School lunches — are kids eating healthfully?

Time Magazine’s special June 23 issue featuring childhood obesity was just released, but needs no review. The script was identical to the recent advertorial series in the Washington Post — the sources were the same, and the very same unsupported claims and doomsday predictions were made. But those concerned about the health and welfare of children and teens will find one article particularly disturbing.

“School Cuisine” described how school lunches and the foods kids eat today are unhealthy and making them fat. While none of its worrying statements and strict recommendations for how children should eat were supported, the nutritional information sadly echoed what a lot of young people have come to believe and fear about their food.

A diet by any other name

Kids have sedentary lifestyles today, according to the article, so when making food choices, they need to “think twice about the impact on their waistlines.”

It quickly became evident that the concept of what makes “healthy” eating is indistinguishable from dieting, with a focus on controlling calories; and limiting foods with fats, salt and sugars. Everything was with an eye on avoiding ingredients popularly believed to be harmful or fattening. So intense were these food fears, that in describing the foods to eschew, the word “fat” appeared 38 times in the text of this 940-word article, “salt” appeared 33 times and “calories” 28 times.

To be healthful, readers were told that foods for kids should be served without flavorings like butter, dressings, or gravies because of the fat, sodium and calories they add. Even “rice can be tasty without all the salt.” Kids eat less of flavorless foods, but that didn’t deter the punitive advice even when eating vegetables. Vegetables “are always a sensible snack,” the author wrote, but beware of dipping sauces which “may carry hidden fats.”

The “fatty pot roast and butter-soaked mashed potatoes” served to previous generations of kids were exampled as unhealthy. “Bag the butter,” the article advised, because “without that excess,” mashed potatoes can be fat-free. Meat portions should be modest, with the fat trimmed, and served without gravy because “that’s where the sodium is.” Even whole milk was said to be “empty calories” and needed to be avoided.

Familiar diet techniques to reduce calories and portions were continual, with an emphasis on foods to make kids feel fuller so they’ll eat less. Fresh fruits were promoted as preferred snacks and as substitutes for dessert because they’re high in fiber and fat-free. Apples were preferable to peaches, however, because peaches are “made less great by all the sugar.” Fresh produce was said to be better than canned. Replacing white bread with wholegrains will also help fill kids up. “Foods like soup, which contains a lot of water, help kids feel full.” But even watery soups warranted caution: “Keep an eye on the salt.”

Sugars were another feared ingredient. Ice cream and desserts should be ditched, and even cookies were said to not keep kids feeling full for long. Orange and other fruit juices are “sugary drinks [that] can lead to rapid weight gain,” the author erroneously reported.

The Mexican food popular in a lot of school lunches, according to this article, “is stuffed with calories, fat and sodium.” In contrast, the article described healthy lunches as being whole grains, fruits and lean protein. But even a lean turkey whole wheat wrap was “a worry” because of the salt.

These ideas are nothing new, although their extremity reflected the heightened panic over a national crisis of obesity presented in this special magazine issue, and its calls for the need of policy makers to do something to get things under control.

This article on school cuisine exemplified the frame of mind of a restrictive weight loss diet program. Perhaps, it might be a diet prescribed to seniors with heart disease, but it is not normal eating or a healthy diet for growing children and busy teens.

This article’s suggestions about what kids should and shouldn’t eat and what foods are unhealthy may be popular in mainstream media, but they weren’t supported by reviews of the body of research evidence by medical professionals, or experts in child growth and development, nutrition, eating disorders, and food science. They even went beyond the 2005 Dietary Guidelines, and those had even taken a weight loss focus.

So, what was the source of this article’s school nutrition recommendations?

Food does a body good

It wasn’t science. Despite this magazine’s cover story on an epidemic of supersized kids and this article's advice for slimming down today’s generation, there was no critical examination of the evidence behind those presumptions. Even all of the media panic about the dire state of children’s diets today and the need for parents to be frightened for their children wasn’t a balanced perspective. As every objective expert review of that evidence has concluded, childhood obesity is not caused by what or how much children eat. Kids eating a vast array of diets will still naturally grow up to be a variety of shapes and sizes. And no dietary or behavioral intervention to reduce obesity in children or change their behaviors long-term has proven effective, even the most comprehensive school based nutritional policies.

Regrettably, missing from this article was the scientific information that could help parents and young people better understand the range of nutrients growing bodies need, and the heartening information to help them develop healthier, more relaxed relationships with food, eat normally and enjoy food. But centuries of parents have held similar fears about their children’s diets and especially of white things like salt, sugar, fat and white flour.

Low-fat is the mainstay of what some today believe means healthy eating, even for children. The thinking is that it can prevent heart disease, cancer and other chronic diseases; and help keep young people from getting fat. But there is little sound clinical evidence to support such diets for young people. In fact, the bulk of the evidence, including the review of the evidence by the U.S. Preventive Services Task Force, shows that restricting fat could be unsafe for children; jeopardize their nutrition; lead to insufficient calories and nutrients, and suboptimal growth and development of their brain and neurological system and hormones; and heighten risks for dysfunctional relationships with food, food fears and even eating disorders. As Dr. Robert E. Olson, M.D., Ph.D., of the Department of Pediatrics at the University of South Florida, has cautioned, the risks of lowering fat and cholesterol in children’s diets “so outweigh the benefits as totally invalidate the recommendation.”

Low-fat eating not only eliminates certain critical food nutrients, researchers have repeatedly shown it reduces absorption of essential fat-soluble vitamins and carotenes in the diet. For example, many of the nutrients in fresh vegetables and salads are more bioavailable, absorbed and able to be utilized by the body when they are eaten with fat. Those vegetable dippers and salad dressings not only help kids enjoy their vegies, but make them more nutritious. Eating salads with full-fat dressings actually increases the bioavailability of the alpha-carotene, beta-carotene, and lycopene, with studies showing as much as a 15-fold increase compared to the same vegies eaten with fat-free dressings. So, telling kids and parents to beware of the vegie dippers because of “hidden fat” is the exact opposite of good nutritional science!

The 2005 Dietary Guidelines don’t even call for low-fat diets in children, saying that children 4-18 years of age need 25-35% of their calories to come from fat, with a number of medical expert analyses concluding that even this might be too restrictive. Despite concerns of fat in the diets of American children, they’re already well within the current recommendations.

It’s also popular to think that raw, fresh vegetables are better than anything cooked, frozen or canned because processing depletes nutrients. This, too, isn’t based on food science. Numerous studies have shown that while heating or storage results in some loss of certain vitamins, it’s in such negligible amounts there’s little actual effect on our health. Cooking and canning turn out to be not much different from what happens to fresh produce when it’s harvested or stored. According to the FDA, canned or frozen produce, which is typically processed so quickly after harvest, it’s often more nutritious than fresh produce. And the nutrients in many different foods, fruits, vegetables and grains are more bioavailable when they’re cooked than eaten raw.

The near magical health-promoting properties of dietary fibers and wholegrains, and the deadliness of white, refined foods, are similarly short on science. In fact, high fiber diets actually reduce the absorption of critical nutrients in foods, especially needed by growing bodies. Worries over what makes food real and nutritious are also based on misunderstandings of science, and would be better realized if Grandma’s homemade dinners or Mother Nature’s foods came with nutritional analyses and the ingredients given their chemical names as are on the food labels scrutinized today.

The 2005 Dietary Guidelines also make no mention of restricting sodium for children; instead, it only recommends that specific population groups, such as seniors with medical conditions such as hypertension, consume no more than 1,500 mg daily. There is no credible clinical evidence that restricting salt is beneficial for children, with recent research suggesting low-salt diets may actually be harmful. The current Dietary Guidelines also make no recommendations for restricting added sugars for children, nor does the research support concerns of sugars and sweeteners as compromising the quality of children’s diet or adversely affecting their health.

In other words, the science is telling us to lighten up about the panic over food. Kids aren’t eating as badly as some are trying hard to convince us to believe, nor is pop culture a source for nutrition advice.

But, if it wasn’t science, what was the source of this article’s school nutrition policy recommendations?

Single source

The writer of the Time Magazine article made only one reference to support her claims that school meals are unhealthy and fattening. She said: “While efforts are being made by governments to ensure that cafeterias offer healthier meals, many schools are still failing to make the grade.” The author referred to a report issued by the U.S. Department of Agriculture last year, which she said found that “fewer than one-third of public schools meet the recommended standard for either total or saturated fat in their meals.”

The details that were left out provide a different story. It reminds us that whenever we see statistics, to ask for definitions: How is “healthier” meals being defined? How is the “standard” that is grading meals being defined? It also reminds us to go to the original source for claims, especially those that sound scary or ominous. And it reminds us that whenever we hear things that depart from sound science, it can be valuable to look at what else may be influencing the conclusions.

The report referenced that made these government school meal policy recommendations and set those “recommended standards” was not an evaluation of the nutrition in children’s school meals by scientists at the USDA. It was a report submitted to the USDA by Mathematica Policy Research, Inc. a firm that writes policy papers and surveys for its clients from government, nonprofit foundations and private businesses. One of its long-time clients is Robert Wood Johnson Foundation, which, among its grants, commissioned Mathematica to study school food policies for their caloric intake and affect on childhood obesity. This was one of 14 grants awarded by RWJF as part of its childhood obesity Healthy Eating national initiative. Mathematica’s policy analysts have been active in childhood obesity policy initiatives for years and they have promoted school-based interventions as the ideal setting to address the epidemic of childhood obesity, as in a recent article in the Journal of Law, Medicine & Ethics.

This paper submitted to the USDA by Mathematica is the third School Nutrition Dietary Assessment (SNDA) study. Let’s take a closer look at the policy paper itself and see if it supports any cause for alarm about the unhealthfulness of children’s diets.

This report found: “There were no major changes in the calories, vitamins, or minerals served in NSLP [National School Lunch Program] lunches between school year 1998–1999 (SNDA-II) and school year 2004–2005 (SNDA-III),” since its last report to the current one. More than two-thirds of schools were meeting its standards for protein, vitamins and minerals and calorie restrictions.

This report explains that it was the source of efforts to require school lunches to restrict fat and calories even beyond recommendations from many medical experts or the government’s own Dietary Guidelines:

SNDA-I helped prompt new policies, known as the School Meals Initiative for Healthy Children, which require schools to offer meals that provide no more than 30 percent of total calories from fat and less than 10 percent from saturated fat. While SMI required schools to offer meals with less than 30 percent of energy from total fat, the DRIs set a range of fat intakes from 20 to 35 percent of energy as acceptable and place more emphasis on types of fat.

In other words, they chose to apply adult guidelines to children. The actual Dietary Guidelines make no specific fat or cholesterol restrictions for young people; it only recommends adults keep saturated fats below 10% of total calorie intakes and that lower levels are only “recommended as part of a therapeutic diet for adults with elevated LDL blood cholesterol. People with an elevated LDL blood cholesterol level should be under the care of a healthcare provider.” The 2005 Dietary Guidelines don’t even call for low-fat diets in children, saying that children 4-18 years of age need 25-35% of their calories to come from fat.

Yet, even their own report found no cause for concerns that children are eating too much fat:

On average, school lunches both as offered and as served contained about 34 percent of energy from total fat and about 11 percent of energy from saturated fat.

It found, however, that nearly a third of schools were now offering and serving lunches that met its more restrictive saturated fat standard and 20% had reduced total fat to below it’s total fat standard. Since 1998, it reported that the percentage of elementary schools that were complying with its standards had doubled from 15% to 34%, and secondary schools from 13% to 24%. But, given that the medical literature shows children need fat, are such severe restrictions a good thing?

The effects of this RWJF-led school meals policy initiative are already being seen. Children’s weights haven’t changed, leading school officials, like the Time Magazine writer, to believe that kids must still be eating too much fat, sugar and calories and that their diets need to be restricted even more rigorously. Large school districts are even taking the restrictions on overall diets to individual foods, and “healthy” eating efforts to slim kids down are coming to mean they must have as little fat, salt, sugars or calories as possible. Increasingly, actual nutrition audits of school lunches are finding children are being underfed and shorted on vital calories and nutrients needed for growth.

Even more concerning are the growing numbers of young people and parents who have come to see “healthy” eating as meaning low-fat, low-sugar, low-salt, low-calorie, and increasingly restrictive, eliminating foods they’ve come to fear are bad for them. Disordered eating and dysfunctional relationships with food have become so common, sadly, few young people even understand what normal eating is anymore. To start, it is not what was exemplified in the “School Cuisine.”

© 2008 Sandy Szwarc