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49–498 PDF 2009

IMPROVING CHILD NUTRITION PROGRAMS 

TO REDUCE CHILDHOOD OBESITY 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTHY 

FAMILIES AND COMMUNITIES 

COMMITTEE ON 

EDUCATION AND LABOR 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

HEARING HELD IN WASHINGTON, DC, MAY 14, 2009 

Serial No. 111–21 

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 Sablan, Northern Mariana Islands 

Dina Titus, Nevada 

[Vacant] 

Howard P. ‘‘Buck’’ McKeon, California, 

Senior Republican Member 

Thomas E. Petri, Wisconsin 

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 

John Kline, Minnesota 

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 

Sally Stroup, Republican Staff Director 

SUBCOMMITTEE ON HEALTHY FAMILIES AND COMMUNITIES 

CAROLYN McCARTHY, New York, Chairwoman 

Yvette D. Clarke, New York 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Carol Shea-Porter, New Hampshire 

Paul Tonko, New York 

Jared Polis, Colorado 

George Miller, California 

[Vacant] 

Todd Russell Platts, Pennsylvania, 

Ranking Minority Member 

Howard P. ‘‘Buck’’ McKeon, California 

Brett Guthrie, Kentucky 

David P. Roe, Tennessee 

Glenn Thompson, Pennsylvania 
(III) 

C O N T E N T S 

Page 

Hearing held on May 14, 2009 ............................................................................... 1 

Statement of Members: 

McCarthy, Hon. Carolyn, Chairwoman, Subcommittee on Healthy Families and Communities ................................................................................... 1 

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

Additional submissions: 

Letters from children regarding the Activity Works program ....... 42 

Braley, Hon. Bruce L., a Representative in Congress from the 

State of Iowa, prepared statement of ............................................ 71 

Additional submissions ............................................................... 72 

Westley, Laurie A., senior vice president of public policy, advocacy, and the research institute, Girl Scouts of the USA, prepared statement of .......................................................................... 69 

Platts, Hon. Todd Russell, Senior Republican Member, Subcommittee 

on Healthy Families and Communities, prepared statement of ............... 4 

Statement of Witnesses: 

Byrnes, Susan P., R.N., Susan P. Byrnes Health Educaton Center ............ 34 

Prepared statement of ............................................................................... 36 

Castle, Hon. Michael N., a Representative in Congress from the State 

of Delaware .................................................................................................... 8 

Prepared statement of ............................................................................... 10 

Copperman, Nancy, MS, RD, CDN, director, public health initiatives, 

North Shore-LIJ Health System .................................................................. 25 

Prepared statement of ............................................................................... 27 

Felton, Reginald M., director, federal legislation, National School Boards 

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

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

Paterson, Michelle Paige, first lady of the State of New York ..................... 13 

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

Ritchie, Lorrene, Ph.D., RD, director and adjunct professor, Dr. Robert 

C. and Veronica Atkins Center for Weight and Health, University 

of California ................................................................................................... 36 

Prepared statement of ............................................................................... 38 

Stallings, Virginia, M.D., director of the nutrition center, Children’s Hospital of Philadelphia ..................................................................................... 20 

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

Woolsey, Hon. Lynn C., a Representative in Congress from the State 

of California ................................................................................................... 6 

Prepared statement of ............................................................................... 7 

(1) 

IMPROVING CHILD NUTRITION PROGRAMS 

TO REDUCE CHILDHOOD OBESITY 

Thursday, May 14, 2009 

U.S. House of Representatives 

Subcommittee on Healthy Families and Communities 

Committee on Education and Labor 

Washington, DC 

The subcommittee met, pursuant to call, at 10:04 a.m., in room 

2175, Rayburn House Office Building, Hon. Carolyn McCarthy 

[chairwoman of the subcommittee] presiding. 

Present: Representatives McCarthy, Tonko, Polis, Platts, and 

Roe. 

Staff present: Paulette Acevedo, Legislative Fellow, Education; 

Tylease Alli, Hearing Clerk; Alejandra Ceja, Senior Budget/Appropriations Analyst; Curtis Ellis, Legislative Fellow, Education; 

Denise Forte, Director of Education Policy; David Hartzler, Systems Administrator; Fred Jones, Staff Assistant, Education; Jessica 

Kahanek, Press Assistant; Joe Novotny, Chief Clerk; Kim ZarishBecknell, Policy Advisor, Subcommittee on Healthy Families and 

Communities; Stephanie Arras, Minority Legislative Assistant; 

Cameron Coursen, Minority Assistant Communications Director; 

Kirsten Duncan, Minority Professional Staff Member; and Linda 

Stevens, Minority Chief Clerk/Assistant to the General Counsel. 

Chairwoman MCCARTHY [presiding]. A quorum is present. The 

hearing of the House Committee on Education and Labor, Subcommittee on Healthy Families and Communities, of ‘‘Improving 

Child Nutrition Programs to Reduce Childhood Obesity’’ will come 

to order. 

Before we begin, I think I heard one of our young ladies talking 

about it. Make sure all cells and BlackBerrys are on vibrate or 

quiet. I appreciate that. 

I now recognize myself, followed by Ranking Member, Todd 

Platts from Pennsylvania, for an opening statement. I would like 

to welcome our witnesses to this hearing on how we can reduce 

childhood obesity through the Child Nutrition Reauthorization. 

As a nurse for over 30 years, I have seen firsthand the risks of 

illness that can result from obesity. In the last several months, I 

have read the studies that one in five 4-year-olds are obese, that 

kids have the arteries of middle-age adults, and that the number 

of children who take medication for chronic diseases has jumped 

dramatically. 
2 

In March, a study was released which indicated that proximity 

to fast food is a factor in student obesity. Some of these reports are 

shocking and, unfortunately, some are not. Childhood obesity, diabetes and heart disease are all on the rise in the United States, 

and one of the best tools that we have to combat these illnesses is 

our ability to provide wholesome and healthy nutrition to children 

in school. 

Childhood obesity is found in all 50 states, in both young children and adolescents, affecting all social and economical levels. 

Low-income communities tend to have the highest obesity rate due 

to factors such as lack of access to affordable healthy foods, lack 

of safe, available venues for physical activity, and a lack of education about nutrition and its benefits. Furthermore, it has been 

found that minority children are at the greatest risk for obesity. 

There is no silver bullet to solve childhood obesity. However, the 

school breakfast and lunch programs can make a great impact because they provide more than 50 percent of a student’s food and 

nutrition intake on school days. The decisions we are making during reauthorization are very important to a great number of children, and that is why we have assembled such a knowledgeable 

panel. 

We were here today to explore how we can reduce obesity 

through the Child Nutrition Reauthorization. There is a wealth of 

information available on the issue of reducing obesity, and, in my 

mind, it comes down to two things: healthy eating and physical activity. These sound simple, but families all over the nation know 

it is far from simple. 

Given the current harsh financial realities, many families in my 

district and throughout the nation, schools have an increasingly 

important role to play in improving with nutritious food during 

their days at school. I also hear from folks in schools finding it 

more and more difficult to meet the increased demand of meals 

with healthy, nutritious and high quality foods without adequate 

funding. 

We also know how critical it is to reach the youngest children 

and infants as soon as possible. I hear from constituents all the 

time how important the WIC programs are to help families transition from poor eating habits to healthy habits. 

This is particularly important because WIC is working with the 

youngest of our children. As we will hear about today, the Institute 

of Medicine has undertaken a study to review and provide recommendations to update the nutrition and meal standards for 

school nutrition programs. 

School meal standards are critical, and I appreciate Dr. Stallings 

being here to discuss her work. Of course, children aren’t just eating school meals when they are at school. 

Foods in vending machines and less healthy a la carte items in 

the cafeteria are readily available. And while in school, many children are subject to junk food advertisements. The students are a 

captive audience, and advertisers have proven to be remarkably effective at influencing their target customers. 

Representative Woolsey has done a lot of work in this area, and 

I am looking forward to her testimony regarding issues surrounding competitive foods. 
3 

Finally, as I mentioned earlier, in addition to healthy foods, 

physical activity is the other critical element in reducing obesity. 

We know that change for adults is hard. But if we start to educate 

our children early enough, we can establish lifelong habits and the 

values of healthy living and wellness for the future. 

We also know that studies show children who are physically active learn better. We will hear testimony today about some terrific 

and innovative programs schools are using to address obesity. 

We have our work cut out for us, but by taking a comprehensive 

approach to nutrition, our children, families and communities will 

all be healthier. I want to thank all of you being here, and I look 

forward to your testimony. 

I now recognize the distinguished gentleman from Pennsylvania, 

Ranking Member Platts, for his opening statement. 

[The statement of Mrs. McCarthy follows:] 

Prepared Statement of Hon. Carolyn McCarthy, Chairwoman, 

Subcommittee on Healthy Families and Communities 

I’d like to welcome our witnesses to this hearing on how we can reduce childhood 

obesity through the child nutrition reauthorization. 

As a nurse for over 30 years, I have seen firsthand the risks and illnesses that 

can result from obesity. 

In the last several months, I have read the studies that one in five four-year-olds 

are obese, that kids have the arteries of middle aged adults, and that the number 

of children who take medication for chronic diseases has jumped dramatically. 

In March, a study was released which indicated that the proximity to fast food 

is a factor in student obesity. 

Some of these reports are shocking, and unfortunately, some are not. 

Childhood obesity, diabetes and heart disease are all on the rise in the US and 

one of the best tools we have to combat these illnesses is our ability to provide 

wholesome and healthy nutrition to children in school. 

Childhood obesity is found in all 50 States, in both young children and adolescents, affecting all social and economic levels. 

Low income communities tend to have the highest obesity rates due to factors 

such as a lack of access to affordable, healthy foods, lack of safe, available venues 

for physical activity, and a lack of education about nutrition and its benefits. 

Furthermore, it has been found that minority children are at the greatest risk for 

obesity. 

There is no silver bullet to solve childhood obesity. 

However, the School Breakfast and Lunch programs can make a great impact because they may provide more than 50 percent of a student’s food and nutrient intake on school days. 

The decisions we make during reauthorization are very important to a great number of children, and that is why we have assembled such a knowledgeable panel. 

We are here today to explore how we can reduce obesity through the child nutrition reauthorization. 

There is a wealth of information available on the issue of reducing obesity and 

in my mind it comes down to two things: healthy eating and physical activity. 

These sound simple, but families all over the nation know it is far from simple. 

Given the current harsh financial realities for many families in my district and 

throughout the nation, schools have an increasingly important role to play in providing children with nutritious food during their days. 

I also hear from folks in schools finding it more and more difficult to meet the 

increased demand for meals with healthy, nutritious and high-quality foods, without 

adequate funding. 

We also know how critical it is to reach the youngest children and infants as soon 

as possible. 

I hear from constituents all the time how important the WIC programs are to help 

families transition from poor eating habits to healthy ones. 

This is particularly important because WIC is working with the youngest of children. 
4 

As we will hear about today, the Institute of Medicine has undertaken a study 

to review and provide recommendations to update the nutrition and meal standards 

for school nutrition programs. 

School meal standards are critical and I appreciate Dr. Stallings being here to discuss her work. 

Of course, children aren’t just eating school meals when they are at school. 

Foods in vending machines and less healthy a la carte items in the cafeteria are 

readily available. 

And while in school, many children are subjected to junk-food advertising. 

The students are a captive audience, and advertisers have proven to be remarkably effective at influencing their target customers. Rep. Woolsey has done a lot of 

work in this area and I am looking forward to her testimony regarding issues surrounding competitive foods. 

Finally, as I mentioned earlier, in addition to healthy food, physical activity is the 

other critical element in reducing obesity. We know that change for adults is hard, 

but if we start to educate our kids early enough, we can establish lifelong habits 

and the values of healthy living and wellness for the future. 

We also know that studies show children who are physically active learn better. 

We will hear testimony today about some terrific innovative programs schools are 

using to address obesity. 

We have our work cut out for us. 

But by taking a comprehensive approach to nutrition, our children, families and 

communities will all be healthier. Thank you all for being here and I look forward 

to your testimony. 

Mr. PLATTS. Thank you, Madam Chair. 

In the interest of time, with knowing we may have votes soon 

and with two of our colleagues waiting, you well captured the importance of this hearing and the importance of this issue in the 

broad sense. So I will submit my statement for the record and look 

forward to the testimony of our colleagues. 

[The statement of Mr. Platts follows:] 

Prepared Statement of Hon. Todd Russell Platts, Ranking Member, 

Subcommittee on Healthy Families and Communities 

Good morning. Welcome to our hearing. Today we are here to discuss childhood 

obesity and child nutrition programs. 

Over the last ten years, obesity in the United States has been increasing at a 

staggering rate. The most recent data from the Centers for Disease Control and Prevention states that more than 72 million adults, or over one-third of the United 

States adult population, are obese. In addition, 17 percent of children ages 2-19 are 

considered overweight. Overweight children are more likely to become overweight 

adults and have a greater risk of developing cardiovascular diseases, diabetes, and 

certain cancers. Because obese individuals are estimated to live 5-7 years less than 

their healthier counterparts, it is assumed that our current generation of children 

will actually have a lower life expectancy than their parents. 

A number of initiatives have been created to combat this obesity epidemic. The 

food industry and trade organizations have joined together to phase-in healthier 

products and smaller portion sizes. Other groups have been promoting increased 

physical activity for children and adults alike. 

The 2004 reauthorization of the Child Nutrition Act required school districts to 

implement local wellness policies in all schools. The objective of the local wellness 

plan is to change students’ eating habits while simultaneously encouraging increased activity. To meet this goal, the plan must include nutrition guidelines, nutrition education, physical activity goals, and school based wellness activities. Many 

schools have incorporated creative ways to meet their wellness plan goals. Today, 

we will hear from Ms. Susie Byrnes, founder of the Byrnes Health Education Center 

in my Congressional District. Many of the local schools bring students to the Byrnes 

Center to teach students about healthy eating practices as part of their local 

wellness plans. 

There are a variety of parties that are responsible for helping to address the issue 

of childhood obesity. At the federal level, we have a responsibility to ensure that 

foods provided by the school breakfast and lunch programs are nutritional and 

healthy. Local school districts also play a role as they make decisions about the activities that take place on their campus. I believe, however, that parents have the 
5 

most important role—as the primary caretaker of their child’s well-being—to ensure 

that their children remain active and consume nutritious meals. 

I am pleased we are joined by such a distinguished panel of witnesses and am 

looking forward to hearing all of the testimony. As we move forward to reauthorize 

the Child Nutrition Act, we must keep the goal of reducing childhood obesity in 

mind while remaining conscious of the impacts of new mandates on our local school 

districts. 

Thank you Chairwoman McCarthy. 

Chairwoman MCCARTHY. Pursuant to Rule Committee 7C, any 

member may submit an opening statement in writing at this time, 

which will be made part of the permanent record. Without objection, all members will have 14 days to submit additional materials 

or questions for the hearing record. 

I would like to briefly introduce our very distinguished panel of 

witnesses here with us this morning. The complete bios of the witnesses will be inserted into the record. 

Today, we will hear from two panels. On our first panel, we will 

hear from two members of Congress, my colleagues and fellow 

members of the Committee in Education and Labor—the Honorable 

Lynn Woolsey from California, and the Honorable Mike Castle 

from Delaware. 

On the second panel, we will hear from six witnesses—First Lady 

Michele Paterson of my home state of New York; Dr. Virginia Stallings, an expert on child nutrition issues; Ms. Nancy Copperman, 

who runs an obesity prevention program on Long Island; Mr. 

Felton at the National School Boards Association to discuss nutrition and standards; Ms. Susie Byrnes, founder of the Susie P. 

Byrnes Health Educational Center; and Dr. Ritchie of Dr. Robert 

C. and Veronica Atkins Center for Weight and Health College on 

natural resources. I thank you all for being here. 

In the interest of time, given the large number of witnesses 

today, I will make my formal introductions short. First, I would 

like to introduce our first panel. The Honorable Lynn Woolsey from 

California and Mike Castle of Delaware have both been in Congress since 1993, and I have served with them on the Committee 

of Education and Labor since I came to Congress. Ms. Woolsey 

serves as the chairwoman of the Subcommittee on Public Works 

Protection. 

Mr. PLATTS. Thank you, Madam Chair, and Mr. Castle is the 

ranking member of the Education and Labor Subcommittee on 

Childhood, Elementary and Secondary Education. He has a distinguished public service career. 

Actually, Mike, I was learning for the first time all the offices 

you held, and delighted—deputy attorney general, state legislator, 

lieutenant governor and two-term former governor of the state of 

Delaware, and makes up the entire House delegation of the state 

of Delaware here in Congress. So we are delighted to have you and 

Lynn with us, and look forward to your testimony. 

Thank you, Madam Chair. 

Chairwoman MCCARTHY. Representative Woolsey and Representative Castle have each used their voices as members of Congress 

to call for action in areas where they are deeply passionate. They 

care deeply about the health and wellness of our youth, and I look 
6 

forward to hearing their testimony on how to fight childhood obesity. 

Obviously, both of the members understand the light system and 

the 5-minute time limit, so let’s get started. I thank you for taking 

the time out of what is an extremely busy day here in Congress to 

address this subcommittee. 

Ms. Woolsey? 

STATEMENT OF HON. LYNN WOOLSEY, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. WOOLSEY. Thank you, Madam Chairwoman and Congressman Platts, members of the committee. Thank you for the opportunity to testify before you today on today’s hearing on childhood 

obesity. 

Our schools have a very powerful impact on the way our children 

eat and the lessons they learn about healthy living. With WIC and 

child nutrition programs set to be reauthorized this year, we have 

an opportunity to actually take bold steps to reverse these dangerous trends. I commend the subcommittee for holding this important hearing, and I commend you for your continued attention to 

the health and well-being of our nation’s children. 

Children spend more than a third of their young lives at school, 

including before and after school, and oftentimes holidays as well. 

So it is important that schools provide healthy foods throughout 

the entire school day. Unfortunately, current nutrition standards 

for foods sold at school but outside of the school meal programs are 

inconsistent, and they are often unhealthy. 

For example, doughnuts are allowed in vending machines, but 

lollipops are not. Cookies are fine, but breath mints are banned. 

These standards don’t make any sense. They haven’t been updated 

since my children were in school in the 1970s. 

And today, my grandchildren, who are in school, are faced with 

the same junk food choices that should have been replaced years 

and years ago. No wonder, Madam Chairwoman, that child obesity 

is becoming an epidemic. 

Today, 23 million children and adolescents are obese or overweight. Obesity rates for children between 6 and 11 years old have 

more than quadrupled over the last 40 years. Throughout their 

lives, these children are at greater risk for heart disease, type II 

diabetes, stroke, cancer, and social and psychological problems. 

That is why I have re-introduced H.R. 1324, the Child Nutrition 

Promotion and School Lunch Protection Act, which will ensure that 

all foods sold in schools during the entire school day are based on 

current scientific and sound nutrition standards. In the Senate, 

Democrat senator Tom Harkins and Republic senator Lisa Murkowski have introduced the companion to this bipartisan bill in the 

House. And this bill has been endorsed by more than 80 organizations, including a wide range of school health and nutrition advocacy groups. 

While critics might expect that schools that switch to selling 

healthier foods might lose money, it turns out to be just the opposite. According to a study conducted by the U.S. Department of Agriculture and the Center for Disease Control, the majority of 

schools switching to healthier competitive foods in their vending 
7 

machines and a la carte lines actually increased their revenues. 

The Center for Weight and Health at UC Berkeley in 2007 also 

found the 65 percent of schools that provided these better meals 

and better choices had total revenue increases of more than 5 percent after switching, and providing, then, schools with improved 

nutrition standards and also increased their revenues. 

H.R. 1324 would require that nutrition standards for foods sold 

in vending machines and a la carte lines meet standards for caloric 

intake, saturated fats, trans fats and refined sugars. The bill would 

depend on leading scientific experts to make recommendations and 

would study the relationship between certain foods and obesity. 

Additionally, while H.R. 1324 would set strong nationwide minimum standards, states could go above and beyond those standards. It is obviously long past time to bring these schools, Madam 

Chairwoman, into the 21st century. Unless Congress updates these 

standards, students will continue to spend money on unhealthy options that undermine their health and their future. 

So I look forward to working with the committee to get these 

changes signed into law. And again, Madam Chairwoman, thank 

you very much for having me today. 

[The statement of Ms. Woolsey follows:] 

Prepared Statement of Hon. Lynn C. Woolsey, a Representative in Congress 

From the State of California 

Chairwoman McCarthy, Congressman Platts, members of the Committee, thank 

you for the opportunity to testify at today’s hearing on childhood obesity. Our 

schools can have a very powerful impact on the way our children eat and the lessons 

they learn about healthy living. With WIC and child nutrition programs set to be 

reauthorized this year, we have an opportunity to take bold steps to reverse these 

dangerous trends. I commend the Subcommittee for holding this important hearing 

and its continued attention to the health and well-being of our nation’s children. 

Children spend more than a third of their young lives at school—including before 

and after school and often times school holidays. So, it is important that schools provide healthy foods throughout the entire school day. Unfortunately, current nutrition standards for foods sold at school, but outside of the school meal programs, are 

inconsistent and often unhealthy. For example, doughnuts are allowed in, but lollipops are not. Cookies are fine, but breath mints are banned. These standards don’t 

make any sense. They haven’t been updated since my children were in school in the 

70’s. Today, my grandchildren are in school, with the same junk foods available that 

should have replaced years ago. 

No wonder the childhood obesity is becoming an epidemic. Today, 23 million children and adolescents are obese or overweight. Obesity rates for children between 

6 and 11 years old have more than quadrupled over the last 40 years. Throughout 

their lives, these children are at greater risk for heart disease, Type 2 Diabetes, 

stroke, cancer, and social and psychological problems. 

That’s why I’ve reintroduced H.R. 1324, the Child Nutrition Promotion and School 

Lunch Protection Act, which will ensure that all foods sold in schools during the entire school day are based on current, scientific, and sound nutrition standards. In 

the Senate, Democrat Tom Harkin and Republican Lisa Murkowski have introduced 

the counterpart to my bipartisan bill, which has been endorsed by more than 80 organizations, including a wide range of school, health, and nutrition advocacy groups. 

While critics might expect that schools that switch to selling healthier foods might 

lose money, it turns out to be just the opposite! According to a study conducted by 

the U.S. Department of Agriculture and the Center for Disease Control, the majority 

of schools switching to healthier competitive foods in their vending machines and 

a la carte lines actually increased revenues. The Center for Weight and Health at 

U.C. Berkely in 2007 also found that 65 percent of schools had total revenue increases of more than five percent after switching, proving that schools offering improved nutrition standards can increase their total revenues as well. 

H.R. 1324 would require that nutrition standards for foods sold in vending machines and a la carte lines meet standards for caloric intake, saturated fats, trans 

fats, and refined sugars. The bill would depend on leading scientific experts to make 
8 

recommendations, and would study the relationship between certain foods and obesity. Additionally, while H.R. 1324 would set strong nationwide minimum standards, states could go above and beyond those standards. It’s obviously long past time 

to bring these school food standards into the 21st Century. 

Unless Congress updates these standards, students will continue to spend money 

on unhealthy options that undermine their health and their futures. I look forward 

to working with this Committee to get these changes signed into law. 

Again, Madame Chair, thank you for having me. 

Chairwoman MCCARTHY. Thank you, Ms. Woolsey, for that information. 

Representative Castle? 

STATEMENT OF HON. MIKE CASTLE, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF DELAWARE 

Mr. CASTLE. Thank you, Madam Chairwoman. Thank you, Mr. 

Platts and other members of the committee. And I thank Lynn 

Woolsey. We have worked together on this issue almost since we 

have been in Congress, I think. And hopefully it is at least working 

to a degree, but I think we can improve it. 

As Lynn has very well pointed out, child nutrition programs are 

a vital significance to the future of the children in our country. We 

are all aware of the basic facts. Kids are not eating enough fruits 

and vegetables. They are not getting enough exercise. They are inside too much. 

There may be a lot of reasons for this, but the bottom line is 

there is an overweight issue among our children, and the CDC data 

shows that approximately 17 percent of children and adolescents 

are overweight. Our statistics in Delaware are even higher than 

that. And in just two decades, the number of overweight and obese 

young Americans has tripled. 

And one of the direct effects of this has been diseases and conditions associated with adults are now being associated with children. Type II diabetes, high cholesterol, high blood pressure, which 

did not used to happen, but happens on a regular basis at this 

time. 

It sort of reminds me. I was just sitting here thinking when Lynn 

was speaking of the ads you see on TV for people who have lost 

weight or whatever. I have never seen an ad for people who have 

gained weight saying what a wonderful thing this is. ‘‘I feel so 

much better,’’ or whatever it may be. I mean, the bottom line is 

that, just from a social point of view as well as a physical health 

point of view, and maybe mental health, we need to worry about 

this particular issue. 

The legislation, which we passed in the past in reauthorizing 

this, and this new legislation is of vital significance. In 2004, we 

did pass and the president signed the law, the Child Nutrition and 

WIC Reauthorization Act. 

In addition to other steps, the law put in place several comprehensive solutions to address the childhood obesity epidemic, nutritional education, which I think is of vital significance, increased 

physical activity, efforts to combat hunger and food insecurity. Included was a provision I authored to require school districts to establish local school wellness policies. 
9 

I might point out, Madam Chairwoman, also kids often can educate adults, I have learned, in many of these areas, seat belts, for 

example, and in this area as well, which is not insignificant, either. 

Under the school wellness policies, the school districts are required 

to establish policies, include nutritional guidelines, nutrition education, physical activity goals and school-based wellness activities 

to encourage the development and implementation of programs to 

promote healthy eating and increased physical activity among children. 

School districts were tasked with developing these plans to accommodate a variety of demographics, economic situations and 

local food preferences. Policies were required to be developed and 

implemented for 2006-2007 school year by school districts. School 

districts developed these plans in an attempt to accommodate a variety of different backgrounds. And resulting from these policies, 

we have nutrition programs offering healthier options, increased 

visibility of school nutrition programs, changes in behaviors, and 

more healthy choices being made by students. 

So one emphasis I would like to make, and I don’t know if we 

are addressing it in legislation, or if some of the speakers to follow 

us will address it, but I use the word ‘‘options,’’ healthier options. 

I still go to schools—well, a couple years ago, I went to a school 

that had all the options. They were serving, broccoli, whatever. 

But one of the options was pizza. And I asked the people in the 

cafeteria about that, and they said, ‘‘Well, most of the kids are taking the pizza.’’ It might not be pizza. It may be doughnuts for 

breakfast or whatever it may be, but the options need to be carefully crafted as well. 

You can’t just offer them and say, ‘‘We have accommodated.’’ You 

need to make sure that is what the kids are eating. And I think 

we need to pay a little more attention to what some of the options 

are. 

In Delaware, each of our wellness plans is reflective of the district’s policies and views of how to best provide and maintain a 

healthy and safe learning environment. And all that, of course, is 

well and good, and they are doing that. And I have seen it, and 

they are working to promote the integration of nutrition education 

into all curriculum areas in K through 12. 

I think that is important, too, that people understand why these 

decisions are being made. Limiting portion sizes of snacks and beverages served in school, which is important, and limiting food being 

used as rewards, which can be difficult for teachers and parents 

sometimes, but is also important. 

In certain of our districts, for example in Laurel Middle School, 

music is played after lunch to encourage physical activity. And at 

the Austin D. Baltz elementary school in Wilmington area, Red 

Clay School District, hip-hop pageant program is put on to encourage physical activity. Many schools are implementing successful 

policies, but there are challenges. 

Strong school leadership is needed. When you find superintendents and principals and teachers who enforce it, it makes a difference. We need a commitment to enhancing school nutrition and 

wellness policies as implementation continues, and we need the 
10 

support and knowledge of communities and families, which is essential to ensure wellness plans extend beyond the school days. 

We are fortunate to have the Nemours operation in Delaware 

working in this area to promote healthy lifestyles in all places that 

children live, learn, and play. Unfortunately, Nemours, by the will 

of Mr. duPont, is only in Florida and Delaware, but they make a 

vast difference in terms of these programs. 

As we move forward with reauthorization of child nutrition legislation, we must work at the federal, state and local levels to address this important issue and complex issue. We have to strengthen local wellness policy and legislative language to ensure all 

schools and students benefit from plans. 

We have to target those with greatest risk. We need to support 

programs under current law that promote nutrition education and 

physical activity, and we need to meet the financial commitment to 

see programs through from start to finish. 

I appreciate the opportunity of being here, and I look forward to 

what this committee will be doing. 

I yield back. 

[The statement of Mr. Castle follows:] 

Prepared Statement of Hon. Michael N. Castle, a Representative in 

Congress From the State of Delaware 

Good morning. Thank you Chairwoman McCarthy for holding today’s hearing. As 

a Member of the Education and Labor Committee and co-chair of the Congressional 

Diabetes Caucus, I welcome the opportunity to testify before the Healthy Families 

and Communities Subcommittee. 

As debate begins in Congress on how best to reform a crumbling health care system to care for the uninsured and help manage the growing number of people who 

are living with chronic diseases, we are more aware than ever of the need to foster 

a national culture that believes in the need for health and wellness. In the context 

of today’s hearing, nutrition and health are both essential for fostering a child’s academic success. 

We know that kids are not eating enough fruits and vegetables, spend too much 

time in front of the TV or computer screen, are not up and moving enough, and consume too many sugary beverages. Childhood obesity has become a major health 

problem in the United States. In fact, recent data from the Centers for Disease Control (CDC) shows that an estimated 17 percent of children and adolescents ages 2- 

19 years are overweight. In my home state of Delaware, approximately 36 percent 

of kids and youth are overweight or are at risk of becoming overweight. I believe 

this is a matter of great concern to us as Members of Congress, to this Committee, 

and to society in general. 

According to a report by the National Institute for Health Care Management 

(2007), in just two decades, the number of overweight and obese young Americans 

has tripled, and studies suggest that overweight children are significantly more likely to become overweight or obese adults. As a result, children are increasingly suffering from conditions traditionally associated with adulthood, including Type 2 diabetes, high cholesterol, and high blood pressure. 

Parents bear primary responsibility for ensuring that their children eat well and 

exercise regularly. Schools, however, can and should also play a positive role by giving children access to nutritious meals and snacks, nutrition education, and time 

to engage in daily physical activity. 

In 2004, Congress passed, and the President signed into law, the Child Nutrition 

and Women, Infants, and Children (WIC) Reauthorization Act. The Law put in place 

several comprehensive solutions that incorporate healthy habits, nutritional education, and increased physical activity with ongoing efforts to combat hunger and 

food insecurity to address the childhood obesity epidemic. 

In addition to making certain students have access to fresh fruits and vegetables, 

and milk; strengthening partnerships between local farms, school gardens, and child 

nutrition programs; and ensuring food safety by maintaining and strengthening 

quality and safety standards, the Law included a provision I authored requiring 

school districts participating in the program to develop and implement a comprehen-
11 

sive wellness policy in their schools. Specifically, school wellness policies include nutrition guidelines, nutrition education, physical activity goals, and school-based 

wellness activities developed by school districts in an effort to accommodate a variety of demographics, economic situations, and local food preferences. The objectives 

of these plans are to change students’ eating habits while simultaneously encouraging increased activity. 

The majority of school districts passed these policies between May and July 2006 

to have them in place for the 2006-2007 school year, as required by the Law. As 

a result, the vast majority of districts established guidelines for food and beverages 

available in a la carte and vending machines. And about 95% of districts established 

goals for nutrition education and physical education (USDA, FNS). 

Studies have shown that as a result of implementing these policies, school nutrition programs are offering more healthy food options, there has been an increased 

visibility of school nutrition programs to students and adults, and there have been 

changes in healthy choices and behaviors of students (School Nutrition Association 

and School Nutrition Foundation). 

In Delaware, each school district’s wellness plan is reflective of the district’s policies and views of how to best provide and maintain a healthy and safe learning environment for students within the district’s care. Overall, however, each wellness 

policy in the state of Delaware works to promote the integration of nutrition education into all curriculum areas for students in grades k-12, limit portion sizes of 

snacks and beverages served anywhere on school property during the school day, 

limit food being used as rewards, and disseminate consistent nutrition messages 

throughout district schools, classrooms, cafeterias, and Delaware homes and communities. 

In Delaware’s Laurel School District at the Laurel Middle School, more physical 

activity has been incorporated into the school’s curriculum. After lunch most days, 

music is played to allow for students to do some large muscle activity. Additionally, 

in Delaware’s Red Clay Consolidated School District at the Austin D. Baltz Elementary School all students have recess after lunch and the school implemented the 

‘‘Hip Hop Pageant Program’’ to encourage cardiovascular activity in which students 

attend a hip hop class leading up to a hip hop pageant. 

While many schools are implementing successful policies, there are several challenges to implementing these plans as well. Schools need strong leadership and a 

commitment to enhancing their nutrition and wellness policies as implementation 

continues. The support of communities and families is also essential to ensure that 

the work of the wellness plans extend beyond the school day. In Delaware, great 

work is being done by Nemours Health and Prevention Services in this area to promote healthy lifestyles in all the places children live, learn, and play, including 

schools. Finally, I am hopeful this Committee will examine how we may strengthen 

the Law’s language pertaining to local wellness policies to ensure all schools, and 

ultimately all students benefit from these plans. 

As Congress works to reauthorize child nutrition legislation this year to strengthen school nutrition programs, it is clear we must work with state and local school 

districts to further address the important and complex issue of childhood obesity by 

supporting programs under current law that promote nutrition education and physical activity at the state and local level; implementing programs with proven results 

in improving health outcomes; and targeting those children who are at the greatest 

risk. 

I hope that this Committee and Congress will continue to examine this issue very 

closely. I look forward to working along with my colleagues at the federal level, as 

well as the state and local level to do our part in the battle against childhood obesity. 

Thank you for allowing me to testify today. 

Chairwoman MCCARTHY. I thank my colleagues for their information and taking the time out on an extremely busy day to be 

here. I hope that when we get this legislation through, which I 

think we will, maybe we should start working on the members of 

Congress on the choices of food that we have here. Thank you very 

much. 

All right. The debate that has been up here, apparently we have 

been notified votes are starting. There are going to be several 

votes, which unfortunately is going to take an awful lot of time. 
12 

But we believe that we should start. So if the witnesses could come 

and sit at the table, we will start with the introductions. 

I want to thank you all for being here, and I now yield to Representative Tonko of New York to introduce the First Lady of New 

York, Michele Paterson. 

Mr. TONKO. Thank you, Madam Chair. 

It is my pleasure to introduce our first guest at the second panel. 

It has been with distinction that our First Lady, Michele Paige 

Paterson, has served New York state in her current role as first 

lady since her husband, our governor, David Paterson, assumed office on March 5th of 2008, but she has a long history of work in 

healthcare and child obesity issues. 

Ms. Paterson has an M.S. in Health Services Management from 

the Milano Graduate School in New York City and a B.A. from Syracuse University. She has worked as the director of community and 

government affairs at North General Hospital in Harlem and as director of external affairs and corporate contributions for the Health 

Plan of New York, where she worked with community organizations, agencies and corporations on issues such as healthcare and 

education. She currently serves as director of integrative wellness 

at Emblem Health, where she works on healthy living and childhood obesity issues. 

In her capacity as our first lady, Ms. Paterson, as in her usual 

warm and compassionate style, worked with organizations and 

schools to help raise community awareness of childhood obesity and 

its consequences. She spearheaded a statewide initiative called 

Healthy Steps to Albany: First Lady’s Challenge. The program 

challenges middle school students to lead healthy lifestyles through 

exercise and healthy eating habits. The program encourages students to increase their physical activity by competing in a 6-week 

fitness competition. 

Madam Chair, I join with you, with my colleagues on the committee and my fellow New Yorkers by welcoming our leader in our 

state, our first lady, Michele Paige Paterson, here today, and I 

thank her for accepting our invitation. 

Chairwoman MCCARTHY. Thank you. 

And welcome, Ms. Paterson. 

Our next witness is Dr. Stallings. Dr. Stallings is the director of 

the nutrition center at Children’s Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania School of 

Medicine. Her research interests include pediatric nutrition, evaluation of dietary intake and energy expedition and nutrition and 

related chronic diseases. She joins us today to discuss her work as 

chair of the National Academy of Sciences Institute of Medicine’s 

Committee on Nutrition Standards for Foods In Schools. 

Our next witness is Ms. Nancy Copperman, director of public 

health initiatives for the North Shore Long Island Jewish Hospital 

Healthcare System from my area of Long Island. She will discuss 

her work in an innovative program in my district called Activity 

Works. 

Activity Works is a school-based program which delivers physical 

activity right in the classroom. Five school districts within my district are using this program, and from the feedback I have gotten 

from the children, they love it. 
13 

Our next witness is Mr. Felton of the National School Boards Association. He will discuss what locals are doing to promote nutrition and also his thoughts on national nutrition standards. 

I yield to Ranking Member Platts for the—I am sorry, Ms. Platts 

isn’t in the building, so we will skip over and—I am sorry? 

I am sorry, Ms. Byrnes is in the building, and she will be up in 

a minute. 

Our final witness is Dr. Lorraine Ritchie, Director of Dr. Robert 

C. and Veronica Atkins Center for Weight and Health College of 

Natural Resources. She has worked for nearly a decade to promote 

the development of science-based solutions to the obesity epidemic 

in children and families. She will discuss her impressions of the 

WIC program and its role in reducing childhood obesity. 

I want to welcome all of our witnesses. And when Ms. Byrnes 

comes, we will stop and have her be introduced. 

I know that you all have been told about the—for those that have 

not testified before Congress, let me explain our lighting system. 

Everybody will get five minutes, including the members. It is limited to 5 minutes of presentations and questions. 

The green light is illuminated when you begin to speak. When 

you see the yellow light, it means you have 1 minute remaining. 

When you see the red light, it means your time is expired and you 

need to conclude your testimony. Please be certain, as you testify, 

to turn on your—and speak into the microphones in front of you. 

We will now hear from our first witness. 

Ms. Paterson? 

STATEMENT OF MICHELE PATERSON, FIRST LADY OF THE 

STATE OF NEW YORK 

Ms. PATERSON. Good morning. 

Chairwoman MCCARTHY. Morning. 

Ms. PATERSON. And thank you, Congressman Tonko, for that 

warm welcome. I would like to also thank Subcommittee Chairwoman Carolyn McCarthy and Representative Yvette Clarke and 

Paul Tonko from the great state of New York and the other members of the subcommittee for inviting me here today to present New 

York’s efforts in fighting childhood obesity. 

As first lady and in my professional career, I continue to be committed to promoting programs that protect and support the health 

of New York’s children. Governor Paterson and I believe that all 

of us share a common obligation to ensure that our children have 

the opportunity to live healthy lives and are given the promise of 

a healthier future. 

But to have that healthier future, we need to address what is 

perhaps the biggest challenge to the health and well-being of our 

youth today: the obesity epidemic, which not only adversely affects 

children’s health, but it threatens to shorten their life span. 

As all of you know, the obesity epidemic touches all ages, all 

neighborhoods, and all socioeconomic groups in New York state. 

One in four children is overweight or obese, and in low-income 

neighborhoods and neighborhoods of color, that number is as high 

as one in three. 

Even though New York state has a strong requirement for physical education in our schools, the recommended 60 minutes of daily 
14 

physical activity is not enough to ensure good health for our youth. 

The governor has proposed state legislation and programs to improve the nutrition of foods available in schools, reduce the availability of junk foods, and increase the opportunity for physical activity. 

He proposed again this year the Healthy Schools Act, which 

would require the establishment of nutrition standards for all food, 

school’s lunch, school’s breakfast and outside food sold or served in 

schools. The governor also proposed and signed into law this year 

the Healthy Food, Healthy Communities Initiative which offers a 

new revolving loan fund to increase the number of healthy food 

markets in underserved communities. 

Additionally, our administration is working with schools, communities and farmers to develop and expand the farm-to-school program to promote the use of local fruits and vegetables in schools 

and to support edible school gardens. The governor’s office collaborated with a wide group of partners and stakeholders in New York, 

including the YMCA and the Boy’s and Girl’s Clubs, to set model 

standards for nutrition, physical activity and television and video 

game limits in after-school programs. 

And we have worked with our healthcare providers and more 

than 400 child daycare centers to provide nutrition training, education and guidance to staff and parents. 

For my part, I created a program called Healthy Steps To Albany: First Lady’s Challenge. This challenges teams of middle 

school students, grades six through eight, are challenged to walk 

4 million steps over a 6-week period. Everyday activities, such as 

biking to school, taking a dance or karate class after school, or 

going for a family walk after dinner were compiled to help the 

classes get their steps to Albany. 

The Healthy Steps to Albany program is unique because students 

are asked to think about the many ways they can increase their 

daily physical activities. With the support of their teachers and 

friends, students are encouraged to turn off the TV, put down the 

video game controller, and be physically active. 

I chose to focus on middle school students for a number of reasons. It is at this age that many students are uncomfortable with 

their changing bodies because they are going through puberty. And 

studies show that children’s physical activities levels decline significantly during middle school years. 

Today’s youth spend an average of 32 hours per week in front of 

a TV, video game or computer screen. This greatly exceeds the recommended limit of 1 to 2 hours maximum per day. 

Although I started Healthy Steps To Albany in Harlem before I 

became first lady, this spring we expanded the challenge to five 

large cities upstate New York, in Buffalo, Rochester, Syracuse, Albany and Yonkers. Nearly 270 classes registered, and the students 

walked more than 1.4 billion steps while mapping their progress 

across New York state. In addition, students had the opportunity 

to earn steps by making smart food choices. 

All the students benefited, because the 13 classroom teams that 

walked the farthest earned a number of prizes, including a visit to 

a local organic farm where they learned how food is grown and prepared. Tomorrow, the governor and I will be in Buffalo to share a 
15 

healthy lunch and present awards to the Buffalo and Rochester 

winners. 

When I took the students from Harlem to a farm last year, I realized how far our urban youth are from the sources of their food. 

One student told me she didn’t realize that cheese came from cows. 

She just thought it came from the grocery store. Another student 

never made the connection between potatoes and potato chips. 

If students do not understand the origins of the food they eat 

every day, they cannot understand what they are putting into their 

bodies. Students learn not only in the classroom, but also in the 

cafeteria, the halls, the gym, the schoolyard and their neighborhoods. They learn from teachers, parents, classmates and neighbors. 

They learn what they see. And too often, in too many schools, 

students see high calorie, low nutrient foods and beverages. 

Today, more than 1,000 schools in New York have already implemented comprehensive wellness policies, enhanced nutrition standards and increased the time of physical activity. I believe we can 

do better. We need federal legislation that raises the nutrition 

standards of all foods and beverages available in our school. 

Many of these standards can be addressed in the 2009 Child Nutrition Act Reauthorization. We strongly support your efforts to request that the USDA strengthen by regulation the nutrition standards governing the federal national school lunch and school breakfast programs, as well as to impose stricter federal standards on 

competitive foods sold or served in schools. 

As you do so, be cognizant of how schools got into selling outside 

food in the first place. They have to compensate for the deficits 

caused by insufficient federal funding for the school lunch and 

breakfast programs. 

As you advocate for improving standards for school’s food, I ask 

you to also examine the cost to states to supply healthier foods. I 

am confident you will find that school food programs are severely 

underfunded. 

Improved federal nutrition standards and reimbursement for 

school lunch, school breakfast and competitive foods, combined with 

programs to increase physical activity, will help children and adolescents establish healthy behaviors. In turn, students will be 

healthier, will have lower obesity rates, obesity-related diseases, 

and they will have lower healthcare costs. It can also contribute to 

increased capacity to learn, higher academic achievement, and 

greater success in school and their careers. 

We look forward to working with you on these important goals 

as the Child Nutrition Act Reauthorization moves forward, and I 

thank you for your time and attention. 

[The statement of Ms. Paterson follows:] 

Prepared Statement of Michelle Paige Paterson, First Lady of the State of 

New York 

Good Morning. 

I would like to thank Subcommittee Chairwoman Carolyn McCarthy, Representatives Yvette Clarke, and Paul Tonko from the great State of New York, and the 

other members of the Subcommittee for inviting me to present New York efforts in 

fighting childhood obesity. 

I would like to congratulate the Subcommittee for convening this hearing on the 

Child Nutrition Act reauthorization to address the childhood obesity epidemic and 
16 

to discuss initiatives that can and should be taken at the local, state and federal 

levels. 

As First Lady and in my professional career, I continue to be committed to promoting programs that protect and support the health of New York’s children. 

Governor Paterson and I believe that all of us share a common obligation to ensure that our children have the opportunity to live healthy lives and are given the 

promise of a healthier future. 

But to have that healthier future, we need to address what is perhaps the biggest 

challenge to the health and well-being of our youth today—the obesity epidemic— 

which not only adversely affects children’s health, but it threatens to shorten their 

lifespan. 

As all of us know, the obesity epidemic touches all age groups, all neighborhoods 

and all socio-economic groups. The State Department of Health estimates that one 

in four New Yorkers, including children, is obese. Among low-income populations 

and communities of color, the prevalence is even higher. 

In our own family, we practice what we preach—we exercise regularly and eat 

healthy foods, including fruits and vegetables from the organic garden at the Governor’s mansion. 

Even though New York State has a strong requirement for physical education in 

its schools, the Centers for Disease Control and Prevention recommended 60 minutes of daily physical activity is not enough time to ensure good health for our 

youth. 

The Governor has proposed state legislation and programs to improve the nutrition of foods available in schools, reduce the availability of high calorie, low nutritional food (i.e. junk foods), and to increase the opportunities for physical activity. 

He proposed again this year the Healthy Schools Act, which would require the establishment of nutrition standards for all foods—school lunch, school breakfast and 

competitive foods sold or served in schools. 

The Governor also proposed the Healthy Food/Healthy Communities Initiative, 

which the legislature passed this year. It offers a new revolving loan fund to increase the number of healthy food markets in underserved communities. 

Additionally, the New York State Departments of Health and Agriculture & Markets have worked with schools, communities and farmers to develop and expand the 

Farm to School program. They worked to obtain procurement exemptions that would 

promote the use of local fruits and vegetables in schools, and to support edible 

school gardens. 

The Governor’s office collaborated with a wide group of partners and stakeholders 

in New York, including the YMCAs of New York State and the New York State Alliance of Boys & Girls Clubs, to set model standards for nutrition, physical activity, 

and television and video game limits in after-school programs. 

With the support of the National Governors Association, we launched the Healthy 

Kids, Healthy New York After-School Initiative and Governor’s Recognition Program, which continues to provide training toolkits and resources. In October, the 

Governor will recognize after-school programs that have adopted and implemented 

these model guidelines. 

We’ve also work with more than 400 child day care centers throughout the State 

to provide training, education and guidance to child day care staff and parents. The 

goal is to provide supports for healthy eating and physical activity, and to reduce 

media use. 

Additionally, we collaborate with our healthcare providers by offering training, 

toolkits and guidance for the implementation of expert guidelines to ensure children 

are being screened for obesity using Body Mass Index (BMI) and that they and their 

families are being counseled about healthy eating and daily physical activity. 

The New York State Office of Health Insurance Programs has launched a 2-year 

Pediatric Obesity Performance Improvement Project in all Medicaid managed care 

plans in the State. It ensures guideline-concordant care to screen for, prevent and 

manage child and adolescent obesity. 

While these successes are significant, working with one community, one school, 

or one childcare provider at a time is not going to end the obesity epidemic. We need 

federal policies, standards, regulations and commitments that help make the 

healthy option the easy choice for New Yorkers and all Americans. 

To better monitor the epidemic, target high-risk communities and identify successful community and/or school interventions, New York passed legislation that 

supports a partnership among the state health and education departments and the 

healthcare community. These groups have developed and implemented a non-duplicative surveillance system that is cost-efficient for BMI screening and determining 

weight status assessment of school-age youth. The data obtained will provide obesity 

rates at local, county and state levels by the end of this school year. 
17 

For my part, to encourage physical activity among the youth in my home community of Harlem, I created a program called Healthy Steps to Alban: First Lady’s 

Challenge. Teams of middle school students, grades six through eight, were challenged to walk 4 million steps over a 6-week period. Small, everyday activities such 

as biking to school, taking a dance or karate class after school or going for a family 

walk after dinner were compiled to help the classes get their ‘Steps to Albany.’ 

The Healthy Steps to Albany program is unique because students are asked to 

think about the many ways they can increase their daily physical activity. With the 

support of their teachers and friends, students are encouraged to turn-off the television, put down the video game controller, and be physically active. 

I chose to focus on middle school students for a number of reasons. It is at this 

age that many students are uncomfortable with their changing bodies, and studies 

show that children’s physical activity declines significantly during middle school. 

Today’s youth watch an average of 32 hours per week at a television, video game, 

or computer screen. This greatly exceeds the recommended limit of 1-2 hours maximum per day. 

Second, having a teenage son, I quickly realized that when he said he was going 

to play football with his friends, he wasn’t always outside being physically active. 

He was often inside with a video game or watching television. 

Although I started Healthy Steps to Albany in Harlem before I became First 

Lady, this spring we expanded the challenge to five large cities in Upstate New 

York—Buffalo, Rochester, Syracuse, Albany and Yonkers. Nearly 270 classes registered, and the students walked more than 1.4 billion steps while mapping their 

progress across New York State. In addition, students had the opportunity to earn 

steps by making smart food choices. 

All the students benefited, but the 13 classroom teams that walked the farthest 

earned a number of prizes, including a visit to a local organic farm where they 

learned how food is grown and prepared. 

After meeting many of these young people and listening to their experiences, I can 

tell you this program is a success. Tomorrow, the Governor and I will be in Buffalo 

to share a healthy lunch and present awards to the Buffalo and Rochester winners. 

When I took the students from Harlem to a farm last year, I realized how far our 

urban youth are from the sources of their food. One student told me she didn’t realize that cheese came from cows—she just thought it came from the grocery store. 

Another student never made the connection between potatoes and potato chips. If 

students do not understand the origins of the food they eat every day, they cannot 

understand what they are putting into their bodies. 

The good news is that we can get our young people, their teachers and parents 

excited about walking and being physically active, but we need to help them stay 

active and to ensure that the school environments and neighborhoods promote 

healthy behaviors. 

Students learn not only in the classroom but also in the cafeteria, the halls, the 

gym, the school yard and their neighborhoods. They learn from teachers, parents, 

classmates and neighbors. They learn what they see. 

And too often, in too many schools, students see high-calorie, low-nutrient foods 

and beverages, which is often coupled with aggressive marketing and advertising. 

New York State has made a significant investment to improve the school nutrition 

environment, as well as after-school programs and child daycare settings. 

Healthcare providers and insurers continue to work with employers, agriculture organizations, farmers and community groups to help prevent childhood obesity. 

New York’s state and local health departments, partners, parents and concerned 

citizens continue to work with schools to set nutrition standards and limit the sale 

of low-nutrient, high-calorie foods and beverages. More than 1,000 schools in New 

York have already implemented improved comprehensive wellness policies, enhanced nutrition standards for meals and snacks, and increased the time for physical activity. 

I believe we can do better. We need federal legislation that raises the nutrition 

standards of all food and beverages available in our schools. Many of these standards can be addressed in the 2009 Child Nutrition Act reauthorization. 

We strongly support your efforts to request that the USDA strengthen, by regulation, the nutrition standards governing the federal National School Lunch and 

School Breakfast Programs, as well as to impose stricter federal standards on competitive foods sold or served in schools. 

As you do so, be cognizant of how schools got into selling competitive foods in the 

first place: they had to compensate for the deficits caused by insufficient federal 

funding for the School Lunch and Breakfast programs. As you advocate for improving standards for school foods, I ask you to also examine the costs to states to sup-
18 

ply healthier foods. I am confident you will find that school food programs are severely under-funded. 

And as US Secretary of Education, Arne Duncan, seeks to reform education in 

this country ‘‘to provide a complete and competitive education to all children’’ to improve student performance and make American students competitive in the world, 

he spoke about increasing the school year and lengthening the school day. 

Keep in mind that with a longer school day, a ‘‘complete education’’ needs to incorporate daily time for physical activity, including walking programs, like Healthy 

Steps to Albany and other types of lifetime activities. 

Also, remember that school breakfast is strongly linked to improved academic performance and higher test scores, reduced truancy and absenteeism. However, the 

breakfast must be high-quality and should demonstrate healthy food options to our 

children. 

Improved federal nutrition standards and reimbursement for school lunch, school 

breakfast, and competitive foods, combined with programs to increase physical activity, will help children and adolescents establish healthy behaviors. In turn, students 

will be healthier, have lower obesity rates and obesity-related diseases, and they 

will have lower health care costs. It also contributes to increased capacity to learn, 

higher academic achievement, and greater success in school. 

Moreover, we strongly support your work on the WIC [Women Infants and Children] program in the reauthorization. WIC provides nutritional information and 

support outside of our schools. Through the program a number of obesity prevention 

initiatives were implemented. They include breastfeeding support, Fit WIC physical 

activity training for parents, patient-centered nutrition education, low-fat milk promotion and the new WIC food package that includes vegetables and fruits, whole 

grains, and non-fat and low-fat milk. In New York, the WIC program reaches 

518,000 low-income women, infants, and children through a network of 100 local 

agency contractors. These programs are part of a comprehensive approach that is 

needed to combat childhood obesity. 

We look forward to working with you on these important goals as the Child Nutrition Act reauthorization moves forward. I thank you for your time and attention. 

New York State Recommendations to Improve School Meals 

Specific recommendations for improvements to school meals, consistent with the 

Dietary Guidelines for Americans issued jointly by the USDA and the Department 

of Health and Human Services: 

• Increase Whole Grains. At least half of the grain products served in school 

meals should be whole grains. 

• Increase Fruits and Vegetables. At a minimum, two servings of fruits or vegetables per breakfast and three servings of fruits or vegetables per lunch should be 

served. (Serving sizes will vary with children’s’ ages and grade levels). Schools 

should offer, at a minimum, five different fruits and five different non-fried vegetables over the course of a week to help ensure variety. Only one serving of fruits or 

vegetables per day should be juice. 

• Sodium. In order to help students stay within the 2,300 mg per day tolerable 

upper intake level for sodium recommended in the Dietary Guidelines, we urge the 

USDA to require that school lunches contain no more than 770 mg of sodium (onethird of the daily limit of sodium) and that school breakfasts contain no more than 

575 mg of sodium (one-quarter of the daily limit for sodium). 

• Fats. The regulations related to the fat content of school meals should be updated to reflect the Dietary Guidelines. Total fat should contribute 20 to 35 percent 

of the total calories in school meals. Saturated fat plus trans fat combined should 

provide no more than 10 percent of total calories. 

• Calories. School meal programs are nutrition promotion programs and, as such, 

should model appropriate portion sizes, calorie levels, and healthy choices from the 

food groups. The calorie levels for ‘‘moderately active’’ children set forth in the Dietary Guidelines for Americans and Dietary Reference Intakes should apply to school 

meals to reflect the current activity levels of the majority of American children. 

• Added Sugars. By the beginning of the 2009-2010 school year, the USDA should 

establish a quantitative limit on added sugars for the school lunches and breakfasts. 

• Milk. All fluid milk served with school meals should be low-fat (1%-fat) or fatfree. 

• Commodities. Efforts to improve the nutritional quality of surplus government 

commodities offered to schools should continue, funding for the Department of Defense (DoD) Fresh Program which delivers fresh produce to schools should increase, 

and other programs that connect locally grown produce to schools should be supported. 
19 

New York State Efforts to Improve Nutrition and Physical Activity Environments 

The New York State Department of Health addresses obesity prevention through 

physical activity and nutrition as part of its Prevention Agenda Toward a Healthier 

State. The purpose is to prevent health problems before they occur or before they 

worsen. The things we do, the food we eat, the air, water around us and the design 

of our communities contribute to the majority of deaths in New York and the nation. 

To accomplish this, policy, systems and environmental changes are pursued in collaboration with a wide range of organizations and community members across a variety of settings. 

Schools 

Multiple contractors of the state health department have worked with more than 

1000 schools (of the over 7600 schools in state) to improve opportunities for physical 

activity and healthier food choices, including: development and implementation of 

comprehensive wellness policies; enhanced nutrition standards for meals and 

snacks; and edible school gardens and Farm-to-School programs. They have eliminated use of food as a reward or punishment and increased time for physical activity 

during, after and before the school day. Funded interventions in the school setting 

include Eat Well Play Hard, Healthy Heart Program, Overweight and Obesity Prevention Program, and Diabetes Prevention and Control Program. 

Child Day Care Centers 

Multiple contractors of the state health department have worked with nearly 500 

child day care centers throughout the state to promote healthier eating, increased 

physical activity and reduced media use among children. 

Chairwoman MCCARTHY. Thank you, Ms. Paterson. 

We are going to have Mr. Platts introduce our witness. We understand you were caught in traffic, so don’t worry about it, Ms. 

Byrnes. 

Mr. PLATTS. Thank you, Madam Chair. 

I am delighted to give introduction to our final panelist, Susie 

Byrnes, who is a great community leader in my hometown of York. 

Susie, welcome. And as those of you who saw her entrance and 

some of her props, the things she has brought with her, Susie 

brings an amazing level of energy to all she does. 

A registered nurse by training since 1988, she has devoted herself to really trying to prevent the premature deaths caused by 

unhealthy lifestyle choices by developing the concept of and then 

following through on the creation of the Susie Byrnes Health Education Center, which officially opened its doors in 1995. After its 

first decade, the center continues to grow and reach its vision of 

becoming a leading resource of innovative, high-quality, effective 

health education. 

And I can tell you that I have had the pleasure of being at the 

center in my official capacity and to partner with the center in any 

way I can. But what was most informative, I have been there as 

a parent chaperoning my son’s sixth grade class just recently for 

a wonderful program. 

And Susie, we are honored to have you here with us, and know 

that, when we get to your testimony, you will bring great insights 

as a leader in the area of health education centers, not just in York 

but across the country with the national associate. So thanks for 

being with us. 

Chairwoman MCCARTHY. And welcome. 

We have a vote going on, and we have to get over to the Capitol 

now to vote. We are going to have four or five votes, so, unfortunately, we are probably going to be at least 45 minutes. So I think 

this is a good time for a break, for everybody to stretch their legs, 
20 

get something healthy to drink and something healthy to eat, and 

we will be back. 

Thank you. 

[Recess.] 

Chairwoman MCCARTHY. We were just told that I am able to 

start, being that there is no one here to object. 

So, Dr. Stallings, please? 

STATEMENT OF VIRGINIA A. STALLINGS, M.D., DIRECTOR, 

CHILDREN’S HOSPITAL NUTRITION CENTER 

Dr. STALLINGS. Madam Chair and Mr. Platts, members of the 

committee, my name is Virginia Stallings. And as you have heard, 

I serve as chair on the Committee of Nutrition Standards for National School Lunch and Breakfast Programs that are under progression of the Institute Of Medicine. 

We have produced a Phase I report on the topic that came out 

in late 2008. We are currently working on Phase II that will provide recommendations for revisions to the nutrition standards and 

the menu requirements for the program. 

I also served as chair of the committee that prepared the 2007 

report on ‘‘Foods In Schools: Leading The Way Towards Healthier 

Youth,’’ that reviewed the scientific evidence and provided nutrition 

standards for snacks and other foods and beverages provided outside of the federally reimbursable meals and snack programs. 

These were mentioned this morning by Representatives Woolsey 

and Castle. 

In 2008, at the request of the USDA, the IOM convened an expert committee to provide recommendations for updating the nutrition standards and meal requirements for the school lunch and 

breakfast programs. These are the nutrition and health foundations for these programs, and much has happened since the current 

standards were last updated in 1995. 

The school lunch program serves more than 30 million children 

each day, and the breakfast program serves about 10 million. Thus, 

improvements to the programs offer tremendous potential to improve the dietary intake and the health of children. Together, the 

two school meal programs can make a great impact because they 

may provide as much as 50 percent of a student’s food and nutrition intake on school days. 

Also, as you know, depending on household income, a child may 

receive meals at no cost, at reduced cost, or full price. The program, 

therefore, serves as a safety net for children in need. 

The school lunch program was established in 1946 as a measure 

of national security to safeguard the health and the well-being of 

the nation’s children. Then, most of the nutrition concerns of the 

United States were centered on deficiencies. 

Although many of the overt deficiencies have now been eliminated, other nutrition-related concerns have emerged. And as the 

chair mentioned, the most notable is the high prevalence of childhood obesity. 

Revisions of the current program standards will enable the programs to incorporate current public health recommendations and 

the newer knowledge about nutritional needs of children and ado-
21 

lescents, and what we now know about the impact of nutrition on 

health both in childhood and throughout the lifetime. 

Among the specific reasons for revising the standards are substantial changes in the dietary guidelines for Americans, which by 

law the school meal programs are required to follow. We also have 

major changes in the nutrient intake recommendation. 

And again, as mentioned, this is on a background of the increased prevalence of obesity. There are short and long-term health 

consequences that will follow this epidemic of childhood obesity. 

The USDA subsidized the cost through cash reimbursements, 

and in 2007, this was near $10 billion. Also, though, the USDA provides about $1 billion in the commodity foods programs. Commodity foods available to schools have changed dramatically over 

the years, and now states can choose from a list of more than 180 

agricultural commodities, including many more fruits and vegetables. 

In Phase I, the committee reviewed the task, formulated working 

principles, assessed the nutrient intake of schoolchildren, and described our planning model. The report was discussed in a public 

forum in January, and the committee expects to complete this report with full recommendations for new standards in this fall. I 

would like to mention the four criteria that have guided this work. 

The nutrition standards and meal requirements will be consistent with current dietary guidance and nutrition recommendations to promote health. The ultimate goal is to improve childrens’ 

diets by reducing the prevalence of both inadequate and excess intake of foods, nutrients and calories. 

The nutrition standards and meal requirements will be developed based on age and grade groups that are consistent with the 

age and gender categories that are important to understanding 

child development and the recommendations. The recommendations 

will also support menus that offer nutritious foods and beverages 

that appeal to students. And lastly, the recommendations will be 

sensitive to cost. 

I will highlight several examples, very briefly, just to illustrate 

how complex this process is going to be. With the 2004 Reauthorization Act of the Child Nutrition and WIC program, schools were 

required to follow the dietary guidelines, which means increase 

fruits, vegetables, whole grains and low-fat and fat-free dairy. 

However, in this setting, there were not specific enough requirements for schools to implement this. Currently, the USDA has two 

different programs that allow schools to plan meals, one based on 

food, one based on nutrients, and the number of servings and the 

requirements for servings of fruits and vegetables are not the same 

in both programs. 

The definition of whole grain products, which we now know are 

important to health, will be considered. In the marketplace, most 

foods that have whole grains represent mixtures. The term ‘‘whole 

grain’’ and the serving size for whole grain are not yet defined by 

the FDA. 

So schools are in an awkward position of being given recommendations but do not have definitions as to how to follow compliance. Recommendations along these lines will help both industry 

and the food service community. 
22 

Dietary guidelines include recommendations for sodium, cholesterol, fiber, and trans fat. Again, not all of the current recommendations follow the science or the current dietary recommendation intakes. 

By law, the dietary guidelines must be reviewed every 5 years. 

And in fact, this process has just begun, and there will be new 

guidelines in 2010. We need to have a way that these constant and 

important updates can be accommodated into ongoing changes in 

the regulations for school foods at lunch and breakfast. 

Incorporating the standards—I think I will skip that in the interest of time. Specifying the issue of age and grade groups is very 

important. Nutrition and energy needs differ by age, and as children grow older, both by gender and age. The current DRI age 

groups different from the USDA age groups, so, again, we need to 

harmonize these things. 

This is particularly true when you think about energy levels and 

calories as we think about issues of obesity. Energy needs differ by 

age, by physical activity, by body size. And when you think about 

kindergarten to 12th grade, you can appreciate how vast that range 

is. It may be appropriate to provide recommendations both for minimum and maximum energy levels in recognition of the concerns 

about both under-nutrition and obesity in school age children. 

In conclusion, the National School Lunch Program and Breakfast 

Program have a long and impressive history of providing nutritious, low-cost meals to school age children. There have been major 

developments in diet and health guidance and scientific understanding since the last revisions were made. It is now time to develop new recommendations so that school meals and the programs 

that they represent can achieve greater benefit for our nation’s 

children. 

With the recommendations for competitive and snack foods which 

came out last year, and the recommendations to revise the WIC 

food basket, which came out shortly before that, we have the unprecedented opportunity to use evidence-based and public health 

evidence to directly improve the dietary intake of children and positively impact child health. 

Thank you for the opportunity to testify. 

[The statement of Dr. Stallings follows:] 

Prepared Statement of Virginia Stallings, M.D., Director of the Nutrition 

Center, Children’s Hospital of Philadelphia 

Good morning, Madame Chair and members of the Committee. My name is Dr. 

Virginia Stallings. I am a pediatrician, Director of the Nutrition Center at the Children’s Hospital of Philadelphia, and Professor of Pediatrics at the University of 

Pennsylvania, School of Medicine. 

I serve as chair of the Committee on Nutrition Standards for National School 

Lunch and Breakfast Programs of the Institute of Medicine which produced the report, Nutrition Standards and Meal Requirements for National School Lunch and 

Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions in 

2008. We are currently working on Phase II of the project that will provide recommendations for revision of the nutrition standards and Menu Requirements for 

the School Breakfast Program and the National School Lunch Program. I also 

served as chair of the committee that prepared the 2007 Institute of Medicine report 

on Foods in Schools: Leading the Way Toward Healthier Youth that recommended 

nutrition standards for foods offered in competition with federally reimbursable 

meals and snacks. Established in 1970 under the charter of the National Academy 

of Sciences, the Institute of Medicine provides independent, objective, evidence- 
23 

based advice to policymakers, health professionals, the private sector, and the public. 

In 2008, at the request of the US Department of Agriculture (USDA), the Institute 

of Medicine convened an expert committee to provide recommendations for updating 

and revision of the nutrition standards and meal requriements for the school lunch 

and breakfast programs. Nutrition standards and meal requirements provide the 

nutrition and health foundation for the National School Lunch Program and the National School Breakfast Program, and much has happened since the current standards were last updated in 1995. The key question is: What changes are needed to 

make these programs consistent with the current understandings about diet and 

health as they relate to our nation’s children? 

The National School Lunch Program serves more than 30 million children per day 

and the School Breakfast Program serves 10.1 million students daily (FY 2007). 

Thus, improvements to the programs offer tremendous potential to improve the dietary intake and health of children. Together, the two school meals programs can 

make a great impact because they may provide more than 50 percent of a student’s 

food and nutrient intake on school days and about half of the food intake in a year. 

As you know, depending on household income, a child may receive program meals 

at no cost, reduced cost, or full (but partially subsidized) price. Thus, the programs 

serve as a safety net for children in need. 

When the National School Lunch Program was established in 1946 as a ‘‘measure 

of national security, to safeguard the health and well-being of the nation’s children,’’ 

nutritional concerns in the United States centered on nutrient deficiencies. Although 

many of the overt nutritional deficiencies in children’s diets have largely been eliminated, other nutrition-related concerns have emerged, most notably a high prevalence of childhood obesity. Although program standards were updated in 1980 and 

1995, additional updates are needed. Further revision of program standards will enable the programs to incorporate current public health recommendations and newer 

knowledge about the nutritional needs of children and adolescents and the impact 

on health in chldhood and throughout the lifetime. Among the specific reasons for 

revising the standards are substantial changes in the Dietary Guidelines for Americans (which, by law, the school meal programs are required to follow), major 

changes in nutrient reference values and ways to apply them, and the alarming increases in the prevalence of childhood obesity coupled with the short and long term 

health consequences that will likely follow childhood obesity. 

The nutrition standards and meal requirements provide the foundation for the 

school meals programs. If the meals offered meet the nutrition standards and meal 

requirements in USDA regulations, the USDA subsidizes the cost through cash reimbursements. In fiscal year 2007 the value of the cash reimbursements were near 

$10 billion total for both programs. In that same year, USDA also provided commodity foods to the programs with a value of approximately $1 billion. Commodity 

foods available to schools have changed over the years, and states may now choose 

from a list of more than 180 agricultural commodities including more foods that are 

encouraged by Dietary Guidelines for Americans, such as fruits and vegetables. 

The committee’s work has been divided into two phases. I am going to talk about 

the Phase I report issued in late 2008 that describes the committee’s proposed criteria and approach to use in making recommendations for revisions to the nutrition 

standards and meal requirements of the school meal programs. The report is available electronically at no charge from the National Academies Press (http:// 

www.nap.edu/catalog.php?record—id=12512 or http://iom.edu/schoolmeals). 

During Phase I, the committee identified and reviewed available data and information on the task, formulated working principles and criteria, and reviewed and 

assessed the food and nutrient intakes of schoolchildren. The committee then described its planning model and analytical methods for developing recommendations. 

The report was discussed during a public forum in January, the committee is now 

engaged in Phase II, and expects to complete this report with recommended revisions to the nutrition standards and meal requirements for School Breakfast and 

Lunch Programs in Fall 2009. 

The committee proposed four criteria to guide its work. The proposed criteria are: 

1. The nutrition standards and meal requirements will be consistent with current 

dietary guidance and nutrition recommendations to promote health—as exemplified 

by the Dietary Guidelines for Americans and the Dietary Reference Intakes from 

the Institute of Medicine—with the ultimate goal of improving children’s diets by 

reducing the apparent prevalence of inadequate and excessive intakes of food, nutrients, and calories. 

2. The nutrition standards and meal requirements will be considered on the basis 

of age-grade groups that are consistent with the current age-gender categories used 

for specifying reference values and with widely used school grade configurations. 
24 

3. The nutrition standards and meal requirements will result in the simplification 

of the menu planning and monitoring processes, and they will be compatible with 

the development of menus that are practical to prepare and serve and that offer nutritious foods and beverages that appeal to students. 

4. The nutrition standards and meal requirements will be sensitive to program 

costs. 

Through its discussion of specific topics that must be addressed in order to revise 

nutrition standards and meal requirements, the Phase I report explains why 

changes are needed. Perhaps most importantly, the standards and requirements 

must be updated to be consistent with the current Dietary Guidelines for Americans 

and the Dietary Reference Intakes. There is also need to identify practical approaches to making revisions, ,to address cost considerations, to continue providing 

a safety net to children who are at risk of insufficient food intake without contributing to excessive weight gain, to enable planning of meals that student will eat and 

enjoy, and to address other factors that affect feasibility of implementing the recommendations. I will highlight the application of Dietary Guidelines for Americans 

and the Dietary Reference Intakes to the school meals program, by way of illustration of the complexities and the necessity for revisions. 

Fruits, Vegetables Whole Grains, and Low-Fat or Fat-Free Milk Products. The 

Child Nutrition and WIC Reauthorization Act of 2004 amended the National School 

Lunch Act to require increased consumption of foods that are recommended in the 

most recent Dietary Guidelines. These include fruits, vegetables, whole grains, and 

low-fat or fat-free milk products. Further, the increased consumption of such foods 

can be related to the decreased intake of other food groups (for example, meats and 

refined grains). Addressing these issues requires careful consideration of food-based 

and nutrient-based planning. Current standards for the two approaches differ with 

regard to number of servings and serving sizes of fruits and/or vegetables and fluid 

milk; and neither requires whole grains. While regulations specify that all schools 

must provide at least two types of milk, they do not restrict the types of milk offered 

by fat content. 

The definition of whole grain products will be considered. In the marketplace, 

most foods that contain whole grain represent mixtures. The term whole grain is 

not defined by Food and Drug Administration and that agency has not provided a 

definition of a whole grain product or a whole grain serving. To assess how well a 

school is meeting [potential] nutrition standards concerning the inclusion of whole 

grains in menus, the definition of whole grain in the school setting will need to be 

clear. This will help industry and the school food service team. 

Sodium, Cholesterol, Fiber, and Trans Fat. The Dietary Guidelines includes recommendations for sodium, cholesterol, and fiber and recommends limiting the intake of trans fat. Especially with regard to sodium, it may be challenging to obtain 

prepared foods that the children will find appetizing Further, not all the recommendations are identical to those in the DRIs. Again, up to date uniform recommendations will likely encourage industry to respond to the nutrition and health 

needs of school age children. 

Planning for Subsequent Revisions to Dietary Guidelines for Americans. By law, 

the Dietary Guidelines must be reviewed every five years. To date, changes have 

been made every five years. Especially because the next revision to Dietary Guidelines is expected in the year 2010, it may be helpful if revisions for the school meal 

programs include a way to accommodate ongoing changes to the Dietary Guidelines 

in a timely way. 

Incorporating Current Dietary Reference Intakes and Related Planning Approaches for School Meals. The current nutrition standards for school meals reference the older 1989 Recommended Dietary Allowances. These have been replaced 

and expanded by the Institute of Medicine’s new reference values known as the Dietary Reference Intakes (DRI) developed between 1994 and 2004. The standards for 

school meals have not yet changed in response. The planning task is complex and 

involves considerations related to program goals, nutritional aspects (such as the selection of target nutrient intake levels), and program implementation. The revisions 

to the nutrition standards and meal requirements for school meal programs must 

take these and related considerations into account. 

Specifying Age-Grade Groups. Nutrient and energy needs differ by age and, in 

older children, by gender. Currently, the regulations for school meal programs specify a number of age-grade groups (for example, kindergarten through grade three) 

and make no distinction by gender. DRI age groups differ somewhat from the ages 

covered by the USDA-specified age-grade groups. 

Part of the committee’s task is to propose serving sizes and numbers of servings 

of the required types of foods of the nutrition standards by age-grade group. These 

amounts would be used in menu planning and in the evaluation of menus. 
25 

Recommending Energy Levels. Energy needs differ by age and by physical activity 

and body size (which vary greatly, especially in grades 7 through 12). Recommendations for energy will need to consider the great diversity of needs of the ages of the 

children being served. It may be appropriate to provide recommendations for both 

minimum and maximum energy levels. 

Specifying Nutrients to Be Covered by the Nutrition Standards. Currently, regulations specify quantitative requirements for energy, protein, calcium, iron, vitamin A, 

vitamin C, total fat, and saturated fat. In addition, the nutrition standards encourage program operators to reduce sodium and cholesterol levels and to increase fiber 

levels in menus with no further specification given. The DRIs include targets for all 

these nutrients plus many more, and the 2005 Dietary Guidelines identified several 

nutrients of concern for children. These developments indicate a need to reassess 

the list of nutrients that are covered in the nutrition standards. 

In conclusion, the National School Lunch Program and School Breakfast Program 

have a long and impressive history of providing nutritious low-cost meals to schoolage children. There have been major developments in diet and health guidance and 

nutrient reference standards and their application to programs since the last major 

revisions to the nutrition standards and meal requirements. It is now time to develop recommendations for further revisions to the nutrition standards and meal requirements of the school meal programs so that the program can achieve greater 

benefits for our nation’s children. Thank you for the opportunity to testify. I would 

be happy to address your questions. 

Chairwoman MCCARTHY. Thank you, Dr. Stallings. 

Ms. Copperman? 

STATEMENT OF NANCY COPPERMAN, DIRECTOR, PUBLIC 

HEALTH INITIATIVES OFFICE OF COMMUNITY HEALTH, 

NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM 

Ms. COPPERMAN. Chairwoman McCarthy and members of the 

Subcommittee on Healthy Families and Communities, I am Nancy 

Copperman, director of public health initiatives of the North Shore 

LIJ Health System, the 10th largest not-for-profit health system in 

the nation that serves the 5.4 million residents in the New York 

metropolitan area. Thank you very much for giving me the opportunity to discuss the importance of implementing and monitoring 

physical activity goals of the local wellness policy requirements. 

I would like to present some data in support of increasing physical activity in schools, the barriers that prevent the implementation of physical activity goals, and discuss a school-based wellness 

program, Activity Works, that addresses the needs of, and the obstacles to, implementing these policies. 

Over 33 percent of U.S. elementary school children are overweight or obese. Increased Body Mass Index in children has been 

linked to reduced physical activity. Physical activity guidelines 

state that children should engage in 60 minutes of activity daily. 

National surveys of activity patterns indicate that less than 50 percent of children meet this goal. 

The 2006 School Health Policies And Programs Study indicates 

that only 3 percent of elementary schools provide a daily physical 

education or its equivalent, and only 13 percent of elementary 

schools provide physical education at least 3 days per week. A recent audit of the New York state elementary schools compliance 

with physical activity regulations found that students in 18 of the 

20 sample districts did not meet minimum requirements of daily 

physical education and a weekly total of 120 minutes. 

Students were provided only 48 percent of the required daily 

classes and 72 percent of the required class time. School districts 
26 

cited the following reasons for failing to meet recommendations: increased academic standards, requirements and testing, lack of 

physical education staff, and inadequate facilities and space. 

A local wellness policy includes goals for physical activity that 

are designed to supplement established physical education programs, but not replace them. School districts have been compliant 

in formulating physical activity goals. 

However, there is very limited data on the implementation and 

monitoring of these goals. School wellness committees have reported that lack of resources such as staff, programs, facilities impact on the achievement of these goals. 

In 2007, the health system partnered with schools to develop the 

Activity Work program, which focuses on increasing childrens’ daily 

physical activity through an integrated classroom approach to meet 

the needs of wellness policies and physical education requirements. 

It is a community benefit program of the health system with additional support from a community building grant from Bank of 

America and the in-kind resources for the pilot program from five 

Long Island school districts. 

The program was developed using feedback from an eight-month 

discovery process led by the health system and a work group of 

parents, educators, administrators, public health and healthcare 

professionals. The process included a review of best practices and 

obesity prevention recommendations, as well as group discussions 

regarding how to develop a successful school-based wellness program. 

The stakeholders felt that the initiative should be school-based, 

measurable, sustainable, scalable and simple. The Activity Works 

program is unique because it integrates subject matter—math, 

science, language arts, social studies, health, art and music—with 

an exercise physiologist designed by permanent exercise protocol. 

The CDs and DVDs contain 10-minute segments with original 

music and activities choreographed to the protocol. The program is 

easily implemented by a classroom teacher who simply loads the 

CD or DVD into a player, and the audio and/or video directs the 

class exercise program. The students learn while they exercise. 

The physical education staff supervises its use throughout the 

academic year. Student calendars and sticker rewards offer positive 

behavior reinforcement. Parent newsletters bring the program’s 

healthy lifestyle messages home to families. 

Five New York school districts, 30 classes and over 1,000 students participate in Activity Works. Program feedback has been extremely positive. Administrator and educator comments include improvement in student attention span, listening skills, behavior, fitness and knowledge. 

Students’ feedback says the program is fun, interesting, and the 

music and exercises are cool. Parents and their children feel they 

are more—parents feel their children are more healthy and active. 

The program has been incorporated into the physical education 

curriculum of three school districts and provides an additional 50 

minutes of physical education per week, increasing daily activity 

without increasing staffing and space needs. It is used as a morning assembly and indoor recess program, along with the parent 
27 

newsletters, enables the schools to meet their wellness policy physical activity goals. 

An evaluation study is also being conducted to assess the program’s effectiveness in obesity prevention, improvement in students’ self-concept and physical activity, and ease of classroom implementation. In order for a wellness policy to be effective in promoting healthy lifestyles and prevent obesity, it must address 

physical activity as well as diet. 

However, the support for implementing and monitoring of the 

physical activity goals has been sparse. Schools encounter barriers 

of limited space, time, equipment, programs, and trained staff to 

achieve these goals. Physical activity programs that are designed 

to be integrated into existing curriculums using existing space and 

involve community partners, parents and school staff need to be developed and supported. Activity Works is an example of one such 

innovative program. 

Thank you very much. 

[The statement of Ms. Copperman follows:] 

Prepared Statement of Nancy Copperman, MS, RD, CDN, Director, Public 

Health Initiatives, North Shore-LIJ Health System 

Chairwoman McCarthy and members of the Subcommittee on Healthy Families 

and Communities, I am Nancy Copperman, MS, RD, CDN, Director of Public Health 

Initiatives, Office of Community Health of the North Shore-LIJ Health System. The 

Health System is the tenth largest not-for-profit health system in the Nation that 

serves the 5.4 million residents of Nassau, Suffolk, Queens and Richmond Counties 

in the New York metropolitan area. Thank you very much for giving me the opportunity to discuss the importance of implementing and monitoring physical activity 

goals of the Local Wellness Policy requirement as established by the Child Nutrition 

and WIC Reauthorization Act of 2004. The local wellness policy was designed to promote the health of students and address the growing problem of childhood obesity. 

I would like to present some data in the support of increasing physical activity in 

schools, the barriers that prevent the implementation of physical activity goals of 

the Local Wellness Policies and discuss a school-based wellness program, Activity 

Works, that addresses the needs of and obstacles to implementing these policies. 

The prevalence of pediatric overweight and obesity is increasing in epidemic proportions in the United States. Over 33% of US children ages 6-11, were overweight 

or obese in 2006 representing a tripling of the prevalence of obese children since 

1980. Several environmental factors have been linked to increased Body Mass Index 

in children. These factors include reduced physical activity and increased leisure 

time spent viewing television. Current physical activity guidelines from the Expert 

Committee Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity are in agreement with recommendations from the 

Centers for Disease Control, the American Academy of Pediatrics and the Institute 

of Medicine. These physical activity recommendations state that children should engage in 60 minutes of physical activity daily. National surveys of childhood physical 

activity patterns indicate that less than 50% of children meet this goal. Expanding 

physical activity programs in elementary schools through the implementation and 

monitoring of Wellness Policies and Physical Education requirements can play a significant role in containing and even preventing overweight and obesity in children. 

National data from the 2006 School Health Policies and Programs Study indicates 

that only 3% of elementary schools provided daily physical education or its equivalent (150 minutes per week in elementary schools) and only 13% of elementary 

schools provided physical education at least 3 days per week or its equivalent for 

the entire school year for students in all grades in the school. 

A recent audit of New York State elementary schools compliance with physical 

education regulations found that students in 18 of the 20 sampled districts did not 

meet the minimum requirements of daily physical education and a weekly total of 

the required 120 minutes of physical education. On average, kindergarten through 

sixth grade students were provided only 48 percent of the required daily classes and 

72 percent of the required class time. The audited school districts cited the following 

major reasons for the difficulty in meeting the minimum physical education requirements: 
28 

1. Increased academic standards, requirements and testing fill elementary school 

schedules which results in limited time for a daily physical education class. 

2. Lack of adequate physical education staff to meet frequency and time requirements due to budgetary constraints 

3. Inadequate facilities/space to offer additional classes to meet the requirements 

A local wellness policy for schools shall, at a minimum include goals for nutrition 

education, physical activity and other school-based activities that are designed to 

promote student wellness in a manner that the local educational agency determines 

is appropriate. It is designed to supplement established physical education programs 

but not replace them. Schools districts have been compliant in formulating these 

policies with physical activity goals. However, data on the implementation and monitoring of these strategies has not been directly measured and reported at this time. 

School Wellness Committees have reported that lack of resources such as staff and 

facilities impact on the implementation of physical activity programs related to their 

physical activity goals. 

In 2007 in an effort to address the childhood obesity epidemic, the North ShoreLIJ Health System partnered with schools to develop the Activity Works Program 

which focuses on increasing children’s daily physical activity through an integrated 

classroom approach to meet the needs of Wellness Polices and Physical Education 

requirements. The program is a community benefit program of the North Shore— 

LIJ Health System with additional support from a Community Building Grant from 

Bank of America and the in-kind resources for the pilot program from 5 school Long 

Island school districts. The program was developed using feedback from an eight 

month discovery process led by community health professionals from the North 

Shore-LIJ Health System which convened a working group of parents, educators, 

administrators, public health and health care professionals. The process included a 

review of best practices and obesity prevention recommendations from expert panels, professional organizations and pediatric obesity experts as well as group discussions regarding the potential strengths, weaknesses, opportunities and threats to 

developing a school-based wellness program. The stakeholder’s consensus was that 

there is an urgent need for elementary school children to increase their physical activity both in school and at home to meet not only New York State Department of 

Education requirements but the Center for Disease Control’s recommendation of 60 

minutes of moderate to vigorous activity per day. The stakeholders felt that in order 

for the initiative to be successful the following criteria should be met: 

School-based—to impact children where they spend a significant portion of their 

formative years. 

Measurable—to demonstrate realistic outcomes throughout the pilot program 

Scalable—a viable offering to any child grades 1-5, anywhere. 

Sustainable—by cultivating participation, usage and loyalty in all stakeholders. 

Simple—ease of adoption and implementation as a critical factor for success. 

The goal of the Activity Works Program is to prevent obesity in elementary school 

children and is addressed by the following program objectives: 

1. Increasing children’s physical activity both during school hours and outside of 

school hours through a school-based program. 

2. Decreasing the prevalence of overweight and obesity by promoting daily physical activity and healthy nutrition messages. 

3. Demonstrating the feasibility and usability and of a classroom based physical 

activity program by cultivating teacher, administration and PTA support. 

4. Increasing the sustainability of the program by integrating it into the Physical 

Education Curriculum of the school to aid in meeting Physical Education requirements 

5. Using the program to implement physical activity goals of School Wellness policies 

6. Improving children’s scholastic competence (knowledge, listening skills, and attention span), athletic competence (exercise endurance) and behavioral conduct 

through daily program participation. 

The Activity Works Program is a unique elementary school physical activity program that integrates subject matter (math, science, language arts, social studies, 

health, art, and music) with an exercise physiologist designed beat per minute exercise protocol. The CDs and DVDs contain original music and activities 

choreographed to the beat per minute protocol. The program was specifically created 

to be easily implemented by a classroom teacher who simply loads the CD or DVD 

into a player and the audio and/or video directs the class exercise program. The 

Physical Education staff in-service the classroom teacher on the program prior to 

its implementation and supervise its use throughout the academic year. 

The themed Activity Works ‘‘toolkit’’ includes facilitator guidelines, activity CDs 

and DVDs, student calendars, sticker rewards and parent newsletters. The purpose 
29 

of the varying monthly themes is to maintain high levels of engagement. Age-appropriate themes include Human Body Tour, Walk through a Book, Visit an Art Museum, and US Tour. The calendars and sticker rewards offer positive behavior reinforcement for daily physical activity. The parent newsletters bring the program’s 

healthy lifestyle nutrition and physical activity massages home to families. The program is currently in 5 New York school districts, 30 classes and reaches over 1000 

students. 

Superintendent, principal, educator, student and parent feedback has been extremely positive. Administrator and educator comments include improvement in student attention span, listening skills, behavior, fitness and knowledge. Student feedback states that the program is fun, interesting and the music and exercises are 

cool! Parents feel their children are more active and healthy. The Activity Works 

Program has been incorporated into the physical education curriculum of 3 school 

districts. It is used outside the classroom during standard physical education classes, morning assembly and indoor recess. The program has provided an additional 

50 minutes of Physical Education /week increasing daily activity and meeting New 

York State Department of Education Physical Education requirements without increasing staffing and space needs. Its use as a morning assembly and indoor recess 

program enables schools to meet their Wellness Policy physical activity goals. 

A North Shore-LIJ Institutional Review Board approved evaluation study is also 

being conducted in a sub-set of students from schools implementing the Activity 

Works Program and schools without the program who are acting as control subjects. 

The purpose of this pilot study is to evaluate the Activity Works Program effectiveness in obesity prevention, improvement of student’s self-concept and physical activity and ease of classroom implementation by collecting and analyzing outcome data. 

In order for a school Wellness Policy to be effective in promoting healthy lifestyles 

for students and prevent obesity it must address diet as well as physical activity. 

A well supported and resourced structure has been created by previous Childhood 

Nutrition Reauthorization Acts to improve nutrition standards and nutrient quality 

for school nutrition services including nutrition education components. These supports enable schools to implement the nutrition goals and objectives of their 

Wellness Policies. However, the support for implementing the Wellness Policy physical activity goals and objectives has been sparse. Schools desiring to increase physical activity encounter barriers of limited space, time, equipment and trained staff 

to achieve this goal. Physical activity programs that are designed to be integrated 

into existing curriculums utilize existing space and involve both physical education 

and classroom school staff need to be developed and supported. By increasing physical activity through the integration of subject matter and prescribed exercise in the 

classroom in daily 10 minute sessions, schools can address their physical activity 

wellness policy goals with gradual expansion to after school and home activities. Activity Works is an example of one such innovative program. 

Thank you. 

Chairwoman MCCARTHY. Thank you very much. 

Mr. Felton? 

STATEMENT OF REGINALD FELTON, FEDERAL RELATIONS 

DIRECTOR, NATIONAL SCHOOL BOARDS ASSOCIATION 

Mr. FELTON. Thank you. 

Chairwoman McCarthy, Ranking Member Platts and members of 

the subcommittee, my name is Reginald Felton, director of federal 

relations for the National School Boards Association. Representing 

the nation’s nearly 15,000 local school districts and over 95,000 

local school board members through our state school board associations, we wish to thank you for the opportunity to address the committee on this important issue affecting children enrolled in our 

public schools. 

Without question, NSBA believes that child nutrition is vitally 

important to fostering a healthy and positive learning environment 

for children to achieve their full potential, and that includes efforts 

to prevent childhood obesity. We believe that improving health requires the commitment of all of us and our communities, including 
30 

families, government, employers, and local schools. Therefore, local 

school boards across the nation continue to actively promote nutrition education, physical education and obesity prevention. 

As an organization, we want you to know that, through our 

school health programs department, we help school policymakers 

and educators make informed decisions about health issues affecting the academic achievement and healthy development of students 

and the effective operations of schools. Services are provides with 

and through NSBA’s member state associations in partnership with 

other national organizations, such as the National Association of 

State Boards of 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. 

In addition to the work of our own organization, local school 

boards are engaging their communities, through partnership and 

coalitions, to ensure that all facets of the community are more informed regarding both the value and cost savings associated with 

improved nutrition. We are convinced that local communities and 

states are assuming greater responsibility for the health and wellbeing of its residents, and very much appreciate the strong support 

of the federal government through incentives and grants that enable school districts and local communities to further expand their 

local commitment and energy. 

We know that educating children as to the healthy behavior is 

most important if we are to ensure sustained changes in nutritional habits. As you prepare for the reauthorization of the Child 

Nutrition Act, we urge you to increase and expand those incentives 

and grants that will garner solid buy-in and commitment on the 

part of local communities rather than to establish broader mandates beyond the current federally subsidized food programs. 

We appreciate your concern to improve nutrition, but we are very 

much concerned with the unintended consequences that are beyond 

the control of our local schools. We remain concerned that the behavioral changes that you desire and expect, through expanded federal mandates and restrictions beyond currently federally subsidized programs, may not be achieved. We believe that there 

would be significant increases in the purchases beyond the school 

grounds, particularly where high school students are permitted to 

leave the campus. 

Secondly, we believe that increased regulatory disagreements in 

schools over what foods and beverages should and should not be 

sold as new products are developed and marketed using newly developed food substitutes, and thirdly, we believe that there will be 

increased misunderstandings and complaints from parents regarding the banning of certain foods. 

Additionally, local school boards view federal efforts to regulate 

or codify into the statue the types of foods and beverages that can 

and cannot be sold at school events, particularly all those schoolsponsored activities, as intrusive and burdensome on school districts. Such efforts we believe would dismiss the work of wellness 

councils and usurp the jurisdiction of local school boards to create 
31 

a policy that reflects the values and capabilities of local communities. 

Therefore, NSBA urges you to reconsider any efforts to enact expanded legislation. Beyond the concerns over the operational impact of—restrictions, local school boards are also concerned with 

the potential impact on local budgets and revenue streams beyond 

the vending machines. As you are aware, the expansion of such federal restrictions on all food and beverages beyond the vending machines substantially reduce revenues that local schools need to support athletic programs and other activities. 

As examples, based on the literal interpretation of the language 

in the proposed bill, local catering businesses desiring to provide financial support to schools would be allowed to provide to students 

food products not meeting federal standards but would be prohibited from selling those same standards to the same students, or 

schools sponsoring a field trip out of town could find itself in noncompliance because some of the food products available to the students in their travels might not fully meet federal standards. 

As you can see from these two examples, such restrictions could 

result in enormous challenges for our local school officials. A national vision for child nutrition is indeed needed, but that should 

not convey, nor equate, to federal mandates. 

In closing, we want to reiterate that local school boards are committed to improving child nutrition and preventing obesity, and we 

clearly view wellness policies as important. We are very committed 

to changing attitudes and sustaining positive behavior related to 

nutrition. Therefore, we feel that community-based decisions are 

much more effective in the long run than mandates from the federal government. 

Federal mandates on our public schools should not be the vehicle 

for changes in society. In our view, federal mandates on what is 

sold in all school-sponsored activities is far beyond what is needed 

or should be adopted. 

We look forward to working with you as you approach the reauthorization. And again, thank you for the opportunity to come. 

[The statement of Mr. Felton follows:] 

Prepared Statement of Reginald M. Felton, Director, Federal Legislation, 

National School Boards Association 

Madam Chairwoman: My name is Reginald M. Felton, director of federal relations 

at the National School Boards Association (NSBA). Representing the nation’s nearly 

15,000 local school districts and over 95,000 local school board members through our 

state school boards associations, we wish to thank you for the opportunity to address the Committee on this important issue affecting children enrolled in our public schools. 

NSBA Position 

Without question, NSBA believes that child nutrition is vitally important to fostering a healthy and positive learning environment for children to achieve their full 

potential—and that includes efforts to prevent childhood obesity. We believe that 

improving health requires the commitment of all of us in our communities including 

families, government, employers and local schools. Therefore, local school boards 

across the nation continue to actively promote nutrition education, physical education, and obesity prevention. 

As an organization, we want you to know that through our School Health Programs department, we 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 
32 

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. 

In addition to the work of our own organization, local school boards are engaging 

their communities through partnerships and coalitions to ensure that all facets of 

the community are more informed regarding both the value and cost-savings associated with improved nutrition. 

We are convinced that local communities and states are assuming greater responsibility for the health and well-being of its residents, and very much appreciate the 

strong support of the federal government through incentives and grants that enable 

school districts and local communities to further expand their local commitment and 

energy. We know that educating children as to healthy behavior is most important 

if we are to ensure sustained changes in nutritional habits. 

As you prepare for the reauthorization of the Child Nutrition Act, we urge you 

to increase and expand those incentives and grants that will garner solid buy-in and 

commitment on the part of local communities rather than to establish broader mandates beyond the current federally subsidized food programs. We appreciate your 

concern to improve child nutrition, but we are very much concerned with the unintended consequences that are beyond the control of our local schools. 

We remain concerned that the behavioral changes that you desire and expect 

through expanded federal mandates and restrictions on foods beyond current federally subsidized programs may not be achieved. From a local school board’s perspective, we believe that what is likely to happen is that there would be: 

1. Significant increases in purchases beyond the school grounds, particularly 

where high school students are permitted to leave the campus for lunch; 

2. Increased regulatory disagreements in schools over what foods and beverages 

should and should not be sold as new products are developed and marketed using 

newly developed food substitutes; and 

3. Increased misunderstandings and complaints from parents regarding the banning of certain foods and beverages. 

Additionally, local school boards view federal efforts to regulate or codify into statute the types of foods and beverages that can and cannot be sold in schools throughout the entire school day and at school events as overly intrusive and burdensome 

on school districts. Further, such efforts would dismiss the work of wellness councils 

and usurp the jurisdiction of local school boards to create a policy that reflects the 

values and capabilities of local communities. 

In our view, these new requirements could also result in additional unintended 

consequences that could require the redirection of time and resources away from the 

school’s primary responsibilities. Therefore, NSBA urges you to reconsider any efforts to enact expanded legislation. 

Beyond the concerns over the operational impact of such expanded restrictions, 

local school boards are also concerned with the potential impact on local budgets 

and revenue streams. As you are aware, the primary responsibility of local school 

boards is to deliver high quality educational programs to ensure that students are 

career- and college-ready to compete in the global society. The expansion of such 

federal restrictions on all foods and beverages could substantially reduce revenues 

that local schools need to support athletic programs and other activities that promote the overall development and well-being of all students. 

As examples, based on a literal interpretation of the language in the proposed bill, 

local catering businesses desiring to provide financial support to a school would be 

allowed to provide to students food products not meeting the federal standards—but 

would be prohibited from selling those same products to the same students * * * 

or a school sponsoring a field trip out of town could find itself in non-compliance 

because some of the food products available to the students in their travels might 

not fully meet federal standards. As you can see from these two examples, such restrictions could result in enormous challenges for local school officials. 

We do not want local school districts to be caught in a bind between demands to 

sustain a quality learning environment and concern over potential allegations of 

non-compliance because of the complexity in operations of such proposed legislation. 

Therefore, NSBA urges Congress to refrain from enacting legislation that would further restrict local authority and create additional operational barriers. 
33 

A New Federal Role 

A national vision for child nutrition is needed but that vision should not convey 

nor equate to federal mandates. A national vision for child nutrition should reflect 

the understanding of current authority and Constitutional responsibilities of states 

and local communities, and re-define the role of the federal government so that it 

promotes national policies within the framework that supports states and local communities. Beyond child nutrition, the federal government should acknowledge more 

broadly that the efforts over the previous decade to employ a ‘‘top-down approach’’ 

have not worked. The federal role should be one of partnership and support to the 

states and local communities. In a paper entitled A New Era in Education: Redefining the Federal Role for the 21st Century, NSBA suggests a potential theme for 

the new federal role might be ‘‘facilitate, don’t dictate.’’ 

Local School Board Commitment 

As you are aware, the Child Nutrition and Women, Children, and Infants Reauthorization Act, passed by Congress in 2004, requires every school district participating in the federal school meals program to enact a wellness policy by the 2006- 

2007 school year. These policies now address: 

• Goals for nutrition education; 

• Goals for physical activity; 

• Nutrition guidelines for all foods available at school; 

• Goals for other school-based activities designed to promote student wellness; 

• Assurances that school meal guidelines are not less restrictive than federal requirements; and 

• Plans for evaluating implementation of the policy. 

To illustrate the success of the current law, a study conducted by the Pennsylvania State University on Local Wellness Program (LWP) implementation among 

Pennsylvania local school districts indicates that: 

• 84 percent of the districts have written implementation or action plans developed for some of their goals. 

• 91 percent of the school districts have functioning wellness committees. 

With respect to nutrition education: 

• 50.3 percent of the school districts reported that their students receive more 

minutes of nutrition education now than they did prior to the establishment of local 

wellness policies. 

• 58.2 percent of the school districts reported that their students are receiving 

higher quality nutrition education now than they were prior to the establishment 

of local wellness policies. 

This data suggests that a majority of local school boards across the nation are actively engaging their communities, as they should, to create policies and local requirements that have the full support of the people in their local communities. 

Summary 

In closing, we want to reiterate that local school boards are committed to improving child nutrition and preventing obesity, and we clearly view wellness policy as 

important. We believe that as these local school board actions increase, positive 

changes in behavior will take place reflecting the will of the local communities. We 

are very committed to changing attitudes and sustaining positive behavior related 

to nutrition. Therefore, we feel that community-based decisions are much more effective in the long run than mandates from the federal government. 

Federal mandates on our public schools should not be the vehicle for changes in 

society. In our view, federal mandates on what is sold in our schools and what cannot be sold in our schools beyond federally subsidized food programs should not be 

adopted. 

We believe that significant improvements in child nutrition and health will not 

be achieved through the expanded authority of the Secretary of Agriculture. Rather, 

it will be through the active engagement of local communities that hold strongly to 

the belief that those at the local level should best make such determinations. 

Thank you again for the opportunity to share our views. 

National School Boards Association’s Efforts to Support Child Nutrition 

Web-based Services through NSBA’s School Health Programs: www.nsba.org/ 

SchoolHealth 

• ‘‘101’’ packets on Wellness, Nutrition, Physical Activity and Coordinated School 

Health to provide the data, background information, research and sample policies 

to support local school board decision making. 

• ‘‘Promising District Practices’’ website that provides the ‘‘stories’’ of how school 

districts have acted to address healthy eating and physical activity. 
34 

• ‘‘Updates and Special Announcements’’ that alert school officials to new research and reports on a wide range of health topics, including childhood obesity, to 

inform decision making. Users can sign up to obtain the ‘‘Updates’’ via an RSS feed. • Searchable database of research, information and sample policies. 

Educational Programming 

• At NSBA’s annual conference, several sessions in partnership with such organizations as the Alliance for a Healthier Generation, Action for Healthy Kids, and the 

School Nutrition Association. • Symposium on Childhood Obesity (July 2008, Little Rock, AR) for 12 state 

teams that include members of state boards of education and local school board 

members to drive initiatives/policy change in states based on state conditions, needs 

and capacity. Follow-up technical assistance provided to state teams. This activity 

is supported by Leadership for Healthy Communities, a national program of the 

Robert Wood Johnson Foundation. 

Publications 

• Special report in American School Board Journal (February 2009) on ‘‘Health 

and Leadership’’ focusing on childhood obesity. This report was produced with support from Leadership for Healthy Communities, a national program of the Robert 

Wood Johnson Foundation. • Articles on nutrition, physical activity, health and wellness are frequently published in American School Board Journal. • Participation in the development of Action Strategies for Healthy Communities, 

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). 

Chairwoman MCCARTHY. Thank you. 

Ms. Byrnes, I am sorry that you had to wear whatever you are 

wearing all this time. Hope you are going to demonstrate what that 

is. 

STATEMENT OF SUSAN P. BYRNES, FOUNDER, SUSAN P. 

BYRNES HEALTH EDUCATION CENTER 

Ms. BYRNES. I will demonstrate. And thank you very much for 

inviting me here. I am thrilled to finally find where everyone was. 

First of all, I wanted to share with everyone that no goal in life 

is possible without one’s health. In 1988, I quit my job as an emergency department nurse. Professionally and personally, I had witnessed physical and emotional suffering of patients and families 

due to unhealthy lifestyle choices. I made a new life goal: to keep 

people well. 

In 1989, with support from hundreds of dedicated business professionals, healthcare providers, educators, parents and organizations that sustain our communities every day, the Central PA 

Health Education Center was incorporated as a 501(c)3. In 1995, 

after 6 years of planning and preparation, the bright red doors of 

the newly dedicated and renamed Susan P. Byrnes Health Education Center were open to the children and citizens of central 

Pennsylvania and northern Maryland. 

What began as two teaching theaters in a refurbished downtown 

historic car dealership site has blossomed into today’s 20,000 

square foot home with five teaching theaters, over $1.5 million of 

interactive exhibits, and over 50 specialized educational offerings 

that include regional outreach programs to children and students 

and teachers in seven counties. 

In addition to this, children and teachers throughout the United 

States, and indeed internationally, over 168 countries, log onto our 
35 

e-learning site. We have 95,000 international members that log on 

to learn about health on our Web site. 

All 50 programs at the Byrnes Health Education Center meet 

state and national guidelines. Our nutrition and fitness programs 

are offered as an integrated series that empower students to adopt 

healthier lifestyles. 

For pre-K and kindergarten students, we offer, ‘‘The Inside 

Story;’’ grade two, ‘‘Fueling My Special Body;’’ grade three, ‘‘Let’s 

Get Physical;’’ grade four, ‘‘Just Fueling Around;’’ grade five, 

‘‘Healthy Hearts;’’ grade six, ‘‘Fat: What is Up With That,’’ and I 

will get to that; and grade eight, ‘‘Extreme Makeover.’’ 

How do schools come to the Byrnes Health Education Center? If 

you were a fifth grade teacher, you would look at our program 

guide. We have over 50 programs listed here. 

You would look and you would see what you are teaching in your 

classroom. You would come for one or two programs. You would get 

on your school bus and you would come to the Byrnes Health Education Center. 

If you couldn’t afford to do that, we have outreach programs. And 

if you couldn’t afford to do that, that is where we have our free 

Web site called learntobehealthy.org. 

What we have in our teaching theaters, if you would come to our 

theaters, we have enthusiastic educators that teach with our larger-than-life interactive exhibits. They incorporate the wow factor 

and the fun factor into health education. We believe that students 

learn by seeing, hearing and doing, and the students are involved 

in the educational activities. 

What I would like to do is demonstrate. This is one of our least 

expensive exhibits. This is 20 to 25 to 30 pounds of fat. We are not 

sure. 

But why I brought this is, for every pound of fat that we put on 

our bodies, our bodies have to produce 200 miles of blood vessels 

to nourish that fat. That is what these little red things are. Those 

are the blood vessels that nourish fat. 

So if you put on 20 extra pounds, you are putting on 4,000 miles 

of blood vessels that your little heart that weighs less than a pound 

has to now pump through. And if those vessels become filled with 

fat, imagine what happens to this little heart that has to pump 

through—normally we have 60,000 miles of blood vessels. 

The kids actually put this on, and then we ask them to run and/ 

or to do jumping jacks. And what we are trying to show them is 

we are trying to give them information so that they will continue 

to make healthy choices. 

When Dr. Oz came to our health education center this past October, he was teaching a heartbeat—a heart-healthy program with 

our little ones. And he looked at me and he said, ‘‘Why doesn’t 

every community have a health education center?’’ And I said, 

‘‘Well, in fact, 34 communities in this nation have health education 

centers in 22 states,’’ and we reach 10,000 school districts. And 

every year, 3.7 million students are educated in health education 

centers. 

However, the National Coalition of Healthcare says that, in 2009, 

the United States is going to spend $2.9 trillion on disease. So it 
36 

is time to turn the corner. And I am here, thanks to Todd, to say 

to you that every community can have a health education center. 

Thank you. 

[The statement of Ms. Byrnes follows:] 

Prepared Statement of Susan P. Byrnes, R.N., Susan P. Byrnes Health 

Educaton Center 

In 1988, I quit my job as an Emergency Department R.N. Professionally and personally I had witnessed physical and emotional suffering of patients and their families due to unhealthy lifestyle choices. I made a new life goal: keeping people WELL. 

In 1989, with support from hundreds of dedicated business professionals, 

healthcare providers, educators, parents and organizations that sustain our communities every day, the Central PA Health Education Center was incorporated as 

501(3)c. 

In 1995, after six years of planning and preparation, the bright red doors of the 

newly dedicated and renamed, Susan P. Byrnes Health Education Center, were 

opened to the children and citizens of Central PA and Northern MD. 

What began as two teaching theaters in a refurbished, downtown, historic car 

dealership site has blossomed into today’s 20,000 sq. ft home with five teaching theaters, over 1.5 million dollars of interactive exhibits and over fifty specialized educational offerings that include regional outreach programs to seven counties. Children throughout the U. S. and over 168 countries around the world now utilize our 

health educational tools through our e-learning programs. The business community 

provides customized, educational programs to employees and their families through 

our corporate wellness works division. 

All 50 Programs of the Byrnes Health Education Center meet state and national 

health education guidelines. Our Nutrition and Fitness programs are offered as an 

integrated series that empower students to adopt healthier lifestyles: 

• Pre-K/K: Inside Story 

• Grade 2: Fueling My Special Body 

• Grade 3: Let’s Get Physical 

• Grade 4: Just Fueling Around 

• Grade 5: Healthy Hearts 

• Grade 6: Fat: What’s Up With That 

• Grade 8: Extreme Makeover 

Our enthusiastic educators teach using our dramatic, larger that life, interactive 

exhibits. They incorporate the WOW and FUN factors into every program. We believe that students learn by seeing, hearing and doing and they are very hands-on 

with our health education lessons. (demonstration of fat vest with Todd Platts) 

When Dr. Oz participated in our heart healthy program with special after school 

scholars in Oct. ’07, he asked: ‘‘Why doesn’t every community have a health education center?’’ 

There are 34 health education centers in 22 states that reach 10,000 schools and 

3.7 million students every year! 

We are organized as the National Association of Health Education Centers. 

www.nahec.com 

Our collective VISION as a national organization is that empowered children and 

adults building healthier communities result in decreased healthcare costs. 

In 2009, the U. S. spent 2.9 trillion dollars on treatment of disease. 

It is time to spend billions on health education and prevention. 

Thank you for the opportunity to speak with you today. 

Chairwoman MCCARTHY. Thank you. 

Dr. Ritchie? 

STATEMENT OF LORRENE DAVIS RITCHIE, PH.D., RD, DIRECTOR OF RESEARCH, ATKINS CENTER FOR WEIGHT AND 

HEALTH 

Ms. RITCHIE. Good afternoon, Madam Chair, Congressman 

Platts, and members of the committee. My name is Lorrene Ritchie, and I am the director of research at UC Berkeley’s Dr. Robert 

C. and Veronica Atkins Center for Weight and Health. 
37 

The Center for Weight and Health is one of the only obesity prevention research centers in the nation to focus primarily on environmental and policy solutions to preventing pediatric overweight. 

Thank you for the opportunity to provide input on the reauthorization of the special supplemental nutrition program for women, infants and children, particularly in regards to preventing child obesity. 

The WIC program offers us an unparalleled opportunity to prevent the development of nutrition-related health problems at the 

most critical stages of life—during pregnancy, post-partum, 

breastfeeding, and in early childhood and infancy. 

As you have heard today, it is critical, too, because child obesity 

oftentimes begins very early in life. Obesity prevention strategies 

must therefore begin at a very, very young age. 

We have a golden opportunity here to position federal child nutrition programs to prevent obesity. And if we do not, this generation of children may be the first in our nation’s history to live a 

shorter life than their parents. 

I offer the following four suggestions for strengthening WIC’s nutrition services to better address child obesity. My first recommendation is to increase time for nutrition education in WIC. 

Making healthful choices for one’s family requires a knowledge 

base, yet many parents have minimal or no education in nutrition. 

I myself had to go to graduate school before I learned what to eat. 

Optimal nutrition education requires sufficient time at WIC appointments. How can this be achieved? First, ensure that there is 

adequate funding for the nutrition services and administration portion of the WIC appropriation. 

Second, redirect time from time-consuming processes like certification activities to education. Currently, states have the option to 

certify infants and breastfeeding women for 1 year at a time. 

However, the eligibility period for children, who make up onehalf to two-thirds of those enrolled in WIC, remains every 6 

months. Allowing annual certification for children would allow WIC 

staff to redirect their focus from paperwork to the provision of 

much-needed guidance on obesity prevention. 

My second recommendation is to increase targeted funding for 

breastfeeding promotion. The values of breastfeeding are numerous 

and well documented in the scientific literature. Breastfeeding not 

only reduces infectious disease and chronic disease, but it also 

helps reduce the risk of obesity. 

WIC is a proven national leader in breastfeeding promotion. In 

California, for example, rates of breastfeeding have increased by as 

much as 11 percent in WIC agencies that have implemented the 

breastfeeding peer counseling program with special funds appropriated by Congress. 

Evaluation of this peer counseling is important so that we can 

identify ways to adapt it to different populations and different settings, yet funds are currently not allocated for evaluation purposes. 

Moreover, current funding for peer counseling is not adequate to 

ensure that all WIC mothers who need it, get it. 

My third recommendation is to coordinate nutrition messaging 

across federal nutrition assistance programs. Among the child nutrition programs, WIC is the leader in nutrition education. A key 
38 

way to strengthen WIC is to align the nutrition messages in all federal food programs, particularly the supplemental nutrition assistance program and the childcare food program, which serves similar 

populations. 

Without this, WIC messages are more likely to get diluted and 

lost in what you know is a daily barrage of alternative messages 

we more oftentimes hear for less nutritious foods. 

My fourth and final recommendation is to increase funding to 

support WIC evaluation and outcomes research. To ensure that 

WIC continues to provide the most nutritious packages of foods 

possible within its budgetary constraints, Congress should protect 

the scientific integrity of the new food packages and require periodic reassessment. The WIC food packages should be re-evaluated 

at a minimum of every 10 years to reflect important changes in 

what we know about science and nutrition and updates in the national nutrition guidelines. 

Lastly, I urge you to increase funding for evaluations that will 

help us build the evidence base for cost-effective and transferable 

WIC best practices that demonstrate promise in preventing obesity. 

We need to discard what isn’t working and strive to optimize the 

return from WIC’s proven investment in nutrition services for the 

millions of at-risk families with young children who participate in 

WIC. 

Thank you for the opportunity to share with you these comments 

on strategies to strengthen the invaluable WIC program. 

[The statement of Ms. Ritchie follows:] 

Prepared Statement of Lorrene Ritchie, Ph.D., RD, Director and Adjunct 

Professor, Dr. Robert C. and Veronica Atkins Center for Weight and 

Health, University of California 

My name is Lorrene Ritchie, and I am the Director of Research at UC Berkeley’s 

Dr. Robert C. and Veronica Atkins Center for Weight and Health. The Center is an 

obesity prevention research center, the only one in the nation focusing on primarily 

environmental and policy approaches to prevent pediatric obesity. I am a co-author 

on the book Obesity: Dietary and Developmental Influences. I have also been an 

Evidence Analyst for the American Dietetic Association (ADA), co-authored the 

ADA’s Position Paper on Pediatric Weight Management and was a member of the 

ADA’s Pediatric Weight Management Workgroup to formulate evidence-based practice guidelines for dietetic professionals. 

Thank you for the opportunity to provide input on the reauthorization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) particularly regarding approaches to reducing the epidemic of childhood obesity. The 

WIC program offers an unparalled opportunity to prevent the development of nutrition-related health problems at the most critical stages of life—pregnancy, infancy, 

and young childhood. Additionally, the program reaches a population in the U.S. 

with the highest risk for obesity and its related health challenges, while at the same 

time having the least access to resources for prevention. This is an unprecedented 

time for WIC, because across the country WIC is beginning to implement the new 

Food Packages. We applaud the USDA’s decision to contract with the Institute of 

Medicine to conduct a study of the WIC foods and to adopt the resulting recommendations into the Final Food Package Rule. The changes to the WIC Food 

Packages represent an extraordinary step in improving this federal nutrition program to address child obesity. In addition to the food package changes, WIC’s impact can be strengthened by enhancing the nutrition services provided as identified 

in the five recommendations I will outline. 

The statistics on child obesity are staggering and unprecedented. Obesity rates 

among children in the United States have more than tripled in the last 30 years 

(Ogden, 2002, 2008). Of most concern, obesity is increasingly affecting our nation’s 

youngest children. Before beginning school, nearly one out of every 5 preschool-age 

child is already obese (Anderson, 2009). Obese preschoolers are more likely to grow 

into obese adolescents and obese adults (Nader, 2006; Gardner, 2009). Increasing 
39 

numbers of children are developing type 2 diabetes, early signs of clogged arteries, 

and sleep and breathing difficulties—side-effects of poor nutrition and excess weight 

gain (Dietz, 1998; Messiah, 2009). Obesity in youth is contributing to escalating 

health care costs (Trasande, 2009). Poor nutrition is also related to reduced concentration and behavioral problems, which in turn, can impact a children’s ability 

to succeed in school (Florence, 2008). A growing body of research further suggests 

that a child’s dietary and health habits form at a young age—prior to entering elementary school (Patrick, 2005). The link between early behaviors and obesity later 

in life leads to the conclusion that successful obesity prevention strategies must 

begin at a very young age. In fact, they should begin prenatally and in the first hour 

of life. If we do not take bold steps now to improve nutrition and prevent obesity, 

the present generation of young children will likely be the first in our nation’s history to live a shorter life than their parents. 

What is contributing to this excess weight gain? On the surface, this problem 

seems deceptively simple—too many calories consumed and too few calories burned. 

However, the forces that lead to this energy imbalance on a population level are numerous and pervasive. Healthy food and beverage options generally require more 

time, money, energy and effort to consume than less healthy options. In particular, 

low-income families face numerous challenges including excessive weight gain in 

pregnancy, low initiation and duration of breastfeeding, overfeeding of formula, and 

inaccessibility to healthful foods. It is essential to position federal child nutrition 

programs so that we can begin to address these issues. 

Fortunately, there are several changes to WIC to consider that could continue to 

make WIC an even more effective public health nutrition program. I offer the following suggestions for strengthening the nutrition services components of the WIC 

Program to address child obesity. 

Recommendation #1: Maintain and increase time for nutrition education in WIC. 

Making healthful choices for one’s family requires a knowledge base. Many young 

parents have had minimal or no nutrition education and as they begin their family 

they are charged with the most important preventive health decisions for their families. Our WIC studies show that WIC education can be effective. Optimal nutrition 

education requires sufficient time at WIC appointments to talk with WIC families 

about their nutrition-related concerns and assist them with overcoming the many 

barriers to healthy choices. One way to address the need for additional staff time 

with WIC participants is to ensure that there is adequate funding for the Nutrition 

Services Administration portion of the WIC appropriation. Another way is to reduce 

time spent on time-consuming administrative activities. 

Precious minutes with WIC families can be saved by extending the ‘‘certification 

period’’ (how often a child has to be assessed for eligibility for WIC) for children. 

Currently states have the option to certify infants and breastfeeding women for 1 

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 paperwork to 

the provision of timely and preventive anticipatory guidance for a vulnerable population. 

Recommendation #2: Congress should ask the USDA to commission a comprehensive scientific review of WIC biochemical assessment and testing regulations. 

There is no question that WIC has a role to play in screening for and educating 

about prevention of iron-deficiency. But it is time to ask: what is the suitable WIC 

role, and what level of screening is appropriate, given the current public health 

challenges facing our population? Given the reduction in iron deficiency anemia concurrent with the dramatic rise in childhood obesity (Sherry, 2001; Polhamus, 2009), 

an evaluation of the relevance of the WIC blood test requirements is warranted in 

much the same way that an evaluation of the relevance of the WIC Food Packages 

was conducted (CWA, 2009).The substantial cost of WIC anemia screening takes 

precious Nutrition Services funds from focusing on obesity prevention. These funds 

could be better used by local programs to harness the WIC program’s full capacity 

to address the obesity epidemic. 

Recommendation #3: Increase targeted funding for breastfeeding promotion. 

The values of breastfeeding are numerous and well known. WIC can be extremely 

successful in this arena. Breastfeeding is a low-cost way to promote health in children—it reduces infectious disease and chronic disease as well as reduces risk of 

obesity (Ip, 2007). Targeted funding for breastfeeding promotion and support activities, including the Breastfeeding Peer Counseling Program funding, is critical for 

WIC to continue its efforts to increase the rates and duration of exclusive 

breastfeeding. In California, breastfeeding rates have increased by as much as 11% 

in WIC agencies that have implemented the Breastfeeding Peer Counseling Program 

with special funds appropriated by Congress (Public Health Foundation Enterprises 
40 

WIC, 2009). Careful evaluation of the Breastfeeding Peer Counseling Program is important so we can understand which interventions are most effective and why. However, none of the funding for the program can be used for evaluation. Moreover, current funding for the Breastfeeding Peer Counseling Program is not adequate to ensure that all WIC mothers who need it have access to peer counseling. 

Recommendation #4: Coordinate nutrition messaging across federal nutrition assistance programs. 

Studies show that nutrition education can be effective in influencing knowledge, 

attitudes and behaviors. A key way to strengthen WIC is to strengthen and align 

the nutrition messages in the other federal food programs. Otherwise the WIC messages get diluted and lost. It is critical to improve coordination of nutrition messaging and health education efforts between WIC and other nutrition assistance programs serving the same population, in particular the Supplemental Nutrition Assistance Program (SNAP—the new name for federal Food Stamp Program) and the 

Child and Adult Care Food Program (CACFP—which is the school meal program 

equivalent in the child care setting). 

Federal nutrition education messages need to be targeted and cohesive, strategic, 

providing families with young children with coordinated, culturally appropriate messages that encourage and support healthy food and activity choices and promote 

breastfeeding. Unfortunately, federal nutrition education efforts are the David to 

private industry’s Goliath in terms of resources spent, thus making the need for 

strong, consistent federal messaging even more important until food marketing to 

young children is eliminated. 

Recommendation #5: Increase funding to support WIC evaluation and outcomes 

research. 

Lastly, I urge you to increase funding for additional large-scale and robust evaluations that will help us build the evidence-base for cost-effective and transferable 

WIC-based best practices, special interventions and service delivery innovations that 

can demonstrate promise in preventing obesity, its precursors, and its consequences. 

I am not suggesting we invest more money to prove once again that WIC achieves 

its overall goals to improve participant nutrition and health—numerous studies 

have repeatedly demonstrated that WIC improves diet, birth outcomes, infant feeding practices, cognitive development in children, immunization rate, and savings in 

health care costs (USDA, 2009). Instead, I emphasize the critical need for a closer 

examination and comparison of the costs and benefits of multiple strategies used in 

nutrition services delivery, nutrition education, breastfeeding promotion and direct 

service activities so that we build upon what works, discard what isn’t working and 

continue to get the most return from WIC’s unique investment in these nutrition 

services to millions of families. 

For example, as a result of the FitWIC obesity prevention initiative, we learned 

that investing in staff wellness was important in increasing staff’s effectiveness in 

engaging participants in obesity prevention behaviors (Crawford, 2004). Based on 

these findings and other studies, California WIC has supplemented implementation 

of the new WIC Food Packages to include employee wellness training, enabling staff 

to counsel more effectively while supporting them to adopt healthy behaviors in 

their own lives (California Dept. of Public Health, 2009). In our WIC studies, we 

have noted a great deal of variation in outcomes across WIC agencies. Systemically 

examining the factors that contribute to these variations between agencies is another example of how evaluation could lead to program improvements. 

Recommendation #6: Finally, to ensure that the WIC Food Package is responsive 

to changes in nutritional needs of women, infants and children and in the food supply, we urge periodic assessments of the Food Package. 

While, we are thrilled with the Final Food Package Rule and greatly appreciate 

the leadership demonstrated by USDA in making significant changes to the Food 

Packages, we want to be sure that there is opportunity for timely future revisions. 

To ensure that WIC continues to provide healthy food that complements the most 

current nutrition education and information provided to families by WIC staff, we 

strongly urge that the Child Nutrition Act be strengthened to require that the WIC 

Food Packages be re-evaluated at a minimum of every ten years to reflect current 

national nutrition guidelines, thus coinciding with the updates to the Dietary Guidelines. 

Thank you for the opportunity to share with you these comments on strategies 

to continually strengthen and update the invaluable WIC program. 

BIBLIOGRAPHY

Anderson SE, Whitaker RC. Prevalence of obesity among US preschool children in 

different racial and ethnic groups. Arch Pediatr Adolesc Med. 2009;163:344-348. 
41 

California Department of Public Health. Healthy Habits Campaign. 2009. Available 

at: 

ww2.cdph.ca.gov/programs/wicworks/Pages/WICHealthyHabitsCampaign.aspx 

California WIC Association. Time to Re-evaluate WIC Blood Test Requirements! 

April 2009. Available at: www.calwic.org. 

Crawford PB, Gosliner W, Strode P, Samuels SE, Burnett C, Craypo L, Yancey AK. 

Walking the talk: Fit WIC wellness programs improve self-efficacy in pediatric 

obesity prevention counseling. Am J Public Health. 2004;94:1480-5. 

Dietz WH. Health consequences of obesity in youth: childhood predictors of adult 

disease. Pediatrics. 1998;101:518-25. 

Florence MD, Asbridge M, Veugelers PJ. Diet quality and academic performance. J 

Sch Health. 2008;78:209-15. 

Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. Contribution 

of early weight gain to childhood overweight and metabolic health: a longitudinal study (EarlyBird 36). Pediatrics. 2009;123:e67-73. 

Harris JL, Pomeranz JL, Lobstein T, Brownell KD. A crisis in the marketplace: how 

food marketing contributes to childhood obesity and what can be done. Annu 

Rev Public Health. 2009;30:211-25. 

Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. 

Breastfeeding and maternal and infant health outcomes in developed countries. 

April 2007. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.ahrq.gov/clinic/tp/brfouttp.htm. 

Messiah S. Overweight Preschoolers Raise Their Heart Disease Risk. American 

Heart Association’s Cardiovascular Disease Epidemiology and Prevention Annual Conference. Palm Harbor, Fl. May, 2009. 

Nader PR, O’Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman S, Mei 

Z, Susman EJ; National Institute of Child Health and Human Development 

Early Child Care Research Network. Identifying risk for obesity in early childhood. Pediatrics 2006;118:e594-601. 

Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA. 2008;299:2401-5. 

Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288:1728- 

32. 

Patrick H, Nicklas TA. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr. 2005;24:83-92. 

Polhamus B, Dalenius K, Borland E, Mackintosh H, Smith B, Grummer-Strawn L. 

Pediatric Nutrition Surveillance 2007 Report. Atlanta: U.S. Department of 

Health and Human Services, Centers for Disease Control and Prevention. 2009. 

Public Health Foundation Enterprises WIC Peer Counseling Program Data, Unpublished, 2009. 

Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of anemia in lowincome infants and children in five states. Pediatrics 2001;107;677-82. 

Trasande L, Chatterjee S. The impact of obesity on health service utilization and 

costs in childhood. Obesity (Silver Spring). 2009 Mar 19. 

USDA. Food and Nutrition Service. How WIC Works. 2009. Available at: 

www.fns.usda.gov/WIC/aboutwic/howwichelps.htm. 

Chairwoman MCCARTHY. Thank you very much for that insight. 

We appreciate that, and we heard a few recommendations that you 

wanted. 

We are going to start our round of questionings. My first question will go to Ms. Copperman. 

I wanted to commend you for the work that you have been doing, 

especially in my district. I understand you have an Activity Works 

program in several of the schools. Roosevelt, Westbury, those are 

part of my district. I have seen a number of the letters from the 

children that have been sent to me, and how they are thrilled with 

the Activity Works program. 

For example, one student named Ramona Robinson says, ‘‘This 

school year, our class began a new exercise program called Activity 

Works. It is a quick, fun way for us to get up and move. We are 

exercising, but it doesn’t feel like it.’’ 
42 

I have about 10 student letters and would like unanimous consent to submit these letters for the record. Hearing no objection, so 

ordered. 

[The information follows:] 
43 
44 
45 
46 
47 
48 

Chairwoman MCCARTHY. As I understand it, the program is used 

by children in first, second and third grade. What made you target 

that age group? 

Ms. COPPERMAN. We started with that age group as a pilot study 

because we felt that kindergarten children had special needs that 

were very different than one through three or one through four as 

far as the curriculum and the physical activity that they could accomplish in the classroom. 

So we decided to target that age group because we could reach 

more children, and we knew that these children were not meeting 

their physical education requirements, as well as the physical activity goals of their wellness policy. 

Chairwoman MCCARTHY. With some of the issues that Mr. Felton 

brought up, the concern that it might cost the school money, timewise and everything else, how would you answer those questions? 
49 

Ms. COPPERMAN. Well, one of the things that we did is we talked 

to the schools and worked with them in designing this within the 

budgetary constraints that they had. So that is how we came up 

with a program that would be delivered by the classroom teacher 

and supervised by the physical education teacher so that the 

schools would not need to devote space or extra staff. And the program itself basically costs about $16 per child per year, so it is fairly cost-effective for the amount of activity as well as regulations 

that it fits. 

So that was one of the reasons why we developed the program 

in the way we did and pilot it to show that it can be integrated 

into a curriculum and that it is feasible before we went out and 

then said, ‘‘Here is a program that is available to schools.’’ 

Chairwoman MCCARTHY. You said that Bank of America basically was involved in working with you on the program. Was that 

developing the program, or was that helping possibly at the 

schools? 

Ms. COPPERMAN. We applied for a community-building grant 

from Bank of America, and that helped us with the production 

costs of the DVDs and CDs so that we would have a product that 

was appropriate for children and that captured their interest, because our students now are very sophisticated by the type of videos 

that they watch, so we wanted something—and audios they hear. 

We wanted something that was of equal caliber so that it would 

pique their interest and would be successful, and that is how Bank 

of America helped us. 

Chairwoman MCCARTHY. Just one final question to you, is that 

with the data that you are collecting, what kind of results are you 

seeing? Do you have any hard data? 

Ms. COPPERMAN. Okay. 

We started collecting the data in the beginning of the school 

year. And currently, now, we are collecting the follow up. The data 

that I do have that is hard is that the teachers are using this program four to five times a week on their own, so that is number one, 

and kids are getting daily physical activity. The teachers and the 

educators report that their classes are more active, are more interested in learning, and are doing better as they see from a subjective point of view. 

The things that we are collecting are BMIs. We want to look at 

prevalence. We don’t expect to see a decrease in necessarily obesity 

rates, but what we hope to see is a prevalence leveling. This is just 

one component of a program. I think that you also have to look at 

comprehensive other measures, as policies and environmental 

changes. 

The other thing that we are looking at is self-concept, the idea 

of how kids look at themselves and how they feel about themselves, 

and is that improved by this type of program. And as I said before, 

three out of the five school districts so far have integrated this into 

their curriculum, which shows sustainability, which was a major 

factor that the schools were worried about and were hopefully 

working with other school districts in New York state. And we 

would like nationally to show this as a solution to meet their physical education requirements and prevent obesity by daily physical 
50 

activity and meet the CDC goal of 60 minutes of physical activity 

per day. 

Chairwoman MCCARTHY. You know, obviously I am very interested in this type of program, and we are probably going to need 

a little bit more data as it goes on. So certainly we would appreciate any data as you go down further in the testing and everything. 

Ms. COPPERMAN. Yes. I will send it. 

Chairwoman MCCARTHY. One of the questions that I wanted to 

ask Dr. Virginia—I have time—Stallings, you recommended specific nutrients to be covered within the nutrition standards. Can 

you give us some specific areas that you want to go into? 

Dr. STALLINGS. Well, as you know, the committee is still actively 

deliberating, so I am limited about what I can talk about, but those 

will be part of the recommendations this fall. The nutrients that 

I did mention are the ones that are on the old recommendation. 

And then, as we go to the dietary guidelines and the review of 

the nutrient intake requirements, comparing that with what children are eating today from our most recent data, what we find is 

the younger children are doing pretty well with getting enough nutrients. And actually, elementary school children—and all this is in 

the Phase I report—are doing better with not getting too many calories. As you go to middle school and high school, you see physical 

activity go down and energy requirements thus go down, and the 

food intake is not going down with that. 

Lastly, the thing we learned, as we go into high school, and particularly for the adolescent females, many micronutrients are being 

consumed at rates that would be considered inadequate, so as you 

look across the board, the vitamin E, the vitamin A, certainly fiber. 

So we are able to use that as our background. But it is very important, and that is part of the work of this committee, is to look 

across the different ages, because there is a lot of change in both 

developmentally and food intake patterns as you go from being 

kindergartener to a high schooler. 

The other part of this is looking at things that there are too 

much of, and that, from the evidence we have now, is saturated fat 

and calories as the primary pieces to that, and sodium. Should 

mention sodium. So those will be nutrients of special consideration 

in the follow-up report. 

Chairwoman MCCARTHY. Thank you. 

Mr. Platts? 

Mr. PLATTS. Thank you, Madam Chair. 

I want to thank all of our witnesses here today for taking time. 

And I know the chairwoman and I both share our regrets in the 

amount of time you have had to spend. And that is just Murphy’s 

Law with the vote schedule around here, and especially here where 

we had the motion recommit, which adds about a half-hour to that 

last series. 

So your patience is greatly appreciated, and your focus on this 

issue, both as elected officials who are the spouse, first lady of the 

state of New York. My wife is from outside of Buffalo. My fatherin-law has now passed on, but my mother-in-law is still in the town 

of Williamsville, and so New York is kind of my second home now 

as we are back and forth regularly. 
51 

And to all of our witnesses, your input—I look at this issue as 

a member of Congress, but again as a dad of a sixth grader and 

fourth grader. I am regularly in my childrens’ schools, and the 

most regular visit I make is to have lunch at their schools, from 

when they were in kindergarten to—my sixth grader in middle 

school still invites me to come in, which is—yes. How long that will 

last, I don’t know. 

And it is interesting that I sit in lunch, and we have the card 

system where we can regulate, as a parent, what they are allowed 

to buy in addition to the main meal, which is a very good empowerment for parents so that you can have some say in what your children are eating. And we do have a responsibility, so, as a parent, 

I am grateful for what each of you are doing in your respective 

lines of work on this issue. 

Susie, I am going to start with you, because your story in York 

is just such a wonderful one. And I think one of the successes of 

the center has been the ability that you have reached out, and all 

the staff at the center, in partnering with our local schools. 

Do you want to touch on how that came to be and the buy-in that 

you have had, which has been so important to the number of students that you have been able to reach? 

Ms. BYRNES. Well, I learned very early on you want to start from 

the top, which are the superintendents, but also with the teachers 

and the parents, as well—and the school boards, as well. 

But from the very beginning, we got the superintendents and the 

teachers on our Board of Directors, if you will, and then we just 

kept them very close to us. We have also involved them in our curriculum. And as I stated, all of our programs are tied to state and 

national health education guidelines. 

The other thing we did is I just visited—we are a regional center, 

so we are in seven counties. But we went out and we visited with 

all the superintendents in our county, which happened to be 16, 

and they all just were singing the praises that came up from their 

teachers after they have been to programs at the health education 

center. So, really, the programs and the curriculum really does sell 

itself. 

But the thing that makes the health education center so unique 

are our educators. And with the exhibits, with the $1.5 million 

worth of exhibits and our educators, we make learning about the 

body fun and exciting for both students, the parents that are visiting, and then also, of course the teachers. So we keep that ongoing dialogue with the schools. And believe me, the only reason that 

more schools aren’t coming—we see about 60,000 kids a year—is 

due to money. 

Mr. PLATTS. Yes. Well, I can vouch for your educators. The last 

program I attended with my sixth grader was diversity education, 

which was outstanding, and then the drug prevention, and the educators in both were really wonderful. The kids and the adults all 

left thinking, ‘‘Wow,’’ you know, it was great. 

And we want you to keep up that great job for our local community and have that emulated elsewhere, certainly as we referenced, 

just 22 states. We have a few more to go. 

Ms. BYRNES. A few more. 
52 

Mr. PLATTS. Dr. Ritchie, I wanted to touch on—you hit on something that I really appreciate in the WIC program, the issue of 

breastfeeding. I am blessed with an incredible wife who, with both 

of our children, breastfed both of them, even to the point where 

when she went back to work at about 10 months—when our first 

son was 10 months old, for about 8 months or so before coming 

home, she would pump at work and bag the milk for later use. 

And when T.J. would go with me to the state capital—I was in 

the State House—I would take frozen milk with me so that his diet 

was breast milk. I got a lot of looks when I was in the men’s room 

thawing out breast milk. But through Leslie, I learned the extreme 

importance of this. 

You reference in your testimony about the peer counseling program and how there are so many not able to participate. Do you 

have any data of what percentage—you talk about the importance 

of additional funding for this program, of how many we are reaching as a percentage. And so, how big is the challenge from a funding standpoint? 

Ms. RITCHIE. Yes. I am afraid I can’t answer that question completely, but what I do know is that only a small minority of women 

have access to the peer counseling program. 

So what that means is that this very effective and proven program is not getting to many of the women who could use it. And 

what we see instead is that a lot of women, for example, when they 

have their baby in the hospital, they are sent home with coupons. 

They are sent home with a bag full of formula. There are a lot of 

things that set them up to fail in breastfeeding. 

And yet, if they can reach out and be engaged with somebody 

who they can relate to who has had those same experiences like 

your wife and has gone through pumping and storing and all of the 

things that go into nursing, they can be empowered to overcome 

the other obstacles that they have in their life. 

So I can’t give you the exact statistics on how many WIC sites 

participate in the breastfeeding peer counseling program, but what 

I can tell you is that it is highly effective and that we need to do 

more to get other women that program. 

Mr. PLATTS. Yes. I see it in a similar way with—we have such 

data with brain development zero to three, and 85 percent of brain 

neurons and stimulation of the brain. This is—if we can make that 

investment at the very beginning, the first hours and beyond with 

breastfeeding, the immunity system and everything is so much 

healthier for the rest of their lives. 

Ms. RITCHIE. Yes. It is the perfect nutritious food, plus the added 

benefit of the fact that the scientific literature supports that it reduces risk of obesity later in life, not even during when the child 

is—— 

Mr. PLATTS. Yes. I appreciate your highlighting that, something 

that we definitely take a look at as part of the reauthorization. 

Ms. RITCHIE. Thank you. 

Mr. PLATTS. Thank you, Madam Chair. 

Chairwoman MCCARTHY. Thank you for that. 

Kim, who is here on the committee, worked with me in my office 

on educational issues. And she had triplets, and then—not triplets. 

Voice. Twins. 
53 

Chairwoman MCCARTHY. Twins. 

Voice. And then a baby. 

Chairwoman MCCARTHY. And then another baby soon after that. 

But anyway, we actually had started here in Congress where we 

are going to have a nursing room, because so many of the members 

of Congress, believe it or not, are having babies—we just had a 

friend of ours, a colleague, have a baby yesterday—and most of 

them all breastfeeding. And I would like to think, because of this 

committee, we have educated more and more people that 

breastfeeding is an important feature. 

Mr. Tonko? 

Mr. TONKO. Thank you, Madam Chair. I have to say, I have been 

sitting here trying to calculate how many additional miles of blood 

vessels I might have created in my activities. 

My first question would be to First Lady Paterson about the 

Healthy Steps To Albany campaign. Can you just discuss, maybe 

develop further for us, please, Michele, the success that has been 

driven by this whole effort? 

Ms. PATERSON. Well, when I started the program about 2 years 

ago in Harlem, and we had some of the winners come to the mansion for the healthy lunch, the kids got up and they talked about 

their experience in the contest, and they talked about how they 

now walk home from school instead of taking the bus, how they got 

their parents involved. They told their parents they need to be buying more fresh fruits and vegetables, and how their parents even 

started buying pedometers and got involved in the contest. 

And at the end of the 6 weeks, many of the kids talked about 

how they lost weight, and the parents talked about how they lost 

weight as well. Even though that wasn’t the focus of the contest, 

that was one of the initiatives. 

And this week tomorrow, as I mentioned, we will be going to Buffalo, and then following on Monday to Albany to congratulate the 

winners. So I haven’t really had a chance to talk to them personally about their experiences, but I am hearing that many of the 

teachers who were involved in the contest as well, with the kids 

encouraging them, got a team together and rallied around this initiative and are eating healthy and exercising more as well. 

Mr. TONKO. Do you see this as a program that perhaps could be 

replicated across more cities in the state, or beyond the state, to 

include in the country somehow? 

Ms. PATERSON. Most definitely. Actually, this is a 2-year program, start with upstate this year. Next year we are focusing on 

the five Boroughs—Long Island, Westchester, Orange County. 

And I also would like to get the Department of Health involved 

with this initiative to help us maybe track some of the results, and 

it is something that I would like to talk to some of the other first 

ladies around the country about doing in their states. 

Mr. TONKO. In your testimony, you also spoke of the partnership 

in New York with the Health and Education Departments and the 

healthcare community, referencing that to the Body Mass Index 

calculations that are done, the measurements that are done. 

That screening obviously is helpful in getting results. Can you 

cite any discrepancies or disparities that might have been por-
54 

trayed by that screening? Were there areas of target that you think 

would—— 

Ms. PATERSON. Well, I am not really aware of right now. I know 

we have a lot of community schools that have nurses in their 

schools and a health center in their schools, and we are trying to 

get them involved more with the BMI testing. But that is something that we will have to work on with the Department of Health. 

Mr. TONKO. And Dr. Stallings, you made mention of the simplification of the menu planning and monitoring processes. Can you 

just elaborate a bit on that, especially with the monitoring program, and what you think needs to be improved upon? 

Dr. STALLINGS. Well, again, as I mentioned, what I can speak to 

is in our Phase I report. We have taken a great deal of time to try 

to understand the challenges at the food service director’s level and 

in the schools. 

And there are a number of opportunities, I think, to make this 

more simple. As I said, right now, there are two different approaches, and really two and a half approaches to putting your 

menu plan out and getting it monitored. Those could be simplified 

and allow then the food service people to focus on things, planning 

that will result in the kind of nutrient and food patterns we want. 

We have also heard through testimony and looking at the reports 

from the USDA that, currently, the monitoring and the goals of the 

program aren’t completely synchronized. And again, it is partly because this has been updated intermittently since the late 1940s. 

And what we have the opportunity to do with our committee is 

to look at this thoroughly. We have a number of committee members who serve on the ground level, and I can attest that they are 

very appropriately vocal to make sure we keep thinking about both 

the rules being simple, easy to understand, what kind of labels we 

might need to make that work, not being dependent on high skill 

sets in every setting across the country. 

That is not necessarily the work environment, and then the 

issues of how we take those, and also continue to understand what 

children want to eat and will eat and turn those, if you will, our 

cultural food patterns for children into more healthful diets. And 

we believe we have got a committee together that can address all 

those operational issues and ultimately work with industry. 

As we have been told, both when I was working on the WIC program and this, from an industry point of view, if we can provide 

well substantiated recommendations that the government would 

endorse, that helps them actually to produce new and helpful products for the school setting. 

It is a really big market. I think we have a really great opportunity to engage them around some of these issues. So they want 

a level playing field. They want to know what they should aim for. 

Mr. TONKO. It seems to me that it was, like, a three-E repetition 

here today, the exercise, the eating right, and the education. That 

kind of equals the soundness of an outcome. 

Across the board, I would ask you, which of those three Es do 

you think is the weakest link that perhaps needs the most addressing? 
55 

Dr. STALLINGS. Well, thank you. That is an incredibly important 

question. And not to diminish the importance of any of the three 

of those, because I agree they are all absolutely critical. 

But we know from, if you will, the energy balance, literature and 

experience, that we have to deal with the food side of it first because you can easily—it is very hard to exercise enough to overcome overeating. It is very easy to overeat, and just the calories per 

intake an hour of activity. 

So there are very important things to the physical activity, including fitness, as well as burning calories, and the evidence supports that some kids learn better in that environment. 

Education is very important, but we also know from extensive experience that education does not always change behavior, and what 

we have to do is keep working towards that. And I will step back 

now. 

As a pediatrician and a community member, the opportunity to 

make the school a very special place for food—I mean, it is a special place for learning, but the idea of making it a special place for 

what food is available in that environment, which does represent 

about 50 percent of eating opportunities, is I think the keystone. 

That is not to detract from the importance of physical activity, 

which has been well demonstrated, and absolutely nutrition continues to need to be a part of the curriculum. 

But we can’t rely on those other two pieces to be effective 

against, really, overeating and obesity, and we know that from 

studies in children and adults of all ages. 

Mr. TONKO. Thank you. 

Anyone else want to comment on that one? 

Mr. FELTON. Well, sir, I guess our concern is that, while schools 

provide a great opportunity for partnerships, that we all recognize 

that, again, it is the education—it is the commitment of families 

and communities to support that so that—we, too, believe that nutrition has to be part of our school day, and improved nutrition is 

very, very important. We want to be sure that whatever happens 

in the day is also accompanied and supported by the total life and 

lifestyle of our children, or else it just simply will not work. 

Mr. TONKO. Were you going to say something else, Doctor? 

Dr. STALLINGS. Just to follow up on that, again recognizing that 

it is a complex environment, but there are virtually no other opportunities where we could impact helpful eating at that level. And 

that doesn’t in any—50 percent of the food or the eating opportunity. 

And that doesn’t in any way limit the other opportunities outside 

the school environment where the parents are really often at the 

child’s side or making decisions about what to bring into the house 

or the food eating. So, again, as a pediatrician and an advocate, I 

would say that we have a more unique opportunity in school, but 

it is meant no ways to limit the freedom and the opportunities for 

families to make other decisions in other settings. 

Families are not aware often of what their children are eating in 

schools. They are often not aware of what is in the vending machines or the snack bar. And if you go to the evidence that was prepared in that first report about competitive foods, I think that 

walks through the behavioral issues you brought up, that this is 
56 

an opportunity, but it is in no way meant to take away the authority of the parents or those many, many other opportunities at 

nights and on weekends and holidays. 

Thank you. 

Mr. TONKO. If I could just toss a final question out there in terms 

of how all of this relates to agriculture, I know there have been 

some programs—I have assisted some in the state of New York— 

where we take perhaps damaged produce that may not be marketable, but it is certainly edible. 

Is there a way to stretch the opportunities here to reach our 

schools with locally produced so that we are addressing the energy 

delta, the energy input that is so important these days because of 

the energy it takes to import or ship in from other regions of the 

country our food sources? Is there a way to stretch the opportunity 

with our Ag community to provide wholesome nutrition for our 

children? 

Dr. STALLINGS. Well, I will be happy to start on that. 

One of the things that, again, our committee has learned a lot 

about is the commodity foods programs and the Department of Defense fruits and vegetable program, and I would like to compliment 

our public servants. In most of what we thought of as the commodity foods program when all of us were growing up is substantially different. 

And I believe that we have partners there that can address some 

of the very things you are talking about, because their purchasing 

power and their transportation opportunities are really vast. So as 

we have gone about collecting information, I believe that is an opportunity as well, that the USDA, and particularly the commodities 

group, are very interested in being a part of the success. 

The other issues that you bring up are ones from a nutrition 

science point of view, not so much the ecology and the energy, 

transportation energy. What we have been learning is, yes, local 

and fresh and involvement with the community is a wonderful part 

of it, but most of us live where that would really severe—when 

things are in season, those are great partnerships. 

But I also want to mention the strength of the—if you will, the 

whole agricultural industry now, that the fruits and vegetables 

that are picked at prime time and frozen and canned that then are 

in compliance with USDA regulations to be a part of the school 

breakfast and lunch program are really very high quality products. 

And so, if you had asked some of us nutritionists, again, 20 years 

ago, we would have said, ‘‘Oh, fresh fruits and vegetables sitting 

out on the stand are always the most nutritious.’’ We have come 

to understand that is not always the case. 

So I would like for the committee to bear in mind these other opportunities and purchases and money-saving opportunities are all 

potentially part of the solution, as well. And the quality of the 

foods served in school is and should be, again with this backdrop 

of specifications for purchase, should be as high a quality as we 

would have in our homes than in any other setting, which is what 

we would want for schools. 

Mr. TONKO. Thank you. 

Mr. FELTON. I agree generally with that statement. Again, our 

concern is we would not want a one-size-fits-all approach, because, 
57 

again, in our rural communities and some of our suburban communities, it may be an appropriate way to do that, which may be inconsistent with some of our larger school districts that provide— 

that do central food preparation. 

But I think the point is we should all be concerned with the quality of food and ensure that there are options to local school districts 

and local schools in terms of how they are able to secure those 

products. 

Chairwoman MCCARTHY. Mr. Polis? 

Mr. TONKO. I think the first lady was going to say something. 

Chairwoman MCCARTHY. Oh, I am sorry. 

Ms. PATERSON. I just wanted to mention that, at the executive 

mansion in Albany, New York, we are going to start inviting school 

kids to come to the mansion and have the executive chef there 

teach them how to make some healthy meals. We also have a garden at the mansion where, every year, we invite children to come 

in and help us plant fruits and vegetables and herbs at the mansion. 

Chairwoman MCCARTHY. Speaking as a gardener, I will tell you, 

if you get kids involved in gardening and growing their vegetables, 

it is a lot easier to get them to eat them. 

Mr. TONKO. Yes. I think, Madam Chair, too, if I might just conclude with this, it is important for us to not deal just in silos, because we are dealing with wonderful dynamics here for our children and across-the-board nutrition, but there is that energy 

quotient that is involved, too. 

And if we can begin to do smarter things as energy consumers 

by buying locally and buying fresh, we can incorporate several dynamics of policy into one package. And that big-picture view I 

think is so critically important to progressive policy development. 

Chairwoman MCCARTHY. And we are probably going to go on to 

a second round, so what I am—because we were so late in staying, 

we understand time restraints and everything else. We are very 

used to that, and especially for the first lady. 

If you need to leave, or anyone needs to leave, we understand 

that. You are not insulting us at all. But we do have more questions, and if you would like to stay, we would love to ask them. 

Mr. Polis? 

Mr. POLIS. Thank you, Madam Chair. 

I represent the state of Colorado, which has some of the lowest 

obesity rates in the country. But like a lot of other states, it is 

heading in the wrong direction. 

Today, more than one in 10 Colorado children is obese. And this 

not only affects their health, but very important to us as a committee and our Congress, it affects their achievement and their 

education. A study of fifth graders found that those with a poor 

diet, too much fat and refined sugar and not enough fruits, vegetables and whole grains, were from 26 to 41 percent more likely to 

fail standardized reading and writing tests than their peers who 

consumed healthier diets. 

Healthy habits start early in life, and the public overwhelmingly 

supports immediate action to reverse the obesity trend. According 

to a poll of people in Colorado by the Colorado Health Foundation, 

86 percent of Coloradoans support requiring 30 minutes of physical 
58 

education each day in our schools even if it takes time away from 

other subjects, and 82 percent support efforts to remove snacks of 

low nutritional value from snack vending machines, an issue that 

I worked on while I was on the state Board of Education in Colorado, and replacing them with healthy snacks. 

My first question is for Ms. Copperman. What are some of the 

challenges that you found in creating and implementing strong 

wellness policies throughout the United States? What are some of 

the biggest challenges to both creating those policies as well as successfully implementing them? 

Ms. COPPERMAN. Okay. I can speak to the New York state experience in conjunction with the audit that was done by the state controller, looking at physical education, now nutrition, is that there 

seems to be a lack of monitoring and evaluation, and that is what 

came out of the physical education requirements, that the requirements were there, but that the monitoring wasn’t there to kind of 

look and see that the legislation that was already enacted was actually being followed. 

And I think with the wellness policies, it tends to be the same 

thing, is that if schools aren’t meeting their physical education, 

then when you go to the wellness policies, they have these policies, 

and they sat down and they have developed them, but there has 

really not been a way of looking at the implementation and the 

monitoring of the goals and whether these goals are actually being 

successful in what they are doing. 

And I can say that when we went to the school districts and 

asked them what would you like to do to prevent obesity in schools, 

we gave them a choice. And they felt that there was a support 

somewhat for nutrition. They felt that there could be more education support and, again, monitoring and following. 

But they felt that the physical activity goals were completely unsupported because they weren’t meeting the physical education requirements. And that is why they asked us to focus on physical activity. 

One of the things we did is that we understand that physical activity—and as a registered dietician by training, physical activity 

goes hand-in-hand with nutrition. So what we tried to do was to 

kind of take nutrition ideas and integrate them with physical activity with curriculum subjects. And what found is, by doing that, 

that is what helped us overcome the barrier of getting it going and 

implement it in the classroom, which was the major problem that 

the schools had. 

Mr. POLIS. And that kind of leads into my second question. With 

all the interest to improve the school food environment, clearly nutrition education is part of that, to really integrate nutrition education into the classroom and the entire campus, whether it is in 

the cafeteria or the history class or wherever appropriate. 

And it seems to me that this should be part of the education reform movement, more broadly, and I am wondering what ideas you 

might have about how we can approach and impress others with 

the merits of nutrition education from a broader lens in these systemic reform discussions. 

Ms. COPPERMAN. Yes. I think several things are important. 
59 

Number one, the school environment is a place where children 

spend 10 months out of the year, so all their formative years are 

basically spent more time in school than at home. So I think it offers us a wonderful opportunity to provide education. 

I think what winds up happening is that it becomes not coordinated, that there aren’t the resources or the national support that 

enabled the schools to take a program that has best practices and 

shown its been successful and actually implement it into the classrooms and into the cafeteria and into the physical education classes 

and into the PTA and into the whole environment of the school. 

So I think what is needed is really looking at best practices and 

offering the schools programs that work, because there are a lot of 

programs that are out there and that have been proposed by different groups, but when you go to evaluate what is needed—and 

I think that is the second part of it, is that there needs to be some 

sort of support that allows the schools the awareness to the program and the implementation that is within budget. 

We would all like to see the Cadillacs and very expensive programs come in, but the schools really cannot afford that. So I think 

it needs to be what we found in Activity Works—targeted, simple, 

economical and utilizing what the schools have. So I think those 

are the nutrition education programs that would be effective. 

Mr. POLIS. Thank you. 

I have one more question, Madam Chair, if I may, for Mr. Felton. 

According to the Colorado Children’s Campaign survey, which is 

a nonprofit focused on education policy in Colorado, our current 

lieutenant governor is former executive director of that organization, they did a survey of 22 of our largest school districts in Colorado. Only three of them require nutritional standards for all 

school snacks for children. 

So given that reality in my state, and also the reality nationally, 

why do you think school districts will remove junk foods from 

schools without federal or state legislation requiring that they meet 

nutritional standards? 

Mr. FELTON. Well, I think our concern is that, as communities 

are more engaged and understand the value of nutrition, that they 

are certainly willing to move toward that direction. And it is not 

that any school district or school wants to say they don’t want their 

children to be knowledgeable about nutrition or that they want to 

have healthy foods within that school day. 

But I think that if we look at schools, its primary role, of course 

as we know, is to deliver quality education. But there is a business 

aspect of schools, and they need to be sure that they can balance 

all of these requirements. 

If we look at, for example, how we evaluate school performance, 

we are looking primarily at our students doing well in three areas. 

When schools and school districts have very limited budgets, that 

is where they focus their attention. 

So I don’t think it is an issue of not wanting to meet standards. 

The question is, is it realistic in every situation. And again, our 

concern is that, if there is a federal law that provides for some 

mandated standards, that there is at least some relief out so that 

we understand, in some cases where it doesn’t work, there is an-
60 

other approach without now being labeled as not in compliance 

and, therefore, a poor school. 

Mr. POLIS. Yes. And I would just submit that not only in Colorado but in other states, it simply hasn’t happened at the district 

level, which I think is why there is a very legitimate discussion 

about these kinds of guidelines at the federal level and, indeed, in 

many states as well. 

Thank you, Madam Chair. 

Chairwoman MCCARTHY. Mr. Platts? 

Mr. PLATTS. Thank you, Madam Chair. 

Mr. Felton, I would maybe pick up there a little bit. In your testimony, you talked about the concern that School Board Association 

has about restrictions could reduce revenues to schools that help 

pay for activities, extracurricular activities. 

In our colleague’s testimony at the beginning, she talked about 

a study done by the CDC and Department of Agriculture that 

showed that revenues actually went up as schools engaged in providing healthier opportunities as opposed to losing revenues. Have 

you, the School Board Association, looked at that study? Are you 

familiar with it and have a response regarding the findings of that 

study? 

Mr. FELTON. Yes, sir. We are familiar with the study. 

For the most part, the focus has been on do schools lose money 

in terms of their vending machines, and there has been enough 

data, mixed reporting, but certainly there isn’t the significant loss 

in revenues in vending machines. Our concern is that the proposed 

legislation would seek to restrict all foods sold on any related 

school activity. 

So, for example, if we think about as—as I said earlier, the local 

field trip to New York and the community is able to get a sponsor 

who will provide boxed lunches for those students. If those boxed 

lunches aren’t in compliance with the new standards of foods 

served and sold during the school day, then local school districts, 

for example, could find themselves potentially in litigation because 

they have not complied. Or for example—— 

Mr. PLATTS. But there would be nothing prohibiting the school 

from saying, ‘‘Hey, we appreciate that support. Here are the guidelines, if you can work with us.’’ 

Mr. FELTON. Oh, certainly. Certainly. 

Mr. PLATTS. Right. And I would say, I am not convinced—and I 

haven’t taken a position on Lynn’s legislation because I am torn between local control school districts and elected school Board members in Pennsylvania having a say versus me telling them what to 

have to do on this issue. 

But there do seem to be some ways you could address that concern and still comply with the law if it was adopted. 

Mr. FELTON. Oh, certainly. And again, many states voluntarily 

are moving toward establishing their own standards that are very, 

very strong because they have the commitment of local communities that are willing to say, ‘‘Not only are we committed to 

stronger nutrition policies, we are willing to pay for whatever is 

necessary to ensure that,’’ as we heard earlier, ‘‘it is properly implemented and evaluated.’’ And where communities have that kind 

of support, it works. 
61 

What our fear is that, if it simply becomes another federal mandate without fully understanding all the operational aspects within 

a local community and school district, then we could find ourselves 

having some unintended consequences. 

Ms. RITCHIE. If I may add just a minute, I am from the Center 

for Weight and Health who did one of those studies that was mentioned earlier. And what we actually found—and we didn’t look at 

field trips—but foods sold not only in vending but in all other aspects besides the school meal and the school breakfast, so that 

could include a la carte foods—— 

Mr. PLATTS. Would that include, like, football game sales, that 

type of thing, too? 

Ms. RITCHIE. It did not include football game sales, because those 

are outside of the school day. But anything sold within the school 

day, including vending but not exclusively of vending, what we 

found is that, when you limit those what we call competitive foods, 

the worry was that then there would be a lot less money coming 

into the school and into food service and into the clubs, et cetera, 

that use those foods for fundraising. 

What they found was that the bottom line in terms of the school 

was actually a net positive because more kids participated in the 

school meal. And when more kids participate in the school meal, 

the revenues go up. So, like I said, we didn’t look at fundraising 

in terms of outside of the school day, and we didn’t look at field 

trips and that sort of thing. 

But in the school day, the net result is that schools are not losing 

money, at least in our study, that they are staying in the red. In 

fact, they are getting more in the red because of the increase in the 

school meal participation. 

Mr. PLATTS. Yes. I think one of the—if children and adults, if we 

provide healthy alternatives, it is all the more likely we will embrace them. 

I am a perfect example. I am a sweet tooth fanatic, and my wife 

this morning when I left the house, said about 10 of 5 to be down 

here early for a school group. I made a point of grabbing some celery that she had soaking in water to give it a little crisper that I 

ate on my drive down here. 

I commute from my district in Pennsylvania each day, and so I 

was eating some delicious celery because my wife made it available 

and right there waiting. So I opened that fridge, I saw it—and 

crunchy, yes. 

Ms. RITCHIE. She makes you eat celery, and she breastfeeds. 

What a perfect wife. 

Mr. PLATTS. Oh, my wife puts me to shame, as my staff will tell 

you, when it comes to fitness and healthy eating. 

Ms. RITCHIE. I was also going to add, and I am happy to share 

this with the committee at a later date, but we have at the Center 

for Weight and Health done a very comprehensive review of what 

works best across all different sectors, so not only in the school, not 

only in programs like WIC, but at worksites, at community-based 

interventions, looking at the real science as opposed to what people 

think or hypothesizing might happen. 

And while, of course, I am a researcher, so I always say we need 

more studies to base our conclusions upon, what we did come to 
62 

conclude, as a base of, again, looking at all of these different sectors, was that it is the marriage between the education and the policy and environmental supports that really make the difference. 

So as Nancy Copperman was saying, when you integrate the education with the policy and environmental supports is when you 

really see change. So you were asking whether it is the education 

or the PE or the nutrition. 

It is really both, intertwined, integrated and coordinated so that 

a child can go to class and hear the message, ‘‘I need to eat more 

fruits and vegetables,’’ and then go to the cafeteria and see a fresh 

salad bar with lots of fruits and vegetables. 

When those messages aren’t coordinated is when we get into 

trouble, and then the nutrition education by itself doesn’t work. 

The policy isn’t so helpful. But when they are combined is—— 

Mr. PLATTS. Yes. I saw that—and I will wrap up here quickly— 

I represent a lot of the apple orchards, and promoting apples as a 

healthy snack. And there is an annual apple promotion week 

where, in schools, they do the Great Apple Crunch program, I think 

is what it is called. 

I guest served in the cafeteria that week, and one of the options 

was fresh apple slices. And it was wonderful to see the kids enjoying them, and like, ‘‘I will take his if he doesn’t want them.’’ It is 

promoting and tying in—they did a program in school tied into the 

product being offered, so it was education along with the opportunity for the kids to have that as part of lunch. 

Ms. RITCHIE. Right. Kids really learn by experiential opportunities. And I was going to add, we also have a reviewed—not that 

we did this one, but one that I have that shows a farm-to-school 

movement. And again, we don’t have a lot of studies on it, but it 

is showing that it does increase childrens’ fruits and vegetables intake, and that combination of being exposed to local produce plus 

having the experience with it is probably what is contributing to 

that success. 

And I am very excited about the new WIC food package and the 

new alignment with the education, because that is exactly what we 

are talking about, providing fresh fruits and vegetables, whole 

grains, all of the things that we know people should be eating, 

along with the educational part. So we are really excited about 

evaluating that in the upcoming year and years. 

Mr. PLATTS. And if I could, Madam Chair, one final comment 

about the importance of this issue, because our focus has been 

about kids. But one of my colleagues I think earlier—it might have 

been Mr. Castle—mentioned about how kids end up teaching 

adults, and he used the seat belt example. 

I am a perfect example that—me learning from my kids, because 

one of the things my children do get snacks, but thanks to my wife, 

healthier more so than my eating habits of the past. But one thing 

they still don’t have at age 10 and 12 is they still don’t get soda 

at all, and never have. And I used to drink about a case of soda 

a week. And sitting at the dinner table, with all my commuting, 

I was always drinking the caffeine, and not good soda—or not that 

there is necessarily good or bad. 

But sitting at the dinner table, I had a glass of soda. And my 

then-41⁄2, 5-year-old, said, ‘‘Well, Dad, if it is bad for us, why do you 
63 

drink so much?’’ That was about 41⁄2, 5 years ago—well, no, almost 

6 years now, and I went cold turkey that week. And so my kids 

taught me, by them being healthy, they ended up influencing me. 

So what you are doing won’t just benefit the children, as we 

know from seat belts. It will ultimately benefit the parents, too, because the kids developing those healthy eating habits can help 

their parents complement what they are doing with their children. 

So all the more how important your work is, and thank you for all 

of your testimonies and work, day in and day out. 

Thank you, Madam Chair. 

Ms. RITCHIE. May I also point out, you could see the opposite 

happen. So no, we no longer have soda in California schools, but 

I have talked to many, many parents who said, ‘‘Well, my kids get 

soda at school, so it must be good for you.’’ So that is an example 

of how the school can set a tone for both positive and not-so-positive education around foods. 

Mr. FELTON. And again, from our perspective, we agree that 

schools provide that opportunity. Our concern is that we must look 

at not only the school environment, but the work environment and 

what happens in the community. And together, we can address this 

issue. 

Mr. PLATTS. I have already used up my time. 

Chairwoman MCCARTHY. Well, no. We are actually very lucky on 

this committee because we both tend to agree that we would like 

to expand, if possible, among just the usual 5 minutes. I feel bad 

when people travel from all over the country to sit down in front 

of us for 5 minutes, and then it is over. 

So, being that no one here seems to be complaining about leaving—we are going to shut it up soon, though, because we are going 

to have votes again. 

What I would like to—and I know my colleague wants to ask another question—I happen to believe very strongly that, when I 

think about what has been mandated in some states or whatever, 

children wearing helmets when they ride bicycles or roller skating, 

teaching children not to smoke, let me tell you, they have the most 

powerful effect on adults. 

If I get on a bicycle with my grandchildren, ‘‘Where is your helmet?’’ Now, I never wore a helmet in my life. I had to go out and 

buy a helmet, mainly because they were right. 

And I think it is going to be the same with nutrition. If we can 

bring good nutrition into the schools—and I don’t particularly like 

any kind of unfunded mandate to go down to anywhere. I believe 

in—I am looking at this as a nurse—we need to look at our schoolchildren, which unfortunately, across this nation, they are overweight. 

This has become a country—and our life differences—they are 

different. When we were young, you were out of the house at 9:00 

a.m., and your mom said, ‘‘Be back by dinner.’’ 

Now, it was different days. I agree with that. But we are competing now with kids watching TV, kids being on their computers, 

the games that they are on, so they are spending a lot of time inside. 

And I think that that is not the best and healthiest thing in the 

world to do. So what we are trying to do, on a number of ways, 
64 

is educate the children on nutrition, get them more active, into 

physical activity, and that brings me up to a question, and I will 

throw it out there. 

We have been talking about a lot of the children, but no one is 

talking about those children with special needs, those children that 

are in a wheelchair. They can do exercise, but they also need good 

nutrition. So if you have any data on any of the work that you have 

done with children with special needs, I think that the committee 

needs to hear about that also. 

Dr. STALLINGS. Well, let me speak to that a little bit. In fact, one 

of the areas that I have worked on for years is children with cerebral palsy. And across the spectrum, from mildly affected to quite 

severely affected for ambulation and cognitive issues. 

And I think you are correct, in the issues in those children, because they are not running around and riding their bike and that 

sort of thing, there is a decrease in total energy needs. And the 

milder the defect, probably the more we will see that difference. 

In children who are severely affected, the interesting thing is 

they are—feeding those children is so difficult that some of the 

most striking examples of malnutrition and under-nutrition are 

children with cerebral palsy who have spastic quadriplegia and 

that sort of thing. So part of the challenge in a school setting is 

now often you have a very big spectrum of children with special 

needs. 

I think the schools, again, with some of the recommendations, because there will be a section on children with special needs, the 

focus, as you mentioned, really is around calories. Most of the other 

nutritional needs don’t change very much as long as you adjust 

them for body size. So if they are overweight, we know a bit about 

that, but certainly if they are underweight. 

Many of the other children with special needs in a school setting 

are children with medical problems that aren’t the same as the 

visible disabilities. And for those children in the current environment, the system of having them known by the school and by the 

food service people is part of the program. Now, whether they are 

able to meet their needs as well with the current recommendations, 

I don’t think we have any evidence for. 

So, in summary, the energy issue is a big deal, and the physical 

activity component, like you said, we have learned from both children and from the elderly the kind of physical activity you can do 

from sitting and that sort of thing. Those are all areas we can improve. 

But I think within the food, school lunch and breakfast program, 

in the professional oversight that is there and the commitment of 

the teams you have already got on the ground, as long as we have 

good clarity about what the conditions are, it should go more directly to the amount of food, which is calories, and then the texture 

or special feedings. And as long as we make the commitment that 

those children will be educated in those school buildings, the issue 

around food and physical activity should be paired with that. 

Ms. COPPERMAN. I would just like to add a couple of comments. 

In our work with Activity Works, it wasn’t designed specifically 

for children with special needs, but it has been used in classrooms 

with children with severe learning disabilities. And it was quite in-
65 

teresting to see that the teacher’s feedback felt that the kids were 

moving, exercising and learning, and it increased their listening 

skills. And the repetition—they used it differently—was very helpful, and they felt it would work. 

I do have, in one of my schools, a child who is in a wheelchair. 

And this child had a mat set up in the back of the class. And when 

Activity Works comes on, he goes down on the mat and he does all 

the exercises that the kids are doing from the upper body, and it 

is just accepted and something that they do. And in the audits for 

New York state physical education requirements, they found that 

the one thing that they were meeting was really providing physical 

education for this population. 

In my practice as a clinical nutritionist dealing with overweight 

and obese children for 20 years, I can tell you that my interaction 

with schools dealing with children that were overweight and obese 

and educating the schools on what is appropriate was very successful in helping those children do well in school, change the nutrition 

that they were receiving in school. 

Many times when you have a child with special needs, the idea 

is that food is love and that over-feeding is doing the children a 

favor. And that was one of the things that I was able to do, was 

to educate and work with teachers and looking at foods as rewards 

in special needs schools and changing things and actually making 

the kids healthier and actually functioning better and being able 

to do the activity. 

Another case would be children that have psychological issues 

that are required to be on medications that can make them gain 

20 to 30 pounds in a year. and they need these medications, otherwise they can’t function. So what do we do with this population, 

which is increasing? And again, working with the families and 

using nutrition and physical education strategies to help change 

and work with the school. 

So I think that it is a partnership of using nutrition professionals 

and using physical therapist and bringing the team together to 

deal with this in setting up program and awareness in the schools 

that they can help. And I have seen that been successful in my career and in working with Activity Works and seeing how they are 

increasing their activity. 

Mr. FELTON. We think that, obviously, schools have come a long 

way in terms of both the academic preparation for students with 

disabilities and providing free appropriate education, as well as 

dealing with other kinds of services like nutrition. 

So I don’t think it is an issue of, ‘‘Well, we will not deal with 

these students because we aren’t aware.’’ I think as Ms. 

Copperman has pointed out, there is the opportunity to collaborate 

on what is needed for each child. And even for those students that 

aren’t formally identified as being disabled, there is a wide, broad 

range of skill sets and learning that takes place. 

So as we all know, it is a very, very complex issue. The key for 

us is that the political will, both at the community level, state and 

federal level to do that and to—the resources and the appropriate 

development for teachers and other staff officials so that it works 

as a total program and not viewed as add-on. 

Chairwoman MCCARTHY. Mr. Tonko? 
66 

Mr. TONKO. (OFF MIKE) 

Chairwoman MCCARTHY. Oh, I am sorry. Did someone else want 

to answer? 

Ms. BYRNES. I just wanted—since I haven’t spoken for a while, 

I just—but I just wanted to reiterate what you were saying about 

the children. And part of being a nurse as well, I realize that we 

have to start with the children, and then they take that information home to their parents. And we also do adult wellness in businesses. 

So we have to complete the circle, but never underestimate the 

power of a child and how they can influence parents and grandparents. 

Mr. TONKO. Madam Chair, if I might, the craze of late is highenergy drinks loaded with caffeine, loaded with sugar, and they 

sound good. They sound harmless. Sound like they are going to 

build up your opportunity to perform. 

What do we need to do? Because so much of this is being ingested by the young crowd because they think it is the cool thing 

to do, or a good thing to do. How do we deal with this? 

Dr. STALLINGS. If I may start, in the report on the competitive 

foods, there is a whole section that looked at beverages very systematically. And in that evidence review, if you look at caffeine, 

there—and as, of course, we all know, caffeine is a drug. It has 

physiological impact with heart rate, with changes in metabolism, 

including glucose metabolism. And yes, it is performance enhancing. It is a performance-enhancing drug. 

So I know that in a military setting, they have gone through this 

and found opportunities to use this. And maybe we might want our 

airline pilot to have his caffeine. 

But if you read through the report, I think you will come away, 

after looking at the evidence, that this is a drug. It is not appropriate in a school setting. And as the committee described, having 

a performance-enhancing drug in the school setting, again, goes 

against everything we are trying to provide there. 

So in that setting, what this committee came out with is the beverages that are appropriate in school would not have caffeine, 

would not have any other special enhancements, including adding 

vitamins and minerals, because the committee recommended that 

the focus be on food, and healthful foods and beverages, not the 

idea that you put a vitamin in a sport drink or something like that. 

The one other issue about sports drinks being a little different 

from the high-energy, which are really highly caffeinated, the evidence, again, supports that, except in very special situations where 

kids are in team sport-type training settings in hot environments 

or very humid environments, there is no evidence to support the 

need for rehydration fluids in the school setting in the noncompetitive setting. 

So the idea that you might have sport drinks for the varsity 

teams during practice and performance comes within the idea of 

safety and in the domain of the coach and looking at the whole environment. 

The idea of having those beverages in the school during the normal day, or in the gym after you have had PE class, again, the 

committee did a lot of work to provide the evidence that does not 
67 

support the necessity of those in that setting. They are high in sodium, high in calories, high in caffeine, depending on which ones 

you are looking at. So they may have a place in other settings, but 

the committee would suggest that is not the school. 

Mr. TONKO. Well, we are promoting these drinks, and the young 

mentality is just consuming to them. 

Dr. STALLINGS. Right. And again—— 

Mr. TONKO. At a dangerous level. 

Dr. STALLINGS. But the evidence that has come out with the impact of the media and being able to influence food and beverage decisions in children as young as 5 and 6 is very, very compelling. 

And so, we know that if kids are exposed to that kind of media attention, then it is effective, and they do begin to make decisions 

based on that. 

Ms. RITCHIE. Oh, I am sorry. I was just going to add that one 

of the reasons for our recommendation to coordinate the nutrition 

education messages across the federal food programs is because of 

some of what you just brought up, that kids are bombarded with 

messages that tell them to do the opposite thing of eating healthy 

and being physically active. 

The average child sees 5,000 commercials on television a day, 90- 

plus percent of which are for unhealthy foods. We have to find 

ways to counteract that. And I would also add, in regards to your 

discussion about sweetened beverages, that we published a book, 

our center, called ‘‘Obesity: Dietary And Developmental Influences,’’ which examines all the evidence on a lot of dietary factors 

in terms of which are contributing to obesity and which may not 

be. And sweetened beverages came up right at the very top of the 

list. 

Mr. TONKO. And we are also dealing with the struggle that many 

districts have, where there are enticements to put in machines that 

are selling high sugar in liquid formats through drinks, unhealthy 

snack food, and getting lights on a field, bleachers put on a field, 

athletic fields paid for, and everybody is saying, ‘‘Well, it is the resource we get, and we need to keep’’—what is the cost of doing that 

into the future, when we are growing unhealthy kids? The price tag 

to society is far beyond the benefit, I think, that comes at the beginning. So how do we address that? 

Mr. FELTON. Well, I think it goes, again, back to what is the political will, and—— 

Mr. TONKO. Well, political will versus consequences, though. 

Mr. FELTON. That is true. But 20 years ago, certainly 20 years 

ago, we may not have envisioned a smoke-free environment, and 

yet we have in many states now smoke-free environments because 

there was, one, not only the support for incentives to move in that 

direction, but again, the commitment and engagement of people 

who said, ‘‘This is the right thing to do.’’ 

I mean, if you look at—, you look 40 years ago when people were 

throwing trash out the windows on highways, I mean, we create a 

model and we create a value in this country which will then drive 

this behavior. I just think we have to be very, very careful. 

Sure, the feds want to push this thing, and it is very, very important, but just keep in mind that many local communities are working with that to the extent that the feds can provide leverage so 
68 

that states and local communities can move at a much more accelerated pace, I think it is very important and should not be discounted. 

Mr. TONKO. I hear you, but I think at the same time the enticements are pushing us backward—can push us backwards rather 

than move us forward, or even hold us where we are at. 

Ms. BYRNES. I would think this would be a wonderful opportunity for school boards to really look at their school districts and 

say exactly what you were saying, is what is more important, putting lights on our field or having a third of our children being 

obese? 

And I will tell you, if you put soda in—they wanted to put a soda 

machine in the Health Education Center, and I said absolutely not. 

Absolutely not. So we have water. We have a water machine. But 

unfortunately, it says ‘‘Coke.’’ You know, the machine says, ‘‘Coke.’’ 

But sometimes you just have to take a tough stance. 

Mr. FELTON. Well, I think, again, it is ensuring that the values 

of a community are well respected and are influenced so that we 

can have sustained programs, not just the point of the Friday night 

games. At some of our communities, Friday night football is a 

major part of that core society. Now, it is easy for us to say, ‘‘Get 

rid of the Friday night games because we don’t have bleachers.’’ I 

think that that local community ultimately will make that choice 

about what is best for their kids, and they should. 

Chairwoman MCCARTHY. I am sorry, but I have to call this to an 

end. We have a vote. 

I just want to say that last year, after we had a hearing, one of 

our first hearings on nutrition, we heard from a lot of the manufacturers, and they understood that they needed to step up to the 

plate a little bit more. 

Now, with that being said, are they there yet? No. But do you 

notice more of the snacks are now in smaller bags, 100 calories? 

So we are getting there. 

It is an education not only of the schools, not only of the general 

public, but also the manufacturers. Hopefully we will continue to 

work with the manufacturing companies. They are putting in water 

into the machines. Airports are carrying more and more water. 

Now we have just got to figure out how we are going to drink 

all that water without, unfortunately, too many bottles all over the 

place. New York is going to probably start charging 5 cents even 

now for the water bottles. 

So we have a long way to go, but you know what? We will get 

there. 

I want to thank everybody here for their testimony. We do have 

our work cut out for us. I am going to bypass my closing statement, 

if nobody minds. 

As previously sorted, members will have 14 days to submit additional materials for the hearing record. Any member who wishes to 

submit follow-up questions in writing to the witness should coordinate with the majority staff within the requested time. 

Without objection, this hearing is adjourned. 

[Additional submissions of Mrs. McCarthy follow:] 
69 

Prepared Statement of Laurie A. Westley, Senior Vice President of Public 

Policy, Advocacy, and the Research Institute, Girl Scouts of the USA 

Girl Scouts of the USA respectfully submits this testimony to the Subcommittee 

on Healthy Families and Communities of the House Education and Labor Committee. 

Girl Scouts and Healthy Living 

Girl Scouts is the world’s preeminent organization dedicated to the leadership development of girls, serving nearly 3 million girl members in every corner of the 

United States, Puerto Rico, the Virgin Islands, and almost 100 countries worldwide. 

Throughout our 97-year history, Girl Scouts has had a long standing commitment 

to the well-being of girls and continues to be an authority on their healthy growth 

and development. From our healthy living programming and a historic emphasis on 

health in the Girl Scout experience, girls are educated and empowered to take action to strengthen their physical and emotional well-being and positively impact 

their communities and the world. Girl Scouts is deeply invested in improving the 

health of our country’s children and adds a unique voice and proven solutions for 

Congress to consider while forming policies to address childhood obesity and improve our youth’s physical and emotional health. 

The Girl Scout Research Institute’s original research report, The New Normal? 

What Girls Say About Healthy Living, provides what is too often missing from the 

dialogue surrounding nutrition and childhood obesity: the voices of girls and youth 

who are directly affected by this health crisis. This research offers insight into how 

America’s girls view their own health and healthy living. We found that girls believe 

being healthy combines good nutrition and physical fitness with emotional and social well-being. Most importantly, we found that without including emotional 

wellness in exercise and nutrition programs, these programs will not work well for 

girls. 

Incorporating Girls’ Voices Into Policy 

The New Normal? What Girls Say About Healthy Living, sheds light on the childhood obesity crisis by asking girls directly how they define health and what motivates them to lead healthier lifestyles. The report combined focus group research 

with surveys of more than 2,000 eight- to seventeen-year-old girls. Girls expressed 

that their emotional and social wellness is equally important to their physical 

health. For girls, being healthy is more than just eating right and exercising; it is 

also includes feeling good about oneself, being supported by friends and family, and 

appearing ‘‘normal.’’ The study found that girls define health holistically, and our 

nation needs to take a comprehensive approach to healthy living programs and policies if we want them to resonate well with girls. 

Emotional wellness, which includes self-esteem and a girl’s body image, plays a 

critical role in girls’ attitudes about diet and exercise. According to The New Normal? What Girls Say About Healthy Living, for girls, being healthy has more to do 

with appearing ‘‘normal’’ and feeling accepted rather than maintaining good diet 

and exercise habits.1 Moreover, physical appearance is of greater concern to girls 

than their nutrition or how much they exercise.2 If our country wants to end the 

childhood obesity crisis, we should form policies and programs that not only encourage good physical health, but emotional well-being as well. Girl Scouts has learned 

that comprehensive approaches are the most effective with helping girls develop 

healthy nutrition and exercise habits. We recommend that nutrition programs 

should include a focus on emotional wellness that empowers girls and all youth to 

develop self-esteem, a positive body image, healthy eating and exercise habits, and 

an overall healthier lifestyle. 

For girls, health is also about being supported by their peers and family. Relationships are crucial to girls’ physical and emotional health. The Girl Scout Research 

Institute’s original research report, Feeling Safe: What Girls Say, found that emotional safety is a top concern for girls. Girls feel the safest and most confident when 

they have strong relationships with their peers who they can trust.3 Relational aggression, or emotional bullying, damages girls’ emotional and physical health and 

safety. Efforts to improve girls’ health should include the prevention of relational 

aggression, since healthy relationships are crucial to girls’ physical and emotional 

well-being. 

The New Normal? What Girls Say About Healthy Living also highlights the important role that adults, in particular mothers, play in shaping girls’ self-esteem and 

their nutrition and exercise habits. Girls cite their mothers not only as role models 

but also as leading sources of nutritional information and emotional reinforcement. 

A mother’s weight, body image, and health habits are strong indicators of whether 

or not her daughter is overweight, physically active, satisfied with her body, and 
70 

looks to her mother for advice on health living.4 In general, having obese parents 

significantly increases a child’s risk of being obese. One study suggests that children 

of obese mothers are fifteen times more likely to be obese by age six than children 

with normal weight mothers.5 This strong correlation between a daughter’s health 

and her mother’s health habits indicates the powerful influence mothers have over 

their daughters’ emotional and physical health. Efforts to inspire and motivate girls 

to make healthier choices should focus on educating parents, teachers, and adult 

volunteers on how to encourage youth to develop healthier lifestyles, as well as 

teach adults that their choices model behaviors for how to live a healthy life. 

Finally, our original research shows that the most effective policies and programs 

give health social relevance, which requires framing healthy living in terms that are 

socially significant to girls of different ages, ethnicities, and backgrounds. Hispanic, 

African American, and Native American children are disproportionately affected by 

obesity when compared to the general population. The highest prevalence of obesity 

among girls is found among African American and Latina girls.6 Children from lowincome backgrounds are also at a higher risk for becoming obese; for girls of all 

ages, obesity is highest at the lowest income levels and drops precipitously at the 

highest income levels.7 Policy solutions should be culturally competent and built 

upon the different needs of children from all backgrounds if we truly want to improve all children’s health. 

Conclusions 

Any reframing or redefining of health needs, including nutrition and physical activity policies, will be most effective if the policies focus on the positive emotional 

outcomes, such as forming healthy relationships, building strong self-esteem, and 

developing a positive body image, that are likely to result from comprehensive, 

healthy behavior, rather than strictly focusing on maintaining normal weight and 

eating nourishing food. According to The New Normal? What Girls Say About 

Healthy Living, a strict focus on physical health does not resonate with girls. Policies that acknowledge the importance of emotional wellness and incorporate emotional health in nutrition and exercise programs will be the most successful among 

girls and all youth. 

Girl Scouts strongly supports H.R. 2276, The Improved Nutrition and Physical Activity Act or IMPACT Act, because it meets a critical need for a comprehensive approach to obesity and eating disorder prevention and improving children’s emotional 

and physical health. This legislation is taking groundbreaking steps by recognizing 

that youth, especially girls, view health holistically. It also promotes cross-sector collaboration among schools, health professionals, and youth-serving organizations, 

such as the Girl Scouts. We greatly encourage the members of the Subcommittee 

to partner with Representatives Nita Lowey and Mary Bono Mack to support this 

legislation that will provide invaluable resources for communities to work together 

to improve children’s nutrition, physical activity, and emotional wellness. 

Girl Scouts has a crucial role to play in ensuring the needs of girls are addressed 

in policy solutions. We are a powerful community-building tool, and our research 

and programming offer proven solutions towards promoting healthy living. As such, 

we seek to partner with the Subcommittee in the future as you develop policies that 

will build a generation of healthy girls and youth. Listening to the voices of girls 

and what they have to say about healthy living can inform the programs, policies, 

and messages that touch their lives. Only by engaging girls in the process do we 

ensure that today’s girls will grow into tomorrow’s healthy women. Girl Scouts 

thanks the Subcommittee for its leadership in examining this important issue and 

including our statement in the record. 

ENDNOTES

1 Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman, The New Normal? What Girls 

Say About Healthy Living, Girl Scout Research Institute (New York, NY: Girl Scouts of the 

USA, 2006). 2 ‘‘Health Status—Adolescents.’’ Child Health USA 2003. 2003 HRSA Maternal and Child 

Health Bureau. Accessed 13 June 2005. http:www.mchb.hrsa.gov/chusa03/pages/status—adolescents.htm 3 Judy Schoenberg, Toija Riggins, and Kimberlee Salmond, Feeling Safe: What Girls Say, Girl 

Scout Research Institute (New York, NY: Girl Scouts of the USA, 2003). 4 Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman, The New Normal? What Girls 

Say About Healthy Living, Girl Scout Research Institute (New York, NY: Girl Scouts of the 

USA, 2006). 5Whitaker, R. et al. ‘‘Predicting Obesity in Young Adulthood from Childhood and Parental 

Obesity,’’ New England Journal of Medicine, vol. 337, No. 13. September 25, 1997. Berkowitz, 

R. ‘‘Growth of Children at High Risk of Obesity during the First Six Years of Life: Implications 

for Prevention,’’ American Journal of Clinical Nutrition, vol. 81, No. 1. January 2005. 
71 

6 Judy Schoenberg, Kimberlee Salmond, and Paula Fleshman, Weighing In: Helping Girls Be 

Healthy Today, Healthy Tomorrow. Girl Scout Research Institute (New York, NY: Girl Scouts 

of the USA, 2004). 7Girl Scout Research Institute. What Girls Say: Healthy Living Inside and Out, Integrated 

Report of Qualitative and Quantitative Findings. (New York, NY: Girl Scouts of the USA, November 2005). 

[The statement of Mr. Braley follows:] 

Prepared Statement of Hon. Bruce L. Braley, a Representative in Congress 

From the State of Iowa 

Chairwoman McCarthy, I rise today to discuss and urge support for a bill that 

I recently introduced, House Resolution 2322, the Healthy Food Choices for Kids 

Act. I strongly urge the Education and Labor Committee to consider including my 

legislation within the reauthorization of the Child Nutrition Programs and the National School Lunch Act. My bill would set up a Pilot Program that would be available to 100 schools (10 schools in each of 10 states). These schools would receive 

funding in order to meet three requirements: 

1. The schools would be required to post nutritional information on the food items 

served in their school cafeterias. 

2. The schools would be required to develop and implement a school nutrition 

awareness program to teach children how to make healthy food choices. 

3. The schools would be required to consult with a Registered Dietitian, Nutritionist, or School Nutrition Specialist at least once a year. 

My legislation would also include an evaluation which would be reported to the 

House Education and Labor Committee. The evaluation would report on the successes and challenges of the program. I believe my legislation would be an excellent 

opportunity to test the idea of labeling the foods served in schools with nutritional 

information. 

I also believe that Iowa would be a perfect state to test this idea. There are at 

least 3 schools in Iowa that are already doing some form of nutritional labeling of 

the foods they serve in their schools. With this statement I have included two examples of current school food labeling already being done in Iowa. One example comes 

from Dubuque, Iowa and the other comes from Cedar Falls, Iowa. My bill requires 

that at least 3 schools in each state must already be providing nutritional content 

information for the foods served in the school cafeteria. This would make Iowa an 

excellent choice as one of the 10 states to receive this Pilot as they already fulfill 

this requirement. 

In addition, my legislation would require that the Secretary of Agriculture choose 

states for this pilot program with a sufficient number of rural schools. As a mostly 

rural state, Iowa would fit this criteria well. By implementing this pilot program 

in a state like Iowa, the Secretary will have the opportunity to thoroughly evaluate 

how this program works in both rural and urban schools, which could provide useful 

information towards our goal of increasing children’s nutrition awareness nationwide. 

I urge the Education and Labor Committee to consider including H.R. 2322, the 

Healthy Food Choices for Kids Act in the upcoming reauthorization of the School 

Lunch Act. This legislation will create a new opportunity in the continuing effort 

to fight childhood obesity. 

[Additional submissions of Mr. Braley follow:] 
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[Whereupon, at 1:47 p.m., the subcommittee was adjourned.] 

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