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Dr. Ayala

Dr. Ayala
Philadelphia, Pennsylvania, USA
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Herbal Water
I’m a physician (Pediatrics and Medical Genetics), artist, and mother of 3 school age active kids. I recently co-founded Herbal Water Inc. (www.herbalwater.com) with my husband, Albert. I am a serious home cook, and love to entertain. My expertise is vegetarian food (I have been a vegetarian all my life). I strongly believe that eating healthy and enjoying good food go hand in hand. My main interests are science, nutrition and art, and I am overall a very curious person that tries to learn something new every day. Dr. Ayala (Ayala Laufer-Cahana M.D.)


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FEBRUARY 23, 2009 9:55AM

Not a healthy choice: junk foods vs. school lunches

Rate: 13 Flag

I devoted a recent post to the school lunch program, a federally sponsored and regulated program, which complies with some (if not altogether satisfactory) nutrition standards for nutrient content and portion size. I was grousing about the sorry state of the food our young ones are served under the guise of an “improved” lunch program.

But to get the full picture of the school food environment, we need to also look at the competitive foods sold in schools–foods that are expressly marketed to our kids–which make up a big part of what kids actually eat while they’re in school.

What are competitive foods? They’re anything sold, served or given to the kids that isn’t part of the school subsidized lunch. They are comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events. The lunch money parents give their kids may very well be spent on these offerings, rather than on the school lunch.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict, in which schools share an interest with the manufacturers of snacks and junk foods.

The US Department of Agriculture administers and regulates the school lunch program, but has practically no control over other foods and drinks available at schools (although some school districts have taken initiatives to impose restrictions banning some junk food sales in schools). In fact, the only existing federal restriction is that foods of “minimal nutritional values”, such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors.

You can imagine that if the content of the regulated school lunch leaves a lot to be desired, the completely unregulated competitive food scene would be a free-for-all candyland galore.

The Journal of the American Dietetic Association’s special supplement this month analyzed the data from the third School Nutrition Dietary Assessment Study. One of the papers is devoted to competitive foods. The data was collected in 287 nationally representative schools and included 2,314 kids.

These were the main findings:

Availability: One or more sources of competitive foods was available in 73 percent of elementary schools, 97 percent of middle schools, and 100 percent of high schools. À la carte foods sold in the cafeteria were common in all school levels. Vending machines were available in more than one quarter of elementary schools, 87 percent of middle schools and virtually all high schools.

Consumption of competitive foods: Overall about 40 percent of the kids consumed these foods on any given day. Consumption was much higher in high school and reached 55 percent.

Energy contribution of competitive foods: Overall kids consumed about 280 calories/day from competitive foods, and almost two thirds of these calories were from foods of low-nutrient and energy-dense food (the study defined “low-nutrient energy-dense food” to include cakes/cookies and other desserts, donuts, toaster pastries, snack chips, French fries and caloric beverages excluding milk and 100% juice). These numbers varied by school type, with middle and high school kids getting more calories from competitive foods. A typical high school kid gets about 340 calories/day from competitive foods, 65 percent (or 220 calories) of which are from junk food.

The most commonly consumed competitive foods: Desserts and snacks were selected by just over 50 percent of kids; these products include cakes, cookies, candy and ice cream. Sweetened beverages were consumed by almost half the kids--these include juice drinks (not 100% juice) and carbonated soda.

The authors conclude:


“SNDA-III (third School Nutrition Dietary Assessment Study) data indicate that consumption of competitive foods was widespread, particularly in middle and high schools. Sources of competitive foods varied by type of school, with vending machines and à la carte purchases most common in middle and high schools and fundraisers and other school activities most common in elementary schools. The specific competitive foods consumed most frequently were low-nutrient, energy-dense foods such as fruit drinks/sport drinks, cookies/cakes/brownies, candy, and carbonated sodas. On average, children who consumed one or more competitive foods obtained 177 calories (8% of total daily energy intake) from low-nutrient, energy-dense competitive foods.”

So, we have low-quality foods sold in the schools competing with a low-quality school lunch–a competition that’s a lose-lose for our kids. Wherever our kids turn they have snacking opportunities that contribute mostly empty calories.

Many parents commented on my previous school lunch post, and told me that they opt to pack a lunch for their kids. It’s sad to say, but for most American kids the only potential source for a healthy nutritious lunch may be the lunchbox from home.

No matter how you approach the school lunch issue, I'm convinced that we as parents have more influence on our kids’ food choices–through what we do, what we say and how we eat–than anyone else. It’s within our reach to exert our influence to better our kids' diet and health.

More on vending machines and the foods they offer here.

Do you give your kids money to buy food at school? What advice do you give them about their choices for lunch?

Dr. Ayala

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This is a super-important issue, and I've been really happy to see it get a little attention recently. We as a nation still do a terrible job of teaching people to eat real food, and we seem to throw up as many obstacles as possible to understanding nutrition and making good choices. I recently returned to my old high school for a conference of the Ohio Ecological Food and Farm Association, and saw that they had made changes in the cafeteria, and the vending machine offerings were less objectionable than they once had been. It seems that we're making some progress, however slowly.
The past couple of years my two kids have taken money for lunch. This year they both wanted to take lunches. The elementary school student had a choice between a couple of entrees (on adorable, tiny cardboard trays from the cafeteria) and the middle schooler got to choose from semi-healthy things.

I like being able to toss in things like a handful of almonds and cashews, celery with peanut butter (sounds awful, doesn't it?), a healthy sandwich like turkey (the cats ALWAYS help me make sandwiches in the morning), some crackers, some homemade cookies, maybe a tiny yogurt cup or an apple.

I love making lunches. Ample tasty food for the mice.
i got to do high school in 5 different schools, and the only decent lunch was in the minority-majority w. r. farrington, in honolulu. the kids there, almost exclusively 'brown' and poor, got a nutritious and passably tasty meal way ahead of the fried and stewed glunge 'white-bread' schools on the mainland were supplying. this was in the '50's, god knows what's happening now.

part of it was oriental cuisine, to suit the ethnic make-up of the school, maybe part of it was strong interest in what was going on in the school by parents. i hope the kids there today are doing as well.
Dr. A.,

Interesting post. There is an unspoken assertion in your post that the competitive foods available in schools and even the foods served in school lunch programs may cause problems in children. Can you make a comment or future post concerning the nature of these problems, hopefully citing some large scale, controlled studies that show an association between the various types of food available to children in schools and specific problems?

I am a big fan of Michael Pollan (see: http://www.michaelpollan.com/write.php) and agree that the food available to students in most schools is personally appalling, but I do not feel it is wise to take the schools to task on this issue based on my current knowledge of the nutrition science. The schools have plenty of other pressing problems and one wonders how much difference changing the cuisine in schools might make in terms of student health, academic performance, and behavior. Further, one must consider the types and amount of food that students eat outside of school and wonder if changing the cuisine in schools is really going to have that much of an impact. Finally, one wonders if the schools did substantially change their cuisine to make it more “healthy”, would the students actually eat it. Quite simply, “You can take a horse to water, but you can’t make him drink.”

In short, in view of the many pressing problems that public schools face, is the strength of evidence on this issue such that it is worth taking public school systems to task on this matter? It is one thing to ask that school lunch programs change based on strong studies carried out in school systems and quite another to ask that they change based on unproven or weak hypotheses and personal preferences. Again, thanks for your provocative post.
While I agree this is important, given the epidemic of childhood obesity, I also have a question.

When I was in high school in the 80's, almost every person in my class was fit, thin (although most of the girls didn't believe they were thin, they were) and reasonably athletic. Due to peer pressue most ate exactly the same lunch: a can of Chef Boyardee heated in the cafeteria, potato chips, a bag of candy or candy bar, and a soda.

Not exactly health food - yet it didn't seem to hurt anyone back then. So what's making the difference now?
You might be surprised at how much "competitive food" comes directly from the teacher in the form of candy as a reward for good behavior or correct answers. It's a practice I abhor for a number of reasons, not the least of which involves nutrition, but it is rampant in schools, especially urban ones.
My son did a nutrition comparision of foods served in his elementary school cafeteria for a statewide contest. It was so disgusting to see what was really being served to our kids, maximum fat usually surrounded in some kind of breading. He may not win the contest but I hope we can use the information to educate our local school board and parents...the ones who will drive any kind of change in our communities. Thanks for the article!
Allie - I was just about to make a similar comment. There were exactly 2 fat people in my high school. Two. And I guarantee you, way more kids were eating brownies and cokes and chips from the snack bar, or burgers and fries, than anything healthy on offer. So that gives, why are Americans so much fatter?

I think that lack of exercise is a huge culprit and does not get nearly enough play when discussing the problem of chronic weight problems and obesity observed in teens today.

Kids will always eat junk food. But they are also blessed with reasonably high metabolisms, so if they use up the energy their youth blesses them with, they can generally stay ahead on the weight game. The thing is,kids today are way way way more sedentary. Many don't have PE. Many don't walk or ride bikes on a regular basis after school - they go straight to their electronic toys.

I think if you kept the school lunch program exactly the same but could get kids to exercise 45 minutes a day, we'd see a big difference in weight.
The American Dietetic Association gets a significant amount of funding from the trillion dollar food industry and associated trade groups. It's all about businesss. Many of the students are suffering from depleted brain chemistry that is the byproduct of an overexposure to High-Fructose Corn-Syrup and Aspartame. This causes them to be mildly depressed and driven to junk-food/drink carbohydrate as a means of short term relief. Corrupted carbohydrates destabalize blood sugar levels so dramatically that the brain produces a burst of this feel good hormone Serotonin. Alas the term mood food, comfort food, emotional eating. The trillion dollar food industry's legal drug for this mild depression is junk-food/drink carbohydrate. As proof of this widespread low serotonin condition, the CDC announced that last year alone , 230 million prescriptions were written for these anti depressants or Selective Serotonin Reuptake Inhibitors. This stunning figure did not include refills but it did include children. We lost 368,000 Americans to obesity related illnesses last year and it all starts with the children. However, the mainstream media chooses to focus on a miniscule number of adult elite athletes doing performance enhancing drugs that didn't cause a single fatality in the U.S. last year.
There are 2,500 calories in one pound of fat. For the average student to burn a number like that they would have to spend 10 hours a day in the gym. Exercise is the least efficient way there is to lose weight. When humans consume corrupted carbohydrate even at a starvation level of 900 cals per day, we are still seeing people store excess body fat in places where obesity was unheard of until the arrival of overlyprocessed western style fast-food. The food industry has a death grip on our political system and until America realizes that the epidemic of excess weight gain/obesity is a far bigger threat than any foreign, Islamic, extremest group, we will continue down this treacherous route. Socrates said that in a free society" If people weren't able to maintain good health,that neglect would manifest itself in the form of such huge healthcare costs that it would bankrupt the society". As an aside, all the illegal drugs in America took the lives of fewer than 14,000 last year.
The kids I teach love Doritos and Cheetos.

We don't sell that stuff at school.

Why should it just be at school that we acknowledge that some of the stuff we put into our mouths isn't really "food."

I think at the store they should label things truthfully:

Not Food (just stuff you put in your mouth that may give you an assortment of rather unpleasant health problems)

My own kids eat school lunches sometimes and bring lunches other times. No chips or weird snacks--but we are addicted to ice cream and they aren't entirely soda-free (though I am--of course I drink vino so, ahem....at least it's grapes.)
Gary kaposta, the problem with your theory is that it doesn't answer the question Sandra and I had: why wasn't this a problem before 1990? Kids of our generation ate junk food every day, yet we weren't obese. Why didn't these magical "corrupted carbohydrates" operate as you're saying until after we both graduated? (Depression is a different issue - and I knew many people in my class who could have benefited from being on antidepressants. Back in the day, depressed kids didn't take Prozac, they just killed themselves.)

I'm not sure what your point is intended to be about the 2,500 calories. Yes, to burn that many extra calories in a day, you would have to spend 10 hours in a gym. To cut back on that many calories in a day through diet, you would have to... oh wait, there's no way to do that, because most people require fewer than 2,500 calories per day. What on earth does "per day" have to do with anything?

It's been demonstrated by study after study that exercise, not diet alone, is the key to long term weight loss. One hour just standing instead of sitting burns 100 extra calories; that's half a candy bar right there.
A couple of years back I was on a parents foodservice advisory committee for my local school system. Our school population is very diverse both ethnically and economically. Most of the parents, myself included just wanted to focus on ridding the lunch program of the highly processed foods and junk type foods that had crept their way in to the cafeterias. Unfortunately there were two members of the committee, a government lawyer (big surprise) and a physician who wanted to feed the children nothing but brown rice and tofu and they were so strident and obnoxious, particularly the lawyer, that they ended up dominating every meeting. I quit in disgust after a few months. We did manage to remove most of the junk food items from the menus much to the dismay of the students who now just bring it in from home.
What those two very bright gentlemen never seemed to understand was, you can't force kids to eat what they don't like and they will in fact go hungry instead of eating food they don't want. School systems are fighting on another front of having to comply with government mandates about school nutrition and what HAS to be served. The same government that subsidizes the production of millions of tons of high fructose corn syrup every year that gets pumped into the very same foods we are trying not to serve our children.
Great post!! Thank you for drawing attention to and making people think about what they and their children are putting into their bodies.

Most kids these days get home from school (after mostly sitting on their butts for 8 hours) and get on their computers, text their friends, spend hours watching TV or playing video games and don't get a tenth of the physical exercise that I did when I was a kid.
I used to walk to and from school (in the snow! 10 miles each way! With 200 lbs of books on my back!!!!... sorry slight exaggeration).
After school I would play with my friends, go bike riding, roller skate, swim in the town lake, and walk to and from their houses. It didn't really matter what I ate because I would burn it off. I would eat entire pizzas when I was a kid and I weighed 110 all through high school. Parents now drive their kids everywhere so they don't get abducted. And the foods they prepare are pumped full of hormones so that one animal can produce more meat. Are we really wondering why we and our kids are getting fatter?

The solution is a two parter... healthier foods along with nutrition education, and/or mandatory involvement in after school sports.
Finally, someone from the regular universe has crossed into my alternative universe! Thank you for letting anyone who reads your post know that we are killing our children with the poison we offer them at school under the guise of food!

The Department of Agriculture is the proud pusher of the USDA so called food pyramid, that is upside down for a reason! Like the FDA and several other agencies of our federal government, the USDA although assigned to protect our agriculture, works for agriculture.

That means high glycemic index carbohydrates, most of which are high calorie and low nutrition, are the largest portion of what we are allegedly supposed to eat for optimum health. BGH, bovine hormones and antibiotics are found in all dairy and meat our children are eating when they forgo the donuts.

Trans-fatty acids or transfats are totally acceptable while soda with either killer high fructose corn syrup or neuro-toxic sucralose is abundant. Even the children who choose water instead are ingesting toxic chorine compounds and EPA approved levels of arsenic, cyanide, lead, mercury, etc.

Where is the survey to tell me what "mission statement" these schools have regarding nutrition for our children? Is it any wonder that a third of our children are obese with another third over-weight?