This overview was prepared by Lauren Smith, M.D., Medical Director in February for Commissioner Auerbach and Members of the Massachusetts Public Health Council
Recently enacted M.G.L. c. 111, s. 223 requires the Department to promulgate regulations establishing standards for competitive foods and beverages sold or provided in public schools. In response, Department staff, in cooperation with the Massachusetts Department of Elementary and Secondary Education (DESE), now proposes regulations included as Attachment A, Nutrition Standards for Competitive Foods in Public Schools, 105 CMR 225.000.
The statute specifies many of the provisions to be contained in the regulations. In addition, the regulations are based on the Institute of Medicine’s Nutrition Standards for Foods in Schools (2007), which contain specific recommendations for the provision of healthy foods in schools. Department staff also has drawn from a variety of source materials, including recommendations of Massachusetts Public Health Association, Massachusetts Action for Healthy Kids, Alliance for a Healthier Generation and other national and state standards.
The goal of the proposed regulations is to ensure that public schools offer students food and beverage choices that will enhance learning, contribute to their healthy growth and development, and cultivate lifelong healthy eating behaviors. The proposed regulations are part of the Commonwealth’s broad-based, collaborative initiative to reduce childhood obesity. For example, this initiative complements Massachusetts’ regulations for BMI screening in public schools (105 CMR 200.000: Physical Examination of School Children), adopted earlier this year.
Overweight/obesity is a public health issue that has reached epidemic proportions in the Commonwealth, and has become a strategic priority for the Department. Negative trends in nutrition and physical activity behaviors are at the center of the growing epidemic (The Health of Massachusetts, 2010). Of special concern is the rise in childhood obesity in Massachusetts. Among low- to moderate-income families, more than one-third of children between the ages of two and five years who participate in the WIC Program are overweight (15.4%) or at risk of becoming overweight (18.4%).[i] The 2009 Youth Health Survey (YHS) shows that 17% of middle school students were overweight and 10% are obese.[ii] In the same year, 11% of high school students were reported to be obese and 15% were overweight.[iii] These rates far exceed the national Healthy People goal of 5%.
State data show that the burden of obesity and its underlying risk factors disproportionately affect Black and Hispanic and low income youth and adolescents throughout Massachusetts. For example, at the high school level, 18% of Black and 15% of Hispanic students are obese, as compared to 9% of their White counterparts[iv].
The YHS and YRBS data is obtained through self report. Analysis of actual Body Mass Index (BMI) screening data demonstrates that the problem is even more prevalent. Of the 109,674 public school students in grades 1, 4, 7 and 10 who were screened in 2008-2009, 16.9% were overweight, and 17.3% were obese. The rates of overweight and obesity varied substantially by town and were strongly correlated with median family income at the city or town level.[v]
Diet appears to be a significant factor in these trends. In 2009, only 19% of middle school students reported consuming the CDC recommended three or more servings of vegetables each day, and more than one in four reported consuming no vegetables. In MA high schools that same year, only 14% of students ate five or more servings of fruits and vegetables daily[vi].
Finally, of particular note is the concern for children with disabilities and special health care needs. While this special segment of children have experienced dramatic improvements in health status in recent years, thanks to advances in medical care and improved access to quality health services, the obesity epidemic has the potential to slow the advances that children with special health care needs have made.[vii]
The proposed nutrition standards are spelled out on this website here. The standards would require all public schools to meet nutritional standards for competitive foods and beverages sold or provided to public school students during the school day. In accordance with the enabling statute, the proposed regulations would also require that public schools:
- make available water to all students, without charge;
- offer for sale fresh fruits and non-fried vegetables at any location where food is sold, except in non-refrigerated vending machines and vending machines offering only beverages;
- make nutrition information available to students for non-prepackaged competitive foods and beverages, in accordance with Department guidelines. This specific standard would take effect on August 1, 2013; and
- prohibit use of fryolators for competitive foods.
The proposed regulations define competitive foods as including all those sold or made available in public schools, with the exception of those foods sold as part of a federal nutrition program. The regulations are to apply to competitive foods and beverages sold or provided on school grounds, except those sold or provided up to 30 minutes before the opening of the school day or 30 minutes after the end of the school day. This exception, however, would not apply to foods and beverages sold by vending machines, which would have to comply with the standards at all times.
The proposed regulations specify the types of beverages that can be sold or provided, and establish standards for beverages with respect to sugar content and serving size. The proposed regulations also would establish limits for competitive foods with respect to calories, fat, saturated fat, and trans fat, as well as sugar, artificial sweeteners, sodium, and caffeine. The proposed regulations also would set standards for whole-grain products.
A supporting document, Guidance for Implementing Massachusetts School Nutrition Standards, will be published once the final regulations are approved. This document is intended to offer clarification to schools with regard to implementing the regulations and will include the following topic areas:
- an easy-to-read chart of the guidelines with examples for each category;
- a list of foods and beverages that meet the guidelines (similar to the MA Action for Healthy Kids “A List” of approved foods and beverages);alternatives for school fund-raising activities;
- recommendations to create and support a healthy school environment; and
- a rationale for selected nutrition standards.
Implementation of the Massachusetts School Nutrition Standards will be enhanced through additional state level activities, mandated by c. 111, s. 223 and coordinated between MDPH and DESE, including, but not limited to:
- training of public school nurses in childhood obesity, eating disorders, behavioral health, type 2 diabetes, BMI screening, and making nutritional/behavioral referrals;
- training in nutrition and diet for school nutrition personnel;
- assessment of a school’s capacity, resources and equipment to prepare and provide recommended foods;the establishment of school-based wellness committees;
- the establishment of a Governor-appointed Commission on School Nutrition and Childhood Obesityto provide guidance and oversight;promotion of, and facilitation in the procurement of locally-grown products; and
- providing technical assistance and educational resources.
[i] PedNSS, 2007
[ii] Massachusetts Youth Health Survey (YHS), MDPH, Bureau of Community Health Access and Promotion, 2009
[iii] Massachusetts Youth Risk Behavior Survey (YRBS), MA Department of Education, 2009
[iv] Massachusetts YRBS 2009
[v] The Status of Childhood Weight in Massachusetts, 2009, MA Department of Public Health
[vi] Massachusetts YHS and YRBS 2009
[vii] Aviva Must, Ph.D., Department of Public Health and Family Medicine, Tufts University School of Medicine