In an age when consumers have ready access through the media to countless scientific studies and the latest information on nutrition is as nearby as the local bookstore, confusion as to what is fact and what isn't still is rampant. An example of the most recent nutrition disagreement focuses on the public school lunch program.
Each side makes pertinent points: The U.S. Department of Agriculture stresses that it is making improvements aimed at bringing the amount of fat in the school food program in line with recommended levels, while a consumer advocacy group says that the USDA isn't doing enough and offers specific suggestions for streamlining the lunch menu.
But the argument remains unsettled, which could affect the long-term health of children who regularly participate in the program. To help sort out the facts, a physician and a registered dietitian were consulted for their opinions.
In the September issue of its monthly newsletter, the Public Voice for Food and Health Policy, a Washington-based consumer group, charged that since the U.S. Dietary Guidelines were issued in 1980, school lunches have failed to provide meals that comply with the recommendations. And it suggests as a remedy to the situation that the USDA set specific limits on the food types that can be included in a child's lunch--particularly foods high in fat, sugar and sodium.
Newsletter's Recommendation on Milk
The consumer group seeks limits on the type of milk offered to youngsters--encouraging the use of skim or 1% fat milk instead of 2% (low-fat) or whole milk (3.2% fat)--and suggests that the USDA examine the feasibility of reinstituting the ban on the sale of foods with limited nutritional value--such as some snack foods and sugary beverages--on the school grounds.
"While the Surgeon General has stated that reducing intake of fat is the most significant change Americans can make in eating a more healthful diet, many schools around the country continue to serve lunches loaded with saturated fat," said Ellen Haas, executive director of Public Voice.
"The U.S. Department of Agriculture and the U.S. Department of Health and Human Services nearly a decade ago issued a set of U.S. Dietary Guidelines which provided consumers with clear-cut principles of proper eating: Eat a variety of foods; maintain desirable weight; avoid too much fat, saturated fat and cholesterol; eat foods with adequate starch and fiber; avoid too much sugar; avoid too much sodium and drink alcoholic beverages in moderation.
"Yet as health experts stridently warn both young and old Americans to change their eating habits, little is being done to achieve this with a critical target group: our nation's schoolchildren," her report states.
"Here is a wonderful opportunity to provide a nutritious, healthful meal, while helping to establish proper lifelong eating patterns . . . but the program falls far short in ensuring that students do not receive too much of the nutrients that may endanger health in high quantities: fat, sodium and sugar."
Haas agrees that some schools have made improvements, particularly in side dishes and desserts, often offering vegetables and fresh fruits, but there remains great concern that main courses at too many schools are "still full of fat."
At issue are food items such as hot dogs, corn dogs, tacos, burritos, hamburgers, turkey nuggets and fish sticks, which are either very high in fat or are prepared with high-fat cooking methods.
While the USDA does agree that some of the recommendations made by Public Voice are worth considering and says that it has, indeed, taken steps to reduce the fat contained in the meals offered to students, it sees several problems with the strict limits the group would impose, primarily because of the lack of clinical data to support such action.
"Some change in school meals is warranted--but how much and to what degree?" asked Dr. Suzanne S. Harris, deputy assistant secretary of Agriculture for Food and Consumer Services, in a written response to Public Voice. "Should the school lunch program be in the forefront of implementing dietary changes that exceed the Dietary Guidelines' recommendations and for which controversy still exists?"
The answer from Yvonne L. Bronner, a registered dietitian in the College of Allied Health Sciences Department of Clinical Nutrition at Howard University, Washington, is a resounding no. But Dr. L. Stephen Gordon, a prominent pediatric cardiologist, who treats children born with congenital heart disease disagrees.
"When you make recommendations for the public you have to be careful," said Bronner, whose specialty is child nutrition. "A child is still growing and it is very important that they have a complement of nutrients . . . . We don't want them to have to rely on vitamin pills.
"When we want to reduce calories (in children), we increase exercise and complex carbohydrates and make sure they have enough of the fat-soluble vitamins--especially Vitamin D."
Harris concurs, adding that the American Academy of Pediatrics has not yet endorsed a fat-restricted diet for children and young people because of insufficient scientific data to justify such action. Further, she said that the evidence linking the risk of heart disease to diet comes primarily from studies of middle-aged white males. There is no long-term data available for children.
"The scientific community still has serious reservations about accepting the contention that the presence of fatty streaks found in children serves as evidence for the childhood origin of arteriosclerosis," Harris noted.
Gordon countered, that in spite of the lacking scientific data, the American Heart Assn. in a 1983 committee report, "Diet in the Healthy Child," recommended a "prudent diet" with 30% of all calories coming from fat, 15% from protein and 55% from carbohydrates. This advice was supported by an American Academy of Pediatrics' verdict that daily cholesterol intake not exceed 300 mg. But these goals should not, according to Bronner, be achieved by imposing limits on the types of food offered to children, particularly skim milk.
"We don't recommend skim milk," Bronner explained, "1% or 2% is the absolute bottom."
Outside the issue of which foods to avoid, Harris contends that a school lunch program that is a "radical dietary change" from the meals served outside the school, will have little impact on modifying children's eating habits. She concluded that a more likely result would be decreased consumption of school meals because they are not acceptable to students. This could reduce a student's daily nutrient intake, which would be "particularly troublesome for those children for whom school lunches provide the only balanced meal they receive each day," Harris said.
This theory is reiterated by Bronner, who added that the process "can't be a quick switch-over. . . . As adults change their eating habits and change the eating habits at home, it will be reflected in the schools. You can't expect kids to respect school lunches if they can't expect to find those foods at home."
Gordon, however, believes that it is possible to develop healthful lunch menus for students and dismisses the USDA theory of plate waste and "decreased consumption."
"There are a lot of good reasons for changing the diet in the schools," he said, describing the limits called for by Public Voice as "not a bad idea."
He explained that 17% of all children in this country perform poorly on cholesterol tests--placing in the 200 and above range. At least 33% have moderately elevated blood cholesterol levels, which range from 170 to 200 mgs. The desired range is about 140 to 160 mgs.
Furthermore, he said that since studies show adults can reverse the process (of atherosclerosis), it should be possible to prevent it.
"There are no long-term studies of children, but look at the school experience," Gordon said. "It's (school) a learning process so they will learn to eat right. If you give them tuna fish, raw vegetables, apples and milk, they're going to have to eat something."
But, for now, at least until further research determines the influence of diet and the roles of genetics and obesity on a child's propensity for atherosclerosis as an adult, Harris said that the USDA will follow "a moderate approach."
"Before USDA can establish limits on the amount of salt, fat and sugar to be permitted in a school lunch, as recommended by Public Voice, quantitative target levels, especially for children, must be developed."