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Learning Center Experience
By Jeanette Andrade, PhD, RDH/LDN
obesity remains a leading public health problem in the United States. According
to a 2011–2012 report, 17% or 12.7 million children and adolescents aged 2–19
years are obese (Ogden, Carroll, Kit, & Flegal, 2014). (However the rate of
obesity among 2–5 year olds has decreased from 13.9% in 2003–2004 to 8.4% in
2011–2012 (Ogden et al., 2014).)
Childhood obesity is not just a problem in the
U.S., but around the world. In 2013, the World Health Organization (WHO) reported
that globally 42 million children aged 0–5 years were overweight or obese and
that the developing countries (e.g., Guatemala and South Africa) have 30% more
children overweight or obese compared to developed countries (e.g., Norway and U.S.)
(WHO, 2015). The risks associated with childhood obesity include a number of
health complications, chronic diseases, and conditions such as type II diabetes
and cardiovascular disease (Ogden et al., 2014; WHO, 2015). Thus, childhood
obesity is not a problem of industrialized countries, but a matter of global
factors may contribute to the rate of childhood obesity, including socioeconomic
status, parenteral education levels, race, and ethnicity (CDC, 2015;
Cunningham, Kramer, & Narayan, 2014). Other factors that contribute to
childhood obesity are the child’s eating and sedentary behaviors (Finch, 2010).
Since the 1980s, children have been decreasing the amount of daily physical
activity and overconsuming high fat and sugary foods while reducing their
consumption of fresh fruits and vegetables (Mozaffarian, Hao, Rimm, Willett,
Hu, 2011; Reidy, Deming, & Pares, 2014). The U.S. has attempted to combat
the rise in obesity and lack of nutritious choices by implementing stricter
guidelines on the USDA’s National School Breakfast and School Lunch Programs,
as an estimated 31 million children in 2012 consumed lunch from school (Food
and Nutrition Services, 2013). The current recommendations are for children to
consume 25% of their total recommended calories and protein from breakfast and
33% of their total recommended calories and protein from lunch, less than 30%
of their total calories from fat, and 50% of their calories from carbohydrates,
of which 50% should come from whole grains (Institute of Medicine, 2008).
recommendations include provisions on specific amounts of food items based on
food groups and on the child’s grade level. For example, for all grade levels, the
fruit selections need to be fresh, frozen without added sugar, canned in
juice/light syrup, or dried fruit, with no more than half the offerings in 100%
juice form (Food and Nutrition Service, 2012). Additionally, for both breakfast
and lunch, no more than 10% of total calories should come from saturated fats,
and less than 600–740 mg of sodium should be present in these foods (Food and
Nutrition Service, 2012).
Many industrialized and developed countries do have
school lunch polices that meet standards based on food groups and plate methods
(Bonsmann, Kardakis, Wollgast, Nelson, & Caldeira, 2014; Florencio, 2001). For
example, Chile’s school lunch program must provide 800 calories and 15–20 g of
protein regardless of the children’s age. In Peru, the program must provide 30%
of total calories, 70% of total calories from protein, and 100% of daily iron
(Florencio, 2001). In many countries within the European Union, school lunches
must provide 65% of total daily calories, of which 59, 50, and 47% of these calories
must come from fats, protein, and carbohydrates, respectively (Bonsmann et al.,
2014). Like the U.S., European Union countries have standards on the types and
amounts of food groups the school lunches serve to children such as frequency
of serving fried foods and sweetened beverages (e.g., juices) (Bonsmann et al.,
However, not all countries, especially developing countries with extreme
poverty, have a school lunch policy in effect due to finances and lack of
dietary diversity. Thus, in 2009, the UN World Food Programme provided school
meals in 70 countries and the World Food Bank Group created a Global Food
Crisis Response facility that was able to generate $1.2 billion to help these
countries provide at least one school meal to children (Bundy, Burbano, Grosh,
Gelli, Jukes, & Drake, 2009). Many of these countries have developed a
school lunch policy to ensure that the meal provides at least 20% of their
total calories and sufficient amounts of vitamins A, B12, zinc, and iron (Bundy
et al., 2009).
to other countries, U.S. school lunches are fairly consistent as far as the calories
and macronutrients are concerned. However, the food items placed on trays
around the world are vastly different due to various factors such as culture, religion,
and finances. A typical elementary school lunch in the U.S. may have four
different choices and may be on a 21-day rotating menu cycle. For instance, a
meal for one day would include a choice among these main dishes: chicken sandwich,
hot dog, sunflower butter and jelly sandwich, or Italian salad with a breadstick.
The sides may include a choice between 1 vegetable and 1 fruit such as carrots
or cauliflower, banana or peaches. The drink choices may be between low-fat
chocolate milk and 1% white milk (Urbana School District #116, 2015).
the standard school lunch meal in England, which is also on a rotating cycle
menu, for one day may consist of breaded beef sticks, mashed potatoes, northern
beans, wheat roll, peaches, and milk (England Public School District #2, 2015).
In Honduras, there is no rotating menu cycle and the elementary school lunch
meal consists of rice, beans, tortillas, and milk (Healthy School Meals, 2000).
Note the author has reviewed the elementary school meal plans from public
schools in these particular countries. High school lunch menus and private
school lunch menus may provide different food items, but these schools should
still adhere to the dietary guidelines established by each country.
In conclusion, the
fight against childhood obesity at home and abroad cannot be fought on school
grounds only. Parents, the community, the government, and health professionals
need to continue to educate and improve social structures to help fight the
childhood obesity epidemic.
Jeanette Andrade is a faculty member of Kaplan University. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University.
Integrated Health and Wellness Solutions of the Future
Healthy Eating Trends
S.A., Kramer, M.A., & Narayan, K.M.V. (2014). Incidence of childhood
obesity in the United States. The New
England Journal of Medicine, 370, 403-411. doi: 10.1056/NEJMoa1309753.
England Public School District
#2. (2015). Elementary October Menu. Retrieved
from http://images.pcmac.org/Uploads/EnglandPublicSD2/EnglandPublicSD2/Departments/DocumentsCategories/Documents/October%20EES%20Menu.pdf on September 30, 2015.
Finch, C.E. (2010). Evolution of the human lifespan and diseases of
aging: Roles of infection, inflammation, and nutrition. Proceedings of the National Academy of Science, 107 (suppl 1),
C. (2001). Developments and variations in school-based feeding programs around
the world. Nutrition Today, 36(1),
and Nutrition Services (2012). New Meal
Pattern Requirements and Nutrition Standards: USDA’s National School Lunch and
School Breakfast Programs. Retrieved from http://www.fns.usda.gov/sites/default/files/LAC_03-06-12_0.pdf on September 21, 2015.
and Nutrition Services (2013). National
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on September 21, 2015.
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(Institute of Medicine) (2008). Nutrition
Standards and Meal Requirements for
National School Lunch and Breakfast
Programs: Phase I. Proposed Approach for Recommending
Revisions. Washington, DC:
The National Academies Press.
D., Hao, T., Rimm, E.B., Willett, W.C., Hu, F.B. (2011). Changes in diet and
lifestyle and long-term weight gain in women and men. New England Journal of Medicine, 364, 2392-2404.
C.L., Carroll, M.D., Kit, B.K, & Flegal, K.M. (2014). Prevalence of
childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association,
311(8), 806-814. doi:10.1001/jama.2014.732
Reidy, K., Deming, D., & Pares, G.
(2014). Dietary impact: Results of FITS
in US and MING in China. Retrieved from https://www.nestlenutrition-institute.org/resources/library/Free/journalarticle/Dietary_Impact_Results_of_FITS_in_US_and_%20MING_in_China/Pages/Dietary_Impact_Results_of_FITS_in_US_and_MING_in_China.aspx
on September 21, 2015.
School District #116 (2015). September
Urbana Elementary Schools Menu. Retrieved from http://www.usd116.org/files/FoodService/foodmenus/Elementary-both-ENG.pdf
on September 30, 2015.
Health Organization (WHO) (2015). Commission
on Ending Childhood Obesity. Retrieved from http://www.who.int/end-childhood-obesity/facts/en/ on September
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