Introduction
Healthy eating leads to a healthy lifestyle. Data from previous years shows that over 78 million adults and 12.5 million children and adolescents are obese. In addition, projected reports have shown that by 2030, half of the adults in the United States will be obese ("President's Council," n.d.). In order to discontinue this, changes need to be made to all individuals’ diets. Because more than 49.1 million Americans experience food insecurity or live in food deserts, it is easy for them to eat less than the recommended amounts of grains, fruits, vegetables, and dairy products ("President's Council," n.d.). A recent study has proven that being overweight puts young children at a greater danger for high cholesterol, plasma insulin, and elevated blood pressure, which are exposures for cardiovascular disease and type 2 diabetes” (Nigg, 2016). Eating healthy provides necessary nutrients that the body needs to clean the body and function.
The Food and Nutrition Service (FNS) has created a rule requiring updated meal patterns for the Child and Adult Food Care Program (CACFP). These meal patterns adhere to the new version of the Dietary Guidelines, incorporate relevant science in regards to nutrition, and involve the correct agency recommendations ("Child and Adult," 2016). This paper will provide information about the need for the Child and Adult Food Care Program’s meal pattern revision, alternative meal options, stakeholders both for and against the proposed regulation, cost benefit, and the impact and effectiveness of the new rule.
Body
Background
The Food and Nutrition Service is a federal agency, part of the United States Department of Agriculture (USDA). FNS works to end hunger and obesity throughout the United States. They work hand in hand with the Center for Nutrition Policy and Promotion (CNPP) and the Supplemental Nutrition Assistance Program (SNAP). In addition to the above stated goals, these agencies also work to increase food security. By ensuring healthy and safe food for children, expecting mothers, and families with low-income, these programs can ensure healthy diets and active lifestyles. In addition, the CNPP works to advance the health of Americans by adhering to dietary guidelines, while SNAP assists low-income families afford an adequate diet. Those who are at or below the 130% of the poverty line are eligible for SNAP ("Policy Basics," 2015). Individuals in SNAP receive about $126 per month for food; this comes out to about $1.40 per meal ("Policy Basics," 2015).
Effective June 2016, The Food and Nutrition Service required the CACFP to encourage health and wellbeing in child care sites while focusing on eating healthy and exercise ("Child and Adult," 2016). They did this through a proposed rule. All of these changes would take place in centers, schools and day cares, if the locations chose to adopt the practice of serving healthier options. Their goals included serving more grains, including a prominent assortment of vegetables and fruit, and finally, decreasing the amount of sugars and fats in foods. Furthermore, this rule supports mothers who breastfeed and allows for the revision of school breakfast and lunch programs, and milk requirements ("Child and Adult," 2016). The School Breakfast Program (SBP) and the National School Lunch Program (NSLP) would help “…infants and children under 5 years of age to reflect the respective proposed meal patterns for CACFP, as well as revising the fluid milk requirements and approved non-dairy milk substitutes for the Special Milk Program (SMP)” ("Child and Adult," 2016). The Healthy Hunger-Free Kids Act (HHFKA) did not provide meal reimbursement or compensation. Therefore, all of these alterations would try to be as cost effective as possible. While providers or these foods have the flexibility of serving non-reimbursable food and drink, the FNS urges them to be cautious when serving these non-reimbursable foods as there may be increased sugar, fats, and sodium ("Child and Adult," 2016). However, reimbursement of meals would be possible for mothers who breastfeed their infant in the child care center or in their home. All of these components are implemented in order to improve the health of young children by ensuring a well-balanced diet is created early and maintained throughout adulthood. In addition, adult day care facilities will also be included in CACFP for adults who are functionally impaired or 60 years of age and older. This not only includes public and private nonprofit facilities, but also for-profit centers that have at least one-fourth of their participants receiving benefits under titles XIX or XX (Murphey, 2011).
Need
There is a need to increase access and availability of healthy food for low income children. Most low income children are not able to eat multiple meals a day, so school breakfasts and lunches are one of their only options. Providing breakfast and lunch to low income children ensures that they will be able to have at least two meals a day. Because of the CACFP, combined with other organizations, these programs will provide over $40 billion per year to ensure that low income children have access to the proper nutrition they need to grow. (Barriers That, n.d.). This regulation is essential to children’s health as it will improve their lives as they transition into adulthood and continue to live healthy. Living and eating healthy can help individuals reduce the risk of conditions such as cancer, diabetes, heart disease, and high blood pressure ("Childhood Nutrition," 2017). A study showed that being overweight during childhood years was connected with higher adult body-mass index (BMI). Undernutrition in childhood proved to be risk factors for high glucose and high blood pressure. In addition, weight gain after birth was linked to chronic diseases (Victora, 2008). As the Department of Health and Human Services has stated, healthy eating and physical activity are the most effective ways to decrease the risk of obesity in all individuals. As seen in Figure 1, the prevalence of obesity is high in children, at 12.1% for children ages 2-5, 18% in children ages 6-11, and 18.4% in children ages 12-19 (CDC, 2015). In addition, there has been a proposed change to reduce the amount of fats and sugars. This is due to the Centers for Disease Control and Prevention (CDC) showing that, “empty calories from added sugars and solid fats contribute to 40% of daily calories for children and adolescents age 2-18 years – affecting the overall quality of their diets” ("Childhood Nutrition," 2017). Although total fruit intake among children have increased, most adolescents still do not meet the daily recommendations. Healthy eating in childhood is imperative for proper growth and development in adult life. A variety of fruits, vegetables, whole grains, fat-free products, and proteins are needed in children’s daily intake of food to prosper and to limit health conditions. In addition, a poor diet can lead to an energy imbalance which can lead to an increased risk of obesity as a child and adult, lower dietary quality and undernutrition, which, in turn, can affect all aspects of life, including physical, cognitive, and emotional health ("Childhood Nutrition," 2017). Due to this, the proposed regulation is needed in order to increase a healthy diet.
As for the adult day care program, one of the requirements is fluid milk. Although many of the adult participant’s decline milk at meals, milk contains calcium, phosphorus, magnesium and potassium, and is vital to growth, even in adulthood ("Importance of Milk," n.d.). In addition, the lack of calcium can result in a calcium deficiency which can result in osteoporosis, or bone deterioration. As seen in Figure 2, about 15% of all men and women ages 65 and over have osteoporosis. Following the government’s U.S. Dietary Guidelines, adults should consume three servings of milk per day. The CACFP requires adults’ fluid milk in these programs to require, “flavored milk to contain no more than 22 grams of sugar per 8 fluid ounces; or recommend…that flavored milk contain no more than 22 grams of sugar per 8 fluid ounces” ("Child and Adult," 2016).
The food that will be served in these schools and centers will better reflect nutritional science, increase the variability in the key food groups, and meet nutritional needs of infants, children, adolescents, and adults. As stated in the Federal Register, this is the first major modification of the Child and Adult Care Food Program meal patterns since the program began in 1968 ("Childhood Nutrition," 2017). Many nutritional needs have changed since 1968, so it is necessary that these meal patterns be revised. Supporting women who breastfeed will ensure infants ingest sufficient nutrients, as it is recommended by the American Academy of Pediatrics (AAP) ("Child and Adult," 2016). Breastfeeding is the best source of nutrients for infants and includes a perfect combination of vitamins, protein and fat. Furthermore, breast milk contains antibodies that aid babies to battle off microorganisms, like viruses and bacteria. In addition, babies who are breastfed will have reduced risks of asthma, obesity, type 2 diabetes, ear and respiratory infections, and sudden infant death syndrome (SIDS) ("Breastfeeding," 2018). As for mothers, there are also many benefits of breastfeeding. For example, mothers have a decreased risk of cardiovascular disease, type 2 diabetes, and ovarian and breast cancer.
Additionally, allowing fruits and vegetables to be two different sections of the food group, increases consumption and variety. Moreover, by not allowing desserts, and creating a sugar limit on all foods, individuals in CACFP will ultimately decrease the amount of added sugars and fats on a daily basis in their diets. Finally, allowing a meat, meat alternate, or tofu will allow participants to consume protein on a daily basis as well.
Alternatives
There are many different alternatives that would allow kids to receive healthy food. For example, there could be a regulation that requires all schools to give free/reduced breakfast and lunch to all students. About 95% of schools have implemented the National School Lunch Program. This program makes it possible for all children in school to obtain a nutritious, healthy lunch every day. If all schools adopted this program, more than 30 million low-income children would receive lunch ("National School," 2018). In addition, requiring all schools in the United States to adopt the School Breakfast Program would assist over 15 million children. When the program began in 1966, only 0.5 million children were participants. However, in 2016, participation had reached to 14.57 million children throughout the United States ("School Breakfast," 2017). Implementing both of these programs to schools would ensure that two healthy, nutrient based meals were being given to students who could not afford anything else.
Stakeholders
The stakeholders for this regulation include positively influencing young children and adolescents with a low-income. These low-income families will now be able to have healthy meals because of this new regulation, which will also positively impact them in the long run. Healthcare providers, students, dieticians, nutritionists, advocacy organizations, and health care associations all voiced their support for not only combatting childhood obesity, but also starting healthy eating habits early for children ("Proposed Rule," 2015). In addition, mothers who breastfeed will also be influenced, as the CACFP reimburses mothers with meals as well if they choose to breastfeed her infant ("Childhood Nutrition," 2017). Food industry councils and trade organizations also supported enhancing meals served to children and adults, but also had concerns about limits on food choices, increased costs, and not serving foods with many nutrients that would not be edible to children. On the other hand, there were organizations who were negatively affected by this regulation. For example, those who previously supplied products for the CACFP will no longer be required to provide foods. This impacts their businesses as they no longer receive their income from this program.
Cost
While making the rule, the FNS took into account response from stakeholders who stated that changes to the meal pattern requirements, “must be sensitive to cost and practical application. The proposed meal pattern revisions were designed to be cost neutral as no additional meal reimbursement was provided by the HHFKA to implement the changes” ("Childhood Nutrition," 2017). In addition, the National Academy of Medicine also agreed to make cost and practical considerations when making revisions to meals and “ensures successful implementation without increasing net costs to CACFP centers and day care homes” ("Childhood Nutrition," 2017). While some healthier options may cost more, there are implementations in place in order to help reduce overall costs.
Additionally, this rule aligns itself with the Dietary Guidelines in an, “…essentially cost-neutral manner, as HHFKA did not provide any funding for additional or increased meal reimbursements in CACFP” ("Childhood Nutrition," 2017). By offering a wide variety of grains, cost savings were increased by $80.1 million, overall. In addition, by not allowing any desserts for meals, $121.3 million were saved. The overall financial goal of this rule was to create a minimal cost, achievable meal revision, without producing adversity for small agencies and organizations who assisted in making the program effective ("Childhood Nutrition," 2017).
Finally, there are long-term societal costs, such as cost saving over time as it pertains to raising healthier kids into adulthood. If children are healthy as they grow up, they will most likely continue to be healthy as adults, which will save them the cost of services like emergency room trips and doctors’ visits.
Impact and Effectiveness
This regulation is extremely effective for those who do not receive the recommended amounts of fruits, vegetables, grains, and dairy daily. This program ensures that meals that are served at centers and schools, “better reflect nutrition science; increase the availability of key food groups; better meet the nutritional needs of infants, children, and adults; and foster healthy eating habits” ("Childhood Nutrition," 2017). In addition, this regulation supports mothers who breastfeed, which, in turn, positively affects infants who are breastfed throughout their first six months of life, as it decreases their risk of Sudden Infant Death Syndrome (SIDS), asthma, obesity, and type II diabetes ("What Are the Benefits," 2016).
Furthermore, studies have shown that fruits and vegetables are significant factors in a balanced and healthy diet. Researchers have proven that the abundant amount of antioxidants in these foods play a substantial role in a balanced diet (Bvenura, 2017). Because many of these low-income cannot afford these rich fruits and vegetables, this leads to hunger and possibly malnutrition, which negatively impacts growing children. All changes to diet need to be implemented in homes as well as other community environments, as these surroundings promote healthy behaviors and changes for all involved.
Lastly, the Kids’ Safe and healthful Foods Project (KSHF) and The Pew Charitable Trusts and the Robert Wood Johnson Foundation began a health impact assessment (HIA) to assess how this regulation affected children who participated in this program. This assessment showed that the expected health impact of vegetables, whole grains and the consumption of nutrients such as vitamins D and E, were all beneficial to participating children. (CACFP Health, 2017).
Conclusion
The Child and Adult Care Food Program proposed a new rule that would increase the amounts of whole grains, vegetables and fruits, and reduce the amounts of fats and sugars in meals. Implementing this new rule will ultimately decrease the number of children who are overweight or obese and will help their health outcomes are they become older. This proposition will save money in the long run as healthy children turn into healthy adults and live longer and healthier lives. These changes will positively impact infants, children, adolescents, and adults all around the United States of America as individuals will now be able to receive a nourishing, balanced diet, possibly starting at a young age, being carried on throughout life.
Reflection
After completing research on this topic, I have learned how necessary it is to start eating healthy at a young age. By consuming the accurate amounts of fruits, vegetables, grains, and dairy, an individual’s life will become exceptionally better as they grow up and continue to eat healthy, decreasing the risk of health conditions and complications. By adhering to the guidelines put together by the Food and Nutrition Service, individuals will consume a healthy, nutritious diet daily, improving their overall wellbeing. The writing process for this paper helped significantly. I believe getting feedback on multiple drafts of the paper is vital to improvement. After writing this paper, I would go back and pay more attention to the subheadings on the Federal Register website as those would have greatly helped specific sections in my paper.