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MyView: Snacking ourselves sick

May 20, 2013

By Mary Jennings, D.D.S.

A few months ago, I was surprised to find myself assigned to the ADA Task Force on Childhood Nutrition. I was surprised because while I know as much about nutrition as the next dentist, I find it difficult to put my education into practice in my own life. Evidently, I am not alone. Childhood nutrition is a hot issue nationwide. Pink slime and childhood obesity have become prime-time news.

According to the Institute of Medicine, 32 percent of American children are obese. The IOM anticipates that the bill for treating obesity related health issues in these children in their lifetime could be well over $147 billion.

I have been researching the role vending machines in schools play in childhood nutrition. Great strides have been made since they first appeared loaded with sodas and candy. I give great credit to dentists and parents seeing the obvious caries consequences and insisting that these products be limited. But have we done enough?

Let's review a few salient points in a deeply complex subject. The Washington Department of Health says that between 19 and 50 percent of a child's daily intake of food is consumed during school hours. They report that at least 88 percent of schools have some type of snack being sold in machines or student stores. Children who consume "competitive foods" participate less in school lunch and breakfast programs. Children who participate in school meal programs get as much as 50 percent of their daily fruits and vegetables from these programs.

In 2007 the Washington State Legislature voted in the RCW 28A.210.365 "Food choice, physical activity and childhood fitness exemption" policy setting up "goals" for foods available on school campuses. They recommend no more than 15 grams of sugar per food item unless it is flavored milk, which can be to up to 30 grams. A can of cola has 39 grams.

Seattle schools have been selling healthy foods since 2004 by school board rulings. According to news reports, since their policy was implemented, competitive food sales revenues in the Seattle schools fell from $217,000 to $17,000 a year. These revenues are used for sports uniforms, yearbooks and other school programs.

In 2010, the Healthy Hunger-free Kids Act was signed into federal law. It adds $4.5 billion in new funding for child nutrition for 10 years. It also puts food sold in schools under the direct supervision of the U.S. Department of Agriculture, which is already managing the school meal program. One of the tenets of the act is that children are able to make healthy choices at a young age by using the principles of "behavioral economics research."

The Department of Agriculture is currently working on guidelines for food sold in schools and at school events. The word from my newly minted nutrition friends is they are going to rely heavily on recommendations from the Institute of Medicine. That is all well and good, but remember the IOM is focusing on obesity, fat content and heart disease, more so than caries. My task force members are quite concerned that sugar will be lost in the miasma if we are not proactive about it.

Whew! To meet everyone's needs we must sell healthy foods that are low in fat and sugar, and that children will actually purchase and eat. I suspect that very few of us are aware that we are supposed to be teaching children the principles of behavioral economics research.

I am concerned that even with USDA rules, there will still be more sugar in the schools than we will be comfortable with. I worry that no one besides the dental community is thinking about the fact that kids' grazing all day greatly increases their caries risk. We are going to need to change some tactics.

The good thing is that dentists are already fully engaged in preaching sugar reduction. We need to include school snack consumption counseling into our sugar speech.

Many of us have already made inroads into schools with things like our "adopt a school program." As a truly grassroots effort, we need to ask hard questions about what is being sold and how machines can be turned off at times to ensure children eat proper meals and limit snacking.

We need parents to understand that they are ultimately in charge of what their child consumes. If their child is going to school with change in their pocket, they need to know what is available and have a frank discussion both at home and with their teachers as to what that child is allowed to eat. Better yet, leave that money in the piggy bank. A child deciding between chocolate milk and apples without an adult looking on is a losing proposition.

We must fight this battle on the home front, in the schools, with the legislature and with the USDA to make sugary treats special again and not set as a standard in a child's daily school life.

Dr. Jennings is the editor of the WSDA News, the publication of the Washington State Dental Association. Her comments, reprinted here with permission, originally appeared in the May 2012 issue of that publication.

Editor's note: Dr. Jennings was a member of an ADA task force that consisted of representatives from a number of councils who examined childhood nutrition, snacking, sugar and the acidic content of foods in order to formulate a strategic approach for addressing the complex emerging issues related to oral health and nutrition.

Led by the Council on Access, Prevention and Interprofessional Relations, the task force developed a number of strategies to guide the ADA's response to this issue. Examples include determining how lower level evidence-based research, the best science that is currently available, can inform policy; supporting pilot programs that produce outcomes that could inform further research, legislative strategies and policies; focusing on education to change behavior; and encouraging states to develop oral health plans that include nutrition-related initiatives.