Position of the American Dietetic Association: child and adolescent food and nutrition programs. (ADA Reports).

The health of children and adolescents is dependent upon food intake that provides sufficient energy and nutrients to promote optimal physical, social, and cognitive growth and development. Children and adolescents who do not consume food and beverages that provide adequate energy and nutrients are at risk for a variety of poor outcomes including growth retardation, iron deficiency anemia, poor academic performance, development of psychosocial difficulties, and an increased likelihood of developing chronic diseases such as heart disease and osteoporosis during adulthood (1-4).

Food and nutrition programs provide a safety net for American infants, children, and adolescents at risk for poor nutritional intakes secondary to low socioeconomic status; racial, ethnic, and/or linguistic diversity; inadequate access to healthcare services, or the presence of special health-care needs. Participation in federally funded food and nutrition programs has been shown to improve intake of select nutrients and energy; reduce rates of low birth weight, preterm birth, growth retardation, and iron deficiency anemia; and provide nutrition education to families of infants, children, and adolescents who are at risk for poor nutritional status (5,6). Yet these programs are under constant threat of elimination or significant alteration of eligibility and service provision because of changing political climates and funding priorities by state and federal governments. To ensure continued availability of food and nutrition programs for children and adolescents, permanent and adequate funding must be guarantee d.

POSITION OF THE AMERICAN DIETETIC ASSOCIATION

It is the position of the American Dietetic Association that all children and adolescents, regardless of age; gender; socioeconomic status; racial, ethnic, or linguistic diversity; or health status, should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, and social growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives; and nutrition screening and assessment followed by appropriate nutrition intervention and anticipatory guidance to promote optimal nutrition status.

RATIONALE

More than 85 million children and adolescents reside in the United States, accounting for more than 31% of the total population (7). In 2000, 11.6 million children and adolescents, or 16% of the population under age 18 years, lived in poverty (8). Eighteen percent of children under six years of age lived in poverty, with African American and Hispanic children under the age of six years almost three times more likely to live in poverty than their white peers (7,9). Children and adolescents of color and children living in households headed by single mothers appear to be more vulnerable to poverty. More than 40% of children living in homes headed by single mothers experience poverty compared with 8% of children living in homes with two parents (10,11).

Children and adolescents who live in poverty are more likely to lack health insurance coverage and a regular source of health care (7,12). In 1999, 14% of children and adolescents under age 18 years (10 million) lacked health insurance, and nearly 25% of children and adolescents received public insurance, primarily Medicaid. Among children and adolescents living in poverty, 24% lacked health insurance, and 59% received public insurance (12). The majority of uninsured children (85%) live in families in which one or more parent works at least part-time (12). Children and adolescents who live in poverty are more likely to receive medical care from publicly funded health centers or clinics than their counterparts who live above the poverty level.

Children and adolescents who live in poverty are also more likely to experience food insecurity and hunger. Recent estimates suggest that 32% to 52% of children and adolescents living in poverty reside in households that report inadequate access to food on one or more days per month, whereas 6% to 11% experience hunger one or more days per month (13). Increases in food insecurity (1) occurred between 1995 and 1999 among two-parent, low-income households containing children as well as those headed by noncitizens. Under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), many families that lost cash welfare assistance eligibility did not know they were still eligible for food assistance programs (13). In addition, many families that were headed by noncitizens became ineligible for food assistance programs under PRWORA. Children living with single mothers and those living in households headed by noncitizens were more likely to report food insecurity than in other groups in 1999 (10,14).

Concurrent to the problem of food insecurity and hunger is a rise in the prevalence of overweight among US children and adolescents. Obesity has been predicted to become the single most prevalent public health problem in the United States (15). Estimates of weight-for-height status among US children and adolescents from the National Health and Nutrition Examination Survey (NHANES) III suggest that approximately 26% of children and adolescents are at risk for overweight (defined as BMI > 85th percentile for age and gender), whereas about 8% of children four to five years old, 11% of children six to 11 years old, and 11% of adolescents are overweight (defined as BMI > 95th percentile for age and gender) (16). Data collected as part of NHANES 1999 indicate that 13% of children six to 11 years old and 14% of adolescents were overweight, suggesting a 2% to 3% increase in the prevalence of overweight during a five-year period (17). The prevalence of overweight is markedly higher among children and adolescents of co lor, For example, African American females and Hispanic males are more likely to be overweight than their peers (18). Native American children and adolescents are also at high risk for the development of obesity (19).

Although exact causes for the rapidly rising of rates of overweight among American children and adolescents in the past three decades have not been identified, changes in physical activity and eating habits of children and adolescents appear to be major factors. The Surgeon General's report …