Junkfood Science: Brain food for kids: Having enough to eat

February 02, 2008

Brain food for kids: Having enough to eat

Efforts to address childhood obesity by lowering fat and calories in school lunch programs are having unintended consequences. A nutrition audit of school children in Florida found that growing youngsters were being underfed and short on vital calories. Some officials whose lunch programs have been flagged for underfeeding children have suggested that since there are still fat children, they must be eating too much and the nutritional guidelines should instead be changed to even greater reductions in fat and calories.

As the Miami Herald reports:

Lunch dilemma: Too few calories, too many fat kids

...[A] recent nutrition audit found that Broward elementary students are eating 85 calories too few, and middle and high school students fall short by 207 calories. School officials are caught in the middle of an evolving view on how much kids should eat: The U.S. Department of Agriculture's caloric requirements were last revised in the early '90s, when kids were more active and childhood obesity was not the concern it is today... “It breaks our heart,” said Broward school district nutritionist Darlene Moppert....

“The majority of schools recently reviewed under the School Meals Initiative were found to be serving fewer calories than federal guidelines suggest,” Florida Deputy Education Chancellor Linda Champion said. “This is most likely the result of outdated federal guidelines.” As a result, Broward schools and others that have been striving to lower fat and calories at lunch are now being flagged for underfeeding kids. The Miami-Dade school district is bracing for a similar conclusion when it is audited later this year....

Like Broward and districts nationwide trying to do something about the obesity epidemic, Miami-Dade has encouraged students to reach for more fruits and vegetables and has added whole-grain breads, while using lower-fat cheeses and cutting whole milk. The health-conscious push now has county administrators concerned. “We always worry when we have a review. If you bake a chicken, it's much less calories than if you fry it,” said Penny Parham, who oversees school meals in Dade. “Let's hope the USDA can help us out and revise some of those guidelines.”...

This isn’t the only school system, caught up in ‘healthy’ eating and childhood obesity concerns, found to be more restrictive in fats and calories than even the Dietary Guidelines recommend for children. School lunches across the country are intently trimming fat, meat and dairy foods from their menus to focus on fruits and vegetables, trying to trim down kids.

National School Lunch Program and Dietary Guidelines

The importance of children having enough to eat has long been recognized. A hungry child will not grow and develop well, or be able to learn. The National School Lunch Program, established in 1946 by the U.S. Department of Agriculture, must provide nutritious lunches for children that comply with the Dietary Guidelines for Americans. Each lunch provides 1/3 the recommended dietary allowances (RDA) for protein, vitamins A and C, iron and calcium.

As fears of fat grew, in 1995, the School Meals Initiative for Healthy Children was enacted with new ‘healthier’ nutritional standards that required schools to limit total fat to 30% of calories and saturated fat to 10% of the calories in meals served over the course of one week; as well as to restrict salt and sugar; and offer more servings of grains, fruits and vegetables.

These changes meant that school lunch restrictions now go beyond what the Dietary Guidelines recommend for children, and apply the adult guidelines to them. Even the most recent 2005 Dietary Guidelines advise:

A fat intake of 30 to 35 percent of calories is recommended for children 2 to 3 years of age and 25 to 35 percent of calories for children and adolescents 4 to 18 years of age.

The Dietary Guidelines, themselves, make no other 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 make no mention of restricting sodium for children; instead, it only recommends that specific population groups, such as older adults with hypertension, consume no more than 1,500 mg daily. The current Dietary Guidelines 2005 also make no specific recommendations for added sugars for children.

Despite concerns over the diets of kids today — What kids have ever eaten as ideally as their parents might like? — they’re actually eating comparably 'better' than past generations; fewer calories, less fat and more fruits and vegetables. And the latest NHANES dietary surveys show the majority of children’s intakes are well within the 2005 Dietary Guidelines for fat and calories.

Low-fat = healthy?

Controversy has raged in the medical community for more than two decades, largely unreported in mainstream media, over these recommendations to restrict dietary fats and sugars in children’s diets. Health professionals have voiced concerns about the need, effectiveness and safety of applying adult recommendations to children (such as limiting total fat to 30% of calories and saturated fats to 10%). The controversy, research and reviews of the evidence were covered in-depth here.

The proper feeding of children is one of the most hotly debated issues among consumers, with everyone having strong feelings about what is best. Everyone is concerned for children’s health and their future health, but there are a lot of fears and beliefs mixed in with science.

Low-fat is most popularly perceived as fundamental to a healthy diet for children and thought to prevent heart disease, cancer, and other chronic diseases; and to prevent obesity. Except, there is no clinical evidence to support that.

Robert E. Olson, MD, PhD, of the Department of Pediatrics at the University of South Florida, wrote that restricting fats, cholesterol and added sugars were the “most irrational” recommendations of public health officials. They “in effect, eliminate a large number of foods,” he said. “The goal is ostensibly to prevent atherosclerosis and cancer,” he said, but that belief has “not been demonstrated in any of the many clinical trials conducted in the United States and Europe.” A review of the science by researchers at the Center for Food and Nutrition Policy at Georgetown University School of Medicine, also found no proven benefit from low-fat diets, but that they could be unsafe for children.

The U.S. Preventive Services Task Force, in its review of the evidence on low-fat diets in children, found no evidence that such diet or exercise interventions "lead to improved lipid profiles or better health outcomes in adulthood." But it did find evidence for harm: “Nineteen studies of dietary fat restriction reported effects on growth, nutrient intake, laboratory safety parameters, or other adverse effects. Twelve studies reported normal height growth...In one study, growth failure occurred in 8 (20%) of 40 children with dyslipidemia, 3 (7.5%) of whom had nutritional dwarfing and no progression of puberty....There have been three reports of growth retardation and nutritional dwarfing in children on unmonitored [low-fat] diets; however, there are several reports of normal growth during [medically] monitored low-fat diet interventions.”

A comprehensive examination of the evidence surrounding dietary fats for children was conducted by researchers for the American Society for Nutritional Sciences. They scrutinized the role of dietary fat in the growth, development and long-term health of children, and reported that researchers have repeatedly tried and failed to demonstrate benefits from lower fat diets beginning in childhood. Instead, children need and benefit from fat in their diets to absorb essential fat-soluble vitamins, produce hormones, and for neurological development and brain function. They concluded that the focus on fat and the nutritional messages to limit fats are unhelpful and actual causing harm.

Dr. Olson concluded that the risks of lowering fat and cholesterol in children’s diets “so outweigh the benefits as totally invalidate the recommendation.” While some children will grow okay eating low-fat if they get sufficient calories, he said, others will be at risk for malnutrition. The number of cases of children getting insufficient calories and nutrients as a result of low-fat diets, and suffering suboptimal growth and development, are being reported in the medical literature with growing frequency. The unintended consequences also include risks for eating disorders and tripling the risks for later developing obesity.

If fat is bad, even less must be better

Largely driven by nonstop stories of the unhealthfulness of school lunches, some state school districts have established school lunch policies that take national guidelines even further. Texas, for example, places restrictions for fats and sugars on individual foods, rather than an entire week’s diet, strictly limits portion sizes, and forbids ‘fattening’ foods. No individual food items may contain “more than 23 grams of fat, with an exception of one individual food item per week,” the policy states, and “no individual food items can exceed 28 grams of fat at any time.” Its policy for elementary to high school student lunches states:

Total fat: Not to exceed 30 percent of calories or contain no more than 3 grams per 100 calories; Saturated fat: Not to exceed 10 percent of calories or contain no more than 1 gram per 100 calories; Sugar: Contain no more 10 grams per ounce.

On-site frying has been eliminated in school kitchens. French fries are to be baked and cannot exceed 3 ounces once a week, and only one serving may be purchased at a time. No access to “foods of minimal nutritional value” or sweets can occur “at any time anywhere on school premises until the end of the last scheduled class.” For high school age, chips must contain no more than 7.5 grams of fat and portions are limited to 1.5 ounces. Beverages with lunches can only be reduced-fat milk, water, or a single cup of whole milk, or drinks with less than 30 grams sugar per cup.

As the Texas Public School Nutrition Policy states: “All school cafeterias and dining areas should be healthy nutrition environments.” The unmistakable message to children, and internalized by a lot of adults, is that healthy eating means carefully controlled portions, only unprocessed foods, and eating low-fat; and that certain foods are forbidden and bad. Child nutritionists have voiced concerns that, while these measures will do nothing to reduce obesity rates, they do exacerbate food fears, disordered eating, and potentially fatal eating disorders. These restrictions will also leave some children hungry, as young people are at all stages of growth and development and their energy needs can vary greatly. Children suffering or recovering from eating disorders (who make up the same percentage of kids as deemed "overweight"), for example, will find this environment especially harmful.

Sadly, children are bombarded from all directions by incessant warnings of obesity and about ‘healthy’ eating, with much of it nutritionally and medically unsound.

Promoting healthy eating might seem only helpful and harmless. But the negative dietary messages about the unhealthfulness of certain foods, that sugar and fat are bad, and even the use of the term ‘junk food,’ contributes to food fears and eating problems, according to international child nutrition and eating expert and researcher, Jennifer O’Dea, MPH, PhD, from the University of Sydney in Australia. Such measures don’t help children develop healthful, normal relationships with food and eating. A compelling body of evidence shows that restrictive eating and trying to control calories and eat “healthy” (or dieting) greatly increases chances of developing eating disorders, as well as life-long struggles with food. This issue was reviewed in detail here.

The ‘healthy eating’ messages, especially fears of dietary fats, salt and calories, and the focus on children’s weights are unmistakable in school lunch programs today. Healthy eating has become indistinguishable from dieting behaviors, with its attention on controlled eating, counting calories and fat grams, and dietary restrictions. A recent Wyoming News story illustrated these concerns:

Kids fall for 'stealth health' tricks

Food service employee Janice Thomas prepares lunch for students near trays of apples, oranges and vegetables at Rossman Elementary Friday morning.... the [Laramie County School District 1] doesn’t serve butter with rolls. And it uses a no-fat butter spray when making grilled cheese. When Willman started in school food service nearly 20 years ago, there wasn't as much emphasis on the nutritional content in food. But now she measures the fat grams of entrees. She posts the information at junior-high and high-school cafeterias and notes it in elementary lunch menus. The effort is required by federal school lunch guidelines. But it's also a way to help deal with childhood obesity, [Linda Willman, director of nutrition services] says. Because of obesity, “this is the first generation where they may have a drop in the average life expectancy," she adds...

School districts in Wyoming, including LCSD1, struggle to limit salt levels as well, Mordhorst said. LCSD1 serves pizza, corn dogs, tacos and chicken tenders. But they are lower in fat and sodium than regular tacos or pizza. And the corn dogs are made from turkey. The district's whole-grain crust pizza has 8 grams of fat per serving....

It is not surprising that obesity fears and ‘healthy eating’ messages have led young people and parents to believe that low-calorie and fat-free foods are good nutrition. The nutritional dangers of increasingly overzealous adoption of “healthy diets” were recently seen in the “A+ Lunches” to “battle the global obesity epidemic” recently promoted by Rudd Center for Food Policy and Obesity at Yale, which were found to supply less than 20% of the calories, fats and iron recommended for a typical 4-year old, let alone an older school child.

Any diet that eliminates or restricts certain foods or food groups, makes it much more difficult to get the full range of needed nutrients, and can jeopardize children’s health. Many children are falling short of nutrients needed for normal growth that are supplied in “fattening” foods, especially teen girls. A 1996 study in the Journal of Adolescent Health examining women 14 to 19 years of age, found a high prevalence of inadequate energy, protein, calcium, iron and zinc intakes among young vegetarians as compared to their counterparts who consumed animal foods. According to research from iron metabolism expert, Nancy C. Andrews, M.D., Ph.D, 20 percent of women of childbearing age and many children were at risk of iron deficiency anemia, especially those not eating meat.

The risks of insufficient calories and nutrients for children are well established in clinical studies, stunting physical and mental growth and development, and contributing to long-term health problems. Self-imposed dietary restrictions among otherwise healthy pre-teens in extremes can even slow puberty by half and delay bone age by as much as 5 1/2 years. Among male teens, growth retardation is a key characteristic of anorexia and many sufferers never achieve their full adult height.

But aren’t school lunches unhealthy?

The media presents a regular drumbeat of stories about the unhealthfulness of school lunches, especially for serving too much fatty foods, but the evidence doesn’t support such worries. Even before the 1995 healthy school meals initiative was launched, School Nutrition Dietary Assessment Studies of the National School Lunch Program were reporting a “meaningful and statistically significant trend toward lower levels of fat and saturated fats” between 1991 and 1999. “In school year 1998-99, lunches served to students in elementary schools provided, on average, about 33 percent of calories from fat and about 12 percent of calories from saturated fat.” It also found that “students in 91% of secondary schools and 82% of elementary schools had the opportunity to select lunches that were consistent with dietary standards.” National School Lunches, as per federal regulations, were generally doing a good job complying with nutritional guidelines.

The School Nutrition Association biannual surveys of nationwide school lunch programs reported in 2003 and 2005 that: “fat-free or low-fat milk is the most popular food option offered daily at elementary, middle and high schools.” It was offered daily in 92.3% of elementary school districts and 85.5% of middle schools and 87.9% of high schools. Their survey also found that “fresh fruits/vegetables and three or more milk flavors are the only other food options offered by a majority of the districts daily in all levels.”

The latest School Nutrition Association report, “School Nutrition Operations Report: The State of School Nutrition 2007,” released this past August, found:

[A] majority of schools offer fat-free or low-fat milk (97%), fresh fruits and vegetables (96%), salad bars or pre-packaged salads (88%), yogurt and yogurt drinks (81%), from-scratch baked items (63%) and vegetarian meals (52%). Additionally, the availability of locally grown fruits and vegetables has increased to 32% of schools.

It also found 92% of schools had wellness policies in full implementation in their school lunch programs.

Nor is there any support for fears that school meals contribute to making children fat. And, more importantly, there is no evidence to support beliefs that bad foods or diets cause childhood obesity or chronic diseases. Even the American Heart Association’s review of the evidence on obesity in youth concluded in its Scientific Statement that “studies of diet composition in children do not identify the cause of obesity in youth.” As they noted, dietary fats and saturated fat intakes are lower today than in the past, unrelated to obesity trends. Fat and thin children eat no differently to explain obesity. Eating high-calorie, low-nutrient dense foods like sweets doesn’t correlate with children’s weights, either, and consumption has been shown to be high among all kids for generations. Canadian researchers looked at the diets of more than 130,000 kids in 34 countries and reported that fat kids even eat the least sweets, and that kids’ body weights had nothing to do with how many fruits, vegetables or soft drinks they consumed. So, not surprisingly, the U.S. Preventive Services Task Force, after reviewing 40 years of evidence on childhood obesity, concurred that there is no quality evidence to support the effectiveness of any childhood obesity intervention in reducing obesity, but they do risk harming children. Lightening up about all of this might just be the healthiest gift for children.

School Lunch Report Cards

These encouraging reports of school lunch programs don’t follow what we hear in the news. For years, the media has been reporting on worrisome evaluations from the Annual School Lunch Report Cards, which have been rating children’s school lunches around the country. We hear that the National School Lunch Program guidelines are nutritionally “inadequate,” according to these report cards, and that our children are being fed unhealthful, fatty foods.

Why are these report cards giving us such a different picture?

The first thing the media never reveals are the criteria being used in these Report Cards to evaluate school lunches that “make the grade.” Nor does the media often reveal the organization behind them. Few parents or consumers know that these dire reports come from the Healthy School Lunch Campaign, a major lobbying effort targeting Congress and the U.S.D.A , sponsored by the Physicians Committee for Responsible Medicine.

Working from the belief that bad foods make kids fat, according to PCRM: “Given the prevalence of obesity among children and adults, it is clear that schools should meet nutrition standards that are more stringent than those set by the USDA. That is why PCRM has developed a new grading system.” How PCRM defines a proper lunch and has come to regard current lunch guidelines as inferior, however, may not be how you would.

The school lunches are judged on three criteria:

· Obesity and Chronic Disease Prevention

· Health Promotion and Nutrition Advocacy

· Nutrition Initiatives

To earn a perfect score, PCRM says school districts must not only meet the Dietary Guidelines, but also must serve nondairy, vegan (vegetarian) entrees daily; offer fresh or low-fat vegetables and fruits; offer nondairy beverages to all students; and “provide nutrition education in the cafeteria, as well as offer programs that promote healthful eating habits.” Veganism is the most extreme of the vegetarian ideologies, according to Dixie Farley with the FDA, and shuns all dairy, meat and eggs and animal foods of any type. PCRM claims these foods have too much fat and are unhealthy.

Under its Obesity and Chronic Disease Prevention criteria, PCRM claims that an exclusive plant diet, low in fat, saturated fat and cholesterol, will help children develop ‘good’ eating habits that will help them maintain an “appropriate weight,” prevent overweight or obesity, and prevent chronic diseases. So, points are given to school lunch programs for the number of vegan/vegetarian entrees offered each week.

Under its Health Promotion and Nutrition Advocacy criteria, meals are evaluated on their fiber content, low-fat vegetables and fruits (3 options per day), and nondairy beverages. PCRM claims that “the consumption of dairy milk has been linked to obesity, anemia, ear infections, constipation, respiratory problems, heart disease and some cancers.” Rice and soy milks must also be offered at no cost.

Under its Nutrition Initiatives criteria, children must be taught about “better nutrition and smart eating habits” which must include “promoting plant-based diets” with vegan foods labeled on the menu as the healthful choice (with schools given extra points if they reward children for choosing them); having school gardens and salad bars and farm-to-school programs; and nutrition education in the cafeteria and food service department about plant foods and their health benefits.

No sound research supports these frightening claims, nor that these restrictive diets are necessary for good health or offer special health benefits for children in preventing obesity or chronic diseases. School lunches are not inadequate because they provide too much fat or calories. But this latest news that some school lunches are providing too little fat and calories out of concerns over childhood obesity, does warrant attention.

All children deserve to have enough to eat to grow and learn. No child should go hungry, including a naturally fat one.

© 2008 Sandy Szwarc

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