, speeds the provision of benefits to eligible children, and helps 

local school food service personnel by reducing paperwork, allowing them to focus 

on serving quality meals. Direct certification may also help qualify children for free 

meals that right now may be unwilling to apply because of the perceived stigma of 

participation in the program discussed in response to your prior question. 

There are several examples of direct certification being used throughout the country, while schools and states anxiously await the opportunity to submit applications 

for the $22 million in direct certification grants included in the FY 2010 Appropriations Act. I believe that direct certification has been a positive experience for USDA, 

for the schools using direct certification, and, most importantly, for the children receiving the meals. 
57 

Questions from Rep. Jared Polis (D-CO) 

Thank you for your inquiry on vegetarian options in school meals. When I testified before the committee I did not have a copy of School Nutrition Association’s 

2009 Operations Report on hand, and I apologize for misstating the findings on vegetarian options. You are correct that the study found that about 64 percent of school 

districts reported offering a vegetarian option. Let me also assure you that this percentage is growing. 

In my initial response to you, I believe I was confusing the percentage of districts 

offering the following: 

Fresh fruits/vegetables—98.8% 

Whole grain items—96.3% 

Salad bar/pre-packaged salads—91.1% 

As you know, school meals must meet federal nutrition standards limiting fat. No 

more than 30 percent of the meal’s calories can come from fat and less than 10 percent from saturated fat. Vegetarian options being served in schools must meet these 

requirements, which is why many schools are making their cheese pizza and other 

entrees with low-fat cheeses. 

In response to your specific questions: 

1. School Nutrition Association (SNA) strongly supports efforts to promote nutrition education. The Association’s 2010 Legislative Issue Paper calls on Congress to 

‘‘address childhood obesity by establishing an effective nutrition education curriculum and increasing the consumption of fruits, vegetables and whole grains.’’ Nutrition education is a critical step in addressing childhood obesity is teaching children the basics of healthy eating. The school cafeteria should be a classroom in this 

regard, and school nutrition programs can be a partner in developing effective nutrition education curriculum. 

2. School nutrition programs do need financial assistance to offer additional 

servings of fruits, vegetables, whole grains and legumes and to meet the Institute 

of Medicine’s recommendations for updating national nutrition standards for school 

meals. In fact, SNA called on Congress to increase the per meal reimbursement for 

all meals in order to keep pace with rising costs and implementation of the Dietary 

Guidelines for Americans. Restoring equipment assistance is vital to helping schools 

develop the capability to serve these very desirable foods. Offering more plant-based 

options means that schools will need greater refrigeration capacity and more steamers for healthy preparation of these items. SNA appreciates the equipment assistance provided as part of the American Recovery and Reinvestment Act. The applications from schools far outpaced available funding, demonstrating that the need for 

this assistance is significant. It is for this reason that SNA has requested that Congress re-establish entitlement funding for equipment assistance in all schools to 

meet this need. 

3. As you noted, some schools are already offering students nondairy milk alternatives, with about 14 percent of school districts serving soy or rice milk, according 

to SNA’s 2009 Operations Report. In fact, federal regulations require schools to offer 

a milk alternative to students with special dietary needs. However, as schools determine whether to offer nondairy milk alternatives they must also balance the additional cost, student demand for the product, as well as product waste on perishable 

food items. 

Sincerely, 

DORA RIVAS. 

[Whereupon, at 4:15 p.m., the committee was adjourned.] 

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