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What’s on Your Tray?

Cafeterias try harder for kids with diabetes

Is it possible for children, particularly children with diabetes, to reach the end of the school cafeteria line with a healthy meal on their tray? Cafeterias, often known for their sugar-laden chocolate milk, fat-filled French fries, and high-sodium processed foods, haven’t always received great grades for nutritious food choices, but recently, some positive changes to the choices offered in school cafeterias are happening. Here is the lowdown on these changes and a few tips to help all kids, whether they live with type 1 diabetes or hope to avoid type 2, select more nutritious meals.

“The biggest overhaul of school nutrition standards in fifteen years just went into effect in July 2012. They’re due to the Healthy, Hunger-Free Kids Act, legislation signed into law by President Obama (with a hefty nudge from the First Lady),” says Dayle Hayes, MS, RD, who runs  Nutrition for the Future.

“The American Diabetes Association, as part of our Safe at School initiatives, had a hand in getting this law passed,” says Crystal Crismond Jackson, parent of a young adult with type 1 diabetes and director of the Association’s Safe at School program.

The biggest changes in school nutrition standards echo the current Choose My Plate Dietary Guidelines for all Americans:

  • Fruits and vegetables on the menu daily
  • Whole grains featured more often
  • Milk limited to low- and non-fat
  • Reduced saturated fat, trans fat, and sodium in foods
  • More cooking from scratch using locally -grown ingredients
  • Portions sized correctly by grade ranges: K-5, 6-8, 9-12

Hayes, a longtime champion for healthier school meals, says, “I’ve observed incredible innovation over the last few years – chef-inspired recipes, school gardens, and the use of locally-grown ingredients. While Hayes is generally positive about the new standards, she highlights that sometimes meeting these requirements with the money available to school food services can be a big challenge.

Are these changes a plus for all children, especially those living with diabetes? “It will be easier for kids to put together healthier school meals,” says Connie Evers, MS, RD, a pediatric dietitian and author of How to Teach Nutrition to Kids“Plus, healthier foods may become the new normal, which can help children with diabetes feel less different.”

But talk to parents of children living with diabetes in the thick of the daily school lunch grind, and you realize that things may be a bit more complicated.

“At our school, the juice is gone, but raisins were replaced. We’ve had to request fresh fruit based on medical needs to help with my daughter’s post-lunch spikes,” says Leighann Calentine, author of Kids First, Diabetes Second and the D-Mom blog and mom of eight-year-old Quinn, who is in third grade at public school.

But both caregivers and advocates agree that there are practical ways to make sure that your kids succeed in the cafeteria line:

Get your homework done. “Before the school year starts, make sure everyone involved with your child’s care is on the same page,” Jackson suggests. Complete and update your Diabetes Medical Management Plan and 504 Plan. Meet with school health personnel, teachers, and any others who help keep your child safe at school. This paperwork gives parents the leverage to make food-related requests. Calentine, for example, requested that her daughter be among the first in line at lunch in order to maximize the time she has to eat.

Go low and high tech. It is important to figure out the most time efficient and effective way to communicate with school health personnel. Calentine uses a combination of tools: First, a simple form goes into her daughter’s backpack in which Calentine jots down a few details about the early morning while the nurse fills in the rest of the school day. The report then returns home at day’s end with her daughter. For more pressing matters, like double-checking a carb count, notification of hypoglycemia, or an unexpected reaction to food, Calentine sends the school nurse a text message.

Log on for food facts. “Nearly every school district across the country posts its menu and nutrition analysis online, and the most forward-thinking also provide the ingredients,” says Hayes. If these food facts aren’t on the school system’s website ask for them to be posted.

Set your menu weekly. “Review the menu with your child before the start of each week,” suggests Evers. Determine which days your child prefers to bring lunch from home. Teach him or her to put together healthy meals from home or the cafeteria with a checklist to keep in mind – vegetable, whole grain, fat-free milk, lean meat, and fruit.

Sample the fare. “The ideal way to get a bird’s eye view of the cafeteria is to have lunch with your child,” suggests Hayes. You’ll take in the whole picture and get a sense of where potential trouble might arise.

Practice healthy eating yourself. Parents should model healthy eating at home and in restaurants. Your behavior speaks volumes to your kids; help them make healthier food choices more easily and confidently, wherever they may find themselves.

Balance sweets and special occasions. “Keep top of mind that there’s more to a child’s life than their glucose results,” say Calentine, who lets her daughter opt for strawberry or chocolate milk on occasion. “Kids with diabetes need to feel a part of, not apart from, lunchroom and classroom treats and celebrations. “

Learn from others. Seek out and get to know other parents of kids with diabetes. Tap their expertise. Identify challenges and brainstorm solutions together.

A stronger focus on feeding kids more healthful foods in school is great news, but challenges remain in and around the school cafeteria. Parents need to be their child’s advocate in the school – continually raising awareness, asking questions, and advocating for more healthful foods, properly timed access to supplies, and improved communication with school personnel.

Hope Warshaw, MMSc, RD, CDE, is the author of several best-selling books published by the American Diabetes Association, including Diabetes Meal Planning Made Easy and Guide to Healthy Restaurant Eating. She’s a frequent contributor to Diabetic Living magazine. Warshaw is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor, and not of Sanofi US, its employees, agencies, or affiliates.

Sanofi US supports MyCareConnect, LLC through a service agreement.

© 2012 The DX: The Diabetes Experience

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