[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
FOOD FOR THOUGHT: HOW TO IMPROVE CHILD NUTRITION PROGRAMS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON EDUCATION REFORM
of the
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
FIRST SESSION
__________
July 16, 2003
__________
Serial No. 108-27
__________
Printed for the use of the Committee on Education and the Workforce
Available via the World Wide Web: http://www.access.gpo.gov/congress/
house
or
Committee address: http://edworkforce.house.gov
______
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WASHINGTON : 2003
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COMMITTEE ON EDUCATION AND THE WORKFORCE
JOHN A. BOEHNER, Ohio, Chairman
Thomas E. Petri, Wisconsin, Vice George Miller, California
Chairman Dale E. Kildee, Michigan
Cass Ballenger, North Carolina Major R. Owens, New York
Peter Hoekstra, Michigan Donald M. Payne, New Jersey
Howard P. ``Buck'' McKeon, Robert E. Andrews, New Jersey
California Lynn C. Woolsey, California
Michael N. Castle, Delaware Ruben Hinojosa, Texas
Sam Johnson, Texas Carolyn McCarthy, New York
James C. Greenwood, Pennsylvania John F. Tierney, Massachusetts
Charlie Norwood, Georgia Ron Kind, Wisconsin
Fred Upton, Michigan Dennis J. Kucinich, Ohio
Vernon J. Ehlers, Michigan David Wu, Oregon
Jim DeMint, South Carolina Rush D. Holt, New Jersey
Johnny Isakson, Georgia Susan A. Davis, California
Judy Biggert, Illinois Betty McCollum, Minnesota
Todd Russell Platts, Pennsylvania Danny K. Davis, Illinois
Patrick J. Tiberi, Ohio Ed Case, Hawaii
Ric Keller, Florida Raul M. Grijalva, Arizona
Tom Osborne, Nebraska Denise L. Majette, Georgia
Joe Wilson, South Carolina Chris Van Hollen, Maryland
Tom Cole, Oklahoma Tim Ryan, Ohio
Jon C. Porter, Nevada Timothy H. Bishop, New York
John Kline, Minnesota
John R. Carter, Texas
Marilyn N. Musgrave, Colorado
Marsha Blackburn, Tennessee
Phil Gingrey, Georgia
Max Burns, Georgia
Paula Nowakowski, Chief of Staff
John Lawrence, Minority Staff Director
------
SUBCOMMITTEE ON EDUCATION REFORM
MICHAEL N. CASTLE, Delaware, Chairman
Tom Osborne, Nebraska, Vice Lynn C. Woolsey, California
Chairman Susan A. Davis, California
James C. Greenwood, Pennsylvania Danny K. Davis, Illinois
Fred Upton, Michigan Ed Case, Hawaii
Vernon J. Ehlers, Michigan Raul M. Grijalva, Arizona
Jim DeMint, South Carolina Ron Kind, Wisconsin
Judy Biggert, Illinois Dennis J. Kucinich, Ohio
Todd Russell Platts, Pennsylvania Chris Van Hollen, Maryland
Ric Keller, Florida Denise L. Majette, Georgia
Joe Wilson, South Carolina George Miller, California, ex
Marilyn N. Musgrave, Colorado officio
John A. Boehner, Ohio, ex officio
------
C O N T E N T S
----------
Page
Hearing held on July 16, 2003.................................... 1
Statement of Members:
Boehner, Hon. John A., a Representative in Congress from the
State of Ohio, letter submitted for the record............. 76
Castle, Hon. Michael N., a Representative in Congress from
the State of Delaware, prepared statement of............... 2
Putnam, Hon. Adam, a Representative in Congress from the
State of Florida, statement submitted for the record....... 72
Woolsey, Hon. Lynne C., a Representative in Congress from the
State of California, letter submitted for the record....... 77
Statement of Witnesses:
Baranowski, Dr. Tom, Professor of Pediatrics (Behavioral
Nutrition), USDA Children's Nutrition Research Center,
Baylor College of Medicine, Houston, Texas................. 39
Prepared statement of.................................... 41
Bost, Hon. Eric M., Undersecretary, Food, Nutrition, and
Consumer Services, U.S. Department of Agriculture.......... 15
Prepared statement of.................................... 19
Response to questions submitted for the record........... 78
Carmona, Vice Admiral Dr. Richard H., The Surgeon General,
U.S. Public Health Service, U.S. Department of Health and
Human Services............................................. 4
Prepared statement of.................................... 7
Clarke, Betsy, President, National WIC Association, and
Director, Minnesota WIC.................................... 43
Prepared statement of.................................... 45
Frank, Dr. Deborah, Professor of Pediatrics, Boston
University Medical School, Boston, Massachusetts........... 55
Prepared statement of.................................... 58
MacDonald, Gaye Lynn, President, American School Food Service
Association, and Manager, Food Services, Bellingham Public
Schools, Bellingham Washington............................. 50
Prepared statement of.................................... 52
Letter submitted for the record.......................... 87
FOOD FOR THOUGHT: HOW TO IMPROVE CHILD NUTRITION PROGRAMS
----------
Wednesday, July 16, 2003
U.S. House of Representatives
Subcommittee on Education Reform
Committee on Education and the Workforce
Washington, DC
----------
The Subcommittee met, pursuant to notice, at 10:02 a.m., in
room 2175, Rayburn House Office Building, Hon. Michael N.
Castle [Chairman of the Subcommittee] presiding.
Present: Representatives Castle, Osborne, Upton, Wilson,
Woolsey, Davis, Davis, Kucinich, Van Hollen, and Majette.
Ex officio present: Representative Boehner.
Also present: Representative Owens.
Staff present: Amanda Farris, Professional Staff Member;
Kevin Frank, Professional Staff Member; Parker Hamilton,
Professional Staff Member; Kate Houston, Professional Staff
Member; Stephanie Milburn, Professional Staff Member; Deborah
L. Samantar, Committee Clerk/Intern Coordinator; Dave
Schnittger, Communications Director; Denise Forte, Minority
Legislative Associate/Education; Ricardo Martinez, Minority
Legislative Associate/Education; Joe Novotny, Minority
Legislative Assistant/Education; and Lynda Theil, Minority
Legislative Associate/Education.
Chairman Castle. The Subcommittee on Education Reform will
come to order. A quorum being present, the Subcommittee has
come to order.
We are meeting today to hear testimony on ``Food for
Thought: How to Improve Child Nutrition Programs.''
Under Committee Rule 12(b), opening statements are limited
to the Chairman and the ranking minority member of the
Subcommittee. Therefore, if other members have statements, they
may be included in the hearing record.
With that, I ask unanimous consent for the hearing record
to remain open 14 days to allow member statements and other
extraneous material referenced during the hearing to be
submitted in the official hearing record.
Without objection, so ordered.
Typically, at this time, I would read an opening statement,
but I understand the Surgeon General needs to leave at 10:30, I
believe, and we'll have other members who will come in as they
come from their other meetings.
I want to give them all an opportunity, if possible, to
participate in the hearing, so I'm going to at this time
suspend my opening statement, except to say that this is our
first step on the reauthorization of the child nutrition
programs, which sound innocent enough, but get extremely
complicated, quite frankly, from the political point of view,
as we have to deal with a whole variety of issues, a lot of
which we're going to start hearing about today.
At some later point, we will discuss those issues and then
perhaps I'll fit in my opening statement, but I want to allow
the time for this illustrious panel first.
So with that, I will waive anything further and at this
time reserve the right to do it later, and turn to Ms. Woolsey
for her statement.
[The statement of Mr. Castle follows:]
Statement of the Honorable Michael N. Castle, Chairman, Subcommittee on
Education Reform, Committee on Education and the Workforce
Good Morning. Thank you for joining us today for this important
hearing on improving child nutrition programs. These programs are
central to providing the nation's children with access to safe,
affordable, and nutritious food. This marks the first hearing to help
prepare Members of this Committee for the reauthorization of the Child
Nutrition Act of 1966 and the National School Lunch Act, which is
scheduled for this year.
There is general agreement on the importance of good nutrition for
everyone, especially children. Child nutrition programs including the
National School Lunch and Breakfast Programs; the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC); and the Child
and Adult Care Food Program help give lower-income children access to
nutritious meals and snacks.
Proper nutrition is essential for children to achieve full physical
development and long-term health. In addition, a healthy diet is
critical for a child's academic success. Numerous studies have shown
that diet affects children's ability to learn. There are proven
linkages between diet and cognitive development, concentration levels,
and psycho-social behaviors.
The federal child nutrition programs were conceived to offer
wholesome meals and snacks to children in schools and child care
centers and to support the health of lower-income pregnant women,
breastfeeding mothers, and their young children. These programs
represent a huge national investment totaling over $12 billion per
year. While the resources spent have been significant, issues remain
about how to best reach the goal of providing lower-income children
with access to healthy, affordable meals.
Childhood obesity is becoming a major health problem in the Unites
States, and studies suggest that overweight children are significantly
more likely to become overweight or obese adults. Children are
increasingly suffering from conditions traditionally associated with
adulthood, including Type 2 diabetes, high cholesterol, and high blood
pressure. I am very concerned about childhood obesity and the fact that
it is slowly becoming an epidemic.
Last year the U.S. Surgeon General issued a report that identifying
schools as a ``key setting'' for developing public health strategies to
prevent and decrease overweight and obesity. Over the past several
years, programs providing meals and snacks to children have made
progress in improving lunch menus to meet Federal nutrition standards
for fat and calories, but I believe more can be done to provide every
child with a school environment that promotes healthy food choices and
regular physical activity.
In an effort to address this very issue, I introduced legislation,
H.R. 2227, the Childhood Obesity Prevention Act, that would authorize
grants to fund pilot programs at the state and local levels to
encourage the development and implementation of programs to promote
healthy eating and increased physical activity among children. This
Committee will examine additional ways to address the important and
complex issue of childhood obesity during the child nutrition
reauthorization while supporting the role of local school districts to
make decisions about the foods that are available to children in
school.
During reauthorization, this Committee also will consider the
challenges faced by the WIC program as well as issues related to school
meal reimbursement, the School Breakfast Program, and other relevant
provisions aiming to strengthen the nation's child nutrition programs.
Today, we will hear from experts who will help shed light on these
programs--their merits and areas where they can be made stronger. Our
witnesses' unique perspectives on child nutrition and health will offer
insights that will be tremendously helpful to the Members of this
Committee as we work to improve child nutrition programs. We look
forward to their comments.
With that, I would like to recognize Mrs. Woolsey
______
Ms. Woolsey. Mr. Chairman, I, too, will waive a statement
at this point and will do it later.
Chairman Castle. Thank you, Ms. Woolsey.
I will introduce the panel of witnesses at this time:
Vice Admiral Richard Carmona is the United States Surgeon
General--by the way, he has so many titles, I'm not sure what
to call him, but we'll figure it out as we go along--as well as
the Acting Assistant Secretary for the United States Department
of Health and Human Services.
Dr. Carmona was appointed by President George W. Bush and
sworn in as the 17th Surgeon General of the United States
Public Health Service on August 5, 2002.
Prior to his current appointment, Dr. Carmona was Chairman
of the State of Arizona Southern Regional Emergency Medical
System and a professor of surgery, public health, family, and
community medicine at the University of Arizona.
With an obvious love of medicine and community, Dr. Carmona
has worked as a paramedic, registered nurse, and surgeon.
The Honorable Eric M. Bost is our other witness on this
panel, who has been the Under Secretary for Food, Nutrition,
and Consumer Services for the United States Department of
Agriculture since June 18, 2001.
As Under Secretary, he is responsible for the
administration of the 15 USDA Nutrition Assistance Programs,
including the Food Stamp Program, the Special Supplemental
Feeding Program for Women, Infants, and Children, and the
National School Lunch and School Breakfast Programs.
Before holding his current position, Mr. Bost worked as the
chief executive and administrative officer of the Texas
Department of Human Services, where he headed one of the
largest human service agencies in the country .
Mr. Bost also served as the Deputy Director of the Arizona
Department of Economic Security, the Human Services agency with
responsibility of welfare reform, child welfare, and protective
services for children and adults.
Just for ground rules, essentially, we encourage our
witnesses to follow the 5-minute guidelines. You have a green
light for 4 minutes; you have a light for 1 minute; and a red
light until somebody bangs a hammer or does something to stop
the whole proceedings, at which point we will then have a
question and answer period with the members who each will have
5 minutes, as well.
So we welcome both of you here, and we turn now to the
surgeon general. Dr. Carmona, for his testimony.
STATEMENT OF VADM RICHARD H. CARMONA, SURGEON GENERAL, U.S.
PUBLIC HEALTH SERVICE, AND ACTING ASSISTANT SECRETARY FOR
HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Dr. Carmona. Good morning, Mr. Chairman and distinguished
members of the Subcommittee. My name is Richard Carmona, and
I'm the United States Surgeon General.
It's a pleasure to be here with you today, and as an
American and as a parent, I want to thank you for your
leadership in this important area.
Mr. Chairman, you've been a leader in developing innovative
approaches to combat childhood obesity. Thank you for your
commitment to the health and well-being of our children.
As Surgeon General, I welcome the chance to talk with you
about the public health crisis that affects every state, every
city, every community, and every school across our great
nation.
This crisis is obesity. It's the fastest-growing cause of
disease and death in America, and it's completely preventable.
Nearly two out of every three Americans are overweight or
obese. One out of every eight deaths in America is caused by an
illness directly related to overweight and obesity.
America's children are already seeing the initial
consequences of a lack of physical activity and unhealthy
eating habits. Fortunately there is still time to reverse this
dangerous trend.
Let's start with the good news. I am pleased to be able to
report that most of America's children are very healthy. About
82 percent of our nation's 70 million children are in very good
or excellent health. Infant mortality is at an all-time low,
childhood immunization is at an all-time high, and our children
are less likely to smoke and are less likely to give birth as
teenagers. These are important gains in pediatric health.
But the bad news is that an unprecedented number of
children are carrying excess body weight. That excess weight
significantly increases our kids' risk factors for a range of
health problems, including diabetes, heart disease, asthma,
emotional and mental health problems.
Every parent in this room wants the best for their
children, but the fact is that we have an epidemic of childhood
obesity. Today I will discuss three key factors that we must
address to reduce and eliminate childhood obesity in America.
That is, increased physical activity, healthier eating
habits, and improved health literacy.
Looking back to the 1960's, just over 4 percent of six-to-
17-year-olds were overweight. Today that rate has more than
tripled, to over 15 percent, and the problem doesn't go away
when children grow up. Nearly three out of very four overweight
teenagers become overweight adults.
I'm not willing to stand by and let this happen. America's
children deserve much better than being condemned to a lifetime
of serious, costly, and potentially fatal medical complications
associated with being overweight.
The facts are staggering:
In the year 2000, the total annual cost of obesity in the
United States was $117 billion. While extra value meals may
save us pennies at the counter, they're costing us billions of
dollars in health care and lost productivity. Physical
inactivity and super-sized meals are leading to a nation of
oversized people.
This year, more than 300,000 Americans will die from
illnesses related to overweight and obesity. Obesity
contributes to the No. 1 cause of death in our nation, which is
heart disease.
Excess weight has also led to an increase in the Type 2
diabetes. There are at least 17 million Americans with
diabetes, and another 16 million have pre-diabetes. It can lead
to eye disease, cardiovascular problems, kidney disease, and
early death.
Unfortunately, the ever-increasing problem of overweight
among American children cannot be explained away by changes in
genetic composition.
We now know more than ever that the combination of genetic,
social, metabolic, and environmental factors play a role in
this children's weight problem, but the fundamental reason that
our children are overweight is this: too many children are
eating too much and moving too little.
Our children did not create this problem. Adults did.
Adults increased the portion size of children's meals,
developed the games and television that children find
spellbinding, and chose the sedentary lifestyles that our
children now emulate; so adults must take the lead in solving
this problem. In some cases, it's as easy as turning off the
television and keeping the lid on the cookie jar.
I'm very pleased that businesses like Kraft, Coca Cola,
Nike, and others are supporting major efforts and making
significant changes to help kids make healthier choices. These
and other business leaders, foundations, schools and
universities, and parents across the Nation are starting to
make a difference in children's health.
Especially now, during the summer, we need to encourage all
children to be physically active for at least 60 minutes a day,
not only sports, but simple things like taking the stairs,
riding their bikes, and just getting out and playing.
I'll be the first to say it won't be easy. My wife and I
have four kids. Families live very busy lives, and it's tough
to prepare healthy meals and have enough time to get in some
physical activity every day, but it's so important, because the
choices that children make, the behaviors they learn now will
last a lifetime.
To help promote lifestyles, I am visiting schools across
America in my 50 Schools/50 States initiative, to talk with
kids about avoiding drugs and alcohol, avoiding tobacco in
every form, being physically active, eating right, and making
healthy choice in everything they do every day.
Do you know that the average American child spends more
than 4 hours a day watching television, playing video games and
surfing the web? We're seeing a generation of kids who grew up
off the playground and on the PlayStation.
We must all work together to help our children lead healthy
lives. We need physical activity and health food choices in
every school in America. We need better food choices and
affordable prices in every neighborhood in America, and we need
community planning that includes neighborhood playgrounds and
safe walking paths.
Some people want to blame the food industry for our growing
waistlines. The reality is that restaurants, including many
fast-food restaurants, now offer low-fat, healthy choices.
For the meals we eat at home and the meals we eat out, it's
still our decision what we eat, where we eat, and how much we
eat. That concept is part of what I'm talking about with
Americans of all ages, in increasing our health literacy.
Health literacy is the ability of an individual to access,
understand, and use health-related information and services to
make appropriate decisions. Low health literacy contributes to
our nation's epidemic of overweight and obesity. Experience
with my own patients and students indicates that many Americans
don't understand the impact of caloric intake versus
expenditure.
Parents are concerned about calories, carbohydrates,
vitamins, and portion sizes. When kids are growing and
developing, a restrictive diet may not be the best choice for
every child. Just as with adults, one diet does not fit every
child. As parents, we know that.
But when we see a child gaining weight and not exercising
enough, we see the social and psychological pain that it is
causing. When we see a child's self-esteem drop day by day
because he or she is left out of schoolyard games, or because
he or she just can't keep up with the other kids on their
bikes, we know that they need help and we must help those
children.
I'm pleased to hear that moms and dads are asking about how
to establish healthy eating habits for their children. Moms and
dads must be involved in these decisions for their children.
Children come in all shapes and sizes, and sometimes a child
just needs a little more physical activity and a little less
food intake. It's about balance.
To make healthy choices, parents and children need to
understand information that fits into their busy lifestyles.
All of us--government, academia, health care professionals,
businesses, schools, and communities--need to work together to
ensure that straightforward information about health eating and
physical activity is available.
I don't have all the answers today, but we can figure this
out together. We can increase health literacy and reduce
childhood obesity.
President Bush and Secretary Thompson have been pioneers in
getting prevention into the American mindset. We're starting to
see some results, and we need your help. As Members of
Congress, as members of your communities, and as parents, you
are role models and leaders.
Please work with me to support our efforts to improve
Americans' health literacy, to put prevention first in all we
do, and to end our nation's obesity epidemic before it has a
chance to reach into another generation of Americans.
With that, I will end my oral testimony. I would ask to be
able to submit my entire written statement into the record, and
I'd be happy to answer any questions; and Mr. Chairman, thank
you for the privilege of speaking and allowing me to go first
so I can catch my flight.
[The prepared statement of Dr. Carmona follows:]
Statement of Richard H. Carmona, M.D., M.P.H., F.A.C.S., Surgeon
General, U.S. Public Health Service, Acting Assistant Secretary for
Health, Department of Health and Human Services
Good morning Mr. Chairman and distinguished members of the
Subcommittee. My name is Dr. Richard Carmona, and I am the Surgeon
General of the United States.
As an American, I want to take this opportunity to thank you for
your service to our nation. I've had the honor of working with many of
you during my first 11 months as Surgeon General, and I look forward to
strengthening our partnerships to improve the health and well-being of
all Americans.
Mr. Chairman, you have been a leader in developing innovative
approaches to combat childhood obesity. Thank you for your commitment
to the health and well-being of our children. The hearing you have
called today will draw further public attention to this growing
pediatric health crisis.
As Surgeon General, I welcome this chance to talk with you about a
health crisis affecting every state, every city, every community, and
every school across our great nation.
The crisis is obesity. It's the fastest-growing cause of disease
and death in America. And it's completely preventable.
Nearly two out of every three Americans are overweight or obese.
One out of every eight deaths in America is caused by an illness
directly related to overweight and obesity.
Think of it this way: statistics tell us that of the 20 members
serving on this subcommittee, at least two will die because of a
completely preventable illness related to overweight or obesity.
Because of overweight or obesity, two of you will spend less time
serving your communities and enjoying your children and grandchildren.
America's children are already seeing the initial consequences of a
lack of physical activity and unhealthy eating habits. Fortunately,
there is still time to reverse this dangerous trend in our children's
lives.
Let's start with the good news: I am pleased to be able to report
that most of America's children are healthy.
Overall, 82 percent of our nation's 70 million children are in very
good or excellent health. Infant mortality is at an all-time low,
childhood immunization is at an all-time high. Our children are less
likely to smoke, and less likely to give birth as teenagers.
These are important gains in pediatric health.
But the bad news is that an unprecedented number of children are
carrying excess body weight. That excess weight significantly increases
our kids' risk factors for a range of health problems, including
diabetes, heart disease, asthma, and emotional and mental health
problems.
As a father, I work hard to teach my children about the importance
of physical activity and healthy eating. Every parent in this room
wants the best for their children.
But the fact is that we have an epidemic of childhood obesity. A
study conducted in May by the New York City Department of Health and
Mental Hygiene and the Department of Education found that, adjusted to
National Standards, nearly one in four of the children in New York
City's public elementary schools is overweight.
Today I will discuss the three key factors that we must address to
reduce and eliminate childhood obesity in America. They are:
1. Increased physical activity;
2. Healthier eating habits; and
3. Improved health literacy.
Mr. Chairman, I ask that my statement and the scientific
information contained in it be considered as read and made part of the
record. In the interest of time, this morning I will present only part
of that statement to the subcommittee.
Looking back 40 years to the 1960s, when many of us in this room
were children, just over four percent of 6- to 17-year-olds were
overweight. Since then, that rate has more than tripled, to over 15
percent. And the problem doesn't go away when children grow up. Nearly
three out of every four overweight teenagers may become overweight
adults.
I'm not willing to stand by and let that happen. American children
deserve much better than being condemned to a lifetime of serious,
costly, and potentially fatal medical complications associated with
excess weight. The facts are staggering:
In the year 2000, the total annual cost of obesity in the United
States was $117 billion. While extra value meals may save us some
change at the counter, they're costing us billions of dollars in health
care and lost productivity. Physical inactivity and super-sized meals
are leading to a nation of oversized people.
This year, more than 300,000 Americans will die from illnesses
related to overweight and obesity.
Obesity contributes to the number-one cause of death in our nation:
heart disease.
Excess weight has also led to an increase in the number of people
suffering from Type 2 diabetes. There are at least 17 million Americans
with diabetes, and another 16 million have pre-diabetes. Each year,
diabetes costs America $132 billion. It can lead to eye diseases,
cardiovascular problems, kidney failure, and early death.
Why are we facing this epidemic of overweight and obesity? Over 50
genes associated with obesity have been located in the human gene map.
But the ever-increasing problem of overweight among American children
cannot be explained away by changes in genetic composition.
Studies conducted by HHS' National Institutes of Health and the
Centers for Disease Control and Prevention are already yielding
important clues about the multiple factors that contribute to
overweight and obesity. Studies are also providing new information
about potentially successful interventions.
We know more than ever about the combination of genetic, social,
metabolic, and environmental factors that play a role in children's
weight.
But the fundamental reason that our children are overweight is
this: Too many children are eating too much and moving too little.
In some cases, solving the problem is as easy as turning off the
television and keeping the lid on the cookie jar.
Our children did not create this problem. Adults did. Adults
increased the portion size of children's meals, developed the games and
television that children find spellbinding, and chose the sedentary
lifestyles that our children emulate. So adults must take the lead in
solving this problem.
I'm pleased that businesses like Kraft Foods, Coca Cola, and Nike
are supporting major efforts and making significant changes to help
kids make healthier choices.
These and other business leaders, foundations, schools and
universities across our nation are starting to make a difference in
children's health. I encourage other organizations and every parent in
America to join the fight against childhood obesity.
We must teach our children to enjoy healthy foods in healthy
portions. As parents, we should never use food as a reward or
punishment.
And especially now, during the summer, we need to encourage all
children to be physically active for at least 60 minutes a day. Not
only sports, but simple things like taking the stairs, riding their
bikes, and just getting out and playing.
And as we are getting our kids to make healthy choices, we also
need to make them for ourselves. James Baldwin captured the essence of
this when he said: ``Children have never been good at listening to
their elders, but they have never failed to imitate them.''
I'll be the first to say it won't be easy. My wife and I have four
kids. I know first-hand that families live such busy lives that it's
tough to prepare healthy meals and have enough time to get in some
physical activity.
But it's so important, because the choices that children make now,
the behaviors they learn now, will last a lifetime.
As adults we must lead by example. Personally, I work out every
day. I do my best to make healthy choices in all I do. My bosses
President Bush and Secretary Thompson also find time to exercise. In
fact, Secretary Thompson put the Department of Health and Human
Services on a diet and has led by example by losing over 15 pounds.
President Bush, Secretary Thompson, and I have made disease
prevention and health promotion a priority in our roles as leaders. As
Surgeon General, prevention comes first in everything I do. Prevention
is the vision behind the President's HealthierUS Initiative and the
Secretary's Steps to a HealthierUS Initiative.
One of the many challenges is that there are so many more
incentives in our current health care system for treatment than for
prevention. When I was a practicing physician in a hospital, I made a
good living treating people who could have avoided my hospital entirely
if they had made better lifestyle choices.
Benjamin Franklin was absolutely right back in the 1700s: an ounce
of prevention is worth a pound of cure. But more than 200 years later,
prevention is still a radical concept to most Americans.
At the Department of Health and Human Services, we're encouraging
healthy habits more than ever through our work to eliminate health
disparities; our many initiatives designed to encourage physical
activity, healthy eating, and regular checkups; and our nationwide
campaigns to discourage smoking and drug and alcohol abuse.
To help promote healthy lifestyles, I am visiting schools across
America in my 50 Schools in 50 States Initiative to talk with kids
about avoiding drugs and alcohol, avoiding tobacco in every form, being
physically active, eating right, and making healthy choices every day.
Each time I'm out on the road, whether at a school or passing
through an airport, I meet young people who are making choices that
affect their health and well-being. I believe that what they see and
hear in the media can have a profound effect on their choices.
Secretary Thompson also appreciates that, and it's why he focused
the Youth Media Campaign on getting young people excited about
increasing the physical activity in their lives and on showing parents
that physical activity and healthy eating are essential to their
children's well-being.
This week, the President's Council on Physical Fitness and Sports
will launch a brand-new Presidential Champions Award. The award
encourages a lifetime of activities for children and their parents or
other role models.
We need initiatives like the Youth Media Campaign and the
Presidential Champions Awards because the average American child spends
more than four hours every day watching television, playing video
games, or surfing the web. We are seeing a generation of kids who grew
up off the playground and on the PlayStation.
We must all work together to help our children lead healthy lives.
I caution people against playing the ``blame game.'' Instead of blaming
children for being overweight, we need to encourage them and help them
to make healthier choices.
We need physical activity and healthy food choices in every school
in America. We need better food choices at affordable prices in every
neighborhood in America. And we need community planning that includes
neighborhood playgrounds and safe walking paths.
Some people want to blame the food industry for our growing
waistlines. The reality is that restaurants, including many fast food
restaurants, now offer low-fat, healthy choices.
For the meals we eat at home, and the meals we eat out, it's still
our decision what we eat, where we eat, and how much we eat. That
concept is part of what I'm talking about with Americans of all ages:
increasing our health literacy.
Health literacy is the ability of an individual to access,
understand, and use health-related information and services to make
appropriate health decisions.
Low health literacy contributes to our nation's epidemic of
overweight and obesity. For example, some mothers are unaware that they
can promote their baby's health through breastfeeding. Experience with
my own patients and students indicates that many Americans don't
understand the impact of caloric intake versus expenditure.
Every morning people wake up and, while they're sitting at the
kitchen table, they read the newspaper and the cereal box. Throughout
the day they read the nutritional information on their meals and on
their snacks. But do they really understand the information they're
reading?
The labels list grams of fat. But do you know how many grams of fat
you should eat in a meal? Or in a day? Or how many is too many? Or too
few? These are seemingly simple questions, but we're not giving
Americans simple answers.
Parents are hearing about overweight and obesity. So they're trying
to figure out how much food they should feed their children. How much
is too much? How much is not enough? They're concerned and confused
about everything from calories and carbohydrates, to vitamins and
portion sizes.
When children are growing and developing, a restrictive diet may
not be the best choice for every child. Just as with adults, one diet
does not fit every child.
As parents, we know that. But when we see a child gaining weight
and not exercising enough, we see the social and psychological pain it
causes. When we see a child's self-esteem drop by the day because she's
left out of schoolyard games, or because he just can't keep up with the
other kids on their bikes, we know that we need to help that child.
I'm pleased to hear from parents and pediatricians that moms and
dads are asking about how to establish healthy eating habits for kids.
Parents should always talk to a pediatrician or family physician
before putting any child on a diet or beginning any vigorous exercise
plan.
The reality is that often, if a child is overweight but still
gaining height, the best thing parents can do is maintain the child's
weight. Kids come in all shapes and sizes, and sometimes a child just
needs a little more physical activity and a little less food intake.
Again, it's not about blame--it's about balance.
And to make healthy choices, parents and children need easy-to-
understand information that fits into their busy lifestyles. All of
us--government, academia, health care professionals, businesses,
schools, and communities--need to work together to ensure that
straightforward information about healthy eating and physical activity
is available.
For example, Secretary Thompson announced last week that food
labels will list trans fat content. By putting trans fat information on
food labels, we're giving American families information to make smart
choices to lower their intake of these unhealthy fats.
The food pyramid is another great example. It's probably the most-
recognized nutrition guideline tool in America. HHS is looking forward
to working with the Department of Agriculture to evaluate and update
the food pyramid based on the latest scientific evidence.
I don't have all the answers today. But we can figure this out
together. We can increase health literacy and reduce childhood obesity.
Secretary Thompson has been a pioneer in getting prevention into the
American mindset. We're starting to see some results, and we need your
help. As members of Congress, as members of your communities, and as
parents, you are role models and leaders.
As Surgeon General, I charge you to make healthy personal choices
in your own lives, and to set good examples for all the children around
you.
And I ask you to work with me to support our efforts to improve
Americans' health literacy, to put prevention first, and to end our
nation's obesity epidemic before it has a chance to reach into another
generation of Americans.
Thank you. I would be happy to answer any questions.
______
Chairman Castle. Without objection, your testimony will be
submitted for the record.
I'm going to ask Secretary Bost for a favor. Can we ask
questions of Dr. Carmona now? He has to leave in 15 minutes.
Mr. Bost. Absolutely.
Chairman Castle. Would you be able to stay and then testify
at 10:30?
Mr. Bost. Yes. Not a problem.
Chairman Castle. That's great. Thank you very much. That
gives us a little bit of opportunity now. I will be brief in my
questions so I can give other members an opportunity.
First of all, I agree with what you're saying. In fact, as
you've indicated, I've been involved with legislation in this
area, and I'm extraordinarily concerned with childhood obesity
because of the continuation into adulthood, and I don't know
all the reasons for it, but I believe it's well-documented and
is accurate and it's also well-documented and accurate that it
does lead to health problems later in life, and I agree with
some of your solutions, the 60 minutes of activities.
I was just thinking, I hate to show my age, but my father
wouldn't allow television in the house, and of course,
obviously, when I was young, it had been invented, but they
wouldn't allow it in the house.
[Laughter.]
Chairman Castle. And we had no video games, and we
obviously couldn't surf the web, and those kinds of things.
The gentleman from Michigan can hold his comments to
himself, if he doesn't mind.
[Laughter.]
Chairman Castle. So some of these things happened
naturally, and obviously, it's not natural now. There are a lot
of very interesting activities these kids can follow.
I also notice, when I go to restaurants, the portions are
larger, much less the portions that are served at home.
Is there a thought here in terms of our society? I mean are
corporations, the fast-food providers, the restaurants at
fault? Are we not educating our kids correctly as far as
nutrition is concerned?
In addition to the things that you are doing in the schools
and the states, and obviously stating the facts--and I think a
hearing like this is helpful unto itself--are there other
societal areas that we should be looking to in terms of the
fat--I was going to say the fact--the fact that we are perhaps
eating too much and growing larger than is healthy?
Dr. Carmona. Mr. Chairman, I think as you've alluded to in
your questioning, this is a multi-factorial problem. There is
no single solution.
I think that, you know, there is nobody that is truly at
fault. I think there are a number of issues that have occurred,
as our society and our culture has changed over the last few
decades, as we've become more sedentary because of TV, because
of movies, because of video games; as we've become a fast-food
society because of all of the things that we need to accomplish
in a day.
All of these things have merged together to create a young
more sedentary population who doesn't pay much attention to
what they're eating, and also quality, but quantity of what
they're eating, and this has resulted in this epidemic of
obesity.
So really, it's a problem that I see that we all need to
address. That is, your leadership in Congress, we as the
Surgeon General, Health and Human Services, parents, schools,
teachers, business, which is why, you know, I think wisely, the
President and the Secretary have directed me, and I strongly
agree, to work with industry, to work with business, to form
partnerships so that we can all change the environment that our
children grow up in and provide healthier lives for them.
Chairman Castle. Thank you. Ms. Woolsey.
Ms. Woolsey. I have to tell a little story.
I have an almost three-and-a-half-year-old grandson, and I
was babysitting a couple weeks ago, and we were sitting on the
floor playing Power Rangers, and I saw one of the little
knicky-knacky things they get from McDonald's, and I said,
well, you know, ``tell me about this, Teddy.''
And he started telling me what it was all about, and then
he said, ``Amma''--that's what he calls me--``you don't have to
do this, but you know, the next time you babysit me, you could
take me to McDonald's.''
And I mean--I laughed, of course, and said, 'You know, it
looks like you already go to McDonald's. You need me to take
you someplace you've not been.''
Now, this is a family where I know how my son was raised,
and he's got a three-and-a-half-year-old that knows all about
McDonald's.
So my question is--and this is not an obese little kid. He
never stops. He never sits down.
Are poor children more or less overweight? Are there any
studies about poor kids that would--you know, I mean, they
supposedly, they eat less if they're that poor, but what do
they eat?
I mean, is there anything that we should be knowing about
that?
Dr. Carmona. There are studies that have been done that
have socioeconomic correlates, as well as correlates with
gender and with ethnicity, and what in general is found is that
minority children, for instance those that are Latino,
Hispanic, blacks, tend to have a slightly higher percentage of
obesity.
In some areas, some poor children, some poor groups tend to
have more obesity associated with them, also, and a lot of
times there's crossover, because it happens to be the same
minority children who happen to be from the lower socioeconomic
groups--not always, but sometimes.
So there is some data to support that.
However, I believe that the same factors play there, a
sedentary lifestyle. Sometimes culture is involved, how we
prepare our foods.
You know, being of Hispanic origin myself, I know how my
grandmother used to prepare food, and it wasn't uncommon that
they made it with lard that was stored in the back of the
refrigerator, because that's how it was brought from her
grandmother, my great-grandmother.
So sometimes, the culture plays a role in how the foods are
prepared, and this is where health literacy is so important,
because very often, the culture doesn't take into account new
scientific advances. This is the way our family has done things
over time.
So health literacy becomes important that we have to
educate people as to better, improved, more appropriate ways to
prepare their food, for instance, that would result in less fat
and less obesity.
Ms. Woolsey. Well, thank you, and I'm not going to ask
another question. I want to make a very short comment.
That is, we're the perfect Committee, because we're both
education and nutrition, so literacy is something we have to
wrap our arms around.
Dr. Carmona. Thank you, ma'am.
Chairman Castle. Thank you, Ms. Woolsey. Mr. Osborne.
[No response.]
Chairman Castle. Mr. Upton.
Mr. Upton. Good to be with you again. You made some very
good points here, particularly that the behavior that our kids
learn today is the behavior that does indeed last a lifetime.
I just want to make a point. I've introduced bipartisan
legislation with my colleague, Mr. Kind, who is from Wisconsin
on the other side of the aisle, that in fact is an important
step toward encouraging kids to eat good food, by tying it into
local farm products.
We have a bill that has $10 million in new authorization
that allows grants up to $100,000 per school district to
actually work with local farmers and growers to get some of
that local produce.
I look at Southwestern Michigan, whether it's blueberries
or asparagus or other vegetables that I have trouble getting my
kids to eat right now, but I know that if they get in that
habit, in fact, they're going to keep those habits forever, and
we're hoping to include this as part of the bill, and your
testimony I think underscores that importance.
So good to see you, and I yield back.
Dr. Carmona. Good seeing you. Thank you.
Chairman Castle. Thank you. Sometimes we have trouble
having our Presidents eat some of those green foods that you're
talking about. We have to work on that.
[Laughter.]
Chairman Castle. Ms. Majette is recognized.
Ms. Majette. Good morning, Mr. Chairman and good morning,
doctor.
I agree with everything that you've said in your testimony,
and with the written testimony that I have here before me, and
one of the concerns that I have is that with respect to the
increased physical activity and getting children to understand,
and parents to understand the importance of that regular
activity, we face a challenge in Georgia and in other places
across the country with respect to funding in the public
schools.
What has happened is that as we look to reduce the costs of
educating our children, physical education programs are being
cut, and I think that has had a direct impact on the ability of
parents and children to be able to have that increased physical
activity and have that built in as a part of their regular
school day.
Is there any way that you can help us in addressing that
situation? What would be your view on that situation?
Dr. Carmona. Yes, ma'am. Thank you.
I think it's an excellent question, because the trend in
increases in physical inactivity is increasing, and one of the
things that we have already begun to do, through programs with
HHS, our Healthier U.S., our STEPS program and such, is to
increase physical activity.
In my own practice as the Surgeon General, as I am moving
about the country, in for instance the 50/50 program that I'm
going, as I visit schools around the country and I meet with
school administrators and such, I encourage them to make sure
that physical activity is not removed from their curriculum, as
I've gone around the country and given public addresses to
large groups of school administrators and teachers and
superintendents, also encouraging them to consider keeping that
in the curriculum, because the ramifications of removing it are
very significant, and that's why we're here.
So I'm doing everything I can to shed light on this
significant problem. Part of it is raising the awareness that I
think some are not aware of regarding what the potential
outcome is of removing the physical education.
So with your help, of course, with Congress, in making this
an area of importance nationally, with raising health literacy
so people understand these issues, I think we can stop this
from occurring, but we really first have to raise the
consciousness, which I understand is the genesis of your
remarks and what you're trying to do, and I will continue to do
so.
Ms. Majette. Thank you. I yield back.
Chairman Castle. Thank you, Ms. Majette. Mr. Osborne.
Mr. Osborne. Thank you, doctor, for being here today.
One thing that has occurred to me is that maybe somewhat of
a parallel problem that we've faced is smoking, and probably
have been proactive in attacking smoking for a longer period of
time, and I would suspect that there aren't very many people in
the United States who don't realize the dangers of smoking,
because of the impact of the advertising campaign.
On the other hand, I would suspect that there are
relatively few people in the country who understand the dangers
of obesity, and so I think that awareness is critical, and I
think we can do some things regarding school lunch, which will
help, and maybe done some things regarding education in the
schools so kids understand nutrition better.
But to reach parents is the key thing, because they're the
ones that are preparing the meals most of the time, and turning
off the TV or not, and so the thing that I'm interested in is
some type of a fairly massive advertising campaign which would
maybe raise this issue to the level of smoking.
I know that takes money. Maybe we'll get some cooperation
from the food industry. Maybe some people will give us some
PSAs.
But I wondered just what your plans were in that regard as
to reaching the American public in a rather large scale effort.
Dr. Carmona. Thank you, sir, and I think it's an excellent
point.
Again, we're already beginning to move in this direction.
One of the things we want to do is raise the issue of health
literacy, because we really feel that that is the currency of
success. You need to understand, after you have the awareness,
understand how to utilize this information and what it means to
your and your children.
I think your comparison to cigarettes is an excellent one,
but I would draw the parallel that Luther Terry, my
predecessor, in 1964 released the first Surgeon General's
Report on Smoking. We are 40 years down the line, and we are
still struggling with that.
Often, many of these cultural transformations are inter-
generational. Even with a lot of time and commitment and money,
it takes time, and I think it's an incremental approach, even
if we saturate the media and have good PSAs.
So I think it's the way to go, and maybe we can learn some
lessons from the lessons of tobacco, which we've seen for 40
years and we see where we are today, where cigarette smoking,
for instance, still is the largest killer of all Americans,
over 400,000 a year, so that we still have a significant
problem, although we have made huge strides, but it's taken us
a long time and inter-generationally.
One of the things I mentioned a little earlier was that,
you know, we have been doing everything we can to partner with
the private sector, as you alluded to, not just for funding,
but to get their true partnership and commitment from those
people who manufacture the foods, the fast-food agencies, those
who make physical activity equipment, and figure out new and
innovative ways to continue to bring the message to the
American public, to the parents especially, and to the children
to look cleverly at the markets, like the private sector does,
and segment those markets.
I mean, how do we best motivate youngsters, I mean
adolescents, teenagers, and so on? Well, the private sector
does that very well. They know how to segment the markets.
So we've had conversations with Sesame Street, with MTV,
with Disney, to look at the best practices so that we can
penetrate those markets and try and start changing the
behavior.
Mr. Osborne. Thank you.
Chairman Castle. Thank you, Mr. Osborne.
And the final member who will be able to ask questions,
because of the time limitations, perhaps for 3 minutes, is Mr.
Kucinich.
Mr. Kucinich. Thank you very much, Mr. Chairman.
Doctor, in light of your stated concern about obesity and
hyperactivity among our schoolchildren, does the administration
have any plans to deal with the presence of junk food,
processed foods, and sugar-based, caffeinated products in our
schools?
Dr. Carmona. Thank you, sir.
We've already begun working on that. The Secretary and I
have met with industry leaders in the food industry, both fast
food and food preparation industry, to form partnerships, to
again raise their literacy, if you will, as to this epidemic
and what they can do to help us.
We've been very pleased at the responses that we have
received from the private sector thus far, willing to change
menus, to improve health literacy, and help us get the word
out.
We've also met with various school districts and school
organizations regarding the issues of the type of foods they
have for snacks in the machine issue. As you know, those are
often local issues, controlled by the local school boards,
those decisions.
So we feel it is our obligation to raise the awareness that
if they choose to have snacks that are available, that they are
nutritious snacks, and that parents, school boards, and the
leadership in the schools become very involved in what the
children eat and can't eat during those schools hours, because
it's very important.
Mr. Kucinich. Thank you.
Chairman Castle. Thank you, Mr. Kucinich.
We actually have you on time, and we thank you, Dr.
Carmona, the Surgeon General, for being here with us. We
obviously wish it could be longer.
I think you will find that this Committee, and I hope I'm
not speaking out of school, but this Committee is very if not
extremely supportive of all that you are doing in this area,
and we appreciate it and we hope you continue to carry out the
good work, as we continue to work with this bill and will
continue to work with your office, as well, in terms of getting
the best legislation possible.
So we wish you luck for the rest of the day, and good luck
making your airplane.
Dr. Carmona. Thank you, Mr. Chairman, and thank you for the
courtesy of allowing me to leave early, and I sincerely look
forward to working with all of you, attacking this very
important problem before us. Thank you.
Chairman Castle. Thank you very much. We appreciate it.
We will now turn to Secretary Bost, who has already been
introduced. Don't leave, everybody. We have not only Secretary
Bost but we have a very good panel after that, continuing to
discuss the same issue, so hopefully, everybody can stay and
absorb some interesting information concerning these problems
of nutrition.
Secretary Bost, we're delighted to have you here. Thank you
very much for your patience, by the way.
STATEMENT OF HON. ERIC M. BOST, UNDERSECRETARY FOR FOOD,
NUTRITION, AND CONSUMER SERVICES, U.S. DEPARTMENT OF
AGRICULTURE
Mr. Bost. Oh, absolutely. Good morning. Thank you, Mr.
Chairman and members of the Committee.
I'm Eric M. Bost, Under Secretary for Food, Nutrition, and
Consumer Services at the United States Department of
Agriculture.
I'm happy to be here today to talk about the
administration's recommendations for the reauthorization of the
Child Nutrition Programs and the Special Supplemental Program
for Woman, Infants, and Children (WIC).
You have my written testimony, so my remarks will highlight
the improvements we recommend for these programs.
What guides our recommendations?
The opportunity to make a difference in children's lives in
evident and our responsibility is clear, but we can't do it
alone. That's why last spring, Deputy Under Secretary Bierman
and I conducted listening sessions around the country.
We listened to parents, providers, school administrators,
students, WIC participants, who came and told us what they
thought about our programs, what they liked, what they didn't
like, and what they recommended we change.
Through this process, we gained important insights to shape
our proposal. We established three guiding principles essential
to the proposal we will bring to you today:
One, access to program benefits for all eligible children;
Two, support for healthy school environments to address the
epidemic of overweight and obesity among our children;
And three, commitment to program integrity to ensure the
best possible targeting of program benefits to eligible
children.
Turning to the recommendations, Ensuring program access:
In our commitment to ensure program access, we propose,
first, to consolidate the school meals programs into one
program;
Second, increase the regular free and reduced-price
breakfast rate to the severe need rate for all schools
participating in the program;
Next, we propose to expand the 14-state pilot project often
referred to as the Lugar Pilot;
Fourth, exclude the military housing allowance to improve
access to those families who make the ultimate sacrifice for
our country;
And finally, streamline the application process for both
families and schools by requiring a single application per
household and providing for year-long certifications.
Healthy school environment:
The prevalence of overweight and obesity among America's
youth is an issue we must address. You have heard the
statistics from the surgeon general. We also know why we have
the problem. The reasons are clear and somewhere uncomplicated.
First, if you eat too much, and if you eat too much of the
wrong thing, and if you get too little physical exercise, you
will be overweight, and you are at risk of being obese.
We also know the environmental influences at work: the
availability of sugary, high-fat foods; the move away from
sports and exercise toward TV and computer screens; the lack of
strong programs of nutrition education and physical education
in many schools.
We all bear the responsibility for this problem and we all
have a very important role to play.
For example, parents need to model healthy eating and
physical activity behavior. Parents must also guide the choices
of their children when they are too young to make informed
choices alone.
Families and communities can make healthy eating and
exercise shared activities, such as Colorado on the Move.
Teachers can find ways to build nutrition and physical
education into their curricula; and of course, the Federal
nutrition assistance programs have a very essential and
important role to play.
Some things that we're currently doing at USDA:
As part of the President's Healthier U.S. initiative, we
promote the Eat Smart, Play Hard campaign that motivates
healthy eating and more physical activity;
We promote healthy eating right from the start through our
breast-feeding promotion and support activities through our WIC
program;
We are expanding and improving program-based nutrition
education and other services;
We promote the eating of fresh fruits and vegetables and
whole grains;
And we encourage schools to establish healthy school
environments.
We work with schools to more closely align the meals they
serve with the dietary guidelines for Americans, but we must do
more.
As part of reauthorization we propose to:
Support expanded funding for delivery of nutrition messages
and materials;
Require schools to offer low-fat milk as a beverage option
for schools;
Seek authority to continue the fruit and vegetable pilots
through the end of school year 2005;
And finally, establish a health school environment that
supports the President's Healthier U.S. initiative.
The administration proposes a multi-departmental
implementation of Healthier U.S. in elementary and middle
Schools through demonstration projects. The school districts
will be asked to volunteer for the demonstration projects and
will be provided financial and other incentives to implement
one or more of the four keystones of Healthier U.S.
One, eat a nutritious diet;
Two, be physically active each day;
Three, get preventative screenings;
Four, make healthier choices.
The Departments of Agriculture, Education, and Health and
Human Services will coordinate to achieve the goals of the
demonstration projects. The evaluation component will provide
information regarding these outcomes.
It's a leadership role, a supportive role, a proper role
for government to give good nutrition a fighting chance by
providing financial support to local schools that take action
to promote children's health.
Our responsibility demands action. The action is real, it's
important, and it supports local decisionmaking. It's outcome-
driven and results-oriented.
Through leadership and support and partnership with the
school districts, local schools, teachers, administrators, and
parents, we take a step to improve the school environment
through these incentive-based demonstrations projects that
include an evaluation component that lets policy be guided by
outcome.
Food safety is another integral and essential part of a
health school environment that this administration supports. We
recommend requiring school food authorities employ safe
handling procedures in the preparation and service of meals.
Program integrity:
We cannot really succeed in our efforts without ensuring
effective and efficient management of the resources that we
have available. It is important to us not only from a
management perspective but also in our role as public stewards.
As you know, we have a problem with the accuracy of
certifications in the National School Lunch Program. While we
do not know the exact scope of the problem, we do know that we
have a problem and it appears from some information that the
problem may be getting worse.
This is important, not only because improper certifications
create a risk that nutrition assistance benefits are not
getting to those who are eligible, but also because our school
lunch certification data are used to distribute billions of
other dollars in Federal, state, and local education aid.
With that said, any solution to the accuracy of
certification in the National School Lunch Program will--and I
repeat, will just as clearly as I can--ensure access to program
benefits for eligible children and also ensure that no undue
administrative burdens are added to the schools.
These recommendations include strong steps that we can take
to begin to improve the process, protect the eligible children,
and ensure their ability to participate in the program, and
streamline the application and certification process.
WIC:
The successful public nutrition program, WIC, is also up
for reauthorization. The President has been very clear
regarding his commitment to this vital program by requesting
unprecedented levels of funding for WIC.
Currently, over 7.5 million at-risk, low-income women and
their young children are served every month. As part of the
administration's reauthorization package, we propose:
Increased budget authority for WIC management information
systems;
Development and support;
Expanded availability of breast-feeding peer counselors;
Establishment of a pilot project to determine how WIC can
help prevent childhood obesity;
And authorization of a national evaluation of WIC every 5
years to ensure the program's effectiveness.
Mr. Chairman, I appreciate the commitment and longstanding
support of you and the members of the Committee. I look forward
to working with the Committee to enhance the effectiveness of
the programs and further the positive impact they have on the
health and nutrition of children and their families today and
tomorrow.
Thank you again for the opportunity to present the
administration's proposal. I will be happy to answer any
questions that you may have at this time.
[The prepared statement of Mr. Bost follows:]
Statement of Eric M. Bost, Under Secretary, Food, Nutrition and
Consumer Services, U.S. Department of Agriculture
Thank you, Mr. Chairman. I am Eric Bost, Under Secretary for Food,
Nutrition and Consumer Services (FNCS) at the U.S. Department of
Agriculture (USDA). I am pleased to be here today to talk about the
Administration's recommendations for the upcoming reauthorization of
the Child Nutrition Programs and the Special Supplemental Nutrition
Program for Women, Infants and Children (WIC).
Within USDA,
Food, Nutrition, and Consumer Services is the lead mission area for
improving the health and nutrition of all Americans, especially
children as well as our most vulnerable individuals and families. Our
agency oversees 15 nutrition assistance programs that touch the lives
of 1 out of 5 people in this country every year. The National School
Lunch Program alone serves an average of 27 million children each
school day. Fifty-eight percent of these children receive a nutritious
lunch free or at a reduced price. Nearly eleven million also take part
in school breakfast, after-school snacks, and summer meals. Programs
like these present us with an extraordinary opportunity to reach young
Americans and send out strong, consistent messages about achieving and
maintaining a healthy lifestyle. Through our school meals programs,
summer feeding, child care and WIC programs, we are making important
strides towards improving the quality of children's diets and raising
their awareness of healthy choices.
Over a year ago, as we began considering possible improvements to
the Child Nutrition Programs and WIC, we knew that an inclusive
process, bringing together the suggestions of interested groups and
individuals from across the country, would serve us well. So we
traveled to nine cities to hear from advocacy groups, school lunch and
child nutrition professionals and the public, about what was working
and what needed improvement. From this process, we gained significant
insight into the ways in which our programs could better meet their
goals.
We have been guided by the belief that ensuring the strength and
integrity of the nutrition safety net depends on programs being readily
accessible by all those eligible for them, a strong commitment to
encourage children to make positive choices about what they eat, how
much they eat, and how active they are; and good stewardship of program
resources, combining effective oversight with a minimum of red tape.
The reauthorization process gives the Administration and Congress
the opportunity to empower local schools, parents, and communities to
move toward a nutrition environment that values and fosters the health
of our children. We believe that reauthorization of these programs
should be guided by the following principles:
Ensuring access to program benefits for all eligible
children. To effectively and efficiently ensure access, we propose
streamlining the application process and the administration of programs
to minimize burdens on both schools and parents;
Supporting healthy school environments to address the
epidemic of overweight and obesity among our children by providing
financial incentives to schools that meet the dietary guidelines; and
Improve the accuracy of program eligibility
determinations, while ensuring access to program benefits for all
eligible children, and reinvesting program savings to support program
outcomes.
This Administration believes that these principles provide the
focus and framework needed to address the challenges and opportunities
our nation faces in promoting good nutrition and health for all
children.
Ensuring Program Access
Streamlining these programs by fostering common program rules and
policies is an important step toward minimizing administrative burdens
for those who operate the programs and ensuring easier access for
parents to enroll their children. Over the years, school cooperators
have requested streamlining of the Child Nutrition Programs, noting
that in order to provide the full array of year-round services that are
offered, they have to participate in four programs, with four different
sets of rules. Further, cooperators argue that the restrictions placed
on each of the various meal services increase administrative costs and
result in schools limiting the meal services offered to children in an
effort to simplify administration of programs.
This Administration proposes to streamline the operations of the
School Meals Programs under the auspices of one program, the School
Nutrition Program. USDA expects that streamlined operations will permit
schools to provide meals to children, 365 days a year. This proposal
would allow schools to offer a full array of meals under one set of
rules. Simplifying the administrative burden would allow schools to
operate under one State administrative office and enable them to
provide meals to children during vacations and holidays without having
to apply for the Summer Food Service Program or the Child and Adult
Care Food Program. We also recommend increasing the regular free and
reduced-price breakfast rates to the severe need rate for all schools
participating in the program.
We are interested in expanding access to the other programs that we
administer, with a special focus on the Summer Food Service Program.
This is one of my top priorities for FNCS. We are committed to
improving access to nutritious food for children in the summer months,
when school is not in session. The Food and Nutrition Service (FNS)
launched a major effort last year, along with providers and advocates,
to expand the number of sponsors, feeding sites, and participants in
the Summer Food Service Program, and we continue to work directly at
the local level, selecting unserved or underserved counties to develop
potential sponsors, sites and vendors for this program.
But to meet our commitment to improve access for all children who
are eligible, we must work closely with our program partners;
individuals and organizations in communities across America who deliver
the nutrition assistance programs, and work to make the programs
accessible and effective. Faith-based organizations have played an
important role in raising community awareness about program services,
assisting individuals who apply for benefits, and delivering benefits.
President Bush has made working with the faith-based community an
Administration priority, and we intend to continue our efforts to reach
out to that community to help accomplish our goal of ensuring access to
all eligible children.
Healthy School Environment
The prevalence of overweight and obesity among America's youth is
an epidemic requiring immediate attention. The percentage of young
people who are overweight has more than doubled in the last 20 years
for children aged 6-11 and almost tripled for adolescents aged 12-19.
And we know that overweight among children is the precursor to obesity,
and its related health problems, among adults.
Obesity is one health issue that affects every single one of us--
through our families, our friends, our communities, our workplaces, and
even our taxes. It causes more health problems than smoking, heavy
drinking, or even poverty.
The immediate reasons for overweight among our children are clear
and uncomplicated: too many of them eat too much, they eat too much of
the wrong things, and they get too little physical activity. But these
seemingly simple factors are influenced by many forces--the too-easy
availability of sugary, high-fat foods; enticement away from sports and
exercise toward television and computer screens; the lack of strong
programs of nutrition education and physical education in many
schools--that contribute to the increasing numbers of overweight and
out-of-shape children.
We all bear some responsibility for this problem, and we all have
important roles to play.
Parents need to model healthy eating and physical activity;
currently 6 in 10 adults are overweight, and children learn from what
parents do at least as much as what they say. At the same time, parents
must guide the choices of their children while they are too young to
make informed choices alone. Families and communities can make healthy
eating and exercise shared activities. Teachers can find ways to build
nutrition and physical education into their curricula, and school
administrators can work to create a healthy school environment. The
media can help as well, by promoting nutrition and physical activity at
times that truly reach children and their caregivers.
And, of course, the Federal nutrition assistance programs have an
essential role to play. We operate programs in over 93% of the schools
across the Nation, serving over 27 million children each day. And USDA
has been working for more than a decade to do our part:
As part of the President's HealthierUS Initiative, we are
pursuing a vigorous nutrition promotion campaign, ``Eat Smart. Play
Hard.'', to motivate healthy eating and more physical activity;
We are promoting healthy eating right from the start by
expanding breastfeeding promotion and support activities;
We are expanding and improving program-based nutrition
education, and other nutrition services to motivate people to eat
healthfully; and
We are working to encourage schools to establish healthy
school environments that offer nutritious foods and increase
opportunities for physical activity through activities such as our
HealthierUS Memorandum of Understanding with the Department of Health
and Human Services and the Department of Education.
Additionally, USDA has worked with schools to more closely align
the meals they serve with the Dietary Guidelines for Americans. Today,
over 80 percent of NSLP schools offer meals that are consistent with
good health. We have supported these changes by improving the quality,
variety, and nutritional content of the commodities we provide to
schools, and by providing food service workers with training and
technical assistance to help them prepare more nutritious and appealing
meals.
But there is more that we must do, and reauthorization offers us a
prime opportunity.
We support expanded funding for USDA to support the
delivery of Team Nutrition messages and materials.
We support requiring schools to offer low fat milk as a
beverage option for school meals.
And we propose to establish a Healthy School Environment
that supports the President's HealthierUS and No Child Left Behind
initiatives through financial incentives to schools that choose to meet
certain criteria.
And so, the Administration proposes a multi-departmental approach
to implementing HealthierUS in schools which is outcome driven.
The Administration proposes demonstration projects in schools
across the country that operationalize the four keystones of
HealthierUS:
Nutrition--Eat a nutritious diet;
Physical Fitness--Be physically active each day;
Prevention--Get preventive screening; and
Avoid Risk Behaviors--Make healthy choices.
Critical to the demonstration projects is an evaluation component
that will provide information regarding outcomes to inform future
policy. School districts will be asked to volunteer for the
demonstration projects, and will be offered incentives to support the
implementation of HealthierUS in their schools. Understanding the
importance of local choice, schools will be able to identify if they
want to implement one or more of the four keystones--incentives will be
attached to each keystone and a special ``HealthierUS'' designation
will be awarded to those schools that implement all four. The
Departments of Agriculture, Education, and Health and Human Services
will coordinate to achieve the goals of the demonstration projects.
For example, to earn a ``HealthierUS'' nutrition incentive, a
school could design a nutrition program that:
Serves program meals that meet Federal nutrition
standards;
Offers healthful food options in vending machines, school
canteens, and their a la carte menu service;
Promotes the consumption of fruits and vegetables; and
Delivers nutrition education and participates as a Team
Nutrition School. Team Nutrition Schools enroll for this program to
encourage nutrition education and related good nutrition practices at
their schools.
Nutrition experts could decide the specifics of these and other
potential criteria. But the thrust of our recommendation is to give
good nutrition a fighting chance by financially supporting local
schools that wish to take action to promote children's health. Such an
action empowers parents, school administrators, teachers, local
communities, and States to improve the health of their children--a
proper role for government, and a wise investment in the future.
The challenge of obesity did not appear overnight; it will not be
solved overnight, and we cannot solve it alone. But our
responsibilities to promote the Nation's health demand action now.
Without it, the problem will only get worse. The cost in increased
health problems among future generations is a price that is too high to
pay.
We look forward to working with the Committee to develop a
demonstration project as work to reauthorize the Child Nutrition
Programs. The Federal government cannot create a healthy school
environment on its own, nor can it mandate one to local schools. But it
can offer leadership and support for schools and communities that are
willing to invest in these efforts for the sake of our children. In
conjunction with local school districts, we can use nutrition education
and promotion to teach and motivate children to choose a healthy diet.
We must also support local schools that make serious efforts to improve
the school-eating environment and promote physical education in the
school's curriculum, and consider financial and other incentives to
reward their successes.
Food safety has always been an integral part of food service for
the Child Nutrition Programs and is an essential part of the healthy
school environment this Administration supports. To promote food
safety, we recommend requiring school food authorities to employ safe
handling procedures in the preparation and service of meals to ensure
the delivery of safe, nutritious food. It is vital that the food we
serve in all our nutrition programs be safe and nutritious under all
conditions.
Fighting Hunger and Obesity
Does the epidemic of obesity mean that we have won the war on
hunger? No. In spite of the success of our nutrition assistance
programs, hunger remains a problem. In data for 2001, 3.5 million U.S.
households were classified as food insecure with hunger. Low-income
households may be eligible for more than one nutrition assistance
program, but only five percent of eligible families receive benefits
from food stamps, school lunch, school breakfast, and WIC in the same
year. The majority of households participate in only one program.
Hunger and obesity co-exist in the United States and are no more
mutually exclusive than cancer and heart disease. The Federal
government has a responsibility to address both, and we are committed
to ensuring access both to enough food and to the skills and motivation
to make healthy lifestyle choices.
Program Integrity
However ambitious our agenda for the Child Nutrition and WIC
Programs, we cannot realize and sustain effective change without
careful attention to program stewardship and integrity. This is true
for two reasons. First, program waste and abuse divert taxpayer
resources from investment in the improvements we seek. Second, and
perhaps more importantly, we cannot sustain these programs without
continued public trust in our ability to manage them effectively. For
these reasons, I consider program integrity as fundamental to our
mission as program access or healthy eating. Program reauthorization
provides a tremendous opportunity to improve the program by decreasing
benefits currently paid in error and reinvesting the savings in
targeted initiatives that increase program access and improve the
quality of meals.
As this Committee knows, a great deal of attention--and some
conflicting information--has emerged in recent months regarding the
accuracy of certifications in the National School Lunch Program. USDA
has been examining this issue for a number of years, and while we do
not have data that allow us to estimate the exact level of error in the
program, we have clear indications from a number of different sources
that there are problems with the school meals certification process.
Further, the evidence suggests that these problems have worsened over
time.
Currently, households report their income on forms sent out at the
beginning of the school year, and school lunch providers are required
to determine program eligibility based on the data; only a small
percentage of the information is verified. Improper certifications
create the risk that nutrition assistance benefits intended for poor
children go to those who are not eligible. Furthermore, data on
children certified for free and reduced-price meals is used to
distribute billions in Federal, State, and local education aid, so
errors in this data can undermine targeting of essential services to
those most in need.
It would be irresponsible for USDA not to take steps to address the
problem, and we have a plan for action. But before I present it to you,
let me emphasize that the Bush Administration is committed to ensuring
that all eligible children have access to free and reduced-price meals.
We have had a continuing dialogue with the Congress, this Committee
staff, the school food service community, and program advocates, and
have been working to develop and test policy changes that improve
accuracy but do not deter eligible children from participation in the
program and do not impose undue burdens on local program
administrators. The recommendations that we will pursue include:
Require direct certification for free meals through the
Food Stamp Program. Direct Certification is a simplified method of
determining some children's eligibility for free meals without having
the family complete a free or reduced price application. The school or
the State agency obtains documentation from the State or local Food
Stamp Program or Temporary Assistance for Needy Families office that
enables the school to certify these children as eligible for free
school lunches. As provided for in the President's budget, this would
increase access among low-income families and reduce the application
burden for their families and schools. The process of direct
certification is significantly more accurate than paper applications.
For those who must continue to apply through paper-based
applications, enhance verification of those applications by drawing
verification samples early in the school year, with all verifications
to be completed within 45 days; expanding the verification sample; and
including both a random sample and one focused on error-prone
applications in each school.
Minimize barriers for eligible children who wish to
remain in the program by requiring a robust, consistent effort in every
State to follow-up with those who do not respond to verification
requests. USDA would require that an initial contact to the household
be in writing, and in the event of no response to the initial contact,
multiple attempts at a follow-up telephone contact would be required.
Streamline the process for those who must still submit
paper applications by requiring a single application for each
household.
Provide for year-long certifications in both paper-based
applications and direct certifications, eliminating the need to report
income changes during the year.
Provide funding to support these new/enhanced
administrative efforts. Let me note that while we consider this
enhanced verification process an important step to improve integrity,
we should not require that these expanded efforts be placed in the
hands of already overburdened food service workers.
Initiate a series of comprehensive demonstration projects
to test alternative mechanisms for certifying and verifying applicant
information, including use of wage data matching that identifies
eligible and ineligible households and a nationally representative
study of overcertification error and the number of program dollars lost
to program error.
These recommendations include both strong steps that we can take
immediately to address the issue, and a plan to continue research and
demonstration efforts to build on these early steps with further
improvements over time. Further, we expect to learn more about the
problem of certification inaccuracy, and potential solutions in the
coming months as the results of our research and analysis continue to
emerge.
The Administration has committed to reinvest any savings that
result from an improved certification system back into the program--and
especially to the low-income children who rely on it. Our commitment to
maintaining access to the program for these children is fundamental,
and the proposal I have outlined offers a substantial response to the
certification accuracy problem without jeopardizing children's
eligibility, or unduly burdening our schools. I look forward to working
with you to pursue these improvements.
Special Supplemental Nutrition Program for Women, Infants and Children
I would now like to talk about the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC). WIC has proven to be
one of the most successful public health nutrition programs ever
created by Congress.
Each month, WIC provides over 7.5 million at risk, low-income
pregnant, breastfeeding and postpartum women, infants and very young
children with supplemental food packages targeted to their dietary
needs, nutrition education and referrals to health and social services.
Nearly one-half of the infants born in this country receive WIC
benefits.
The success of WIC is well documented. Participation in WIC leads
to better pregnancy outcomes--fewer infant deaths, fewer premature
births, and increased birth weights. Medicaid savings for newborns and
their mothers in the first 60 days after birth average between $1.77
and $3.13 for every dollar spent on WIC. These results, we believe, are
attributable to the unique design of the program, which is comprised
of:
A nutrition prescription that allows pregnant and new
mothers to purchase food dense in nutrients that are often lacking in
the WIC population;
Individualized nutrition education and counseling; and
Critical referrals to other health care and social
service assistance programs.
As we study improvement to the WIC Program during reauthorization,
the Administration is especially supportive of improving nutrition
services and expanding Federal support for technology and innovation.
In the area of technology and innovation, this Administration supports
$30 million in annual budget authority. This money would be earmarked
for WIC Management Information System (MIS) development and support.
Many WIC State agencies are operating outdated systems. These funds
would help to strengthen these systems, which are critical for
effective program management.
Additionally, promising improvements would result from authorizing
a national evaluation of WIC's effectiveness every five years;
expanding the availability of breastfeeding peer counselors to provide
support to breastfeeding mothers; and authorizing obesity pilot
projects to evaluate whether WIC can help prevent childhood obesity.
Conclusion
Mr. Chairman, I appreciate the commitment and long-standing support
of this Committee in recognizing the importance of good nutrition as
part of an overall healthy lifestyle for all Americans. As we prepare
to reauthorize the child nutrition programs, we are mindful of the
critical contribution they make to life-long eating habits and good
health.
But, the Federal government cannot--and should not--do this job
alone. Meeting this challenge requires all of us parents, family
members, our schools, our communities, local and national
organizations, industry and all levels of government, State as well as
Federal.
Mr. Chairman, this Administration looks forward to working with
your Committee in reauthorizing the Child Nutrition Programs and WIC to
enhance their effectiveness and further their impact on the health and
nutrition of families today and in the future.
This concludes my prepared remarks. I would be happy to answer any
questions you might have at this time.
______
Chairman Castle. Well, thank you, Secretary Bost.
Mr. Bost. Thank you.
Chairman Castle. You touched on a lot more subjects than I
can ask about in a very brief period of time, and I'm
appreciative of that, and unfortunately, we can only hit on
certain things.
I'm going to sort of stay with the health theme here for a
while. Obviously, we have to worry about the WIC program and
others and the funding of those kinds of things, too.
But one question I have. We fuss about this. But I'm
worried about the educational component in all this, but not
education, per se, perhaps, as much as a combination of
education and culture--that is, what we see on TV or whatever.
Are we accepting, in the culture of the United States, not
just TV, but in general, the fact that we have overweight kids
that may lead to overweight adults which may lead to health
problems, or are we trying to make some sort of a statement,
other than those of us who take ourselves very seriously and
come to these hearings and say these things, saying it, are we
doing it in a way that's really going to get to people?
Ms. Woolsey mentioned, or asked whether or not there's a
greater problem in lower-income communities, and I have to
believe, to some extent, there is, again because of lack of
perhaps education and culture.
They probably don't read Nutrition Newsletter, or whatever
it may be, and perhaps don't get the information on the health
connection.
What are we doing, or what do you feel comfortable that we
should be doing as a government in terms of cultural outreach,
as well as the pure education?
I mean, I know at my state fair, I hand out literature from
our various agencies. I wonder if anybody ever reads it or if
it's written in a way that anybody would want to read it. I
mean, it's not the Da Vinci Code, it's something that's just
not very interesting to a lot of people. So I'm concerned about
that.
In other words, how do we reach people? What can we do to
reach people without pointing a finger and lecturing them?
Mr. Bost. Well, I think that there are several things that
we're currently doing in the Department that we're ultimately
responsible for in terms of, for example, the Eat Smart and
Play Hard campaign that essentially targets essentially
children and to some extent their parents.
Also, there's a Changing the Scene Kit that we actually
have distributed to schools that teachers are able to use as a
part of their curriculum in terms of making some informed
decisions and choices.
We also do a lot of work with stakeholders in terms of
being able to get the message out.
However, it's really important to note, because you hit on
something that the Surgeon General also mentioned. It is really
my belief that in this country at this juncture, we don't see
this as a serious problem yet. It is a major problem.
For example, 65 percent of all children in this country
have a TV in their room--65 percent. They spend their time
looking at TV as opposed to involved in any level of physical
activity. They eat more. That contributes to issues of obesity.
It's those types of issues that we need to start to address
if we're going to start to turn this issue around.
In terms of some specific things that we're doing to
address the cultural aspects of this problem, one of the best
programs that we have available to us, that's in our tool box,
and I'll use that, is our WIC program.
Our WIC program is a wonderful program in terms of
providing hands-on, very individual-based nutrition education
and counseling to mothers with their child and while their
child is present, and so that's why we're doing some things to
expand that program.
In addition to that, one of the simple things that we could
do is to encourage breast-feeding.
Research indicates that those children that are breast-fed,
for whatever reason, are not as likely to be obese when they
get older. It's good for the child. It's also good and healthy
for the mother.
So this is a program that we have that is very important in
terms of, one, addressing the issues of obesity that we're all
facing, but it also goes a long way toward addressing some of
the cultural issues that you spoke to.
Last but not least, we are and have looked at some of the
programs around the country that go a long way toward
addressing some of the cultural based issues that you spoke to.
For example, went to Alabama, met with staff in Alabama to
talk about a program that they're devising and actually working
with clients to start to address some of the issues that
they're facing.
For example, Alabama has one of the highest rates of heart
disease of any state in the country. That's based on the way
the types of foods that they eat are prepared. Almost
everything is fried.
The work that is being done at Alabama University is to
work with persons to essentially say, ``There is nothing wrong
with that fried catfish that you want to eat today, but maybe
next time, why don't you broil it? Maybe the next time, why
don't you grill it?''
So we're providing people with some information that they
can use, but also we're hopeful that we're able to move them in
the direction where they're able to make some healthier
decisions and choices.
Chairman Castle. Thank you, Secretary Bost.
I yield to Ms. Woolsey for 5 minutes.
Ms. Woolsey. Thank you. I'm going to ask three questions.
I'm not going to say anything else.
One, what is the Department doing to ensure that funding
will be there for these good programs you just outlined for us?
Two, why demonstration programs when we know these programs
work?
Three, what do you need us to do at our reauthorization so
that we can fulfill your wishes with WIC?
Mr. Bost. Let's talk about your first question,
Congresswoman Woolsey.
If you look at all of the things that I laid out, I laid it
out in terms of a package, and they all interrelate and they
all fit together.
Providing the Department and me with some latitude to put
those pieces of the puzzle together will afford us an
opportunity to have some money at our disposal so that we're
able to do some of the things that I talked about.
If you take some of those pieces away, then essentially
it's a push-pull and money won't be available to do many of the
things that I talked about, and so that's why it's so important
that I presented these things as a package, because they all
interrelate with each other.
We're looking at using some of the improved efficiencies
that I'm hoping to gain in this program that we will take money
and put it back into the program, and so it's and not really
savings. It's a redirection of money that we hope to be able to
utilize.
In terms of demonstration projects, you say that we know.
Well, we have some data that would lead us to believe that
there are some thing that are working, but I think it's really
important that we look at providing schools with the
opportunity to volunteer for some of the demonstration projects
so that we can take that information and make informed
decisions and choices that we can utilize across the entire
country.
Let me add some specificity to that.
I had an opportunity to attend a conference, maybe six to 8
weeks ago, at the University of California at Davis. The
leading researchers around the country were there to talk about
this issue of meeting the needs of poor people and obesity.
And one of the things that they said was that we don't have
enough research, we don't have enough data to make some
informed decisions about exactly what we need to do in the
future in terms of dealing with this issue, because it comes
down to a basic issue of getting people to change their
behavior in terms of decisions and choices that they make
regarding how they eat.
So we have some information, but the demonstration projects
would allow us an opportunity to get, hopefully, better data
and information.
Ms. Woolsey. And the WIC, you want just a big basket of
money and then you'll take care of WIC?
Mr. Bost. Well, we're in support of the President's budget.
The President's budget provides us, we believe, with a
significant level of resources to meet the needs of people in
this country that are eligible to participate in the WIC
program.
Ms. Woolsey. Is there anything in the budget that will help
with the connection between a nutritious breakfast and
learning, and for not just elementary kids but particularly for
teenagers who don't, in some way to get them to want to eat
breakfast?
Mr. Bost. Well, interestingly enough, as you know, we are
into the last year of the breakfast pilot, and--
Ms. Woolsey. That would be mine.
Mr. Bost. Yeah, that was yours--and we are continuing to
review the results of that pilot information to make a
determination of things that we need to do to extend it to
older children.
The one thing that we saw from the pilot was the fact that
younger children essentially, I think 96 percent currently do
already participate in breakfast for young children.
For older children, and I'm specifically talking about
teenagers now, the issue of tying breakfast to what's in it for
them is something that we've started to talk about.
Teenagers, as you know, are a different animal, and those
who have had some can appreciate, what I'm saying, is the fact
that we're trying to take a different approach in terms of just
trying to go beyond the issue of nutrition education, but
essentially saying what's in it for them.
For example, one of the programs that I looked at in
Eastland, Texas was that the high school had some of the
athletes talk to the middle school and younger kids about
eating healthy and eating breakfast and exercising, and it
resonated, because you had kids that they looked up to to do
that.
So we're looking at those types of activities and trying to
be innovative and creative so that we're able to look at making
some changes to address some of these issues.
Ms. Woolsey. I'd like to remind you, though, that it has to
be available to them. You can't tell a kid they have to have a
nutritious breakfast and then it's just not even there.
So thank you.
Mr. Bost. Absolutely.
Ms. Woolsey. Thank you very much, Mr. Secretary.
Mr. Bost. Absolutely.
Chairman Castle. Thank you, Ms. Woolsey.
Mr. Osborne.
Mr. Osborne. Thank you, Mr. Chairman.
Thank you for being here today. We had a chance to talk
yesterday, so I understand much of what you're trying to do.
I'd like to focus on a couple of areas here.
One is, you mentioned in your testimony program integrity,
and apparently right now, for lunch and breakfast programs,
it's pretty much self-report in terms of your income level, and
there's some concern about how accurate these reports are.
And I guess one of the real concerns also that we have is
that ofttimes, Title 1 money is distributed based on how many
students participate in these programs, so if the data is
inaccurate to start with, then the distribution of not just
lunch and breakfast money but also Title 1 money can result.
So to get this accurate, I think, is really important, and
I think you're trying to do some things here, and I just
wondered if you could amplify that a little bit for us as to
what you feel you might be able to get done and what savings
might result, and get into that a little bit.
Mr. Bost. Well, interestingly enough, this is an issue that
I faced when I became Under Secretary, and it's one that we've
looked at.
Before I get into some of the initiatives that I've, one,
laid out, and that we hope to implement, we're looking at
striking that balance, striking the balance of ensuring that we
maintain or improve the integrity of our program without either
inhibiting or preventing eligible children from participating,
and of course not bringing an additional administrative barrier
on the schools.
So I'm looking at those types of initiatives that we can
put in place that's going to be able to strike that balance so
that all of those things occur, and we believe that some of the
ideas that I laid out, and I'll talk about them again, will go
a long way toward addressing some of those issues.
First and foremost, utilization of direct certification
through our Food Stamp program.
Essentially, that would mean that those children and their
families that are currently enrolled in the Food Stamp program
would automatically be eligible for free meals.
It would mean that they wouldn't have to produce any
documentation at all, and so that would go a long way toward
ensuring that they're eligible, and would be somewhat easier on
the schools, because they would have to match up the tapes, and
we're going to provide them with some additional monies
essentially to do that.
Year-long certification, which essentially means that
they're able to do it after you've done it one time, regardless
of the changes that may occur in your family situation, you're
still certified for the course of the year.
One, streamline the process for those, with a single
application per household instead of multiple applications for
children in the family, and of course, I think the issue that
everyone has a significant amount of concern about is the
enhanced verification to actually go back and check on those
that happen to produce paper-based applications.
But the issue for me is that we're also building into this
process a very robust followup system to ensure that we reach
any child that may be eligible to participate, that for
whatever reason, may fall through the cracks.
Very clearly, as clearly and succinctly as I can make it
today, there's a real commitment on myself, on the part of the
Secretary, and the President of this country to ensure that
every single child that is eligible to participate in this
program, that we don't do anything to prevent that from
occurring.
And for those, for whatever reason, whether it be through a
misstep on their part or some administrative problem, we don't
want that to occur, because essentially, you're taking money
away from eligible children who should receive that free,
whether it be lunch or breakfast.
And so we've laid out some proposals that we feel will go a
long way toward beginning to address this issue.
As I've said to the stakeholders, I'm interested in putting
something to start something out. It can't be a demonstration
project. I think we have to go beyond that, because we won't
receive any information or address the issue.
I'm interested, since the all-star game was on last night,
I'm interesting in getting to first base.
I'm not interested in hitting a home run, because I don't
think that we have enough reliable data to hit that home run,
but I am interested in getting to first base, because I'm
committed to ensuring that we improve the integrity of this
program. I think the time is overdue for us to at least try.
Mr. Osborne. Thank you. I yield back.
Chairman Castle. Thank you, Mr. Osborne.
Ms. Majette is recognized for 5 minutes.
Ms. Majette. Thank you, Mr. Chairman, and thank you,
doctor, for being here this morning.
I'm very encouraged by what you've said in your testimony
and by what you just said about the trying to streamline the
process and make it easier to identify people who should
participate, and making sure they continue to participate.
Can you be a little more specific in terms of the plans
that you have? Are there things in place, or are you
anticipating putting things in place that will address the
different language barriers that exist with respect to getting
people involved in the programs?
Mr. Bost. Well, interestingly enough, I think right now we
interpret applications into 18 different languages already, and
staff are continuing to work on doing that.
We also have out reach services to help those persons that
might have some difficulty in terms of completing applications
to participate in our programs.
But interestingly enough, with direct certification, it
doesn't require a person to fill out an application. They're
automatically enrolled if they're receiving or participating in
the Food Stamp program.
So that's why it goes a long way toward making it easier
for the client and child to participate in the program, because
essentially it doesn't mean that they have to do anything.
If they're currently enrolled and participating in one of
our programs, they will be automatically enrolled in the
National School Lunch Program, receiving a free lunch.
So that's why we believe that it goes a long way toward
one, improving the integrity of the program, and two, making it
easier for children to participate.
Ms. Majette. Would that same coordination take place with
other agencies that are also providing support for low-income
children and families?
I mean, we have the CHIP program, Medicaid, the Low-Income
Home Energy Assistance Program, community service block grants.
We are considering the reauthorization of Head Start.
And one of the big issues that has been raised is the
coordination of services.
Is there some way that you see that we can continue that,
along the lines of coordinating these various services,
identifying people who are receiving some of these services,
and having them be able to have a one-stop application process
for all of these to make it easier to have access?
Mr. Bost. Well, interestingly enough, that's one of the
things that we're looking at and I did consider.
Let's talk about Medicaid and S-CHIP, and why we went to
Food Stamps. For Food Stamps, essentially, the eligibility
requirements are the same.
For CHIP, they vary from state to state, the eligibility
requirements in terms of 133 percent of poverty level up to 200
percent of the poverty level. So essentially, it was difficult
in terms of essentially doing that.
Another example that I'd also like to give you that we
looked at regarding S-CHIP was the fact that even in some
states, I think it's Arizona and one other state, that the
eligibility requirements are different depending even on the
age of the child.
And so to start, we thought it would be exceptionally
difficult and an administrative nightmare and would not make it
easier for the schools to do, but essentially more difficult
for the schools to do in terms of starting.
With that said, however, we are looking at the possibility
of providing states with a state option to add some of the
other programs that you talked about, but one of the things
that I would say to you is that, depending, or dependent upon
what state and how many people were enrolled, it would add a
significant cost to this proposal that we would not be able to
fund. That would be one consideration.
And two, I'm always sensitive to any additional
administrative paperwork that we would put on the schools when
they've told me that they want me to try to take some off.
Ms. Majette. Do you think it would be easier if we just
drew a bright line and had a national level that wouldn't
require this continuing state-by-state parsing it out?
And I'm asking that question because we're struggling here
with this whole notion of now giving back to the states, just
giving them the money and letting them figure it out.
Isn't it simpler if we have one standard that everybody can
work with and eliminate a lot of that duplication of paperwork
and effort?
Mr. Bost. Well, interestingly enough, it would probably
make it easier for us to administer the program. I don't know
if some of the states would be happy with that decision.
Ms. Majette. But it would make it easier for--
Mr. Bost. It would make it easier for me.
Ms. Majette. --for you?
Mr. Bost. But we're also in the business of affording the
states a great deal of latitude and flexibility in terms of
providing services to clients and students and children,
because we believe that they do know best.
So the issue is, it's not necessarily what I think. It's
what would be in the best interests of meeting the needs of
children, and that's always my focus.
Ms. Majette. Thank you.
Mr. Bost. Thank you.
Chairman Castle. Mr. Wilson.
Mr. Wilson. Thank you, Mr. Chairman, and thank you, Mr.
Bost, for being here today, and I particularly appreciate the
Surgeon General and yourself promoting exercise, promoting
better nutritional habits, and I know that we're very fortunate
that you also recognize the role of parents in promoting
exercise.
We've got leaders right here--Chairman John Boehner has
been promoting young people in golf. I'm going to be doing my
part next week--
[Laughter.]
Mr. Boehner. Will the gentleman yield?
Mr. Wilson. Yes.
Mr. Boehner. Of course, the gentleman realizes I take a
walk every morning?
Mr. Wilson. And walk too, yes.
[Laughter.]
Mr. Wilson. And I've seen the Chairman walking. It's very
impressive.
[Laughter.]
Mr. Wilson. And I will be doing my part next week. I'll be
going with my teenager, 15, to film our Boy Scout camp, for a
100-mile backpacking trip, so I'm trying to do my part.
But on the issue today, with more and more evidence
pointing to the health benefits of fresh fruits and vegetables,
what step is the Department making to promote fresh fruits and
vegetables available in the various school meal programs?
Mr. Bost. Well, interestingly enough, as a part of our
commodity program, we've increased the availability of fresh
fruits and vegetables, one, that are part of our surplus
program, and two, that are on the list essentially for schools
to actually request.
I think last year alone we purchased $7 billion worth of
fresh fruits and vegetables that we actually distributed to
school, and also we have an MOU with the five-a-day people in
Health and Human Services to continue to get the word out about
its consumption, and last but not least, we're also
recommending an expansion of the fresh fruits and vegetables
pilot that took place in the four states/100 schools and the
Indian reservation.
Fresh fruits and vegetables are indeed very, very
important, but also, whole grains are also, eating a balanced
meal also, eating in moderation--all of those things are very
important when we talk about encouraging people to move toward
having a healthy lifestyle.
I'm really trying to get away from talking about all of us
being too chubby, because it kind of turns us off. I'm trying
to get us all to move in the direction of encouraging all of us
to get a healthy lifestyle.
One of the questions that I was curious about with Chairman
Boehner's golfing thing was, do you walk, do you carry your own
bags, or do you ride a cart? So that's a question, you know.
[Laughter.]
Mr. Wilson. I wouldn't dare ask that question.
Mr. Boehner. On Saturday, I walked.
Mr. Bost. OK. So when we talk about playing golf, you know,
that's one of the things that we'd have to consider.
Mr. Wilson. But we do have a national junior golf program
that the Chairman has been very active in.
Another point in regard to fresh fruits and vegetables, I
have a keen interest, with Congressman Majette, in that we feel
that the peaches from the Southeastern United States are
particularly helpful in promoting a glow of health, and so as
you look around for fruits, I do want to raise that peaches are
in ample supply.
Ms. Majette. Will the gentleman yield?
Mr. Wilson. Yes.
Ms. Majette. And I do want to point out that every year we
have the annual Peachtree Road Race, which is the largest 10-K
in the entire country, and so people are able to enjoy that and
get their exercise, and I guess they eat peaches later.
Mr. Bost. Interestingly enough, let me take 30 seconds to
respond to that by essentially saying the peach people come and
see me, they would come and see me every day if we would let
them.
Mr. Wilson. Yes.
Mr. Bost. They visit quite frequently, and believe me, we
understand the importance of peaches, and one of the products
that the kids love that's in one of the schools is the small
tub of frozen peaches that the children really, really like,
and it's a part of many of the fruit and vegetable bars that
I've seen around the country.
So I think peaches are well represented.
Mr. Wilson. Well, it's certainly a great interest of the
Congresswoman and myself, and being from South Carolina, we
always like to point out that our sister state, which is much
larger in terms of population and is known as the Peach State,
is second in the Southeast after South Carolina in production.
And I yield the balance of my time.
Chairman Castle. On that high note, Mr. Owens.
Mr. Owens. Thank you, Mr. Chairman.
I would like to--I appreciate the endeavors of the
Subcommittee, since I'm not a member of the Subcommittee, but I
have a great interest in the child nutrition programs and free
lunch programs, because New York City, with more than a million
students, and 60 percent of those being eligible for free
lunches, has the largest free lunch program in the country.
There's a couple of questions I have, which get off the
subject of peaches and onto the subject of milk.
You mentioned that breast-feeding is highly desirable and
youngsters who are breast-fed come to have a tendency to be
less obese. In another point in your testimony, you mention the
fact that you're encouraging low fat milk to be utilized.
Now, we've had debates in the past on this Committee, and I
don't know whether things have changed or not, but can you tell
me, do we still require that all programs in the Department of
Agriculture must serve whole milk?
Mr. Bost. It is my understanding that that is a
requirement.
Mr. Owens. That's a requirement in the law, right?
Mr. Bost. Yes, and that's why as a part of child nutrition
reauthorization, we're also recommending that skim milk be
offered as a choice, also.
Mr. Owens. Well, is that a violation of the law if you
recommend that skim milk be offered? Because we've had great
debates here in this very room about skim milk being offered as
an alternative and the law says whole milk must be served.
Now you mentioned low fat milk before. Is that a violation
of the law?
Mr. Bost. No. What we're saying is, we're saying you can
continue to offer whole milk, but we want schools to offer skim
milk, also, and so not--
Mr. Owens. The law allows you to do that?
Mr. Bost. Well, no, not yet.
Mr. Owens. The law does not allow you to offer skim milk as
an alternative?
Mr. Bost. Well, that's why we're here as a part of child
nutrition reauthorization. That's part of my recommendation.
And I'm saying that the law, as I understand it, says that
you have to offer whole milk.
What I am recommending is that I want the schools to also
offer skim milk.
Mr. Owens. That's part of the revision of the law that
you're offering?
Mr. Bost. That is correct. That is part--
Mr. Owens. Do you have the President's support for this?
Mr. Bost. Yes. That is one of my recommendations.
Mr. Owens. Why do you think we have this requirement for
whole milk?
Mr. Bost. I can't speak to that. Apparently that happened
before my time.
Mr. Owens. That happened before people became more diet-
conscious, you think, in terms of these programs?
Mr. Bost. You're asking me to suppose, and--
Mr. Owens. Are there any other requirements for any other
food? Do we have to serve Texas beef or Iowa pork, or are there
any other mandates of that kind--
Mr. Bost. No.
Mr. Owens. --other than whole milk?
Chairman Castle. How about Delaware chickens?
[Laughter.]
Ms. Woolsey. California wine.
Mr. Boehner. Will the gentleman yield?
Mr. Owens. I'd be happy to yield to the gentleman from
Wisconsin, is it?
Mr. Boehner. Mr. Bost, why wouldn't we serve to kids what
they're willing to drink in terms of their preference of milk?
Maybe it's skim milk, maybe it's 1 percent, maybe it's 2
percent.
Why wouldn't we allow a food service director to
determine--and it wouldn't take them long to determine--what
the children in their school, what type of milk they'd prefer
to drink?
Mr. Bost. I agree, we do. What we're saying in this
specific instance, we also would like for them to be able to
offer skim milk, too.
Most recently, I was up in the school district up in
Bellingham, Washington. Gaye Lynn MacDonald, who is here, does
an outstanding job in terms of providing those types of
choices, and I saw skim, 1 percent, 2 percent, chocolate. I saw
all of those varieties there.
But it's my understanding that the law says you have to
offer whole milk.
What I'm saying is, or the recommendation that we're making
is, we would also like for them to say, ``We would like for you
to also offer skim milk, low fat milk, given the fact that some
of our children are increasingly becoming overweight.''
Mr. Owens. Reclaiming my time, would the chair join me to
make sure that we pull that out of the law, that requirement
that whole milk must be offered?
I don't think you can subsidize the chocolate milk and you
can't subsidize the skim milk, but the subsidized milk is the
whole milk.
Mr. Boehner. As a member of the Ag Committee who has dealt
with dairy policy for the last dozen years, I think I
understand the political ramifications of why the law says what
it says. Maybe I shouldn't be so blunt. It's total nonsense.
Mr. Owens. I appreciate the Chairman--
Mr. Boehner. If we want kids to drink milk, we ought to
give them a variety of types of milk that they may drink. I
like 2 percent. You may like skim.
Mr. Owens. Would you join me in--
Mr. Boehner. I'd be happy to.
Mr. Owens. --removing that mandate?
Mr. Boehner. I'd be happy to.
Mr. Owens. Thank you very much. Thank you.
Chairman Castle. Thank you, Mr. Owens.
Ms. Woolsey, I understand, has requested an additional 5
minutes for further questioning, and I yield to her for 5
minutes.
Ms. Woolsey. Thank you for letting me do this, and thank
you, Mr. Secretary, for coming before us today. You've been
really thorough.
When you talk about reviewing the eligibility and
certification verification, we have to be very careful that
we're not spending more money to do something we're not going
to save anything from in the long run.
So, I mean, how are you making sure that will happen?
And two, wouldn't it--I'm going to take you to where I want
to be on this.
I think it would be totally more effective if we just do
away with that middle level reduced lunch fee in the first
place, because that costs everybody money to implement, and it
sets up the who's eligible, who isn't, who's embarrassed and
who isn't.
So would you do me a big ole favor and respond to that?
Mr. Bost. Absolutely.
Interestingly enough, Ms. Woolsey, that was one of the
things that I looked at over a year or so ago when I looked at
putting some of these proposals together, and to do away with
reduced price would cost us anywhere between $600-and-700
million.
In terms of the package that I laid out, I did not think
that, one, that was supported by the President's budget, and I
didn't think that, in terms of the complete package that I was
interested in putting together and the priorities that it
established, that I could afford to do that, and that's why it
is not one of the recommendations. That's the first point that
I'd like to make.
The second point that I'd like to make is the fact that we
believe, based on the proposals that I've laid out for you this
morning, that several things will happen, but at least two
things will happen:
One, it will make it easier for eligible children to
participate in our program;
Two, that it will save some money that we will be able to
put back into the program;
Three, it will improve the overall integrity of the
program;
And last but not least, it will probably increase the
number of eligible children participating in the program.
And I don't believe--well, initially, it may cost some
money to set the system up, but in the long term, it will end
up saving us a significant amount of money that we will be able
to use to meet the needs of eligible children that are not
participating in this program.
Ms. Woolsey. Excuse me. There is a concern that many
eligible families will opt out of the program rather than be
scrutinized, because they will think it's going to harm them in
other ways, and these will be kids that need to be part of the
program. How are we going to prevent that?
Mr. Bost. You're absolutely right, and that's one of the
things that we're looking at, and that's why we're building
into it a very robust followup system to address some of those
concerns.
Ms. Woolsey. Well, OK. Well, we're wanting to help you with
that.
Mr. Bost. Absolutely.
Ms. Woolsey. Because we have to be super sensitive that we
don't harm those that need it the most.
Mr. Bost. And I think, and hopefully I was very clear, that
we agree with that, and we're not interested in harming any
eligible children.
Ms. Woolsey. Thank you very much.
Mr. Bost. Thank you.
Chairman Castle. Thank you, Secretary Bost. We very much
appreciate you being here, your very thorough testimony, and
your willingness and ability to answer questions, and also your
patience for waiting--
Mr. Bost. Not a problem.
Chairman Castle. --with our scheduling problems with Dr.
Carmona, but we thank you and we look forward to working with
you as we take up this legislation, which won't be until after
the summer break, so it will be sometime in the fall.
Mr. Bost. Thank you, Mr. Chairman, and we also look forward
to working with you as we move forward in terms of improving
the lives of children in this country.
Chairman Castle. Good. This panel, then, is dismissed, and
we will now form the second panel. We'll just take a minute or
two to do this, so please don't take too much of a break.
If the staff can help with this and the other panelists
will come forward, we'll get to them just as soon as they're
ready.
The Subcommittee will come to order.
As some of you may recall who were here before, we did not
do our opening statements, which I'm entitled to and the
ranking member, Ms. Woolsey, is also entitled to do, and we're
going to proceed with those now, although I'm going to try to
slice and dice a little bit here to speed things along so we
can get to the panel as soon as possible.
I think everybody here is cognizant of the fact by now that
this is the first hearing to help prepare us as the
Subcommittee for the reauthorization of the Child Nutrition Act
of 1966, and the National School Lunch Act, which is scheduled
for this year.
There is general agreement on the importance of good
nutrition for everyone, especially children.
Child nutrition programs, including the National School
Lunch and Breakfast Programs; the Special Supplemental
Nutrition Program for Women, Infants, and Children, which we
know as WIC; and the Child and Adult Care Food Program help
give lower-income children access to nutritious meals and
snacks.
Proper nutrition is essential for children to achieve full
physical development and long-term health. In addition, a
healthy diet is critical for a child's academic success.
Numerous studies have shown that diet affects children's
ability to learn. There are proven linkages between diet and
cognitive development, concentration levels, and psycho-social
behaviors.
The Federal child nutrition programs were conceived to
offer wholesome meals and snacks to children in schools and
child care centers and to support the health of lower-income
pregnant women, breast-feeding mothers, and their young
children.
These programs represent a huge national investment,
totaling over $12 billion per year. While the resources spent
have been significant, issues remain about how to best reach
the goal of providing lower-income children with access to
healthy, affordable meals.
Childhood obesity is becoming a major health problem in the
United States, and studies suggest that overweight children are
significantly more likely to become overweight or obese adults.
Children are increasingly suffering from conditions
traditionally associated with adulthood, including Type 2
diabetes, high cholesterol, and high blood pressure. I am very
concerned about childhood obesity and the fact that it is
slowly becoming an epidemic.
Last year, the U.S. Surgeon General issued a report that
identified schools as a ``key setting'' for developing public
health strategies to prevent and decrease overweight and
obesity.
Over the past several years, programs providing meals and
snacks to children have made progress in improving lunch menus
to meet Federal nutrition standards for fat and calories, but I
believe more can be done to provide every child with a school
environment that promotes healthy food choices and regular
physical activity. Obviously, we've heard a lot about that
already today.
In an effort to address this issue, I introduced
legislation, H.R. 2227, the Childhood Obesity Prevention Act,
that would authorize grants to fund pilot programs at the state
and local levels to encourage the development and
implementation of programs to promote healthy eating and
increased physical activity among children.
This Committee will examine additional ways to address the
important and complex issue of childhood obesity during the
child nutrition reauthorization while supporting the role of
local school districts to make decisions about the foods that
are available to children in school.
During reauthorization, the Committee will also consider
the challenges faced by the WIC program as well as issues
related to school meal reimbursement, the School Breakfast
Program, and other relevant provisions aiming to strengthen the
nation's child nutrition programs.
Today, we will hear from experts--already heard from a
couple--who will help shed light on these programs, their
merits, and areas where they can be made stronger.
Our witnesses' unique perspectives on child nutrition and
health will offer insights that will be tremendously helpful to
the members of the Committee, as we work to improve child
nutrition programs, and we look forward to the comments of all
of you.
And I turn to Ms. Woolsey for her opening statement.
Ms. Woolsey. Thank you, Mr. Chairman.
Authorizing the child nutrition programs is going to be a
huge challenge. There are so many programs, so many issues to
consider, and so little money.
With yesterday's report on the national deficit being the
largest in U.S. history, and worsening, I am truly worried, and
we are going to be truly challenged when we work on this.
I know that there have been proposals to use
recertification to find additional funds, and while I'm not
totally ruling it out at this point, I do want to express my
very deep commitment to doing nothing in this reauthorization
that would result in more hungry children or fewer hungry
children having access to meals and snacks both in and out of
school.
The primary goal of this reauthorization just has to be an
increase in the opportunities for low-income infants and
children to have nutritious food at home, in child care centers
and homes, at school, and when school is out for the day or the
year.,
Anytime the economy takes a turn for the worse, as it has
done for a while now, you can see it first in the number of
low-income children who don't have enough to eat, particularly
at home. We need to figure out ways to get more food to hungry
kids, particularly kids in the working poor families.
In addition to that, we should be trying to help all
children make healthy eating choices.
I certainly don't mean that we or anyone else should become
the food police, but schools can be offered incentives to make
healthy food available to children and schools can educate so
that children will choose those healthy foods.
I have a few specific issues that are near and dear to my
heart, such as the expansion of the Universal School Breakfast
Pilot, and adding teenagers to it, but this is our first
hearing, and I plan to listen. I plan to ask questions. I plan
to learn from all of these wonderfully knowledgeable witnesses.
I thank you all for coming. You are a great resource to us.
So thank you for having this hearing, Mr. Chairman, and thank
you all for coming today.
Chairman Castle. Thank you, Ms. Woolsey, and with that, we
will now turn to our panel.
I'll introduce each of you and then we'll follow as we did
before. Each of you will testify and then we'll take turns
asking questions here.
Our lead-off hitter today, referring to the all-star game
again, I guess, is Dr. Tom Baranowski, who is Professor of
Pediatrics specializing in behavioral nutrition at the
Children's Nutrition Research Center at Baylor College of
Medicine.
Dr. Baranowski's research is directed toward understanding
children's eating and physical activity choices and evaluating
programs to help change these behaviors. His specific areas of
interest are in fruit, juice, and vegetable consumption,
obesity prevention, and physical activity behaviors.
In addition to his current involvement as primary
investigator for four grant-funded nutrition and physical
activity research studies, Dr. Baranowski is also serving on
advisory committees at the Institute of Medicine, National
Academy of Sciences, and the National Institutes of Health.
He's accompanied today by Dr. Karen Cullen, who is an
Associate Professor of Pediatrics at the Children's Nutrition
Research Center at Baylor College of Medicine, and her work
focuses on development of programs that improve children's
fruit and vegetable consumption and reduces their dietary fat
intake.
Dr. Cullen has participated in the development of several
five-a-day programs for children and adolescents, and she is
currently evaluating an innovative snack bar, fruit juice, and
vegetable intervention program for middle school students that
was implemented in 10 Houston area middle schools, and she'll
be assisting Dr. Baranowski during the question period.
The second witness who will actually testify today is Ms.
Betsy Clarke, who is the Director of Supplemental Nutritional
Nutrition Programs for the Minnesota Department of Health. Ms.
Clarke is a founding member of the National Association of WIC
Directors, which is now known as the National WIC Association,
or NWA.
She previously held NWA offices of Vice President and State
Director Representative, and is currently serving as President
of the National WIC Association.
Ms. Clarke, along with other NWA partners, helped develop
the WIC infant formula purchasing, which contributes over $1.5
billion per year to WIC funding nationally.
Our next witness will be Gaye Lynn MacDonald. Ms. MacDonald
is Manager of Food Services at Bellingham Public Schools in
Bellingham, Washington and the President of the American School
Food Service Association.
The American School Food Service Association represents
food service operations, staff, and school food directors
across the nation. ASFSA has 52 state affiliates, hundreds of
local chapters, and over 55,000 members.
Accompanying Ms. MacDonald today is my constituent, Ms.
Angelucci, who is the Legislative Chair of the Delaware School
Food Service Association as well as the Food Service Supervisor
in the Colonial School District located in New Castle,
Delaware, and was probably sent here today to keep me straight,
if I had to guess.
Our final witness, our cleanup hitter, using the baseball
analogy again, is Dr. Deborah Frank, who is a pediatrician and
the Director of the Grow Clinic for Children at the Boston
Medical Center.
Dr. Frank also serves as a Professor of Pediatrics at the
Boston University Medical School and as an Assistant Professor
of Public Health at the Boston University School of Public
Health.
Cited is a respected authority in her field, Dr. Frank
focuses on child advocacy and fighting child hunger. Throughout
her career, Dr. Frank has served on numerous anti-hunger
committees and advisory boards.
Before the panel begins, let me apologize. All of us serve,
as you may know, on more than one Committee.
I happen to serve on the Financial Services Committee, and
we're having a markup and votes over there, so I may have to
just rise abruptly and go running out of here in order to make
votes and actually participate in something that's important.
Mr. Osborne has been kind enough to sit in when that happens.
So if I disappear, it's for valid legislative reasons that
I disappear. Any of us have those problems from time to time.
You're an extremely qualified group of witnesses, and we're
delighted to have you here, and we look forward to your
testimony, and now we will start with Dr. Baranowski.
STATEMENT OF TOM BARANOWSKI, PROFESSOR OF PEDIATRICS
(BEHAVIORAL NUTRITION), USDA CHILDREN'S NUTRITION RESEARCH
CENTER, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS, ACCOMPANIED
BY KAREN W. CULLEN, ASSOCIATE PROFESSOR OF PEDIATRICS,
CHILDREN'S NUTRITION RESEARCH CENTER, BAYLOR COLLEGE OF
MEDICINE, HOUSTON, TEXAS
Dr. Baranowski. Thank you, Mr. Castle. It's an enormous
privilege for us to present to the U.S. Congress.
The U.S. currently faces an obesity epidemic which will
have enormous consequences for the health care system and
health care costs. The children in the United States are the
heaviest in the world, and they're still getting fatter.
This rapid rise in obesity is almost certainly due to
changes in our environment and in our behaviors, not in
genetics, since changes in the gene pool require many
centuries.
Having children eat more fruit and vegetables and get more
physical activity would both be protective against obesity.
With over 95 percent of children in school, schools are an
important environment. Schools are a major source of children's
nutrition and physical activity information via the curriculum,
a major food environment, and provide opportunities for
physical activity. Schools also can reach out to parents.
Elementary schools are a major source of fruit and
vegetables for students, but when children get to middle
schools with snack bars, their consumption of fruit and
vegetables declines, and their consumption of higher fat and
sugar foods increases.
Also, in many low-income middle schools, there is a sigma
attached to eating the National School Lunch Program meal on
the part of students, teachers, and staff. Many even very-low-
income students would rather buy foods from the snack bar and
vending machines than eat the free lunch, to avoid the stigma.
Comments from students were that, ``We know what to eat ...
we eat this way because we can,'' which suggests that the lack
of knowledge of what to eat to be healthy is not the primary
problem.
We have also reviewed the literature on school-based
obesity prevention programs. Many different types of programs
have been tried. Few of these programs were effective at
changing obesity.
The bottom line was that the problem is complex and there
are no simple, safe, easy-to-implement, and inexpensive
solutions to this enormous problem. As a society, we have to
make an investment in our children to avoid obesity and its
serious consequences.
We believe that there are things that could be done to
improve the situation. Schools alone cannot be blamed for the
epidemic of obesity. The schools alone cannot solve the
problems, but they can play an important role in reversing the
current situation.
First, our research has shown that children tend to eat the
foods that are available to them--not rocket science, but a
fact.
This suggests that we should encourage schools to offer a
variety of healthier foods. This would include offering more
attractively prepared and packaged fruit and vegetables offered
in ways that children like to eat them, offer more access to
water in a form desired by children, and better market these
items to children within the school to enhance their
attractiveness--or ``coolness''--to eat.
Second, since many children in middle and high schools are
not currently eating the National School Lunch Program lunch,
we need to reduce the stigma.
Making the School Lunch Program attractive to all students
will require addressing the quality and costs of the pre-
prepared foods used in those school food services, innovative
approaches and changes in the school food guidelines, and
marketing a revised and enhanced National School Lunch Program
to children.
Third, some have advocated for restricting foods in the
schools.
While we agree that some foods are better for health, like
fruit and vegetables, and others may be less desirable, all
foods can have a place in a healthy diet.
Health through optimal nutrition is a question of balance,
variety, and moderation. Simply restricting foods in school
will work for some children, but many will go elsewhere to buy
foods they want, with the school losing the child's dollar.
Effective programs will likely introduce healthy
alternatives in a form attractive to children, within the
context of a marketing program to change the perceptions of the
student body, faculty, and staff, a nutrition education
curriculum that promotes healthful dietary change, and controls
placed on portions available to children of the less desirable
products, like small bags of potato chips.
Fourth, physical activity is another necessary component of
the solution.
Restoring physical education to schools that have dropped
or limited it would be important. Increasing the amount of
physical activity during the physical education period is an
important step, since many students are active for only short
periods of time during PE.
But how best to accomplish this is complex in a PE period
that may have 200 students, only three PE teachers, and only
one gym. How best to engage children in physical activity when
they may not want to poses challenges. Marketing research on
school physical activity is needed.
Other areas to be explored include programs for after-
school physical activity, walking to school, making the streets
safer and child-friendly streets for walking and bicycling, and
reducing TV watching. Any new programs introduced should be
thoroughly evaluated to ensure they attain the desired ends.
A major limitation on action at this time is that the
primary contributors to the obesity epidemic are not clear.
Researchers have identified several likely causes, including
increased consumption of fast foods and soft drinks, low
consumption of fruit, vegetables, water, and milk, excessive TV
watching, poor physical education, low physical activity, and
various other contributing factors.
While there is likely an element of truth to all these,
some of these factors are more likely, and some are larger
contributors than others. Research is necessary to better
understand the problem.
The research should not stop efforts to deal with obesity
now, but would give clearer guidance to effective steps that
could be taken in the future.
Although we may learn the most important factors
contributing to obesity, we may not know how to effectively
change them. Behavioral research is needed to develop and test
procedures to encourage change and to understand the processes
by which change occurs.
The National Institutes of Health, the U.S. Department of
Agriculture, the National Academy of Sciences, and other
agencies have extensively funded the biological sciences for
billions of dollars per year to very good advantage. It has
taken 40 years of major investment to get to the point of
knowing the molecular processes that predispose to disease and
to divine effective cellular and molecular solutions for
disease processes.
Since the current obesity epidemic is largely environmental
and behavioral in origin, a similar investment must be made in
behavioral research.
Why do we eat the foods that we eat? Why are some of us
physically active and others not? How can we help people to
make effective choices for health, in part through healthier
environments?
Changing a small number of behaviors--for example,
increasing fruit and vegetable consumption and physical
activity--could have broad health effects, preventing heart
disease, several cancers, stroke, diabetes, and many other
adult chronic diseases. This would appear to be an outcome
worth the investment.
Thank you, Mr. Chairman.
[The prepared statement of Dr. Baranowski follows:]
Statement of Tom Baranowski PhD and Karen W. Cullen, DrPH, RD, USDA
funded Children's Nutrition Research Center, Baylor College of
Medicine, Houston, TX
Dr. Cullen and I are Behavioral Nutritionists from the Children's
Nutrition Research Center of the Baylor College of Medicine in Houston,
Texas. We study the factors that influence children's diet intake and
physical activity, and design and evaluate programs to help children
and their families improve these behaviors.
The U.S. currently faces an obesity epidemic which will have
enormous consequences for the health care system and health care costs.
The children in the U.S. are the heaviest in the world and they are
still getting fatter. This rapid rise in obesity is almost certainly
due to changes in our environment and in our behaviors, not in
genetics, since changes in the gene pool require many centuries. Having
children eat more fruit and vegetables and get more physical activity
would both be protective against obesity.
With over 95% of children in school, schools are an important
environment. Schools are a major source of children's nutrition and
physical activity information via the curriculum, a major food
environment and provide opportunities for physical activity. Schools
can also reach out to parents.
Elementary schools are a major source of fruit and vegetables for
students, but when children get to the middle schools with snacks,
their consumption of fruit and vegetables decline, and their
consumption of higher fat and sugar foods increases. Also, in many low
income middle schools, there is a stigma attached to eating the
National School Lunch Program (NSLP) meals, on the part of students,
teachers and staff. Many even very low income students would rather buy
foods from the snack bar and vending machines than eat the free NSLP
lunch to avoid the stigma. Comments from students were that ``we know
what to eat...we eat this way because we can,'' which suggests the lack
of knowledge of what to eat to be healthy is not the primary problem.
We have also reviewed the literature on school based obesity
prevention programs. Many different types of programs have been tried.
Few of these programs were effective at changing obesity. The bottom
line was that the problem is complex, and there are no simple, safe,
easy to implement and inexpensive solutions to this enormous problem.
As a society we have to make an investment in our children to avoid
obesity and its serious consequences.
We believe that there are things that could be done to improve the
situation. Schools alone cannot be blamed for the epidemic of obesity.
They cannot solve the problems alone, but they can play an important
role in reversing the current situation.
First, our research has shown that children tend to eat the foods
that are available to them. This suggests that we should encourage
schools to offer a variety of healthier foods. This would include
offering more attractively prepared and packaged fruit and vegetables
offered in ways children like to eat them, offer more access to water
in a form desired by children, and better market these items to
children to enhance their attractiveness (``coolness'' to eat).
Second, since many children in middle and high schools are not
currently eating the NSLP lunch, we need to reduce the stigma. Making
the NSLP meal attractive to all students will require addressing the
quality and costs of the pre-prepared foods used in most school food
services, innovative approaches and changes in the school food
guidelines and marketing a revised, enhanced NSLP to children.
Third, some have advocated for restricting foods in the schools.
While we agree that some foods are better for health (like fruit and
vegetables) and others may be less desirable, all foods can have a
place in a healthy diet. Health through optimal nutrition is a question
of balance, variety and moderation. Simply restricting foods in school
will work for some children, but many will go elsewhere to buy the
foods they want (with the school losing the student's dollar).
Effective programs will likely introduce healthy alternatives in a form
attractive to children, within the context of a marketing program to
change the perceptions of the student body, faculty and staff, a
nutrition education curriculum that promotes healthful dietary change,
and controls placed on portions available to children of the less
desirable options (e.g. small bags of chips).
Fourth, physical activity is another necessary component of the
solution. Restoring physical education to schools that have dropped or
limited it would be important. Increasing the amount of physical
activity during a physical education (PE) period is an important step
since many students are active for only short periods during PE. But
how best to accomplish this is complex in a PE period that may have 200
students, only 3 PE teachers and only one gym. How best to engage
children in physical activity when they may not want to, poses
challenges. Marketing research on school PA is needed. Other areas to
be explored include programs for after school physical activity,
walking to school, making the streets safer and child friendly for
walking and bicycling, and reducing TV watching. Any new programs
introduced should be thoroughly evaluated to ensure they attain the
desired ends.
A major limitation on action taken at this time is that the primary
contributors to the obesity epidemic are not clear. Researchers have
identified several likely causes including increased consumption of
fast foods and soft drinks, low consumption of fruit, vegetables, water
and milk, excessive TV watching, poor physical education, low physical
activity and various other contributing factors. While there is likely
an element of truth to all these, some factors are more likely, and
larger contributors, than others. Research is necessary to better
understand the problem. This research should not stop efforts to deal
with obesity now, but would give clearer guidance to effective steps
that could be taken in the future.
Although we may learn the most important factors contributing to
obesity, we may not know how to effectively change them. Behavioral
research is needed to develop and test procedures to encourage change
and to understand the processes by which change occurs.
The National Institutes of Health, U.S. Department of Agriculture,
National Academy of Sciences and other agencies have extensively funded
the biological sciences for billions of dollars per year to very good
advantage. It has taken 40 years of major investment to get to the
point of knowing the molecular processes that predispose to disease,
and divine effective cellular and molecular solutions for disease
processes. Since the current obesity epidemic is largely environmental
and behavioral in origin, a similar investment must be made in
behavioral research. Why do we eat the foods we eat? Why are some of us
physically active and others not? How can we help people make effective
choices for health, in part through healthier environments? Changing a
small number of behaviors (e.g. increasing fruit and vegetable
consumption and physical activity) could have broad health effects,
preventing heart disease, several cancers, stroke, diabetes, and many
other adult chronic diseases. This would appear to be an outcome worth
the investment.
______
Chairman Castle. Thank you, Dr. Baranowski.
Ms. Clarke.
STATEMENT OF BETSY CLARKE, DIRECTOR, WOMEN, INFANTS, AND
CHILDREN PROGRAM, STATE OF MINNESOTA, AND PRESIDENT, NATIONAL
WIC ASSOCIATION
Ms. Clarke. Thank you, Mr. Chairman.
Chairman Castle. Can you--that may be a little hard to do--
get that as close to you as you can, make sure it's on, and all
those kinds of things?
Ms. Clarke. OK.
Chairman Castle. Good. Thanks. Great.
Ms. Clarke. Good morning. Thank you, Mr. Chairman, members
of the Committee.
We appreciate your invitation to present for the National
WIC Association and our view on reauthorization of the WIC
Program.
At the outset, I would like to thank you, Mr. Chairman, and
members of the Committee, for your commitment to WIC, as well
as President Bush and Secretary Veneman for their support.
The National WIC Association is proud of the strong
bipartisan commitment WIC has had since its inception. WIC has
an extraordinary, nearly 30-year record of preventing
children's health problems and improving their health, growth,
and development. WIC children enter school ready to learn.
In the December 2001 Report to Congress, the GAO identified
six challenges, and with your permission, I'd like to highlight
our proposed responses.
First, Coordinating Nutrition Services with Health and
Welfare Programs.
WIC has become the single greatest entry point for health
services contact for many WIC families.
To achieve better coordination of WIC Services with other
programs, to eliminate unnecessary clinic visits for working
families, to provide for more adequate nutrition counseling
time, and to streamline paperwork, the National WIC Association
recommends giving states the option to extend certification
periods for up to 1 year for children and breast-feeding women.
Meeting Increased Program Requirements with Available
Resources.
WIC resources are being stretched in unimaginable ways.
Currently, WIC staffs are mandated to provide participant
information on a wide variety of subjects, some of which relate
to WIC's mission, while others do not.
Each minute of an unfunded mandate results in the loss of
over 125,000 hours of nutrition education interventions
annually. The GAO identified at least nine new program
requirements that have been added to WIC since 1988 without
additional funding.
WIC is proud to play the role that we play in our public
health system. However, expecting so much of WIC while
providing no commensurate resources challenges the WIC
infrastructure, staff, and the families WIC serves.
Indeed, these unfunded mandates may eventually contribute
to a lessening of WIC's ability to achieve the outstanding
health and nutrition outcomes demonstrated by numerous program
evaluations.
Responding to Health and Demographic Changes in WIC's
Populations.
WIC's population, like the general population, has
experienced increases in the prevalence of overweight and
related health issues. In addition, there have been dramatic
increases in the ethnic diversity of WIC's population.
The National WIC Association recommends:
First, while WIC programs have been actively engaged in
obesity prevention efforts, the program's definition of
nutrition education may be self-limiting.
The National WIC Association recommends expanding the
definition of nutrition education to allow but not mandate
anticipatory guidance related to physical activity, feeding
relationships, and child development.
Second, the current WIC food package is now nearly 30 years
old, and no longer consistent with current science. WIC
agencies have independently taken steps to combat the nation's
obesity epidemic by modifying the food package within current
regulations.
Agencies provide low-fat milk and cheese, reducing the
cholesterol, fats, and calories of the food package. Simply
put, the WIC food package is not a cause of obesity. But more
can be done.
In the year 2000, the National WIC Association recommended
changes to the WIC food package to reflect current nutrition
science, improve dietary intake, and reduce the incidence of
obesity, including broader choices and foods that reflect
diverse cultural dietary patterns.
While Under Secretary Bost and his FNS team are to be
commended for their efforts to publish a proposed rule on the
WIC food package and applauded for their referring the food
package evaluation to the Institute of Medicine, the time has
passed for WIC to provide healthful changes in and enhance the
food package.
The National WIC Association recommends USDA report to
Congress within 6 months of authorization on National Academy
of Sciences' Institute of Medicine's review of the food package
and that USDA publish, within 6 months of the release of the
IOM Report, a proposal to revise the WIC food package.
Third, in the interim period, NWA asks Congress to direct
USDA to allow states to implement pilot or demonstration
projects which would allow for food substitutions such as
fresh, frozen, and canned fruits and vegetables and food items
responsive to the needs of WIC's culturally diverse
populations.
Fourth, NWA recommends that the Institute of Medicine
reevaluate the WIC food package every 10 years, recommending
changes to reflect current nutrition science.
Fifth, the competitive bid requirement for infant formula
has resulted in significant savings to the WIC program,
allowing WIC to serve roughly one in five participants.
NWA urges Congress to ensure that this vital and highly
successful program element is protected. The current funding
formula does not allow states sufficient NSA funds to support
funded participation levels or to maintain and protect client
services, integrity, or USDA initiatives.
NWA recommends that states have the option to convert
unspent food funds to NSA and apply a portion of the cost
savings dollars received to nutrition services.
With that, finally, Mr. Chairman and members of the
Committee, NWA looks forward to working with you in this
reauthorization process.
I'll answer any questions.
[The prepared statement of Ms. Clarke follows:]
Statement of Betsy Clarke, MS, President, National WIC Association, and
Director, Minnesota State WIC
Thank you Mr. Chairman and members of the Committee, for your
invitation to present the National WIC Association's views on
reauthorization of the Special Supplemental Nutrition Program for
Women, Infants and Children, known as WIC. As NWA's President, I am
speaking on behalf of the thousands of nationally recognized WIC health
professionals, nutritionists and dietitians who are committed to
addressing the nutrition and healthcare needs of WIC families. Our
members serve over 7.5 million participants through 2,100 WIC agencies
in 10,000 WIC clinics each month. They are the front lines battling to
improve the quality of life for our most vulnerable populations.
With your permission I would also like to introduce a member of the
NWA team accompanying me today who is available here in Washington to
address any questions you may have following the hearing--the Rev.
Douglas A. Greenaway, Executive Director of the Association.
At the outset, I would like to thank you Mr. Chairman and members
of the Committee for your long-term commitment to WIC and the other
Child Nutrition Programs as well as the President and Secretary Veneman
and their teams for their tremendous support of WIC. NWA is proud of
the strong bi-partisan commitment WIC has engendered since its
inception. The future of our nation's low-income women, infants and
children depend upon your support.
WIC is a short-term intervention program designed to influence
lifetime nutrition and health behaviors in a targeted, high-risk
population. It has an extraordinary, nearly 30-year record of
preventing children's health problems and improving their health,
growth and development. WIC children enter school ready to learn. They
show better cognitive performance.
Quality nutrition services are the centerpiece of WIC: nutrition
and breastfeeding education, nutritious foods, and improved healthcare
access for low and moderate income women and children with, or at risk
of developing, nutrition-related health problems. WIC serves almost
one-half of all infants born in this country and roughly 1 in 4 of all
children between one and four years of age.
WIC's committed, results oriented, entrepreneurial staff stretch
resources to serve all eligible women and children and ensure program
effectiveness and integrity.
Mindful of the challenges WIC faces in delivering high-quality
nutrition services, during the last reauthorization cycle NWA asked
Congress to invite the General Accounting Office, GAO, to examine those
challenges.
In its December 2001 report to Congress entitled, ``Food
Assistance: WIC Faces Challenges in Providing Nutrition Services,'' GAO
identified six challenges: coordinating nutrition services with health
and welfare programs, meeting increased program requirements with
available resources, responding to health and demographic changes in
WIC's populations, meeting increased program requirements, improving
the use of information technology to enhance service delivery and
program management, assessing the effects of nutrition services, and
recruiting and retaining skilled staff.
To these, NWA has added an additional challenge: visioning the
future landscape of WIC. A copy of our legislative proposals, including
suggested bill language, has been attached to our written testimony.
With your permission, I would like to highlight our proposed
responses to these challenges:
Coordinating Nutrition Services with Health and Welfare Programs
Local public health departments are reducing or eliminating
referral and case management services. WIC is consistently challenged
to coordinate with other health and welfare program services. Indeed,
in the current environment of fewer services, WIC has become the single
greatest point of health services contact for many WIC families.
To achieve better coordination with healthcare services, eliminate
unnecessary clinic visits, reduce invasive blood work for infants and
children, provide for more nutrition counseling time and streamline
paperwork for clients and clinic, NWA recommends giving states the
option to extend certification periods for up to one year for children
and breastfeeding women, or until women stop breastfeeding, whichever
is earlier.
To offer families flexibility for physical presence because of
distance, transportation, weather, other local conditions or special
needs hardships, NWA recommends that where participants are receiving
on-going health services from a provider that the physical presence
requirement for children be required to be met one time, at some time
during the certification period and not necessarily at the time of
certification.
Meeting Increased Program Requirements with Available Resources
NWA and USDA/FNS have worked together over the past two years to
reinvent the way nutrition education is delivered to participants. We
continue to work to enhance these efforts. Both the quality of time and
the availability of time that WIC nutrition staff have available to
spend with WIC participants is critical to the success of the nutrition
and health care intervention.
WIC resources are being stretched in unimaginable ways. Currently,
WIC staffs provide participants with information on a wide variety of
subjects ranging from alcohol and drug abuse to voter registration.
Some of these responsibilities relate to the mission of WIC, others do
not. Each minute of an unfunded mandate results in the loss of over
125,000 hours of nutrition education interventions annually.
The GAO has identified at least nine new program requirements that
have been added to WIC since 1988 without a commensurate increase in
nutrition services administrative funding.
The GAO writes in its report that ``with the reduction in the
number of public health departments serving women and children, public
health officials have increasingly turned to WIC to help address the
health needs of low-income children. According to CDC, WIC has become
the single largest point of access to health related service for low-
income preschool children. Consequently, the CDC has turned to WIC to
provide services traditionally funded by other federal, state and local
health funds, such as identifying children who are not immunized.''
WIC is proud of the significant and critical role that we play in
our public health system. However, expecting so much of WIC while
providing no commensurate resources as we assume these additional
responsibilities challenges not only WIC infrastructure and staff, but
increasingly the families that WIC works so hard to serve. Indeed,
these unfounded mandates may eventually contribute to a lessoning of
WIC's ability to achieve the outstanding health and nutrition outcomes
demonstrated by numerous program evaluations.
To protect the quality of WIC nutrition and healthcare services and
the limited nutrition services administrative dollars that are
available to WIC, NWA recommends that the administrative costs that WIC
encumbers related to providing services for other programs should be
reimbursed by those programs.
Moreover, to guarantee the integrity and quality of WIC nutrition
and healthcare services and to maintain the nutrition and health
mission of WIC, NWA recommends exempting WIC from services that are
inconsistent with the intent and purpose of the Program.
To preserve the integrity of basic WIC services--nutrition benefits
and coordinated healthcare, to streamline paperwork and reduce
administrative costs and reduce service barriers, NWA recommends
exempting WIC from the requirements of the National Voter Registration
Act and the requirement to offer voter registration applications and
document these opportunities for all applicants and participants.
Responding To Health and Demographic Changes in WIC's Populations
WIC's population, like the general population has experienced
dramatic increases in the prevalence of overweight and related health
issues. In addition, there have been dramatic increases in the diverse
ethnicity of WIC's population. To respond to the health and demographic
changes in WIC's populations, NWA recommends a six-point approach.
First, while WIC Programs across the nation have been actively
engaged in obesity prevention efforts since the turn of the millennium,
the Program's definition of nutrition education may be self-limiting.
To positively affect our nation's most serious nutritional problems--
obesity and related health consequences, NWA recommends expanding the
definition of nutrition education to allow, but not mandate,
anticipatory guidance related to physical activity, feeding
relationships and child development as part of approved nutrition
education activities.
Second, the current WIC food package is now nearly 30 years old and
no longer consistent with current dietary guidelines and science. WIC
agencies have independently, within allowable guidelines, taken steps
to combat the nation's epidemic of overweight and obesity by modifying
the food package within the current regulations. For example, agencies
provide low and reduced fat milk and cheese, reducing the total
cholesterol, fats and calories of the food package. Agencies also
tailor the food package to assist participants in weight management and
to meet other dietary needs. Simply put, the WIC food package in and of
itself is not a contributing factor to obesity.
Nevertheless, in 2000, NWA recommended changes to the WIC food
package to reflect current nutrition science, improve dietary intake
and reduce the incidence of obesity including broader choices of grain
products, addition of fresh, frozen or canned fruits and vegetables,
reduced quantities of juice for infants, offering low-fat milk as the
standard, reduced quantities of cheese and foods that reflect diverse
dietary cultural patterns.
While Under Secretary Bost and his team at the Food & Nutrition
Service are to be commended for their efforts to publish a proposed
rule on the WIC Food Package, a proposal has yet to be published. The
time has past for WIC to provide healthful changes and enhance the food
package, improving WIC nutritionists' flexibility in prescribing foods
and responding to America's obesity epidemic.
NWA recommends USDA report to Congress within 6 months of enactment
of reauthorization legislation on the status of the National Academy of
Sciences' Institute of Medicine (IOM) review of the WIC food packages
and efforts to adopt a comprehensive food package proposal that
reflects the need for fresh, frozen and canned fruits and vegetables
and culturally appropriate foods responsive to participants nutritional
needs and consistent with national nutrition guidelines. Also that USDA
publish within 6 months of the release of the IOM report to Congress a
comprehensive proposed rule to revise the WIC food package to meet
these minimum changes.
Third, in the interim period as we await the report of the
Institute of Medicine and USDA to Congress, NWA asks Congress to direct
USDA/FNS to allow states to implement pilot or demonstration projects
which would allow for food substitutions, including fresh, frozen or
canned fruits and vegetables and food items responsive to the needs of
the diverse cultural populations WIC serves.
It should be noted, Mr. Chairman, that NWA supports a federally
approved WIC food list that includes national, store and private label
brands, giving states flexibility to select WIC foods to manage food
costs and nutritional options for participants.
Fourth, NWA supports USDA's current intentions to have the National
Academy of Sciences' Institute of Medicine re-evaluate the WIC food
package. To ensure that WIC foods continue to provide healthful food
supplements for WIC families and complement nutrition education efforts
NWA further recommends that the National Academy of Sciences' Institute
of Medicine re-evaluate the WIC food package at least every 10 years,
recommending changes to reflect current national nutrition science and
concerns.
Fifth, the competitive bidding requirement for infant formula has
resulted in significant savings to the WIC Program. Indeed, USDA
reports that use of competitive bidding reduces federal WIC costs by
approximately $1.5 billion a year. Roughly 1 in 5 WIC participants are
able to participate in WIC because of the infant formula cost
containment program. It generated $1.7 billion last year in non-tax
revenue for WIC. Efforts to weaken this program will have unintended
consequences on the Program and NWA opposes efforts to weaken
competitive bidding requirements and urges Congress to work closely
with the Association and USDA to ensure that this vital program element
is protected.
Among the Federal Regulations related to the competitive bidding
requirement are regulations which potentially put formula fed WIC
infants at health risk. These regulations set a maximum amount for
infant formula to be issued to WIC participants each month at a rate of
8 lbs. (3.6 kg) per 403 fluid ounces of concentrate for powdered
formula. Infant formula manufacturers offer powdered formula in a
variety of can sizes, which they change periodically.
Because the maximum amount cannot be exceeded and because the
powdered can size variations rarely exactly match the authorized
amount, WIC clients are provided less formula and nutritional benefit
than infants need for optimal growth. To avoid a substantial,
cumulative shortage over the certification period and potential health
risks, NWA recommends that USDA allow State WIC agencies to round up to
the next whole can size of infant formula to ensure that all infants
receive the full-authorized nutritional benefit of at least 944
reconstituted fluid ounces, at standard dilution, per month for
powdered infant formula.
Sixth, to be income eligible to participate in the WIC Program an
applicants' gross income (i.e. before taxes are withheld) must fall at
or below 185 percent of the U.S. Poverty Income Guidelines. For a
family of 4, this amounts to $33,485 or $644 weekly. Because families
increasingly find their income stretched to meet rising healthcare,
housing and transportation costs and are frequently placed in a
position of nutritional insecurity, NWA recommends that Congress
respond to the income challenges of the working poor by increasing the
income guidelines to 200 percent of the U.S. Poverty Income Guidelines.
Meeting Increased Program Requirements
The WIC shopping experience is intended to reinforce the WIC
nutrition education experience and provide WIC families with a full
complement of not only WIC foods, but a full market basket of foods to
ensure comprehensive, quality meals for WIC families.
To insure cost competitiveness and reasonable food prices, NWA
recommends that with the exception of non-profit agencies, pharmacies
and vendors required to ensure participant access, all WIC vendors
should be food stamp authorized and offer participants a full market
basket of foods.
The WIC Farmers' Market Nutrition Program (FMNP) funds are provided
through a legislatively mandated set-aside in the WIC appropriation. If
the entire WIC allocation is needed to maintain WIC caseload, FMNP
would not be funded. This unstable situation leaves the status of FMNP
in doubt from year to year and does not allow planning and management
of resources with confidence for the upcoming growing season. For
participating FMNP states Federal funds support 70 percent of the total
cost of the program. The remaining 30 percent of the program's cost
must come from a state match.
NWA recommends that Congress separate the funding for WIC and FMNP
to eliminate direct competition for funds and enhance collaboration
between WIC and FMNP. Separation of funding will ensure resources for
WIC benefits, that WIC caseload funds are not diverted to FMNP and that
FMNP stands on its own.
The current funding formula does not allow states sufficient
Nutrition Services Administrative (NSA) funds to support funded
participation levels, maintain, protect and improve client services and
program integrity or USDA initiatives.
NWA recommends that states 1) have the option to convert unspent
food funds to NSA by a change in the Act which will allow states to
increase the spend forward amount from 1 percent + .5% for management
information systems (MIS) to 1.5 percent + .5% or 2 percent for MIS as
well as 2) apply a portion of the rebate dollars received to nutrition
services in accordance with the proportional nutrition services/food
split used in allocating food and NSA grant dollars. Currently, cost
containment savings may only be used for food.
While states currently have the ability to use vendor and
participant recovered funds for program purposes, states would like to
extend this ability to the use of funds recovered from local agencies.
NWA recommends that states have the ability to utilize collections
of WIC program recovered funds in a consistent manner.
USDA has promulgated interim regulations concerning infant formula
cost containment without the benefit of public comment, without
consideration for failing to consider State agencies' experience with
bidding and contracting and preventing States' from negotiating the
best contract for individual circumstances.
NWA urges Congress to direct USDA to partner with the Association
to review the interim regulations on infant formula cost containment
and propose regulatory changes to appropriately respond to States'
concerns thereby ensuring maximum participant benefits.
Improving the Use of Information Technology to Enhance Service Delivery
and Program Management
Technology provides a critical foundation for quality WIC services
and Program Integrity. Funding WIC technology from existing resources
compromises WIC's ability to deliver services and develop responsive
MIS systems. Lack of adequate funding prevents more than half--56%--of
WIC state agencies from meeting USDA core functions.
To develop and maintain MIS and electronic service delivery
systems, and to link with other health data systems NWA recommends that
Congress provide an additional $122 million annually outside the
regular NSA grant to implement MIS core functions, upgrade WIC
technology systems, maintain MIS and electronic services and expedite
the joint NWA/USDA 5 year plan for state MIS systems.
Assessing the Effects of Nutrition Services
To support rigorous research and evaluation documenting WIC's
continued success, NWA recommends the flexible use of Special Project
Grants funds, state WIC funds and other grant resources for health
outcomes research and evaluation to identify effective nutrition
education and breastfeeding promotion and support services, to test
innovative service delivery and food prescriptions, and to support
USDA's partnership with NWA to achieve WIC research and evaluation
objectives.
Recruiting and Retaining Skilled Staff
The recruitment and retention of quality professional staff
continues to be a challenge for WIC. Programs are not able to offer
competitive salaries or benefits and must increasingly rely on
paraprofessionals to deliver nutrition services.
To assist in this effort, NWA recommends that Congress revise the
National Health Service Corps Program to include WIC nutrition interns,
registered dietitians and nutritionists in student loan forgiveness
programs.
Visioning the Future Landscape of WIC
Over the course of the past decade there has been discussion about
the value or appropriateness of converting WIC from a domestic
discretionary program to a mandatory program. Little is known about the
real consequences of affecting such a conversion.
NWA recommends that before policy makers entertain conversion of
the Program's funding mechanism from a discretionary to a mandatory
program, that Congress fully study the consequences of such a change
and its impact on eligibility, participation, and services prior to
implementing a conversion.
Finally, Mr. Chairman and members of the Committee, as the nation's
premier public health nutrition program, WIC is a cost-effective, sound
investment--insuring the health of our nation's children. Our Executive
Director, Douglas Greenaway, the members of NWA and I look forward to
working with you in this reauthorization process. We remain ready to
answer any questions or provide additional information you may request.
______
Chairman Castle. Thank you, Ms. Clarke. We appreciate your
testimony.
Ms. MacDonald.
STATEMENT OF GAYE LYNN MacDONALD, PROGRAM MANAGER, FOOD
SERVICES, BELLINGHAM, WASHINGTON PUBLIC SCHOOLS, AND PRESIDENT,
AMERICAN SCHOOL FOOD SERVICE ASSOCIATION; ACCOMPANIED BY PAULA
ANGELUCCI, FOOD SERVICE SUPERVISOR, COLONIAL SCHOOL DISTRICT,
NEW CASTLE, DELAWARE, AND CHAIR, PUBLIC POLICY AND LEGISLATIVE
COMMITTEE, DELAWARE SCHOOL FOOD SERVICE ASSOCIATION; AND
MARSHALL MATZ, COUNSEL
Ms. MacDonald. Mr. Chairman and members of the Committee, I
am Gaye Lynn MacDonald, President of the American School Food
Service Association and, as you introduced, the Manager of Food
Services for Bellingham Public Schools.
I appreciate your acknowledgement of Paula Angelucci, and
also present today is our counsel, Marshall Matz.
I would like to begin by thanking you and the Committee for
holding this important hearing, and in addition, I would like
to thank you for your leadership in the 1998 reauthorization of
child nutrition programs.
We are delighted to be with you this morning to discuss
these programs and explore how we might improve the programs.
I have written testimony that I have asked to be included
in the record, but I will briefly summarize it for you.
The success and security of a culture is often measured by
how it nurtures its children. A traditional Masai greeting,
``Kasserian Ingera'' asks, ``And how are the children?'' If the
children are well, the society is well, and the future is
secure.
How are the children in the United States? Children are
hungry in our urban cities and rural communities, yet, as we
have heard, there is also the paradox of overweight and
obesity, and we believe that school meal programs are proven,
effective tools to address these problems.
We are here to share with you stories of the real people
who our members see in school meal programs every day.
ASFSA believes that 2003 is a pivotal year for child
nutrition. Reauthorization of child nutrition programs offers
an excellent opportunity for the Congress to consider changes
that will improve health outcomes for children and further the
goals of No Child Left Behind. Congress should reauthorize
these programs that expire in 2003.
Additionally, we would advance for your consideration a
number of proposals to strengthen school and community based
nutrition programs, and I will frame those proposals in three
areas: program access, healthy children, and program integrity.
In terms of program access, many children from families
qualified in the reduced price category are not participating
in the lunch and breakfast programs because they can't afford
the fee of 40 cents for lunch or 30 cents for a breakfast.
While that may not seem like a lot of money to those of us
in this room, to families with incomes between 130 percent and
185 percent of the poverty line, many with more than one child,
it is often too much. The reduced price fee is a major barrier
to the working poor, particularly at the end of the month when
we see the reduced category participation rates decline.
As you know, in the WIC programs, all those with family
incomes below 185 percent of poverty and who otherwise qualify
receive benefits without charge. The same income guidelines
should be extended to school nutrition programs.
The reduced category is by far the smallest of the current
school meal categories of free, reduced, and paid. In fact,
less than 10 percent of the meals served are served to children
in the reduced price category.
The reduced price co-pay should be eliminated and meals
should be available at no cost to all children with family
income up to 185 percent of poverty, and reimbursed to schools
at the free rate. This change provides necessary support to
working families who are already struggling to keep up with
increases in housing, fuel, health, and child care costs.
Mr. Chairman, ASFSA's recommendation to provide school
meals at no charge to children in these households up to 185
percent of poverty has significant support nationwide.
The North Carolina State Board of Education, the Colorado
Association of School Business Officials, the Texas Department
of Agriculture, three local school boards, as well as the State
Education Association in your home state of Delaware, among
many others, have passed resolutions in support of this
proposal, and the list is growing.
In fact, we have a number of resolutions with us to submit
with our testimony.
Additionally, industry has also expressed support for this
initiative. They know the value of a healthy, well-educated
workforce, and are anxious to assist in strengthening these
programs.
The cost of this proposal, while justified, is significant.
May we suggest that it might be possible to phase in this
change by raising the eligibility guideline for free school
meals until it reaches the WIC guideline of 185 percent.
In short, Mr. Chairman, I'm hoping that we can join hands
on the principle of eliminating the reduced price category over
whatever timeframe we can afford.
In terms of healthy children, we are deeply committed to
the health of our nation's children, and are working
collaboratively to further positive health outcomes. We are
about good nutrition, not just providing food.
We have several recommendations that would enhance the
school nutrition environment, and have provided them to staff.
In terms of program integrity, we take very seriously our
responsibility to administer these programs. We are aware of
the concerns raised by reports indicating there may be errors
in the number of children being approved for free and reduced
meals.
We are continually working with the Department on this
issue and we believe that reasonable income verification
requirements are necessary, but that eligible students should
not be intimidated by excessive income verification
requirements, for the greater the regulatory burden on the
program, the greater the cost to produce a meal.
We applaud enhancing proven strategies, such as expansion
of direct certification to improve program integrity.
I would sum up by adding that we also have a food safety
statement that has been included with our testimony.
We do appreciate we're meeting at a difficult time.
However, it is our responsibility as those who work in child
nutrition programs to share our views on what is needed to
assure that healthful meals and nutrition education are
available to all children.
We look forward to working with the Committee and the
Congress, and will be pleased to answer any questions.
[The prepared statement of Ms. MacDonald follows:]
Statement of Gaye Lynn MacDonald, President, American School Food
Service Association
Mr. Chairman, Members of the Committee, I am Gaye Lynn MacDonald,
President of the American School Food Service Association (ASFSA), and
the Program Manager of Food Services for Bellingham Public Schools in
Bellingham, Washington. With me this morning is Paula Angelucci, Chair
of our Public Policy and Legislative Committee for the Delaware School
Food Service Association and Food Service Supervisor for the Colonial
School District in New Castle Delaware, and our Counsel, Marshall Matz.
Let me begin by thanking you and the Committee for holding this
important hearing. We are delighted to be with you this morning to
discuss child nutrition and explore how we might further improve these
important federal programs. The federal child nutrition programs are a
major success story, serving over 28 million children each school day.
ASFSA believes that 2003 is a pivotal year for child nutrition.
Reauthorization of child nutrition programs offers an excellent
opportunity for the Congress to consider changes that will improve
health outcomes for children and further the goals of No Child Left
Behind. Congress should reauthorize those programs that expire in 2003
(WIC, Commodity Distribution, State Administrative Expense, the
National Food Service Management Institute and the Summer Food Service
Program). Additionally, ASFSA advances, for your consideration, a
number of proposals to strengthen school and community based child
nutrition programs.
Mr. Chairman, ongoing studies confirm that a hungry child cannot
learn effectively. A hungry child is distracted from learning and is
more likely to experience discipline and health problems. It is
critically important that child nutrition programs be effectively
extended and easily accessible to all children who are eligible.
PROGRAM ACCESS
* Many children from families qualified in the reduced price
category are not participating in the lunch and breakfast programs
because they can't afford the fee of $.40 for a lunch or $.30 for a
breakfast. While that may not seem like a lot of money to those of us
in this room, to families with household incomes between 130% and 185%
of the poverty line, many with more than one child, it is often too
much.
The reduced price fee is a major barrier to the working poor,
particularly at the end of the month when we see the reduced category
participation rates decline.
As you know, in the WIC program, all those with family incomes
below 185% of poverty, and who otherwise qualify, receive benefits
without charge. This same income guideline should be extended to the
school nutrition programs. The reduced price category is by far the
smallest of the current school meal categories---free, reduced, and
paid - less than 10% of the meals served are served to children in the
reduced price category. The reduced price co-pay should be eliminated
and meals should be available at no cost to all children with family
income up to 185% of poverty. Schools should be reimbursed for these
meals at the free rate. This change provides support to working
families who are already struggling to keep up with increases in
housing, fuel, health and childcare costs.
Mr. Chairman, ASFSA's recommendation to provide school meals at no
charge to children in households with income up to 185% has significant
support nationwide. The North Carolina State Board of Education, the
Colorado Association of School Business Officials, the Texas Department
of Agriculture and three local school boards as well as the State
Education Association in Delaware, among many others, have passed
resolutions in support of this proposal.
The cost of this proposal, while justified, is significant. May we
suggest that it might be possible to phase in this change by raising
the eligibility guideline for free schools meals until it reaches the
WIC guideline of 185%.
* Consistent with a GAO analysis showing the gap between the cost
to produce a school lunch we propose the federal reimbursement rates
for all meal categories be increased. The current reimbursement rate of
$2.19 for a free lunch is simply inadequate. The rates for reduced and
``paid'' meals are not adequate either resulting in higher and higher
prices being charged to the paying child. The gap between the costs of
doing business and reimbursement rates widens each year as costs
escalate at a rate greater than the federal rates increase. And, as I
will share later, federal nutrition guidelines are expensive to
implement.
* It is also our recommendation, that Congress extend the USDA
commodity program to the school breakfast program. Schools currently
receive 15 3/4 cents in USDA commodities for each reimbursable lunch
served. This commodity assistance is very helpful and much appreciated,
not only by schools but also by the agriculture communities in the
states. The school breakfast program, however, receives no USDA
commodity assistance. We recommend that USDA contribute $.05 in
commodities for each breakfast served in the program.
HEALTHY CHILDREN
The American School Food Service Association is deeply committed to
the health of our nation's children and is working collaboratively to
further positive health outcomes. We are about good nutrition not just
providing food. As you know, we strongly supported amending the
National School Lunch Act to require implementation of the Dietary
Guidelines for Americans.
According to the most recent USDA study on the subject, schools are
making very significant progress in implementing the Dietary Guidelines
in school meal programs. The fat content of a reimbursable meal is down
significantly, and an increasing variety of fruits and vegetables are
more readily available. Program operators have modified food
preparation methods and re-written product specifications to lower fat,
sodium and sugars. Industry has responded to our requests and familiar
student favorites like pizza, burgers and fries are part of meals
meeting the Dietary Guidelines.
We are proud of the meals our members serve but it is not realistic
to expect children to select a lunch in school that is much different
from the meals they consume outside of school. Further, the school
lunch program--the USDA reimbursable meal--has significant competition
inside and outside the school. Every day program operators are caught
between the challenges of very limited resources, pressure to cover all
direct and indirect costs or to even be a ``profit center'' for the
district, competition from other groups selling food on campus and the
demands of the customer.
Our customer is no longer a captive market. Young people are making
more and more of their own decisions beginning at a very early age and
have options other than a school meal available. For example, a la
carte is increasingly available at all grade levels and many high
schools have open campuses and a limited number of lunch periods both
of which encourage students to leave school for lunch.
* ASFSA recommends that an additional $.10 per meal be provided to
schools to further improve the nutritional quality of school meals.
There are significant costs associated with meeting nutrition
standards, such as continuing to increase the availability and variety
of fruits and vegetables and to purchase products consistent with the
Dietary Guidelines.
* The recent ``Call to Action to Prevent Overweight and Obesity''
recommends that schools ``adopt policies ensuring that all foods and
beverages available on school campuses and at school events contribute
toward eating patterns that are consistent with the Dietary Guidelines
for Americans''. We urge the Congress and the Administration to
implement the recommendation of Secretary Tommy Thompson, and the
Surgeon General, with regard to foods available in school.
* Financial support for nutrition education continues to fade into
oblivion. Not many years ago nutrition education was a federal
entitlement program, a small program, but one that provided some
guaranteed funding. Nutrition education is now a discretionary program
without any funding. Students cannot learn to make healthy food choices
without access to age appropriate nutrition education. At a minimum, we
propose an entitlement of 1/2 cent per meal be allocated to states to
develop state and local infrastructures to deliver nutrition education.
PROGRAM INTEGRITY
Mr. Chairman, ASFSA members are public employees. We take very
seriously our responsibility to administer the programs consistent with
the law. We are aware of concerns raised by reports indicating that
there MAY be errors in the number of students receiving free and
reduced-price benefits in the federal school meal programs. It is a
subject we have discussed with USDA at great length. The Department has
stated in its testimony that the extent of this problem is unclear.
We believe that:
Reasonable income verification requirements are necessary
to guarantee that the program is administered consistent with current
law.
Eligible students should not be intimidated by excessive
income verification requirements and
The greater the regulatory burden on the program, the
greater the cost to produce a meal.
Expanding and enhancing proven strategies, including
direct certification, improves the integrity of the program.
In an effort to respond appropriately and reasonably, ASFSA offers
these recommendations:
Make school meal application approval valid for the full
year.
Expand the use of categorical eligibility, such as is
currently authorized for TANF and Food Stamps, and expand the use of
direct certification for the school meals application process. This is
a proven approach that improves program integrity. Categorical approval
should be expanded to include state children's health insurance
programs, Medicaid and SSI, where state eligibility guidelines for
these programs are compatible with school meal eligibility guidelines.
Furthermore, ASFSA supports requiring states to provide approved lists
to local school districts for direct certification
Conduct rigorous, representative demonstration projects
to determine if there is an error problem in the school meal programs
and the true extent of that error if it does exist; and evaluate the
impact of a variety of proposed changes to the current system for
evaluating and verifying paper applications on eligible children to
ensure that, in addressing program integrity, we don't have the
unintended consequence of denying benefits to children who depend on
these programs.
FOOD SAFETY
Last, but definitely not least, allow me to comment on food safety.
Maintaining high food safety standards in the federal nutrition
programs is critical to their success and is an ongoing high priority
for ASFSA. Data shows that in the majority of schools nationwide the
foodservice staff demonstrates very high standards and performance in
safe handling of food. We support the public expectation that foods be
handled using consistently monitored and reinforced food safety
training and techniques for foodservice staff--as is found in most
school meal programs across the Country. The United States has the most
abundant and safest food supply in the world. But food safety it is not
an area in which to take any chances, particularly when we are talking
about the nation's children.
Therefore, ASFSA has outlined legislation that ensures the
development and implementation of food safety systems in all schools
participating in the federal school lunch program. The legislation
includes funding for development of such a program, for training
consistent with the program, for facility improvements necessary to
meet these standards and development of a reasonable implementation
time frame.
CONCLUSION
Mr. Chairman, Members of the Committee, we present to you a very
full agenda for the child nutrition programs. We do appreciate that we
are meeting at a very difficult time for the United States, and that
the Congress has many issues to address. However, the health and well
being of our children is paramount to the security and future
development of our Country. It is our responsibility, as those who work
in child nutrition programs, to share our views on what is needed to
assure that healthful meals and nutrition education are available to
all children. The success of a culture is often measured by how it
nurtures its children. A traditional Masai greeting-- ``Kasserian
Ingera'' asks ``and how are the children?'' It is our joint
responsibility to assure that the children in the United States of
America are well.
We look forward to working with the Committee, and the Congress, on
the 2003 child nutrition reauthorization legislation. We would be
pleased to answer any questions that you may have. Thank you very much
for your continuing support of child nutrition.
______
Chairman Castle. Thank you, Ms. MacDonald.
You mentioned some resolutions, and actually other
materials that may be attached to your written testimony. The
statements and written testimony of all of you are admitted for
the record. If you have anything in addition to that, that also
can be admitted for the record, so please submit it when you
can, if that's the case.
Ms. MacDonald. Thank you. Yes.
Chairman Castle. Dr. Frank.
We need to move that over. Correct.
STATEMENT OF DEBORAH A. FRANK, M.D., PROFESSOR OF PEDIATRICS,
BOSTON UNIVERSITY SCHOOL OF MEDICINE; DIRECTOR, GROWTH AND
DEVELOPMENT PROGRAM, DEPARTMENT OF PEDIATRICS, BOSTON MEDICAL
CENTER; AND PRINCIPAL INVESTIGATOR, CHILDREN'S SENTINEL
NUTRITION ASSESSMENT PROGRAM, BOSTON, MASSACHUSETTS
Dr. Frank. Chairman Castle, Ranking Member Woolsey, I am
honored to come before such a well-informed and concerned
Committee as a pediatrician representing a group that you
really haven't heard about much, which is malnourished babies.
I am also one of the principal investigators of the
Children's Sentinel Nutrition Assessment Program, or CSNAP,
which since 1998 has monitored the impact of current public
policies and economic conditions on the nutritional and health
status of low-income children less than 3 years old, those who
aren't visible to most other systems, including the school
system, because they're so little, in six medical institutions.
In the time I have available, I would first like to give
you a crash course, which you don't need as much as I thought
you did, compacting into a few paragraphs a month or two of
medical school to explain why pediatricians are so deeply
concerned about the nutrition of mothers and children.
From the pediatric perspective, reauthorizing and enhancing
national investment in child nutrition programs is really a
life or death matter, and I assure you if it wasn't, I wouldn't
be here on a Wednesday, which is my clinic day, but I would be
back where I belong, on the fifth floor of Boston Medical
Center, doctoring malnourished babies.
It is not only health professionals, though, who are
concerned, but all who work in public-private partnerships to
serve poor and near-poor children of working and unemployed
families.
I would like to request to insert in the record the
National Call to Congress signed by 2,300 of these
organizations.
Chairman Castle. Without objection, that will be included
in the record.
[The information referred to has been retained in the
Committee's official files.]
Dr. Frank. From my perspective, food is something that is
always needed, and so that I'm here to talk about the
physicians' concern for all these programs, including WIC,
child and adult care food programs, school meals, summer and
after-school feeding, which hasn't been mentioned but is really
crucial, and the feeding programs for children who tragically
are residing in homeless and domestic violence shelters.
All these programs serve families that lack the financial
resources, never mind the information, for the healthy eating
that the Surgeon General recommended.
As clinicians, we know that food insecurity is not a
political problem or a sentimental issue. It's a health
problem.
Food insecurity threatens human health at all stages of
life, but particularly in prenatal life and early childhood,
when the critical growth of body and brain occur.
Hunger threatens the well-being of the next generation in
the womb. A mother's nutritional status when she enters
pregnancy and her weight gain during pregnancy are critical
determinants of whether the baby will be low birth weight.
Low birth weight, in turn, is the most important
contributor to infant mortality, which is the doctors' fancy
way of saying dead babies, and although the Surgeon General is
correct that that's going down, in fact there are still huge
disparities in whose babies die.
The majority of low-birth-weight babies do survive in this
country, but the lower the birth weight, the more likely the
child will suffer from lasting impairments, including
blindness, deafness, cerebral palsy, and school failure.
WIC, as you know, has been repeatedly shown to decrease the
risk of low birth weight and thus of all its lifelong
consequences.
After birth, even subtle deficits in nutrition continue to
exert major influences on health, development, and learning.
As my distinguished colleague, the Surgeon General, would
have told you if you had asked him, from his career as a trauma
surgeon, malnutrition impairs the body's ability to heal. At
all ages, malnutrition decreases immune function, leading to an
infection/malnutrition cycle.
For many low-income, food-insecure families, where food
supplies, particularly as my colleague said, at the end of the
month, are marginal even for feeding well children, once a
child has developed a nutritional deficit from a normal
childhood illness, a stomach flu, there is no additional food
for repletion.
The child is then left malnourished and more susceptible to
the next infection, which is more likely to be more prolonged,
more severe, and require costly medical interventions.
Here, too, in CSNAP, we found that WIC works. Income-
eligible infants under a year of age who did not receive WIC
were significantly more likely to be underweight or short and
to be in fair or poor health than comparable infants who did.
This relationship between food security and physical
illness persists beyond infancy. In our same data set, with a
larger sample of kids up to 36 months, we found that 21 percent
of these very young children live in food-insecure households
and that those in food-insecure households were 25 percent more
likely to have been hospitalized since birth than those whose
households were food secure.
I don't have to tell you that two or days in the hospital
would fund several WIC packages.
WIC supplies only a portion of the calories needed for
children older than 4 months of age. Thus, in addition to WIC,
the child care feeding programs are also crucial to child
health, reaching preschoolers in family and center-based day
care, whose mothers work long hours and do not necessarily have
either the time or the financial resources to prepare adequate
meals.
I had one patient whose mother was sending lettuce to the
day care providers that didn't provide meals. That was it, for
one.
Early and concurrent malnutrition have effects that last a
lifetime, and that you have heard, but under-nutrition as well
as over-nutrition has serious and lasting effects.
Malnutrition is an important but entirely preventable cause
of school failure from impairments of cognition, attention, and
behavior, as the Chairman noted.
As you know, participation in school breakfast programs has
been repeatedly shown to decrease absenteeism, raise children's
academic test scores, and decrease behavioral acting out in
school.
No amount of standardized testing will alleviate the impact
of hunger on children's ability to learn. To educate children,
first you must feed them, and you must feed their mothers, so
that from conception through high school, tomorrow's future
workforce will be sufficiently well-nourished to participate
fully in a global information economy.
I would suggest to you, and I know my time is running
short, that we have found that in 2002-2003--we're probably one
of the only programs that has current data, up through May
2003--the need for these child nutrition programs is greater
than even when you reauthorized it before, in 1998 to 1999.
We found, in our two hospitals, in our hospitals that we've
just had time to analyze in the 2 minutes for this thing, a 29
percent increase in the families with these young children that
are food-insecure, and an 83 percent increase in the need of
children to be hospitalized, which just staggered us at the
time.
Now, I'm aware that some people have suggested that child
nutrition programs contribute to childhood obesity. These
commentators have no medical credentials, and there's no
medical data which supports that claim.
Child nutrition programs are crucial to assure that
children and their families can eat every day, so they can eat
wisely, and not gorge when food is available in fear of being
hungry tomorrow.
You have heard the established determinants of childhood
obesity, none of which have been caused by or even associated
with participation in child nutrition programs.
I would also like to insert a paper from colleagues of mine
at Brandeis University entitled ``The Paradox of Hunger and
Obesity in the United States.''
Chairman Castle. Without objection, it will be inserted.
[The information referred to has been retained in the
Committee's official files.]
Dr. Frank. As I conclude, I realize that you're probably
feeling absolutely overloaded with facts and figures, and
especially since I'm the cleanup hitter.
But pediatric clinicians can't really forget that
statistics reflect the lives of real children and real
families, and I can tell you as a doctor, in my daily
experience, child nutrition programs work well, and the
children need them, and those who need them and don't get them
suffer greatly.
I wish you could have been with me at the end of last
summer in clinic, when I talked to a little 6-year-old who had
been malnourished and was better. We had found him a campership
in a Salvation Army day camp, which is almost as hard as
getting a kid into Head Start, which is also a very good
treatment for malnutrition.
He had clearly had a really good summer, and gained almost
a pound, and I asked him what did he do in day camp, expecting,
of course, to hear about swimming and so on.
He looked at me with his eyes shining, and he said, ``We
sang songs about God and ate breakfast, lunch, and snack.''
None of these meals would have been available to this child
without the summer feeding programs.
Distinguished members of this Committee, I am here to urge
you to prescribe a miracle drug for America's families, by
expanding and enhancing child nutrition programs at all levels.
This miracle drug, which maybe we could call it
``foodamycin,'' decreases premature birth, enhances immune
function, and improves school achievement.
Millions of American children, many of whom I lay my hands
on many days of the week, are intermittently but repeatedly
deprived of this drug, both before and after birth.
The programs which you have so wisely supported in the past
are today more crucial than ever to sustain our children. Any
legislative provision that would serve fewer rather than more
children would be a child health catastrophe.
Only you can write the prescription that prevents this
catastrophe for America's children, and I tell you that it's
stat, meaning urgent, to do so.
Thank you.
[The prepared statement of Dr. Frank follows:]
Statement of Dr. Deborah A. Frank, Director, Grow Clinic for Children
at Boston Medical Center, and Principal Investigator, Children's
Sentinel Nutrition Assessment Program
Distinguished members of the committee, I am honored to come before
you as one of many pediatric clinicians who daily treat malnourished
American children. I am also one on the Principal Investigators with
other pediatric researchers of the Children's Sentinel Nutrition
Assessment Program (C-SNAP) initially funded by grant from the W.K.
Kellogg Foundation and other private donors. Since 1998 we have
monitored the impact of current public policies and economic conditions
on the nutritional and health status of low income children less than 3
years old in six medical institutions serving Baltimore, Boston, Little
Rock, Los Angeles, Minneapolis and Washington DC. CSNAP provides some
of the most current information available about the status of food
security and health among America's youngest children. I will share
with you some of our newest data comparing July 1 2002-May 30 2003 to
similar data collected by CSNAP from June 1998- until July 1, 1999 when
child nutrition programs were last re-authorized. But first I would
like to give you a ``crash course,'' compacting into a few paragraphs a
month or two of medical school to explain why pediatricians are so
deeply concerned about the nutrition of mothers and children. From the
pediatricians' perspective, re-authorizing and enhancing national
investment in child nutrition programs is a life or death matter, or I
would not be here on a Wednesday, but would be back where I belong, on
the fifth floor of Boston Medical Center, doctoring a dozen or more
malnourished children in a single day in our outpatient clinic. It is
not only health professionals who are concerned, but all who work in
public-private partnerships to serve poor and near poor children and
their families. I would to request to insert in the record this
National Call to Congress signed by multiple organizations in all 50
states attesting to the crucial need for strengthening these programs
which protect America's children from conception to high school
graduation including WIC, Child and Adult Care Food program, school
meals, and summer and after school feeding programs, and feeding
programs for children tragically residing in homeless and domestic
violence shelters.
As clinicians and as scientists we know that food insecurity
(defined by the Life Science Research Office of the Federation of
Associations and Societies for Experimental Biology as limited or
uncertain availability of nutritionally adequate safe foods or limited
or uncertain ability to acquire acceptable foods in socially acceptable
ways) is not a political or a sentimental issue but a major health
problem.
Food insecurity threatens human health at all stages of life, but
particularly in prenatal life and early childhood when critical growth
occurs. Hunger threatens the well being of the next generation even in
the womb. Even after considering all other important factors
influencing pregnancy outcome such as cigarette and other drug use,
infections and other stressors., the nutritional status of a woman as
she enters pregnancy and the amount of weight she gains during
pregnancy are critical predictors of infant birth Low birth weight is
the most important contributor to infant mortality. The majority of low
birth weight infants survive in this country, but the lower the birth
weight the more likely that the child will suffer from lasting
impairments, including blindness, deafness, cerebral palsy and school
failure. Even more subtle variations of birth weight not sufficient to
require neonatal intensive care appear to have lasting implications for
adult health. Data have emerged from around the world showing that
there is a continuous inverse relationship between birth weight and the
likelihood the adult will suffer from cardiovascular disease and its
associated disorders, including hypertension and non-insulin dependent
diabetes and its precursors. In other words the lower an adult's
birthweight, the greater the likelihood that adult will suffer from
cardiovascular disease. In addition, there is evidence that severe
maternal malnutrition in pregnancy is associated with increased
likelihood of both schizophrenia and major affective disorder
developing in her children when they reach adulthood. Even
micronutrient deficiency in the presence of adequate maternal weight
gain in pregnancy can have devastating consequences. There is a well
established relationship between inadequate maternal folate intake at
the time of conception and the risk of neural tube defects (spina
bifida) in children. This is a particular concern since food insecure
women have been shown to have seriously inadequate intake of folate,
along with other critical micronutrients. WIC, as you know, has been
repeatedly shown to decrease the risk of low birth weight and thus of
all its lifelong consequences.
After birth, even subtle deficits in nutrition continue to exert
major influences on health and development. As my distinguished
colleague the Surgeon General would confirm from his career as a trauma
surgeon, malnutrition impairs the body's ability to heal. At all ages
malnutrition decreases immune function leading to the infection/
malnutrition cycle. With any acute illness all children lose weight.
However, in food secure homes once the acute illness is resolved,
children are able spontaneously to increase their dietary intake to
restore normal growth and body composition. For the many low-income
food-insecure families, where food supplies are marginal even for
feeding well children, once a nutritional deficit has been established
by even a normal childhood illness there is no additional food for
repletion. The child is then left malnourished and more susceptible to
the next infection, which is likely to be more prolonged and severe,
and followed by even greater weight loss. It is this infection/
malnutrition cycle, which in settings without adequate medical care
leads to the death of malnourished children. In this country the cycle
often manifests in preventable recurrent illness and a need for costly
therapeutic health resources.
Here too we have found WIC works. When in CSNAP we evaluated 5,923
WIC eligible infants less than 12 months of age between August 1998-
December 2001, we found .after taking into account numerous other
family characteristics that those who did not receive WIC due to access
problems had statistically significantly higher rates of food
insecurity (28%) than WIC participants (23%), p = .001. This food
insecurity was manifested in hard evidence of inadequate nutrition
measured on the bodies of the infants. Income eligible infants who did
not receive WIC were significantly more likely to be underweight or
short, and nearly twice as likely as infants who did receive WIC to be
perceived as having only fair or poor health. In contrast, rates of
overweight did not differ significantly among groups.
This relationship between food insecurity and illness persists
beyond infancy in findings of our research and that of many other
investigators. When we looked at data from the larger CSNAP sample of
11,539 children ages 36 months and younger collected over the period
1998-2001 at inner-city hospitals and clinics in six states, we found
21% of these little children lived in food insecure households.
Children in food insecure households were 25% more likely to have been
hospitalized since birth than those whose households were food secure.
WIC supplies only 40% of the calories needed for children older
than a year of age. Day care attendance increases the risk of
infectious illness in young children of all social classes. Thus, in
addition to WIC, the Child Care feeding programs are also crucial to
child health, reaching preschoolers in family and center based child
care centers whose mothers work long hours and to do not necessarily
have either the time or the financial resources to prepare adequate
meals.
Even though, with refeeding and medical care, a malnourished child
can be brought eventually into the normal range for immunocompetence,
malnutrition can inflict concurrent and lasting deficits in cognitive
development with grave implications for the malnourished child's future
ability to participate in the knowledge economy. The last two prenatal
trimesters and the first years of life constitute a critical period of
brain growth, a time when the brain has biosynthetic ability to
generate new brain that it will never have again. Different regions of
the brain undergo their critical development at different developmental
periods. The cerebellum, which is involved in later reading ability,
for example, completes much of its development in the first year of
life. Lack of nutritional building blocks during a critical period will
lead to actual distortions and deficits in the part of the brain under
development. Initially, the greatest concern about the developmental
effects of malnutrition were expressed about those children who had
actual lasting deficits in brain size reflected by small head
circumference. However, as knowledge of the importance of nutrition as
substrate for neurotransmitters has evolved, awareness has grown that
although brain size and structure can be most affected by malnutrition
in early life, brain function can be seriously affected at all ages.
Even in the absence of measurable deficits in body size, food
insecure or malnourished children may miss many opportunities for
learning. The first physiologic strategy for maintaining growth and
body heat in the face of inadequate nutrient intake is for a child to
decrease their ``discretionary activity,'' particularly their voluntary
exploration of their environment and interactions with other people.
Such discretionary activity is essential experience for children's
learning about the inanimate and social worlds. By the time a child has
actually developed a deficit in weight or height, this compensatory
mechanism has already failed repeatedly. By the time a health
professional detects physiological signs and symptoms of malnutrition
in a child, there have already been many opportunities of missed
learning that were not detected. Although certain aspects of brain
structure and function can recover with refeeding, others appear to be
permanently altered, such that the previously malnourished organism can
function under baseline conditions, but has more difficulty than the
previously well nourished organism in functioning under conditions of
stress and challenge. Both early and concurrent malnutrition are two
critical and entirely preventable causes of school failure from
impairments of cognition, attention, and behavior. As you know,
participation in school breakfast programs has been repeatedly shown to
decrease absenteeism, raise children's academic test scores, and
decrease behavioral difficulties in elementary school. No amount of
standardized testing will alleviate the impact of hunger on children's
ability to learn--to educate children first you must feed them, and you
must feed their mothers so that from conception through high school
tomorrow's future work force will be sufficiently well-nourished to
participate fully in an information economy. As children age out of WIC
and into the school age, school meals, after school and summer feeding
become crucial
C-SNAP research shows food insecure children are more likely to be
iron deficient and anemic and thus more susceptible to lead toxicity,
which together further jeopardizes their cognitive development.
Preliminary C- SNAP data from Minnesota and Boston suggests that
the need for child nutrition programs has become even more urgent in
the post 9/11 economy than it was even 5 years ago, when these programs
were last re-authorized. In a sample of more than 3000 infants and
toddlers under 3 (average age 12 months) we saw no significant change
from 1998-1999 to 2002-2003 in rates of parents' employment (about 40%
both years) or receipt of WIC (about 80%). However, we did find
decreased rates of receipt of welfare and food stamp benefits and a 29%
increase in risk for families of young children to be food insecure and
an astounding 83% increase in risk that children would require
hospitalization at the time of emergency room visits to the Boston
site. These figures make me concerned that America's poor children may
be getting both more food insecure and sicker. There is ample
physiologic evidence to support that the first problem is probably
playing a causal role in the second.
I am aware that some commentators without medical credentials have
suggested that child nutrition programs contribute to the childhood
obesity. Although obesity among American children is indeed increasing,
I know of no medical data which supports this claim. There is, however,
a preliminary but growing body of empirical work which shows that in
certain sub-populations such as impoverished African-American and
Hispanic/Latino adolescent girls food insecurity is associated with
obesity, This might be expected from what we know of the physiology of
weight cycling related to alternating under and over consumption that
is found not only in dieting and eating disorders, but among those who
if they are able to eat on one day do not know if they will be able to
eat on the next. Child nutrition programs are crucial to assure
children and their families that they can eat every day so they can eat
wisely and not in fear of tomorrow's hunger.
I do not wish to over-simplify the complex phenomenon of the
obesity epidemic, which, as physicians say, is over-determined by
multiple factors so that no one can offer the full explanation. These
factors include not only by food insecurity in poor families, but in
all families increased intake of sweetened beverages lack of
opportunity for healthy exercise, over dependence on ``supersized''
fast food meals (which again cannot be purchased with any federal
feeding money) and the millions of ads that our children see each year
encouraging poor food choices. However, none of these determinants of
childhood obesity have been shown in the peer reviewed scientific
literature to be caused by, or even associated with, participation in
WIC, school meals, summer or childcare feeding.
That does not mean that perhaps in certain cases the menus of some
of these useful programs could not be improved to make them more
consistent with the most recent nutritional knowledge. Just as the
optimal treatment of pneumonia is different now from ten years ago, so
too is the most current thinking about the healthiest dietary choices,
thinking which may not yet be fully reflected in standards set in
earlier eras. However, I would not let a baby's pneumonia go untreated
if I did not yet have the most current antibiotic available and neither
should you should decide not to fund child nutrition programs because
there is still work in progress to update their content.
By now you may be feeling somewhat overloaded with facts and
figures, but pediatric clinicians can never forget that cold statistics
reflect the lives of real and suffering children and families. I wish
that you could have sat with me in my office several weeks ago in the
hungry time between the end of school in mid-June and the beginning of
summer feeding programs after the fourth of July. A father came in with
four children ranging in age from a baby in a stroller to a second or
third-grader, who, he proudly told me, could ``read chapter books.''
The children were so hungry, that they were trying to grab jars of baby
food out of the scant supply on the shelves of my office. I tried to
distract them while my assistant typed out a food pantry referral and
then I went off on rounds. When I came back, my assistant said, ``They
were so hungry I just gave them spoons. You should see how much baby
food they ate.'' I do not have to tell those of you who are parents and
grandparents that when second or third-graders are eating baby food
they are really hungry. Indeed my staff found another school age child
eating dry dog food out of a plastic bag in order to stave off hunger
pangs. I also wish you could have rounded with me a month or so ago on
the wards of Boston Medical Center and seen the little eight-month-old
son of two working parents born at normal birth weight who at six
months weighed less than 14 pounds, which is the weight of a normal
three-month-old. As you saw his pitiful ribs sucking in and out trying
desperately to catch his breath from a viral infection that his
weakened immune system could not resist, you would not have had any
doubt about the importance of child nutrition programs. On a happier
note, I wish you could have been with me in clinic at the end of last
summer, when I talked to a formerly malnourished six-year-old for whom
we had found a campership to the Salvation Army Day Camp. He had
clearly had a good summer and gained nearly a pound. When I asked him
what he did in day camp, expecting of course to hear about swimming and
soft ball, he looked at me with his eyes glowing and said, ``we sang
songs about God and ate breakfast, lunch and snack,!'' None of these
meals would have been available to this child without the summer
feeding programs.
Distinguished members of the committee, I am here today to urge you
to prescribe a miracle drug for America's families, by expanding and
enhancing child nutrition programs at all levels. This miracle drug
which perhaps we should name foodamycin decreases premature birth,
enhances immune function, and improves school achievement. Millions of
American children are intermittently but repeatedly deprived of this
drug both before and after birth. Any legislative provision that would
serve fewer rather than more children would be a child health
catastrophe. Only you can write the prescription to treat their
deprivation and it is ``stat'' (urgent) that you do so.
Additional reports and data from the Children's Sentinel Nutrition
Assessment Program are available at: http://dcc2.bumc.bu.edu/
CsnapPublic/.
______
[Attachments to Dr. Frank's statement have been retained in
the Committee's official files.]
Chairman Castle. Thank you, Dr. Frank. We're all a little
drug-price-sensitive right now, so watch your comparisons.
[Laughter.]
Chairman Castle. We've had some problems with that here in
Congress.
We now have our option to ask questions. The way this is
structured, we have 5 minutes to ask the questions and get the
answers from all of you, so if you could be helpful in terms of
fairly concise answers.
I can't possibly ask Members of Congress to be too concise.
It's not the way we function. But if you could help us with
that, that would be very helpful.
Dr. Cullen, you didn't get a chance to testify, so I do
want to hear about your five-a-day programs that you have
worked on, and your introduction also mentioned innovative
snack programs involving healthier foods. That may or may not
relate to the five-a-day.
If you could, bring us up to date on what you're doing in
those areas.
Ms. Cullen. We recently finished a 2-year program and we
spent the first year talking with students in middle schools in
three different districts in Houston, two primarily Hispanic
districts, one African American, trying to find out what they
would purchase, what fruit and vegetables they liked, what they
would purchase, how it should be marketed, because I think we
forget that students, when they reach fifth or sixth grade and
get into middle school are actually consumers and they have
definite preferences and likes and dislikes.
We developed the intervention. The schools agreed to put
fruit and vegetables in the snack bar. Based on what the
students told us, we cycled them over about a school year. We
developed posters, different kinds of materials to entice it
with strictly environment. You know, can we make the food in
the cafeteria and the snack bar fruit and vegetables that they
want to purchase, and we did that over last year.
Chairman Castle. Did it seem to work?
Ms. Cullen. We were able to move fruit consumption. We
served fresh fruit, fresh vegetables, canned fruit, because the
students said they would purchase that, and 100 percent fruit
juice, and we did get some results in fruit consumption in the
second semester.
We did have students who said they would never, ever buy
fruit and vegetables in the snack bar. We did not see any--we
couldn't tease out whether it was snack bar or school lunch.
We had students, again in some low-income schools, where we
asked students to fill out lunch records during lunchtime, so
we actually have their consumption. We're doing analysis right
now to see did snack bar consumption increase, did the school
lunch meal consumption increase. Vending we also measured. So
we know exactly what students are eating in these schools, and
the food source. So we're looking at that data right now.
Chairman Castle. Don't even answer this, but I mean, I look
at it as a form of convenience. I tend to eat what is
convenient. I sit here and rail against fat and everything, and
I show up at a fast food place or whatever, because it's there
and it's convenient; and with kids, it's probably convenient
and cool.
Ms. Cullen. Well, you know, we found out they can't--I
mean, middle school students with braces can't bite into
apples, so the apples were wedged, the oranges were sliced. I
mean things like that--
Chairman Castle. You learn these things.
Ms. Cullen. Yeah. You need to make it so kids are not going
to--they don't have time to go to the bathroom and wash their
hands if they peel an orange.
So we have to look at them as consumers. They don't want
brown lettuce.
Chairman Castle. Right.
Ms. Cullen. I mean, they're consumers.
Chairman Castle. Dr. Baranowski, you mentioned something
that everyone virtually touched on some way or another, and
that is restoring physical education to schools.
As one who excelled in recess and virtually nothing else in
school, I'm a great believer in that, but how do you do it?
I mean, schools, in the time I've been in government,
schools tend to be trending away from physical education,
recess, those kinds of things, because of academic pressures
and perhaps lack of teachers or whatever.
Do you have a method, a secret answer to make sure this
restoration takes place so we can get this 60 minutes of
physical activity a day in, that has been recommended here by
the earlier panel?
Dr. Baranowski. We don't have any answers. We're
participating in programs where we're trying to introduce
activities that teachers can use that would get moderate to
vigorous physical activity during the program.
We're working with trying to change the PE teachers' use of
time, so rather than use 15 minutes on the front end and 15
minutes on the back end to change, use 5 minutes on the front
end and 5 minutes on the back end to add more time available
for physical activity.
We're trying to work on making physical activity cool. Like
Karen was saying, kids are consumers. They want cool, and how
can we sell physical activity at school?
A project recently done in California showed that if the PE
program is reoriented toward sports, which is something that
boys like, the boys become much more physically active, but it
doesn't affect the girls; so we need to find programs that are
reaching the different segments of the child market.
Chairman Castle. Thank you.
I'm going to skip quickly to Ms. MacDonald, and I obviously
have other questions, but I'd like, if you can tell me, I think
you'd be the best person on the panel to do this, what are
these kids actually eating?
And let me tell you why I ask that question. In our
Delaware schools, I go to the schools a lot, and I go into the
cafeterias a lot, and actually occasionally eat there, and I
see, frankly, a lot of foods that I guess that send off signals
that maybe we shouldn't be eating these things --you know,
pizza and other areas that perhaps are not as healthy as green
vegetables or whatever may be.
So to me, it's clearly, you clearly could put together a
pretty wretched meal from a nutritional point of view, if you
wanted to, in our school cafeterias.
On the other hand, the foods you should eat are all there,
as well.
I understand that the kids are pretty clever about making
sure they get the fat foods if they possibly can, even though
it may not seem that way in terms of what they're taking, with
swapping and other things that go on. I'm not an expert on
that. I'm not suggesting that that is the case, but I've heard
that.
And I am concerned that what they're actually consuming is
not necessarily as nutritionally balanced as we would like it
to be, meaning that maybe we have to make some of these kinds
of foods less available.
I've talked to our Delaware nutritionists a little bit
about this, but I'd be interested in your views on it, on a
national level, as to how we need to try to direct the kids to
eating the right food.
Ms. MacDonald. Thank you for that question.
As was alluded to earlier, we need to look at foods
available at school in the context of the entire campus--what's
available in the cafeteria as well as what might be offered
elsewhere on campus.
Actually, according to the most recent USDA study on the
subject, schools are making and have made very significant
progress in implementing the dietary guidelines in school meal
programs. The fat content of a reimbursable meal is
significantly down, and an increasing variety of fruits and
vegetables are being available.
One of the things that you may not see is what we do behind
the scenes in the school cafeteria, and that is we've modified
food preparation methods, we have rewritten product
specifications to specify lower fat, lower sodium and sugars,
and industry has responded to our requests.
So familiar student favorites, such as the pizza that you
mentioned, are part of school meals that meet the dietary
guidelines.
Chairman Castle. Before I yield to Ms. Woolsey, I might add
we probably eat pizza around here in our meetings three times a
week, but we'll let that slide by.
Ms. Woolsey is recognized for 5 minutes.
Ms. Woolsey. Where is that pizza? It's lunch time.
I have to make a comment. The Pilot School Breakfast
Program is because of a lot of the people out in the audience,
and legislation that my office has put together.
I want to tell you what the experience is there, Mr.
Chairman. It's elementary school. I give it that. It's harder
to tell high school kids what to do. But it is a forced
balanced program.
The kids come for the school breakfast. They are given so
many units of each food group. They can't have three muffins
and nothing else. They have a muffin. They have--I mean, they
get to choose among those food groups, but they don't get to
fill it all up with just one food group.
The kids love it, the teachers adore it, the parents love
it, and the administration loves it, because these kids are
learning something about eating, and they're eating.
They may already have eaten at home. We're learning that
elementary kids do. But we don't know what they eat at home.
They come to school, and they learn about balance.
They all sit down. I visit these programs, of course,
because one is in Santa Rosa, California in my district, and
the kids are sitting and talking politics. I mean, they are so
cute. They love being there, and they love doing this, and it
works.
So, OK. Now, that's enough of me. I want to ask Dr. Frank.
I don't want to waste her.
Tell us if there are barriers that you know of preventing
participation in the child nutrition programs for infants and
children, and what you think we could do to eliminate them.
Dr. Frank. First of all, the barriers in parents' work
schedules make it very difficult, often, to access WIC sites,
to come to school and present all the paperwork and miss a day
from work, and also having to recertify, I think, you know,
frequently, because so many people have fluctuating incomes.
When the hotel is full, they're working; when the hotel is
empty, they're not working.
So anything that requires frequent recertification that
doesn't have evening and ideally Saturday hours, and anything
that frighten people, because remember, you know, in our
multi--people are readily frightened, and therefore, many
eligible people, if you increase paperwork barriers and this
and that, just get frightened, and they--we spend a lot of time
handholding individual families to get them onto Food Stamps,
you know, to fill out the paperwork for school lunch.
And also, in Boston, we have the horrible situation where
we can't deem child care feeding, because we have a very few
wealthy neighborhoods, even though everybody in the child care
programs is very poor, and so every single home has to do this
unbelievable paperwork to get feeding, so many of them don't
participate.
So again, things that sound like--I forget, what was--there
was a lovely word that was used, accountability, something like
that. It makes sense, but it has to be looked at from the other
perspective, which is what harm are they doing to children who
need it?
You know, the first thing you teach to med students, you
bring them in the first day at med school and you look at them
and you say, ``Do no harm.''
So that, I would think, would be step first, in thinking
about how to enhance the administrative issues in these
programs.
Ms. Woolsey. I'm going to ask a question that I didn't
think Secretary Bost answered very well, and that's about the
upcoming reauthorization and what we need to do for WIC.
Ms. MacDonald, you start, and then Dr. Frank, and then
maybe all of you could answer that, if you would.
What do you think in our reauthorization is the most
important thing that we do on this Committee?
Ms. MacDonald. For WIC or for school meals, for anything?
Ms. Woolsey. Yeah, let's go for anything. Each of you gets
to pick your No. 1 thing you want us to do. We better hurry.
Ms. MacDonald. Our primary priority is to eliminate the
reduced price category, at least begin to look at that.
We also--
Ms. Woolsey. OK. That's all you get.
Ms. MacDonald. That's all I get? That's good. That's my
primary priority.
Ms. Woolsey. Now we'll go down here.
Dr. Baranowski. I advocate for enhanced funding for
behavioral research, so it could guide policy in the future.
Ms. Woolsey. OK. Dr. Cullen.
Ms. Cullen. From the research perception, I would agree
with Dr. Baranowski, but I also think we don't know much about
how to encourage kids to eat foods when other kids are not
eating healthy foods, and the whole atmosphere around school
lunch and the negative stigma.
Ms. Woolsey. OK.
Ms. Clarke. The proportion of the WIC funding that can go
for nutrition services is our biggest problem.
Ms. Woolsey. And Dr. Frank, you are the cleanup batter.
Dr. Frank. I wish for all programs the same way you have to
have an environmental impact statement, you would have to have
a baby impact statement, as to what is this change going to do
to poor, young children.
Ms. Woolsey. Thank you very much.
Chairman Castle. Thank you, Ms. Woolsey.
Mr. Osborne is recognized for 5 minutes.
Mr. Osborne. Thank you, Mr. Chairman. I'd like to thank the
panelists for being here today.
Dr. Baranowski, you mentioned in your testimony that
particularly in middle school and higher grades, children seem
to know what's healthy. They simply, at times, refuse to eat
what is healthy, and so a stigma to school lunch and motivation
is a problem.
In our society, obesity is a problem, too, and I would
think that those who are overweight would be motivated, and I
wonder if you had ever looked at special counseling or special
programs for those who are suffering from that stigma, because
I would think they would be the most likely to be highly
motivated to do something about whatever situation they're in.
Dr. Baranowski. That's an excellent question, Mr. Osborne.
Behavior change is very, very difficult, by anybody. The
obese have the same kinds of difficulties in changing their
behaviors as anybody else.
For children, the parents are particularly important. Many
of the parents don't recognize the difficulties and challenges
of obesity or changing behaviors.
In many cases, the families have, from a research
perspective, dysfunctional feeding practices that encourage
over-consumption of foods, perhaps permissive feeding practices
that also permit over-consumption of foods.
In general, obese children have a very difficult time
changing the behavior, just like obese adults do. We see many
obese adults, and while they feel guilty, there's huge anxiety
associated with it, the motivation to change in the sense that
it results in effective behavior change isn't there.
Mr. Osborne. I appreciate your response. I used to be
involved in an environment where we did have a nutritionist who
worked with our people, and I would think that nutritional
counseling that also included the parents at times might have
some effect. I don't know. And of course, you're always
concerned with cost.
Ms. MacDonald, I don't know if you read Secretary Bost's
testimony or not, but he indicated in that testimony that only
5 percent of the households who are available for multiple
programs use all of them.
In other words, there are many households who are eligible
for reduced lunch and breakfast costs, and also the WIC program
and Food Stamps, and yet it seems like most households just use
one.
So I noticed that you said that we should eliminate the
reduced fee, and yet I would wonder if we have so many people
who are eligible for more than what they're using, if we're
adequately informing people of what's available, because
certainly if they're eligible for multiple programs and they're
struggling to pay the 30-or-40-cent fee, you would think that
if they used all the programs, that they would not have that
trouble.
I wonder if you had thought about that or if you had
noticed the testimony that Under Secretary Bost brought to us.
Ms. MacDonald. I have not had a chance to read his
statement, but I did hear that fact, and I think what's
important is, about the elimination of the reduced price
category, is that that 40 cents or 30 cents is keeping children
out of the program.
They may be qualified for WIC when they're four or five.
When they come to school, they are not qualified for free. They
may fall into that reduced category, and they cannot pay that
fee.
I think it's important to note that even Under Secretary
Bost said that the extent of, you know, the problem of program
integrity is not, it's not clear, and we're very, very
concerned, and strongly urge Congress to not make any changes
in the current application or verification system that might
deny eligible children access, since we know that they're not
participating.
We need a more accurate picture of the problem, if it
exists, and as Dr. Frank said, to analyze the impact of
whatever solution might have on that population.
Mr. Osborne. If I might follow that comment up with another
question, in your testimony you did indicate that income
verification was needed and you also stated that you didn't
want this to be burdensome, you didn't want to scare people
off.
So that's kind of a tightrope, and what would you suggest?
Because, you know, we're at a point here where something has to
be implemented, and what do you think would be effective in
making the system more accurate and more accountable, and yet
avoid driving people who need the service off?
Ms. MacDonald. Well, one of the proven strategies is, as
Secretary Bost mentioned, direct certification where, if a
family currently qualifies for temporary assistance for needy
families on Food Stamps, they are automatically qualified in
some states for free meals.
We would like to see the expansion of direct certification
to programs such as Medicare, Children's Health Insurance, and
SSI, because these parents and families have to apply and
provide income documentation to become eligible for those
programs, and we feel that it is very reasonable to expand that
so that they will not have to fill out a separate set of
paperwork.
Mr. Osborne. Thank you.
Chairman Castle. Thank you, Mr. Osborne.
Ms. Majette is recognized for 5 minutes.
Ms. Majette. Thank you, Mr. Chairman, and thank all of you
for being here today and for what you are doing to make sure
that every child is able to be fed and prepared to learn.
I'm still wondering if there is some way that we can
streamline this process and reduce the stigma, and I know that
you're concerned about that, the stigma.
I guess I would ask if you have some ideas in terms of the
use of technology that might enable us to have people--well,
maybe that's a little vague.
But we have new technology in the grocery store where I
shop, at Kroger, in Georgia, where you get a card and you can
scan the items and they can keep track of everything that you
do.
It's my understanding that there are some systems that
might be available for schools to be able to give children a
card and maybe they wouldn't have to deal with money and having
somebody know how much they paid, and we could also track what
they're eating, what they're buying, what they're consuming,
and use that information in order to determine if there need to
be adjustments nutritionally, or those kinds of things.
Have any of you had any thoughts on using those kinds of
processes to address some of these issues?
Ms. MacDonald. Well, if I could answer that, actually, we,
in my district, we use that type of technology, and it is very,
very effective.
Students enter a PIN number. Even students who qualify for
free have an account balance that comes up on the screen, so if
someone is behind them, they don't know that they are qualified
for free.
However, that technology can cost quite a bit of money and,
as you know, in our programs, the recent GAO study that was
released showed that the current reimbursement for the cost to
produce and sustain the infrastructure to deliver meals is
inadequate. There's a gap between the free of 6 cents, 18.5, or
36 cents for reduced and 18.5 for free, or for paid.
So the schools are struggling. We would appreciate some
looking into that, so maybe some of this technology could be
incorporated.
Mr. Osborne [presiding]. Obviously, we have a vote coming,
and we have two more people to ask questions, so we'll try to
expedite things.
Ms. Majette. I'm sorry. Should we go on, Mr. Chairman?
Mr. Osborne. Certainly. Go ahead. Proceed.
Ms. Majette. When we talk about the cost, you know, I'm
always concerned about us being--and excuse the pun--penny wise
and pound foolish.
If we already know that on the back end, the cost of obese
children or undernourished children or undernourished young
people has an effect on their ability to learn and therefore
their ability to be well-educated, properly prepared citizens
or workforce, as well as the health concerns and the health
costs if you're dealing with diabetes and cancers and those
kinds of things that really do cost us in dollars and cents and
lots of other ways, would you suggest to us that it might be,
or perhaps would you agree with it that it might be more
effective in the long term to spend a little extra money to
eliminate the paperwork and get people on the track of being
able to meet those needs on the front end so that we don't have
to deal with it on the back end?
Ms. MacDonald. We would absolutely agree with that, and to
that point, that's one of the reasons why the elimination of
the reduced price category has such support from industry.
As you know, as I mentioned, they have a very strong
interest in a healthy and well-educated workforce, and these
programs not only benefit our children nutritionally now, but
they benefit the economy, as well, and of course, health costs,
as you mentioned, down the road.
So industry would rather put their money into research and
development, product development, rather than remedial programs
for employees who can't read or high health care costs.
So we would agree that it is a fine investment in the
future of this country to invest dollars in child nutrition
programs.
Ms. Majette. Thank you.
Mr. Osborne. Thank you. I think we probably better proceed.
We have a series of four votes and we'd like to conclude the
panel.
We have Mr. Van Hollen, who would like to ask question, and
Mr. Davis, so we'll try to get this finish. We have about five
or 6 minutes left.
Mr. Van Hollen. Thank you, Mr. Chairman. I'll try and be
brief. I want to thank all the members of the panel.
I have a question for Ms. MacDonald, about your proposal to
phaseout the reduced lunch portion and bring up the free lunch,
up to 185 percent of poverty. It's something I support. I think
it's a great proposal.
It obviously will require some resources to do it. I don't
have the exact estimates, but my understanding is it could be
$600 million additional per year when fully phased in,
somewhere in that range.
My concern is that, for those who sort of take half of your
proposal, but not the full proposal, and look for ways to
eliminate some of those kids who are on reduced price lunch and
pay for it by not replacing them with free lunches, and I would
ask what your response to that would be.
In other words, my sense is if we move forward, we should
also move forward with the understanding we should do no harm,
that children who are currently receiving reduced lunches, that
none of them should end up having to pay, because as I
understand your testimony, your reason for proposing free
reduced lunches is they're already having trouble paying what
they're paying. Is that right?
Ms. MacDonald. That's absolutely right, and it's very
important, the point that you make, because as our
reimbursements haven't kept up, the price to the paying child
has been raised higher and higher.
So we would want the caveat that, you know, certainly no
children who are currently eligible would be eliminated from
the program.
Ideally, we would love to just go the whole way, but we are
willing to, you know, work with Congress to explore if there
are other ways to get there.
One of the things that I find quite interesting is that the
current administrative cost to verify and do the applications
is about $640 million a year. That's a lot of lunches at 40
cents.
Mr. Van Hollen. Right. Thank you, Mr. Chairman. I had some
others, but in the interest of time, I will--
Mr. Osborne. Thank you.
Mr. Davis.
Mr. Davis. Thank you, Mr. Chairman.
I'd like to just ask if I can submit written questions for
the Secretary.
Chairman Castle. Without objection.
Mr. Davis. Many of my questions were, in fact, generated by
his testimony. Unfortunately, I had some duties on the floor
that kept me from getting here, but I will ask one question,
and maybe if the panel would respond, if they would care to.
In the Secretary's written testimony, he supported
expanding the portion of students that would be subject to
income verification.
Under current law, the number of approved applications that
must be verified by any single district is capped at 3,000. The
Secretary's testimony did not mention retaining such a cap.
However, retaining a cap on the number of applications that
large districts like mine--I come from Chicago--must verify is
extremely important, even if it is a higher cap than what we
now have.
Without a cap, what the Chicago public schools had to
verify, 12 percent of approved applications, we would face a
900 percent increase in the number of applications that we'd
have to verify. It would be extremely difficult for us to
absorb such an increase in our administrative responsibilities
and would have a great impact on our budget.
Moreover, we're concerned that eligible children in Chicago
and other big cities would be disproportionately affected if
there were no cap because the verification non-response rate
tends to be higher in urban areas.
If our Committee were to include a cap, even if it were a
slightly modified cap, on the number of approved applications
that the largest districts must verify, would you be opposed to
such a provision?
You can answer this if you would care to. If not, I
certainly will understand. It's not within your testimony and
it's not necessarily within your purview, but if any of you
would care to respond to that, I'd appreciate it if you would.
Ms. MacDonald. Well, I think that we look forward to
working with you and resolving those concerns, because we are
very, very concerned about the impact of any various potential
solution to that problem.
The Center on Budget and Policy Priorities has done
significant analysis on the extent of what the Secretary was
talking about, and we would be happy to ask the Center to share
those facts with you.
Mr. Davis. All right. Thank you very much. Anyone else?
[No response.]
Mr. Davis. If not, just a quick--obesity has been generated
and has generated a great deal of conversation lately relative
to child obesity.
What can we really do about it, quickly? You know, anybody?
Dr. Frank?
Dr. Frank. Well, first of all, interestingly enough, if you
prevent low birth weight, you will prevent later obesity,
because that turns out to be a huge predictor, paradoxically.
The other things I think are rational, but probably not
politically acceptable.
You can't advertise tobacco to kids, but you can advertise
any kind of unhealthy food, about millions, literally millions
of ads a year on the children's television programming.
Also, there's issues of things like neighborhood safety. We
just had a 3-year-old shot and paralyzed, in my hospital.
So it's all very well to tell people to go for a walk, but
they realistically understand that, you know, it's bad to be
obese, but it's worse to be paralyzed, and anytime one of those
happens, everybody locks their kids up indoors, and then once
the kids are indoors, all they've got to do is watch TV.
So you have to sort of have a real sense of real life when
you address these things.
Mr. Davis. Thank you very much, Mr. Chairman.
Mr. Osborne. Thank you, Mr. Davis.
I'd like to thank the witnesses for your testimony, and
members for their participation.
If there's no further business, the Subcommittee stands
adjourned.
[Whereupon, at 12:32 p.m., the Subcommittee was adjourned.]
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