North Carolina school nutrition chief cites problems with new federal rules

Today, during a hearing before the House Subcommittee on Early Childhood, Elementary, and Secondary Education, Dr. Lynn Harvey, the incoming Vice President of the School Nutrition Association (SNA), testified about the costs of complying with new regulations on school meals and snacks. As the Chief of School Nutrition Services for the North Carolina Department of Public Instruction, Harvey discussed how North Carolina schools have struggled with student acceptance of new menus and financial challenges under the new standards.

“Compliance has come at a significant cost for schools in North Carolina and, more important, for students,” she said. “Student participation in school meals has declined by 5% under the new rules.”

Harvey highlighted challenges with the new mandate that all grains offered with school meals must be whole grain-rich.  “For two years, local School Nutrition Directors have offered these items under ideal conditions and have encouraged students to try them. Yet, students continue to reject them because their taste, texture and appearance are quite different from that to which they are accustomed…Students’ dissatisfaction with whole grain-rich biscuits has led to a decline in breakfast participation in 60% of our school districts.”

Harvey also cited the higher cost of meeting the new rules’ mandates and a statewide loss of more than $20 million in a la carte revenue as a result of the Smart Snacks in School mandates. These factors have contributed to “significant financial challenges” in North Carolina’s school meal programs. “Over half of School Nutrition Programs in North Carolina are operating at a revenue loss. The average loss is nearly $2.5 million,” Harvey testified.  She called for increased funding and flexibility under the rules to address these losses.  Harvey submitted to the record similar stories highlighting challenges in school districts in each of the Subcommittee members’ home states:

I believe that the new regulations were rushed to implementation without taking into consideration the impact they would have on plate waste, food costs or customer acceptability. My grandkids go to one of the schools in my district and they used to LOVE eating lunch at school. NOW I get complaints from them every day! (Arizona)

As a dietitian, I do believe it is important for children to get the vitamins and minerals they need to support a healthy lifestyle, but when a lot of that ends up in the trash, it becomes a financial issue as well. There has to be a more cost effective way to get children the nutrition they need- but requiring them to take something that is going to go straight in the garbage is wasteful. (Florida)

I have been offering and encouraging students to choose more 100% whole grains, but there are certain items that just don’t go over well in a whole grain-rich variety. Our Thanksgiving lunch was embarrassing – the whole grain-rich corn bread dressing was sad, sad, sad. We need flexibility to allow exceptions for a few menu items. (Oklahoma)

Ever since the implementation of the new regulations, Bloomfield Hills School’s food service department has seen a decrease each year in the number of students buying lunches. In addition we have seen a decrease in our a la carte sales after the Smart Snacks rule went into effect. If we were allowed to have more flexibility with the regulations we could find the items our students want to eat.” (Michigan)

Children need salt for good health

The health benefits of salt also apply to children.  A recent Washington Post article  notes that it’s possible that sodium aids growth. “As scientists from New Jersey Medical School found out, if you put rats on low-salt diets, their bones and muscles fail to grow as fast as they normally would,” Martin Zaraska reports. “In one of his experiments, Leshem found that children in general reach for more salt than adults do–independent of calorie intake–which may be explained by the needs of their growing bodies.”

This is yet another reason why we should prevent drastic reductions in sodium in school meals.

A tragic example of a misguided zealotry to limit salt intake in a young patient lead to his death. Zaraska reports:

In 1940 the case of a little boy was described in the Journal of the American Medical Association. From the time he was a year old, the boy would go out of his way to eat massive amounts of salt. When he started speaking, one of his first words was “salt.” During a hospital stay (unrelated to his dietary habits), he was put on a low-sodium diet. To prevent him from sneaking around the hospital and stealing salt, he was strapped to his bed. He soon died. The reason? Due to severe and undiagnosed cortico-adrenal insufficiency, his kidneys were unable to retain sodium. Only eating huge amounts of salt had kept the boy alive.

Prevent drastic reductions in sodium in school meals

More scientists doubt salt is as bad for you as the government says.  This excellent Washington Post article explains the science (or lack of science) behind the government recommendations on salt. Left unmentioned is the lack of science regarding healthy salt levels for children. In the absence of such studies, it seems more important than ever to follow the recommendation of the School Nutrition Association (SNA) to hold off on further restrictions on salt in school lunches and breakfasts.

Here is the SNA 2015 position paper on sodium in the re-authorization of the Healthy, Hunger-Free kids Act.

Maintain the Target 1 sodium level reductions and suspend implementation of further targets.

Naturally occurring sodium present in milk, meats and other foods will force schools to take nutritious choices off the menu, and drive more students away from healthy school meals. Studies have shown school meals are more nutritious than packed lunches or lunches purchased from fast food restaurants. Despite these benefits, student lunch participation is down by 1.4 million per day since 2012, when the new standards took effect. Schools made significant sodium reductions to meet Target 1, effective July 2014. Before advancing to Target 2, the Institute of Medicine recommended assessing the impact of Target 1 “on student participation rates, food cost, safety and food service operations to determine a reasonable target for the next period…reducing the sodium content of school meals as specified and in a way that is well accepted by students will present major challenges and may not be possible.” (School Meals:  Building Blocks for Healthy Children)

The Government Accountability Office affirmed that the new standards influenced this decline in participation and warned that forthcoming limits on sodium would remain problematic with cost and product availability making sodium targets difficult for many schools to implement.

The health benefits to students choosing nutritious school lunches within Target 1 sodium limits is clear. Additional sodium reductions, at the risk of decreasing student participation, are not merited based on the inconclusive evidence on the benefits of sodium reduction for children.

National School Lunch Program

Sodium Reduction Targets

Grades Target 1
July 2014
Target 2
July 2017
Final Target
July 2022
K-5 ≤1,230 ≤935 ≤640
6-8 ≤1,360 ≤1,035 ≤710
9-12 ≤1,420 ≤1,080 ≤740


I support the School Nutrition Association proposals

The most recent New York Times article on school lunch controversies was written by Nicholas Confessore, a political correspondent. His article focuses on personalities and doesn’t address the substance of the advocacy of the School Nutrition Association (SNA) for changes in some of the new regulations.

He calls the members of SNA “lunch ladies,” a term he says that almost nobody in Washington uses in public and almost everyone uses in private.

The consistent use of this term throughout the article adds to a dismissive bias against critics of certain regulations. I think that Congress should change some school lunch requirements. Perhaps the Times should assign some of its science reporters to explain the scientific, rather than the political, controversies on subjects such as salt and fat.

It is misleading to imply that this is a contest between politicians and scientists. At one point in the article, Confessore describes the School Nutrition Association as “isolated.” He cites other organizations that opposed the one-year waiver of some of the school meal standards.

So, instead of trying to explain the rationale behind certain rules, such as the amount of sodium in school lunches and breakfasts, the Times instead subtly tries to persuade its readers to ignore the “isolated” lunch ladies. The article refers to the federal dietary guidelines for sodium, but does not note the new studies questioning these guidelines or the Times editorial noting these questions.

Is this an article about the latest fashions, or the latest in the science of nutrition?

I support the school lunch ladies.





More on salt and health

If you are looking for a good summary about the recent scientific studies on salt and health, the New York Times editorial board says, “There is considerable evidence that lowering sodium can reduce blood pressure, but there is scant evidence that reducing blood pressure from levels that are not clearly high will necessarily reduce the risk of heart attacks, strokes and death.”

Previous studies have found little evidence to support those low recommended sodium targets. Now a large study by researchers at McMaster University in Ontario, Canada, which tracked more than 100,000 people from 17 countries on five continents, has found that the safest levels of sodium consumption are between 3,000 and 6,000 milligrams. Consumption below that level (but higher than our current targets) showed increased risk of death and cardiovascular events. Roughly 10 percent of the patients followed in the study fell below 3,000 milligrams, a sizable number to put at risk. Other studies have found that very low levels of sodium can disrupt biochemical systems that are essential to human health or trigger hormones that raise cardiovascular risk

Clearly the U.S. Department of Agriculture should reconsider how far to reduce salt content in school meals.

USDA should reconsider how far to reduce salt content in school meals

Just One Minute has an interesting summary of three recent studies of salt and health. Some news reports focus on the dangers of too much salt, other reports about the same studies say the currently recommended amount of salt may be too low. “New research suggests that healthy people can eat about twice the amount of salt that’s currently recommended — or about as much as most people consume anyway,” NBC news reports. “The controversial findings could potentially undercut widespread public health messages about salt.”

More from the NBC report:

An international study of more than 100,000 people published Wednesday in the New England Journal of Medicine suggests that while there is a relationship between salt intake and high blood pressure, if you don’t already have high blood pressure and you’re not over 60 or eating way too much salt, salt won’t have much impact on your blood pressure.

In fact, people who consumed 3,000 to 6,000 milligrams per day had a lower risk of death and cardiovascular events than those who had more than 6,000 mg or less than 3,000 mg.

This tends to lend support to the position of the School Nutrition Association (SNA), which recommends suspending the implementation of sodium Target 2 pending the availability of scientific research that supports the reduction in daily sodium intake for children. To see the reductions scheduled to be made by school year 2017-18, as as well as the final target scheduled for 2022-23, see the table below:

Previous Nutrient Standards

Current Standards K-12 (as of 7/1/12)


Reduce, no set targets

Target  1: SY 2014-15


Target 2: SY 2017-18

Final target: 2022-23






















SNA makes the following recommendation:

Retain the July 1, 2014 Target 1 sodium levels, and suspend implementation of further sodium levels unless and until scientific research supports such reductions for children. Schools are already making significant reductions in the sodium levels on school menus to meet the first sodium reduction target, which goes into effect in July 2014.

Here are the reasons SNA gives for this recommendation:

The Institute of Medicine states that before advancing to Target 2, “it would be appropriate to assess progress and effects of the actions on student participation rates, food cost, safety and food service operations to determine a reasonable target for the next period. The committee recognizes that reducing the sodium content of school meals as specified and in a way that is well accepted by students will present major challenges and may not be possible.” (School Meals: Building Blocks for Healthy Children)

Naturally occurring sodium present in milk, meats and other foods, make the later sodium targets extremely difficult to achieve. Popular and healthy choices such as low-fat, whole grain cheese pizza, macaroni and cheese and deli sandwiches could be stripped from school menus if manufacturers are unable to develop cheeses that meet these extreme standards.

Many schools have already experienced increased plate waste, increased costs, and declines in student participation as they have transitioned to lower-sodium foods. Before school meal programs are forced to make additional costly changes, more scientific research should be done into the efficacy of further reducing children’s sodium intake.

How menus are changing in Fairfax school cafeterias

The May issue of Fairfax Voter features an article describing the changes that have recently been made in the school cafeterias in Fairfax County. Some of the questions that are mentioned in this newsletter of the League of Women Voters of the Fairfax Area were also raised in an Associated Press report featured on WTOP today.

“Some schools say the changes have been expensive and difficult to put in place, and school officials are asking Congress and the Agriculture Department to roll back some of the requirements,” according to  Mary Clare Jalonick. “Their main concerns: finding enough whole grain-rich foods that kids like, lowering sodium levels and keeping fruits and vegetables from ending up in the trash.”

In addition to meeting the new U.S. Department of Agriculture requirements for school meals, Fairfax County Public Schools has studied and implemented several other changes and plans are underway for further improvements. An update on these plans is included in the agenda for a school board work session May 12 at 11 a.m.

If you would like to join in one of the group discussions sponsored by the League, check out the 10 meeting locations listed on page 7 of the Voter.  The meeting dates are May 8, May 12, May 13, and May 14.

Real Food for Kids participates in White House event

JoAnne Hammermaster, Sam Hammermaster, Michelle Obama







Sam Hammermaster (right) watches as First Lady Michelle Obama greets his mother, JoAnne Hammermaster.

Real Food for Kids Executive Director JoAnne Hammermaster was invited to the White House on February 25 to share the work of Real Food for Kids in promoting health and wellness in Fairfax County Public Schools.

Hammermaster’s appearance preceded an announcement from First Lady Michelle Obama and U.S. Secretary of Agriculture Tom Vilsak on new proposed policies to limit sugary beverage and junk food marketing in public schools.  The new rules will help ensure that foods marketed to students align with the new standards for snacks and lunches put in place through the Healthy Hunger Free Kids Act of 2010.

“The idea here is simple,” said Obama, “when parents are working hard to teach their kids healthy habits at home, their work shouldn’t be undone by unhealthy messages at school.”

This action comes after the White House Summit on Food Marketing to Children last fall where Mrs. Obama called on the country to ensure children’s health was not undermined by marketing of unhealthy food.

“The food marketing and local wellness standards proposed today support better health for our kids and echo the good work already taking place at home and in schools across the country.  The new standards ensure that schools remain a safe place where kids can learn and where the school environment promotes healthy choices.  USDA is committed to working closely with students, parents, school stakeholders and the food and beverage industries to implement the new guidelines and make the healthy choice, the easy choice for America’s young people,” Secretary Vilsack said.

To help schools with the implementation of the school wellness policies, the U.S. Department of Agriculture has launched a new “School Nutrition Environment and Wellness Resources” website, which includes sample wellness policy language for school districts and a dedicated page of resources for food marketing practices on the school campus.

These new resources will complement a second announcement which highlights the nationwide expansion of a successful program that was piloted in 11 states  with the goal of ensuring children who are in need of nutritious meals are receiving them.  Beginning July 1, 2014, more than 22,000 schools across the country—which serve primarily low-income students—will be eligible to serve healthy free lunches and breakfasts to all students.  This will help as many as nine million American children eat healthy meals at school, especially breakfast, which can have profound impacts on educational achievement.  Research shows that kids who eat breakfast in the classroom preform over 17 percent better on math tests and have fewer disciplinary problems.

Hammermaster’s son, Sam, also addressed the group on the importance of learning healthy eating habits at a young age and how it has informed the food choices he now makes.

A highlight of Tuesday’s event was the First Lady’s reference to the Marshall High School Statesmen Station “wRap” which has been recently updated for national school audiences. The First Lady quoted lyrics from the rap and later tweeted about it from #FLOTUS. Marshall Principal Jay Pearson and wRap co-author Nikki Pope, from Marshall, were in the audience.

Lunch starts at 10:30 a.m. or earlier at 41 Fairfax County public schools

Fairfax County Public Schools serves lunch at 10:30 a.m. or earlier in 41 schools. Prismatic, which submitted a report on the FCPS Food and Nutrition Services, recommends that FCPS should adopt a division policy on lunch start times. “This is an area that will require school board review and action. It is contrary to the guidelines of national organizations to begin offering lunch service within the first two hours of school and to offer it during what most adults would consider to be breakfast times.”

At the November 11 work session when this report was presented, Sandy Evans (Mason District)  asked for a list of the schools which served lunch at 10:30 or earlier.  Susan Quinn, FCPS chief financial officer, provided the following response:

Elementary Schools

10:00    Forestdale ES
10:15     Churchill Road ES, Kings Park ES,  Lynbrook ES, Sangster ES
10:20     Bonnie Brae ES, Cardinal Forest ES, Mount Vernon Woods ES
10:30     Cub Run ES, Groveton ES, Gunston ES, Hollin Meadows ES, Hutchison ES, London Towne ES, Pine Spring ES, Sleepy Hollow ES, Spring Hill ES, Stratford Landing ES

Middle Schools

10:05     Carson MS
10:10     Longfellow MS
10:13     Holmes MS
10:20     Kilmer MS
10:22     Stone MS
10:30     Poe MS

 High Schools

10:10     South Lakes HS
10:20     Fairfax HS
10:21     Stuart HS
10:22     Herndon HS, Madison HS
10:23     Lee HS, Mount Vernon HS
10:25     Woodson HS
10:28     Annandale HS
10:29     Edison HS
10:30     Chantilly HS, Falls Church HS, Oakton HS, West Potomac HS

Secondary Schools:

10:00    Lake Braddock SS, Robinson SS
10:18     Hayfield SS

The consultants for Prismatic said that there could be costs associated with changing the early start times for lunch:

….In schools where classrooms have been added without a commensurate expansion of the cafeteria, the solution may be to expand the cafeteria footprint. In some schools, moving the first lunch period to a later time may result in increased labor costs, if the current schedule has little idle time between the breakfast and lunch periods. However, these costs will likely be at least partially offset by an increase in participation in schools where lunch will be served at more appropriate lunch times, which are also times when students are more likely to be hungry.
What a concept, serving lunch at a time when students are more likely to be hungry. It reminds me of the equally startling idea of starting school when students are actually awake and ready to learn.

Will USDA change its requirements for reducing salt in school lunch and breakfast programs?

Recent studies that examine links between sodium consumption and health outcomes support recommendations to lower sodium intake from the very high levels some Americans consume now, but evidence from these studies does not support reduction in sodium intake to below 2,300 mg per day, says a new report from the Institute of Medicine. Perhaps this means that the U.S. Department of Agriculture may need to reevaluate the timeline and amount of sodium reduction in the nutrition standards in the National School Lunch and School Breakfast programs.

Despite efforts over the past several decades to reduce dietary intake of sodium, a main component of table salt, the average American adult still consumes 3,400 mg or more of sodium a day – equivalent to about 1 ½ teaspoons of salt. The current Dietary Guidelines for Americans urge most people ages 14 to 50 to limit their sodium intake to 2,300 mg daily. People ages 51 or older, African Americans, and people with hypertension, diabetes, or chronic kidney disease – groups that together make up more than 50 percent of the U.S. population – are advised to follow an even stricter limit of 1,500 mg per day. These recommendations are based largely on a body of research that links higher sodium intakes to certain “surrogate markers” such as high blood pressure, an established risk factor for heart disease.

The expert committee that wrote the new report reviewed recent studies that in contrast examined how sodium consumption affects direct health outcomes like heart disease and death. “These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “But they also suggest that lowering sodium intake too much may actually increase a person’s risk of some health problems.”

The New York Times  provides a good summary of the issue in today’s edition:

Although the advice to restrict sodium to 1,500 milligrams a day has been enshrined in dietary guidelines, it never came from research on health outcomes, Dr. Strom said. Instead, it is the lowest sodium consumption can go if a person eats enough food to get sufficient calories and nutrients to live on. As for the 2,300-milligram level, that was the highest sodium levels could go before blood pressure began inching up.

In its 2005 report, the Institute of Medicine’s committee said that sodium consumption between 1,500 and 2,300 milligrams a day would not raise blood pressure.

That range, Dr. Strom said, “was taken by other groups and set in stone.” Those other groups included the Department of Agriculture and the Department of Health and Human Services, which formulated dietary guidelines in 2005.

But those dietary guidelines will soon be revised, with new recommendations to be issued in 2015.

The baseline of the average current sodium levels in National School Lunches as offered in grades K-5 is 1,377 mg. This is scheduled to be reduced to 1,230 mg or less in July 2014, 935 mg in 2017, and 640 mg in 2022. The sodium levels for grades 6-8 in milligrams is supposed to be reduced from 1,520 to 1,360, then 1035, then 710. For grades 9-12 the reduction from the current 1,588 is supposed to go to 1,420, to 1,080, and then to 740 in 2022.

While cautioning that the quantity of evidence was less-than-optimal and that the studies were qualitatively limited by the methods used to measure sodium intake, the small number of patients with health outcomes of interest in some of the studies, and other methodological constraints, the committee concluded that:

  • evidence supports a positive relationship between higher levels of sodium intake and risk of heart disease, which is consistent with previous research based on sodium’s effects on blood pressure;
  • studies on health outcomes are inconsistent in quality and insufficient in quantity to conclude that lowering sodium intake levels below 2,300 mg/day either increases or decreases the risk of heart disease, stroke, or all-cause mortality in the general U.S. population;
  • evidence indicates that low sodium intake may lead to risk of adverse health effects among those with mid- to late-stage heart failure who are receiving aggressive treatment for their disease;
  • there is limited evidence addressing the association between low sodium intake and health outcomes in population subgroups (i.e., those with diabetes, kidney disease, heart disease, hypertension or borderline hypertension; those 51 years of age and older; and African Americans). While studies on health outcomes provide some evidence for adverse health effects of low sodium intake (in ranges approximating 1,500 to 2,300 mg daily) among those with diabetes, kidney disease, or heart disease, the evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general U.S. population. Thus, the evidence on direct health outcomes does not support recommendations to lower sodium intake within these subgroups to or even below 1,500 mg daily; and
  • further research is needed to shed more light on associations between lower levels of sodium (in the 1,500 to 2,300 mg/day range) and health outcomes, both in the general population and the subgroups.

The report does not establish a “healthy” intake range, both because the committee was not tasked with doing so and because variability in the methodologies used among the studies would have precluded it.

The recent studies suggest that dietary sodium intake may affect heart disease risk through pathways in addition to blood pressure.  “These studies make clear that looking at sodium’s effects on blood pressure is not enough to determine dietary sodium’s ultimate impact on health,” said Strom. “Changes in diet are more complex than simply changing a single mineral. More research is needed to understand these pathways.”

The report was sponsored by the Centers for Disease Control and Prevention. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.