Recent Articles About Nutrition

Want to Send Healthy Food to Your Child’s Daycare? You Might Need a Doctor’s Note

Imagine a daycare center serving your child doughnuts or Pop Tarts and then demanding proof of your child’s medical “disability” when you ask to send healthier food from home. As bizarre as that scenario may sound, it’s one that parents around the country may face if they send their children to daycare centers participating in the federal Child and Adult Food Care Program (CACFP).

The CACFP is similar to the federal school food program, providing funding for meals served in daycare centers, after-school programs, group homes, and similar facilities. Just as with school food, CACFP meals and snacks must meet nutritional standards established by the U.S. Department of Agriculture (USDA) in order for the government to reimburse providers on a per-meal-served basis. And while these meals are an important safety net for millions of economically disadvantaged kids, the USDA’s standards don’t necessarily require real, whole foods to be offered.

Faced with a relatively low reimbursement rate and seeking assurance that a given food meets federal requirements, both schools and daycare facilities have an incentive to choose packaged foods bearing a “CN label” (verifying that the food may be served in federal child nutrition programs) over fresh, whole foods that require potentially expensive kitchen labor and adequate facilities to prepare.

As Kellie Morrill, former director of a 100-child daycare center in Seattle, says, “That’s the flaw in the program. They give you money to buy food, but it’s in your best interest to buy the cheapest stuff you can find with a CACFP-approved label. I often would go to Costco and buy generic brands with the label, just to make my money last.”

Not all daycares operate this way. But for parents sending their children to those that do, opting out can be onerous at best, impossible at worst.

Take Susan*, a North Carolina mom who feeds her 15-month-old daughter well at home. Her CACFP-participating daycare center regularly serves highly processed junk food like Rice Krispies treats, Pop Tarts, and vanilla wafers.** When this mother asked the center if she could send in healthier options for her daughter’s snacks, she was told no, unless she could establish with a doctor’s note that her child has an actual medical disability or allergy that would prevent her from eating those foods.

“I’m just so frustrated,” says Susan. “I would never serve her those things at home, let alone eat them myself. But they said the only way around it is getting a doctor’s note.”

In actuality, the CACFP regulations don’t contain any provision requiring a doctor’s note. However, they don’t prohibit daycare centers from establishing such a policy either. When asked about the matter, a USDA spokesperson would only say, “any decision to enact such a policy would be at the state’s or local provider’s discretion.”

Why would a daycare center make it difficult for parent to opt out of CACFP meals? It’s all about the bottom line. If too many children bring food from home, a daycare operator will be hard pressed to keep the CACFP meal program afloat for the remaining families who want to participate. As Morrill puts it, “Allowing kids to bring lunch from home was not in my best interest as a business person. That federal funding was a big part of my budget and I knew what it cost me for food and for my cook and all my helpers, regardless of whether a child wanted to bring something from home. So if I’m using USDA money, then I have get the highest participation possible.”

State licensing may also require daycare operators to ensure that children in their care eat balanced meals drawn from all of the major food groups. Unless daycare centers prohibit food from home, under these licensing rules they’re required to evaluate a child’s home-packed lunches on a daily basis and supplement those lunches with any missing food categories. That practice, which can be burdensome, has also been the subject of several headline-grabbing (and often inaccurately reported) news stories about “federal agents” peering into kid’s lunch boxes, stories that have been seized upon by right wing pundits as examples of “nanny state” overreach.

There are also more subtle reasons why a daycare operator might want all children to eat the same meal. For one, individualized meals can be disruptive when caring for young children. As Amanda*, a former home daycare aide, says, “Just the whole idea that one kid gets to eat something different–and therefore does not take part in the rituals we tried to teach around waiting your turn, helping each other, taking only your share of a communal dish, using prescribed table manners–undermines vital lessons in cooperation.”

And even though Kellie Morrill understands firsthand why daycare centers adopt the doctor’s note policy, she has since become a strong proponent of healthful eating and says she’d do things differently today. For example, Morrill remembers standing in the way of parents who wanted their son to eat a “clean,” gluten- and dairy-free diet while in daycare, but now she would do her best to accommodate such requests.

“Now I would say, yes, we can do that, but I’d have to convince the state licensor to interpret the statutes in a different way,” she says. If that effort failed, Morrill says she would refer such families to a sympathetic pediatrician or naturopathic doctor to obtain a note.

In the short term, that latter option may be the only solution for parents like Susan, who want their children to avoid highly processed junk food. But on a systemic level, Morrill laments the lack of adequate funding to support serving fresher, whole foods to children in all of these facilities.

Now the director of a Seattle preschool, Morrill’s current meal program is a progressive one and therefore far more expensive to operate. “We serve real, good food and we just claim what we can [under the CACFP],” she says. “It’s what we call the ‘quality gap’ between what it costs to run a meal program the way you want to and what you actually get paid by the government.”

And it mirrors the national gap between the nation’s wealthiest and poorest eaters, a gap that has doubled in recent years. In the case of her school, the budget deficit created by serving children healthier food must be covered every year by third-party subsidies–through grants, foundations, and outside fundraising.



* Name changed at the interviewee’s request.

** Given recent (and controversial) nutritional improvements in school meals, one might assume there have been similar efforts to improve the CACFP’s nutritional standards. But a CACFP guidance document makes clear that items like Rice Krispies treats, Pop Tarts, and cookies are permissible daycare snack foods and that Pop Tarts (along with other “sweet grain” foods like coffee cakes, doughnuts, and sweet rolls) may also be served for breakfast, in both cases up to twice a week.



The Vermont Paradox: Youth Program Takes on Hunger and Chronic Disease in a Locavore State

A visitor who swings by the Vermont Youth Conservation Corps (VYCC) on a Wednesday afternoon will see rows opened boxes lined up across the barn floor. Farm crew members between the ages of 15 and 18 are distributing the week’s harvest evenly between the boxes. Some sort tomatoes while others weigh and bag green beans over a small table. On the wall behind them is a whiteboard with a chart. Stephanie Bartlett, a 15-year-old with a chestnut brown ponytail, tallies 464 pounds of cucumbers and 448 pounds of squash. Read more

Low-Fat vs. Low-Carb: The Winner is Neither

Welcome to round 3,752 of the Diet Wars. This week’s opponents have been battling it out for decades, each with hordes of devoted fans. In one corner: carbohydrates. In the other: fat. Both have taken their share of punches throughout the years, and they are back for more following the release of a new study published in the Annals of Internal Medicine.

A much-cited New York Times article on the study titled “A Call For a Low-Carb Diet” reads: “People who avoid carbohydrates and eat more fat, even saturated fat, lose more body fat and have fewer cardiovascular risks than people who follow the low-fat diet that health authorities have favored for decades.” Read more

Processed Feud: How the Food Industry Shapes Nutrition

What exactly does “processed food” mean? According to a new position paper from the American Society For Nutrition (ASN) processing means “the alteration of foods from the state in which they are harvested or raised to better preserve them and feed consumers.” By this definition, processed foods encompass everything from washed raw spinach and frozen strawberries to Betty Crocker’s Cheesy Scalloped boxed potatoes (a box of the latter is made up of reconstituted ingredients held together with partially hydrogenated oils, artificial dyes, and the sodium equivalent of 60 potato chips per serving). Read more

Ex Trader Joe’s Exec Wants to Use Expired Food to Get People Cooking

If you care about food waste, odds are good that you’ve heard of the Daily Table, a new Boston-based model of grocery store that will take safe food that has been discarded or is close to expiring and sell it at prices that compete with fast food in low-income areas. It’s an important model that comes at a time when U.S. consumers, companies, and businesses throw away 165 billion dollars worth of entirely edible food each year–or 40 percent of the food we produce in this country. Read more

American Hunger, by the Numbers

As I report in next month’s National Geographic feature, “The New Face of Hunger,” millions of American families are struggling with a new kind of hunger. Some of the increase can be traced to a change in definition; in the 1960s, America equated hunger with physical starvation. By the 2000s, though, researchers started asking whether people were skipping meals because they couldn’t afford to eat, coining the term “food insecurity” to replace hunger. And with wages stagnating and public support of commodity crops far exceeding that for produce, the number of food insecure Americans now far outstrips the number of those who were ever counted as “hungry.” But don’t take my word for it: The numbers speak for themselves.

How bad is the new American hunger?

Millions of people hungry in the U.S. in 1968   10

Millions of people food insecure in the U.S. in 2012   49 Read more

‘Groceryships’ Could Set a Course for Healthy Eating

In recent years, a consensus has been taking shape among food justice advocates, as well as nutrition and public health experts. While access to fresh, healthy food is important to changing dietary trends, these groups tend to agree, it’s only one piece of the puzzle.

A new project in South Los Angeles has set out to prove that another piece of the puzzle—educating people how to cook whole foods—can work wonders. Read more

San Francisco’s Healthy Corner Store Movement: Getting it Right

Despite its reputation as a Mecca of farmers markets and foodie culture, San Francisco is also home to quite a few people who lack access to good, whole food. In the low-income Bayview-Hunters Point neighborhood, for instance, residents have an 8- to 14-year decreased life expectancy compared to their neighbors in other parts of the city. This is due in large part to diet-related illnesses like diabetes, congestive heart failure, hypertension and other types of heart disease. In addition, nearly 42 percent of adults in San Francisco are overweight or obese, and only one-third of those adults eat three or more servings of fruit and vegetables each day. Read more