Jump starting fitness and nutrition in schools

“Eat your breakfast.  It’s the most important meal of the day.”  Most parents can’t tell you how many times their own mothers repeated that phrase to them while growing up, yet today they continually voice those same words to their own children. 

Breakfast is still the most important meal of the day,  however more than 51 percent of U.S. school children go to school every day without eating breakfast staples like cereal, eggs, or toast, according to the School Nutrition Foundation. Without breakfast, children get irritable and tired; whereas, those who eat breakfast do better in school and eat healthier.

From March 8-12, 2010, National School Breakfast Week is raising awareness of the availability of the School Breakfast Program (SBP) to all children across the U.S.  The SBP is a federally-assisted meal program in schools that offer students breakfast for free, at a reduced-price or at full-price depending on family income. Currently, 80 percent of the breakfasts offered are free or reduced-price.

Although participation in the SBP has increased over the years, the program is underutilized when compared to the National School Lunch Program (SLP).  Currently, 30.5 million children receive low-cost or free lunches every day, while only 10.6 million children receive breakfast. To be eligible for free meals a child’s family income must be at or below 130 percent of the poverty level or $28,665 for a family of four.  Those with incomes 130 percent to 185 percent of the poverty level are eligible for reduced-price meals at or below 40 cents.

All low-income children who participate in the SLP are also eligible for breakfast; however, consuming a healthful breakfast is often not a part of morning routines.  Limited family income, time constraints and lack of appetite in the morning are some of the reasons children skip breakfast.

School nutrition programs in Southern Colorado’s low-income communities

With increasing childhood obesity throughout the United States, school nutrition is a growing concern.  Beyond the federally-assisted breakfast and lunch programs, Colorado schools are trying to implement ways to improve nutrition and increase physical activity.

In Southern Colorado’s San Luis Valley, the Rocky Mountain Prevention Research Center (RMPRC) at the Colorado School of Public Health is dedicated to improving health in K-12 schools. In the fall 2005, 10 elementary schools participated in the School Environment Project, a five-year community-based participatory research project that helps schools implement environmental and policy changes focused on health.

“Our projects work to increase opportunities for healthy eating and physical activity through school environment and policy changes,” explains Dr. Elaine Belansky, RMPRC associate director and assistant professor at the Colorado School of Public Health.  “We use a community-based participatory research approach and truly share in the decision making process with our partners.”

Five of the schools in the School Environment Project used the RMPRC’s “AIM Process” or Adapted Intervention Mapping to determine the best changes for their schools.  Task forces of administrators, teachers, food service staff, P.E. staff and parents brainstormed about changes they could make to increase opportunities for healthy eating and physical activity.  Then they refined their list of ideas based on a menu of evidence-based practices, says Dr. Belansky.

School lunch at one of the schools participating in the Rocky Mountain Prevention Research Center's School Environment Project.

Strategies included: providing free breakfast and lunch for all kids; offering more healthy choices in school lunch programs; creating a “healthy food zone”; reversing the order of recess and lunch so recess comes first; offering PE classes daily; and providing additional equipment for students to use during recess.

“Universities are well positioned to provide schools with information about the latest evidence-based practices as well as to facilitate schools through a process where teachers and administrators focus their limited time and energies on making environment and policy changes that affect most students most of the time,” says Dr. Belansky.

“While there is certainly no harm in implementing policies about foods served in classroom parties, it makes more sense to devote energy to increasing the number of fruits and vegetables offered at school breakfast and lunch. That way, you can impact almost every student, almost every day,” she continues.

During the 2008-2009 school year, 28 percent of first graders and 36 percent of fifth graders in the San Luis Valley were overweight or obese.  These rates are significantly higher than similar-age Colorado children, 22 percent and 26 percent respectively.

“Because the San Luis Valley has high poverty rates, children are getting two of their three main meals at school every day,” Dr. Belansky states. “It is important to make sure those meals are as healthy as possible.”

The School Environment Project was conducted from 2004-2009.  Outcomes of the project included six out of the 10 schools scheduling recess before lunch, a 29 minute per week increase in physical education, and an additional eight minutes per day for recess.  Compared to trends observed in a random sample of low income, rural Colorado schools, Belansky says schools in the San Luis Valley are making greater strides.

Impact of Local Wellness Policy on school health

During the same time the RMPRC was conducting the School Environment Project, the U.S. government issued a mandate under the Child Nutrition and Women Infants and Children Reauthorization Act requiring school districts participating in the School Lunch Program to create a Local Wellness Policy. 

The goal of the federal mandate was to increase opportunities for physical activity and healthy eating in the school setting.  Districts were required to establish policies that included goals for nutrition education, physical activity, and nutritional guidelines for all food served on campus. Schools were also asked to establish an implementation and evaluation plan. 

The RMPRC’s What’s Working project looked at the initial impact of the Local Wellness Policy in Colorado’s rural, low-income elementary schools.  Before and after the policy mandate went into effect, RMPRC surveyed a random sample of 45 low-income elementary schools about nutrition and physical activity.  The survey looked at a range of evidence-based practices such as the number of fruit and vegetable offerings at breakfast and lunch, number of minutes of recess per week, minutes in physical education, and school knowledge of the Local Wellness Policy.

The study found that local wellness policies were weakly worded and that most of the time, principals weren’t familiar with the contents of their districts’ policy.  In low-income, rural Colorado, opportunities for physical activity decreased.

After the Local Wellness Policy went into effect, physical education increased by 14 minutes per week, but recess decreased by 19 minutes. Modest progress was made in the nutrition arena, however: increases in the percent of schools with policies stipulating predominantly healthy items be offered in classroom parties, daily fresh fruit offerings in the lunchroom, and the % of schools using skinless poultry.

Interviews with principals and superintendents suggested that barriers to the Local Wellness Policy included weak policy language, competing school priorities, principals’ lack of knowledge about the policy, lack of financial resources for implementation and a lack of accountability mechanisms, says Dr. Belansky.

“Principals are more focused on academic achievement and No Child Left Behind. While they value students’ health, they frequently told us they didn’t have the time or resources to implement a Local Wellness Policy,” she says.

“To improve school health, I would recommend that schools partner with groups that have the expertise and time to conduct literature reviews and identify evidence-based interventions such as a university group or local public health agency,” Dr. Belansky believes. “It’s unfair to ask schools to improve their health programs without providing financial or staff resources dedicated to those programs.”

“A school is a ripe environment for teaching and promoting a healthy lifestyle.  All the ingredients are there: a school nurse, teachers, the cafeteria, a playground, a gym, and a PE teacher who can support healthy development.”