Task Force on Childhood Obesity Summary

Thursday, February 11, 2010

Children’s Access to Nutritious Food:  PreK-12

Senator Purcell, Co-Chair

Representative Yongue, Co-Chair

Dr. Sara Benjamin, Assistant Professor, Department of Community and Family Medicine,

Duke University Medical Center addressed the issue of childhood obesity in preschool children or children in day care and home centers. Almost seventy-five percent of children ages 2-6 are in some form of child care. Does child care attendance contribute to childhood obesity? There are two ways to approach this issue and that is through policy and the other is intervention. North Carolina was given a Grade of C when it comes to state rankings for healthy eating and physical activity regulations. This grading system was done using ten standards for healthy eating and physical activity regulations state by state. Georgia and Nevada, even Mississippi had a B grade compared to NC. After making the assessments of the states it was concluded that most states lacked adequate healthy eating and physical activity policies for family child care homes and NC scored average for child care centers and low for family care homes. Delaware, Alaska, and Massachusetts have a required time for physical activity of 60 minutes for children in all day daycare. Dr. Benjamin shared information on the NAP SACC program (Nutrition and Physical Activity Self-assessment for Child Care Project). They have defined nutrition standards and physical activity areas. They work with child care providers to support their program. An intervention project, “Watch Me Grow” works with community partners to establish gardens for child care facilities to grow fruits and vegetables during the growing season. The NC Child Care Deputy informed members they are working on new rules to require 60 minutes of physical activity as well as limiting video or sedentary time. There were questions about what Massachusetts did and how they were able to implement new standards and she indicated that for the most part new requirements were accepted and they just need time to make the changes.

Jessica Donze Black, National Director, Healthy Schools Program, Alliance for a Healthier Generation Jessica spoke to the group by phone from Washington D.C. The alliance is a joint effort with the Heart Association and the Clinton Foundation. Forty states participate in this organization and more than 3,500 schools nationally. They have developed a best practices framework for schools to achieve. The Child Nutrition Act of 1960’s is reauthorized every five years and USDA is setting their priorities for renewing the law this Spring. Only six states had school nutrition policies in 2004, but that has increased to 27 in 2009. Good nutrition is linked to improved student behavior, lower absenteeism, and reduced tardiness. Eating breakfast at school is linked to greater improvement in standardized test scores and math grades. Physical fitness levels are linked to math performance and less stress. Severely overweight children miss 4 times as much school as normal weight children. Access to competitive foods (a la carte items, we call them extras) are a major problem, but limited access to these problem foods during the school day tends to lead to lesser calorie intake at home too.  Ms. Black provided data on schools and various aspects of their best practices, including policies, school meals, competitive food and drinks, health education, physical education etc. In reviewing the data on the percentage of secondary schools not selling poor nutrition foods, NC’s numbers were between 37 and 45 percent. Congratulations to Scotland Neck Primary and Inborden Elementary (both Halifax County Schools) for being silver award winners for their achievements in reaching the goals of the Alliance for a Healthier Generation.

Dr. Lynn Hoggard Harvey, Section Chief-Child Nutrition Services, Division of School Support, NC Department of Public Instruction Dr. Harvey began her presentation with a question to members. What is the purpose of the Child Nutrition program? Is it a nutritional program promoting growth development and health of students as well as academics or is it a food enterprise program generating funds to support its operations and those of the school system? NC has the eighth largest breakfast and lunch program in the nation with more than 1.8 million meals served daily. Fifty percent of the students qualify for free and reduced lunch. DPI administers the programs for breakfast and lunch as well as the After School Snack Program, Summer Seamless Option, and the Fresh Fruit and Vegetable program. The school lunch program began with President Truman in 1946. Between 1946 and 1980 the philosophy was “this is the right thing to do for children,” but sometime after this the massive federal budget cuts of the eighties resulted in severe cuts and schools began using the a la carte service to keep from going in debt. In 1987 the federal funds were restored, but the a la carte sales did not go away as school systems saw it as a way to make money. In the 90s direct and indirect costs assessments began. The priorities for the Child Nutrition Program changed and they were replaced with “How much revenue can CNS generate?” NC has the fifth fattest student body in the nation. Meal costs have increased over the past five years (4-25 percent higher). The federal reimbursable programs are not the cause of the epidemic, but the school nutrition program can be a part of a solution. NC has piloted the nutrition standards with $25,000 and the standards have not been fully implemented, because the State has not had the funding to move forward.  The estimated cost of implementing the standards in just the elementary schools is estimated at $20 million statewide.  CNS programs are challenged to pay for food, supplies, equipment, technology, salaries and benefits for staff, state mandated pay raises and salary schedules, indirect costs, and any other costs assessed by each LEA. Operating costs have increased by 28 percent from 2005 to 2008, due largely to the high fuel and delivery costs. Funds to operate the CNS program are generated from federal reimbursements (60 percent), local funds (38 percent) and grants.  The major expense in the CNS budget is salaries and benefits ($32 million). The average cost to produce a school lunch is $3.20 however the federal reimbursement is only $2.68, leaving a shortage of $.52 per lunch, which is usually passed on by increasing the cost of school lunches for paying students. As a result the CNS programs have been required to increase the sale of high calorie foods and beverages, return to the sale of fried foods, cut labor, decrease the amount of fruits and vegetables and consider the elimination of the school breakfast program.  The success of the program now becomes a matter of healthy school foods vs. healthy school finances.  Several solutions were provided that included: the CNS program must become a nutrition program, adequate Federal, State, and local funding must be available, school meals must be nutritious, affordable, achievable, and appealing to students, students must have a reasonable amount of time for lunch, and nutrition education must be a part of the curriculum.

Philip Price, Chief Financial Officer, NC Department of Public Instruction provided an explanation of indirect costs, indirect cost rates and how the receipts are expended. NC DPI approves the LEA rates and the formula is federally approved. Rates vary by LEA based on expenditure patterns and they can charge up to the “approved rate”. The LEAs can collect these funds and use without restrictions to pay for anything from teacher’s salaries and benefits to computers. DPI can request that some of the indirect cost receipts be budgeted in the agency to support services. In 2008-2009 Indirect receipts (from the federal funds) totaled $4.6 million and DPI expended $3.6 million.  NC is only one of ten states nationally that does not support the school lunch program with State funding. In 1995-1996, CNS directors funding was collapsed into the state Central Office allotment provided to the LEAs. Fewer than half of the LEAs pay for CNS directors through this fund today most require the CNS enterprise to cover the cost of the director. Any shortage in operating the school lunch program between revenue and expenditures must be covered by local funds.  Over the last two years CNS has requested $20 million in State funding to support providing a nutritious lunch, at a reasonable cost to children. Statewide Indirect costs collected in 2008-2009 totaled $27.8 million. DPI spends federal child nutrition funds for administration and this amounted to $2.7 million in 2008-2009.  Can the indirect costs be tracked or do they simply go into the General Fund for LEAs? Currently, 67 LEAs are running at a deficit and 45 are working with a reduced fund balance.  A request was made to have additional information provided to include the names of the LEAs involved and a breakdown of the 25 percent of the students who were not eating lunch at school. Members are concerned that a portion of the 25 percent of students not eating the school lunch may not be eating anything for lunch. How many high school students leave campus to eat lunch? A complete list of LEAs Indirect cost rates was provided to the members. The restricted percentages ranged from a low of 0.064 percent in Swain County to a high of 7.835 percent in Jones County. Wake and Mecklenburg’s rates were 2.585 and 2.311 respectively. The unrestricted Indirect cost rates low was 9.754 percent in Alexander County and the high of 28.238 percent is in Graham County. Wake and Mecklenburg’s rates were 11.087 percent and 12.798 percent respectively. Finally, Mr. Price provided a list of the purposed codes for school expenditures and which areas the Indirect costs may be spent and the codes where direct costs are disallowed.

Alice Lenihan, Director, Nutrition Services, NC Department of Health and Human Services discussed the origins and influences on childhood obesity. Two scenarios were compared on the birth, feeding, and growth of a child from prenatal to six months and the impact breastfeeding and good nutrition had on the baby’s weight. Several Federal Nutrition Assistance Programs were highlighted including: Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Child and Adult Care Program (CACFP), and National School Lunch Program (NSLP).  The presentation concluded with a brief review of school standards and wellness policy.  There were no questions after the presentation.

Margaret Samuels, Executive Director, Orange County Partnership for Young Children briefly outlined several programs in Orange County for children and the efforts provided by the community to establish nutrition and physical activity environments.  She emphasized the physical activity programs like the “Move It” program sponsored by the Parks and Recreation Department and the “Play More, Move More” program funded by a grant from Blue Cross Blue Shield.  “Preventing Obesity by Design” and the “Growing Healthy Children” were the other nutrition programs mentioned.

Cindy Marion, Director, Child Nutrition Services, Stokes County Co-Chair, Public Policy Committee, School Nutrition Association of NC provided historical legislative information on the school lunch program and addressed some of the challenges impacting Child Nutrition Services across the state. Over the past seven years more than ten bills were introduced at the request of CNS to try and help with some of the issues facing the school lunch program. The program receives 52 percent of their funds from Federal reimbursement, and 47 percent from revenues from meals including a la carte foods and beverages.  The kindergarten breakfast program provides 1 percent of the funding. They serve breakfast to 307,000 students and lunch to 810,000. Sixty-five of the 115 LEAs in the state ended in debt in 2008-2009 losing more than $5 million. Food costs have increased by 40 percent in the last seven years. In addition, the state has mandated salary increases for CNS employees by 19 percent and 31 percent for benefits, with no state funding to support these increased costs. Statewide the CNS programs across NC paid more than $18 million in Indirect costs to LEAs. The CNS programs employee 15,000 people in NC. Senator Purcell asked “What would happen to the program if they did not have to give any Indirect funds to the LEAs?” She responded by saying they do not mind paying the Indirect costs, but they are requesting they have a three months fund balance before they begin distributing those funds to the LEAs.

Cynthia Sevier, Director, Child Nutrition Services, Guilford County Co-Chair, Public Policy Committee, School Nutrition Association of NC presented three short-term goals for the program: 1) to invest the state match funding to Central Administration ($7.2 million) which would allow CNS to eliminate the reduced price category. This would result in an additional $5.2 million in federal reimbursement funds coming into NC, 2) allow Child Nutrition Programs to achieve and sustain a three month operating balance before indirect costs could be assessed, and 3) strengthen the competitive food regulations.  Additional goals, included reimbursement of state funds in quality nutrition programs, options to fund benefits and/or salaries for Child Nutrition employees, and strengthen nutrition education curriculum requirements in the standard course of study. A complete list of possible solutions was provided to the task force for their consideration (a copy is available upon request).

Deborah Carpenter, Director, Child Nutrition Services, Hoke County President, School Nutrition Association of NC provided the members with comments from Child Nutrition Directors statewide emphasizing the challenges, struggles, and accomplishments in providing nutritionally adequate food for their students. She read several quotes from CNS directors to try and help the task force understand some of the major issues. They worry about the cost of fresh fruits and vegetables. Equipment is old and outdated and in some instances falling apart. Lunch prices continue to rise and as they do, more children bring their lunch from home. The CNS programs across the state are having to depend on supplemental sales (a la carte) for money to pay the bills.

Future Meeting Dates:

Monday, February 15, (9:30 am – 3:00 pm) Children’s Physical Activity, BMI, and Fitness

Tuesday, February 23, (10:00 am – 3:00 pm) Food Industry

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