BILL ANALYSIS                                                                                                                                                                                                    






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                        Senator Elaine K. Alquist, Chair


          BILL NO:       SB 1255                                      
          S
          AUTHOR:        Padilla                                      
          B
          AMENDED:       As Introduced                               
          HEARING DATE:  April 14, 2010                               
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          REFERRAL:      Education Committee                          
          2
          CONSULTANT:                                                 
          5
          Orr/cjt                                                     
          5              
                                     SUBJECT

                          Schools: nutrition: beverages  
                                         
                                     SUMMARY  

          Commencing July 1, 2011, this bill restricts the sale of  
          electrolyte replacement beverages from being sold in public  
          schools from 30 minutes before the start of the school day  
          to 30 minutes after school has ended. 

                             CHANGES TO EXISTING LAW  

          Existing law:
          Restricts the fat, saturated fat, sugar and calorie content  
          of entr?e food items sold at middle, junior, or high  
          schools.  

          Restricts the fat, saturated fat, sugar, and calorie  
          content of food items sold a la carte in schools. A la  
          carte refers to individually packaged items and snack  
          foods.

          Allows certain exceptions from these restrictions for foods  
          served as part of United States Department of Agriculture  
          (USDA) meal programs.

          Prohibits schools from making available foods containing  
                                                         Continued---



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          artificial trans fats. 
          
          Restricts the beverages that can be sold to pupils at  
          elementary schools to fruit-based drinks, vegetable-based  
          drinks, drinking water, and milk, as specified, and with  
          specified exceptions.  

          Restricts the beverages that can be sold to pupils at  
          middle or junior high schools to fruit-based drinks,  
          vegetable-based drinks, drinking water, milk, and  
          electrolyte replacement beverages, as specified. Restricts  
          the time of day the beverages may be sold to 30 minutes  
          before the start of the school day until 30 minutes after  
          the end of the school day. Makes specified exceptions. 

          Requires schools to follow the Enhanced Food Based Meal  
          Pattern, Nutrient Standard Meal Planning, or Traditional  
          Meal Pattern developed by the USDA, or the Shaping Health  
          as Partners in Education (SHAPE) Menu Patterns developed by  
          the state, in order to qualify for reimbursement for free  
          and reduced-price meals sold or served to pupils.

          This bill:
          Provides that commencing July 1, 2011, electrolyte  
          replacement beverages cannot be sold to a pupil from 30  
          minutes before the start of the school day until 30 minutes  
          after the end of the school day.

                                  FISCAL IMPACT  

          This bill has not been analyzed by a fiscal committee.


                            BACKGROUND AND DISCUSSION
                                         
          According to the author and sponsor, extensive studies show  
          that sugar-sweetened beverages are widely consumed in  
          California and are associated with increased rates of  
          obesity and obesity-related illnesses. Recognizing that  
          sodas were widely available in schools, Governor  
          Schwarzenegger co-sponsored SB 965 (Escutia) in 2005 which  
          eliminated sodas from public schools and limited beverages  
          with added sweeteners. However, the established standards  
          still allowed sugar-sweetened electrolyte replacement  
          beverages, commonly known as sports drinks, to be sold in  
          middle schools and high schools.  




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          According to the author, studies show that students are  
          overwhelmingly replacing soda with these sports drinks,  
          which are high in sugar and sodium. California has one of  
          the fastest growing rates of obesity of any state in the  
          nation. Nearly 16 million Californians are obese or  
          overweight. One-third of children in California ages 9-11  
          are overweight or are at risk of becoming overweight and  
          are increasingly suffering from nutrition-related illnesses  
          that normally occur in adulthood, such as type II diabetes  
          and pre-hypertension.  By prohibiting the sale of  
          electrolyte replacement beverages to pupils, this bill  
          seeks to close the loophole of allowing sweetened beverages  
          to be offered to California students.
          
          Electrolyte replacement beverages
          Electrolyte replacement drinks are designed to replace the  
          fluids (water) and electrolytes (sodium, potassium,  
          chromium, manganese, etc.) lost during exercise.  
          Commercially available carbohydrate/electrolyte (C/E)  
          beverages have become popular as fluid replacements during  
          endurance sports such as running, cycling and the  
          triathlon. However, any activity involving intense physical  
          exertion for long periods of time can expose a person to  
          substantial carbohydrate depletion and electrolyte loss, as  
          well as fluid depletion through the process of sweating.  
          According to a USDA report on Carbohydrate/Electrolyte  
          Replacement Beverages, Brian J. Sharkey, Ph.D., claims  
          "(C/E) beverages provide carbohydrate (glucose, sucrose,  
          glucose polymers) replacement to sustain energy output, and  
          electrolytes (sodium, potassium) to replace those lost in  
          sweat." He continues with "well-planned meals provide for  
          electrolyte needs via ample sodium (salt in food and use of  
          the salt shaker) and potassium-rich foods (citrus fruits,  
          bananas)?. C/E beverages may be useful when individuals  
          lose more than 8 liters of sweat daily, are not heat  
          acclimatized, are performing a prolonged, continuous  
          exercise bout (over 60 min.),  skip meals, have meals  
          interrupted or lose appetite, experience a caloric deficit  
          in excess of 1,000 cal/ day, or are ill with diarrhea." 

          The report goes on to say, "Recent research indicates that  
          urine production is reduced and fluid retention enhanced  
          when fluid replacement beverages include some electrolytes.  
          This insures a better plasma volume for cardiac output, and  
          more water for temperature regulation via sweating?.   




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          However, there is no need to substitute C/E beverages for  
          water as the primary form of fluid replacement."

          According to the American College of Sports Medicine,  
          "During exercise, consuming beverages containing  
          electrolytes and carbohydrates can provide benefits over  
          water alone under certain circumstances. After exercise,  
          the goal is to replace any fluid electrolyte deficit?.   
          Drinks containing sodium such as sports beverages may be  
          helpful, but many foods can supply the needed  
          electrolytes."

          According to a recent study from the UC Berkeley Center for  
          Weight and Health, per capita consumption of sports drinks  
          has continued to increase steadily since 1993, and  
          experienced double-digit growth (11.7 percent) in 2006,  
          while fruit drink consumption has been on the decline.   
          Sports drinks are fourth in terms of beverage market share,  
          with the average consumer drinking 4.1 gallons in 2005,  
          preceded by fruit drinks (3rd), bottled water (2nd), and  
          carbonated soft drinks (1st, averaging 50.4 gallons per  
          consumer annually). 

          Obesity trends
          According to the Centers for Disease Control and  
          Prevention, approximately one out of every four children  
          between the ages of two and five has a high body mass  
          index, putting these children at risk for obesity.  
          According to data from the 2007 California Health Interview  
          Survey, 11.2 percent of children in California are  
          classified as overweight for their age. Being overweight or  
          obese can lead to developing type II diabetes,  
          hypertension, sleep apnea, and several other adverse health  
          conditions. Estimates suggest that the prevalence of  
          overweight and obesity is costing Californians at least $21  
          billion a year.  

          Impact of beverage consumption on obesity
          In a September 2009 report titled "Bubbling Over: Soda  
          Consumption and its Link to Obesity in California" the UCLA  
          Center for Health Policy Research found that 24 percent of  
          California adults, 62 percent of adolescents ages 12-17,  
          and 41 percent of children ages 2-11 drink at least one  
          soda or other sugar-sweetened beverage every day. They  
          claim that between 1977 and 2002, Americans have increased  
          their calorie intake from soft drinks by 228 percent. Over  




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          the past three decades, UCLA cites that the prevalence for  
          overweight and obesity nationwide has nearly doubled for  
          adults, has tripled among 12-19 year olds and has more than  
          quadrupled among 6-11 year olds in the last three decades.   
          In California, 21 percent of adults and 14 percent of  
          adolescents are obese. Thirty-five percent of adults and 16  
          percent of adolescents are overweight. They also cite that  
          the rates of overweight and obesity are 18 percent higher  
          among those who drink soda daily compared to those who do  
          not. 

          On November 5, 2009, the Senate convened a joint hearing  
          with the Committee on Health the Select Committee on  
          Obesity and Diabetes, titled "Exploring the Link Between  
          Sugar Sweetened Drinks and Obesity."  At the hearing,  
          leading nutrition and obesity researchers from across the  
          nation gave testimony that sweetened beverage consumption:  
          1) adds unnecessary calories to an individual's daily  
          intake due to lack of nutritional value; and, 2) parallels  
          the rise in obesity in the nation. Researchers affirmed  
          that reducing the consumption of sweetened beverages is an  
          important strategy to reverse obesity trends in the United  
          States.

          Impact of obesity on scholastic achievement
          Research supports the assertion that healthy eating and  
          physical activity play an important role in learning and  
          cognitive development.  Poor diet and physical inactivity  
          have been found to adversely influence the ability to learn  
          and decrease motivation and attentiveness.  Such findings  
          indicate that young people will not be ready to learn and  
          achieve their full potential unless they are well nourished  
          and healthy. 

          Current school food nutrition standards
          In most schools, the nutrition environment has two  
          components: the USDA school meals program and the sale of  
          competitive foods. USDA defines competitive foods as those  
          foods and beverages, regardless of nutritional value, sold  
          at a school separate from the USDA school meals program.  
          Current state law imposes calorie limits and a 35/10/35  
          requirement on a la carte foods sold or served in schools  
          beginning July 1, 2007. This means no more than 35 percent  
          of the calories can be from fat, no more than 10 percent of  
          the calories can be from saturated fat, and no more than 35  
          percent of the total weight can be composed of sugar. For  




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          elementary schools, the 35/10/35 requirement applies to  
          individually sold dairy and whole grain items, and limits  
          calories per item to no more than 175. Additionally, only  
          full meals or individual portions of nuts, nut butters,  
          seeds, eggs, or cheese packaged for individual sale, fruit,  
          non-fried vegetables and legumes can be sold in elementary  
          schools. For middle, junior and high schools, the 35/10/35  
          requirement applies to all snacks. In addition, entrees are  
          limited to 400 calories and 4 grams of fat per 100  
          calories.

          Other state and federal standards apply for schools seeking  
          reimbursement for free and reduced-price meals. These  
          standards regulate the amount of calories (minimum  
          calories), fat (30 percent maximum) and saturated fat (10  
          percent maximum), as well as levels of certain vitamins and  
          minerals, that can be provided in a full meal.           
          
          The Pupil Nutrition, Health and Achievement Act of 2001 
          The Pupil Nutrition, Health and Achievement Act of 2001  
          (Act), in conjunction with subsequent related bills,  
          established various prohibitions on the sale of beverages  
          in elementary and middle schools and placed nutritional  
          standards on the types of foods that may be sold to pupils  
          by the schools, during specified hours. It also required  
          the Department of Education to establish a pilot program in  
          which high schools voluntarily adopt food sale  
          requirements, in exchange for eligibility for an increased  
          reimbursement rate for free and reduced-price meals served.  


          In order to test the implementation of the Act in middle  
          and high schools, the California Department of Education  
          (CDE), Nutrition Services Division with funding from the  
          California Department of Food and Agriculture (CDFA),  
          established the Linking Education, Activity and Food (LEAF)  
          program. Through LEAF, grants of approximately $200,000  
          each were competitively awarded to 16 middle and high  
          schools in 9 California school districts, totaling nearly  
          $4 million. The University of California, Berkeley, Center  
          for Weight and Health (CWH), in fulfillment of the  
          requirements of the Act, prepared the LEAF Evaluation  
          Report to provide an independent evaluation of the pilot  
          projects.  The evaluation found among other things, that:  
          1) the development of a district nutrition policy is a  
          necessary first step to school nutrition reform, including  




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          the clear articulation and gradual phase in of standardized  
          regulations governing the sale of all campus competitive  
          foods and beverages; 2) the implementation of nutrient  
          standards for competitive foods needs to be complemented  
          with increased availability and promotion of nutritious and  
          appealing alternatives, especially in the form of complete  
          meals; and, 3) the limits on fat and sugar established by  
          the Act should be viewed in the context of overall  
          nutritional goals to avoid the pitfall of providing items  
          which comply with certain standards but are still not  
          otherwise healthy. 

          Many policies were not fully institutionalized until  
          somewhat late in the LEAF grant period; the ultimate impact  
          of these changes on the school environment, students, and  
          other stakeholders therefore could not be fully measured  
          within the time constraints of the evaluation. The  
          sustainability of many of these efforts at participating  
          schools was also in question. Berkeley concluded that, in  
          order to adequately address these issues and determine  
          their applicability to other sites, a follow-up study of  
          the longer-term impacts of the LEAF is merited.

          Related bills
          SB 1210 (Florez) would impose a tax upon every sweetened  
          beverage manufacturer, concentrate manufacturer, or other  
          person who makes the first sale in this state of a  
          sweetened beverage or concentrate of a rate of $0.01 per  
          teaspoon of sugar placed into the sweetened beverage or  
          equivalent amount of concentrate. The revenues collected  
          from this tax would be deposited in the Childhood Obesity  
          Fund, which the bill
          would create, for appropriation by the Legislature. Pending  
          in Senate Revenue and Taxation Committee. 

          SB 1413 (Leno) would require a school district to provide  
          access to free, fresh drinking water in school food service  
          areas by January 1, 2012. Pending in Senate Education  
          Committee. 
          
          AB 1982 (Ammiano) would declare intent to enact legislation  
          to further encourage schools to offer healthy and  
          nutritious foods to pupils. Pending in Assembly Rules  
          Committee. 

          AB 2084 (Brownley) would require a licensed child day care  




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          facility to follow
          specified guidelines relating to the provision of  
          beverages, including limiting juice
          to not more than one serving per day of 100 percent juice,  
          prohibiting beverages with added sweeteners, either natural  
          or artificial, and making clean and safe drinking water  
          readily available and accessible for consumption throughout  
          the day. Pending in  Assembly Human Services Committee. 

          

          Prior legislation
          AB 627 (Brownley) of 2009 would have required the  
          Superintendent of Public Instruction
          to establish a pilot program in which licensed child care  
          centers and child day care homes selected by the department  
          that participate in the federal Child and Adult Care Food  
          Program shall implement certain nutrition and physical  
          activity standards in exchange for a higher state meal  
          reimbursement. Vetoed. 

          SB 490 (Alquist) Chapter 648, Statutes of 2007, prohibits  
          beginning July 1, 2009, a school district from making  
          available to pupils enrolled in kindergarten or grades 1-12  
          a food containing artificial trans fat, and prohibits the  
          use of artificial trans fat in the preparation of a food  
          item served to those pupils. Exempts from these  
          requirements food provided as part of a USDA meal program.
          
          AB 1503 (Fuller) of 2007 would have revised the  
          requirements for schools to receive the $0.21 state  
          reimbursement rate for free and reduced-price meals,  
          including not selling or serving any food item that is  
          fried in any manner, and initiating the process of  
          eliminating foods containing manufactured trans fats. Would  
          have reduced the statutory reimbursement rate for free and  
          reduced-price meals from $0.21 to $0.1563. These provisions  
          were amended out of the bill.
          
          SB 965 (Escutia) Chapter 237, Statues of 2005, modified the  
          list of beverages that may be sold to pupils at an  
          elementary, middle or junior high school, in effect banning  
          the sale of sodas in schools.

          SB 677 (Ortiz) Chapter 415, Statutes of 2003, expanded  
          restrictions on the types of beverages allowed to be sold  




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          in middle and junior high schools and eliminated, as a  
          condition for implementation of restrictions in elementary,  
          middle and junior high schools, a requirement that funds be  
          appropriated for certain programs.
          
          SB 56 (Escutia) Chapter 361, Statutes of 2002, required  
          schools that are selected to participate in the pilot  
          program prescribed by the Pupil Nutrition, Health and  
          Achievement Act of 2001 to comply with specified food sale  
          requirements, and made various technical and clarifying  
          changes in related provisions. The bill would subject  
          operation of the existing law to funding being appropriated  
          on or before January 1, 2004.

          SB 19 (Escutia) Chapter 913, Statutes of 2001, established  
          the Pupil Nutrition, Health and Achievement Act of 2001. It  
          established, as of January 1, 2004, various prohibitions on  
          the sale of beverages in elementary and middle schools and  
          placed nutritional standards on the type of foods that may  
          be sold to pupils during school breaks and through vending  
          machines. The bill increased the reimbursement a school  
          receives for free and reduced-price meals, permits school  
          districts to convene a Child
          Nutrition and Physical Activity Advisory Committee, and  
          required the Department of Education to establish a pilot  
          program in which high schools voluntarily adopt food sale  
          requirements, in exchange for eligibility for an increased  
          reimbursement rate for free and reduced price meals served.  
          
          
          Arguments in support
          According to the California Department of Public Health,  
          studies have shown that electrolyte replacement beverages  
          are overwhelmingly replacing sodas as the beverage of  
          choice for school-age children, and claims that a student  
          who drinks a 20 oz sports drink a day will consume enough  
          calories to lead to a 13-pound weight gain per year.  
          Closing the loophole that allows electrolyte replacement  
          beverages to be sold at school is an important part of the  
          current effort to ensure that California schools provide  
          healthy beverage options to students. 

          The American Academy of Pediatrics believes that it is  
          critical that children be offered healthy food and beverage  
          choices, and claims that consumption of electrolyte  
          replacement beverages can cause weight gain. The American  




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          Diabetes Association cites that the percentage of  
          overweight younger people has tripled since 1980. They  
          believe that schools should serve as models of healthy  
          behavior encouraging both physical activity and proper  
          nutrition.  

          The California School Nurses Association believes there is  
          a direct correlation between healthy, fit students and  
          academic success, and believes that electrolyte replacement  
          beverages are designed to replace the fluids (water) and  
          electrolytes (sodium, potassium, chromium, manganese, etc.)  
          lost only after long periods of physical activity, which  
          does not occur during the school day, and are therefore  
          unnecessary for students during the school day. 
          
          Arguments in opposition
          The California Nevada Soft Drink Association (CNSDA) is  
          opposed unless amended, and sites that a better option  
          would be to provide choice and no- and low-calorie beverage  
          alternatives to these students. They note that the soft  
          drink industry has adopted voluntary school beverage  
          guidelines on a national basis that create a range of  
          beverages that are appropriate for various types of school  
          campuses based on total calories and portion size. The  
          guidelines allow sports drinks or other beverages that  
          contain no more than 66 calories per 8 ounce serving. They  
          believe that sports drinks have a functional place on high  
          school campuses, and claim their bottlers have voluntarily  
          limited the sale of sports drinks to only high schools, and  
          have limited the portion size to no more than 12 ounces.   
          CNSDA claims they support efforts to address the problem of  
          obesity comprehensively rather than targeting any one food  
          or beverage type. 

                                     COMMENTS

           1.    Availability of clean drinking water in schools.  
          Students need to remain hydrated throughout the day, and  
          removing an available beverage that students apparently  
          desire may hinder them from remaining hydrated if this bill  
          becomes law. Policy- makers may wish to consider addressing  
          the issue of access to clean drinking water in schools.

          2.  Exceptions during extreme heat. According to the  
          abovementioned USDA report, "?it would seem prudent to use  
          C/E beverages when sweat losses are high; in the early  
       



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          stages of heat exposure; during prolonged heat stress; when  
          meals are not available; and as an energy/electrolyte  
          supplement for fluid-loss illness." It is possible that  
          electrolyte replacement beverages may be moderately  
          beneficial to students when they are exposed to extreme  
          heat. In the absence of other provisions pertaining to  
          student activities during extreme weather, the author may  
          wish to consider amending the bill to allow school  
          districts discretion to suspend the provisions of this bill  
          for student athletes or all students during instances of  
          extreme heat during the school day. 

          3.  Technical amendments: The existing statutes regulating  
          beverages to be sold to public school pupils contain  
          sections that are no longer inoperative, due to more recent  
          statutes taking effect. The committee suggests cleaning up  
          the statutes to reflect only those that are operative. 

                                    POSITIONS  


          Support:  American Academy of Pediatrics
                 American Diabetes Association
                 California Center for Public Health Advocacy
                 California Department of Public Health
                 California Food Policy Advocates
                 California Medical Association
                 California School Nurses Organization
                 California School Nutrition Association
                 California Teachers Association
                 County Health Executives Association of California
                 Health Officers Association of California
                 Mission Community Hospital
                 San Mateo County Board of Supervisors
                 Two individuals
          
          Oppose:  California Nevada Soft Drink Association


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