Article 48-Summer Day Camps
Proposed Rules: Closed to Comments
Statement of Basis and Purpose
These amendments to the Health Code are promulgated pursuant to §§558 and 1043 of the Charter. Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the Health Code all matters to which the authority of the Department of Health and Mental Hygiene (the “Department” or “DOHMH”) extends. Section 1043 grants the Department rule-making authority.
Background of Proposed Amendment
Children’s camps (a term that includes summer day camps, children’s overnight camps, and children’s traveling summer day camps) provide a structured place for children up to the age of 16 years during the summer months, when the majority of young people are not in school. In the 2010 summer season, DOHMH issued permits to 862 children’s camps in New York City (NYC). Approximately 165,000*children attended these programs.
Many of these camps provide food and beverages for campers. To help combat childhood obesity, as well as enable children’s camps to improve the diets and better safeguard the health of the City’s children, the Department proposes that the Board of Health amend Article 48. This proposal would align nutritional requirements for children’s camps with similar standards used for other child care environments. Those standards include requirements in Article 47 for early child care centers and City standards for school-provided meals.
Overview of Proposed Amendment
The proposed changes would establish nutritional requirements for children’s camps that hold permits issued pursuant to Article 48 of the Health Code. Specifically, the new requirements would:
- Prohibit service of certain beverages to campers, specifically:
- Sugary drinks,
- Non-100% juice,
- Beverages with additives, and
- Higher fat and flavored milk;
- Require potable water; and
- Prohibit camper access to vending machines both on and off camp premises.
The goal of these amendments is to decrease the amount of energy-dense items that children in New York City consume.
- Childhood obesity has reached critical levels
Nearly 40% of NYC public school students (K-8) are obese or overweight.1,2 Obese children are more likely than normal-weight children to have risk factors for heart disease3, type 2 diabetes4 and many other disorders and conditions.5,6,7 Obese children are more likely to become obese adults,8,9 and obesity in adulthood is associated with serious diseases and conditions, and with higher rates of death.10
- Sugary drinks are a leading driver of the obesity epidemic
Children have dramatically increased their intake of sugary drinks over the last few decades. At the same time, consumption of healthy beverages such as milk has declined.11,12,13 Sugary drinks are the primary source of added sugars and a significant contributor of excess calories in children’s diets.14 Sugar intake has been linked to heart disease risk factors in adolescents,15 and there is also a link between sugary drinks and weight gain.16,17,18,19,20
According to DOHMH survey in 2009, 44% of NYC children aged 6 to 12 years consumed more than 1 sugary drink per day.21 As for public high school students, 26% had consumed 2 or more sugary drinks per day in the last week.22
- Experts recommend limits on 100% juice
The United States Department of Agriculture (USDA)23 and the American Heart Association24 recommend limiting children’s intake of 100% juice. When consumed in moderation, 100% juice can be a healthy beverage; however, the USDA recommends that the majority of a child’s recommended fruit servings should come from whole fruit. Despite this recommendation, children are consuming more than half of their fruit intake as juice. One hundred percent (100%) juice intake has been associated with higher body weight in overweight and obese children,25 which is of great concern given the large number of overweight and obese children in New York City.
- Snacking on energy-dense foods and high-calorie beverages leads to weight gain26
Not only are children drinking more sugary drinks than they were several decades ago, but they are also snacking more.27 Although nutrition experts recommend that children consume snacks that are nutritious and minimally processed,28 young people often snack on unhealthy foods, such as sugary drinks, candy, salty snacks, and dessert items.29
- Experts recommend that additives be limited in children’s diets
The nation’s leading health advisory organization, The Institute of Medicine (IOM), has taken the position that additives such as caffeine and artificial sweeteners should be limited in children’s diets. They recommend that foods and beverages served to children through school meal programs should be caffeine-free, as caffeine “has no place in foods and beverages offered in schools.”30 With regard to non-nutritive sweeteners, the IOM states that “there is still uncertainty, particularly about long-term use and about low-level exposure effects on health and development in children” and recommends that high school-age students should limit consumption to after the school day.31
- Children are heavily influenced by their environment
Young people are greatly affected by what is around them.32 Vending machines, which typically sell energy-dense foods, may increase the number of unhealthy snacks that children consume.33,34 Like other child care settings in NYC, such as early child care centers and schools, camps should provide an environment that promotes—rather than undermines—health and wellness.
- The proposed requirements are similar to other City and national guidelines pertaining to children
These include: Article 4735 of the New York City Health Code, the New York City Department of Education’s Wellness Policy36 and Chancellor’s Regulation A-812,37 New York City Food Standards,38 Dietary Guidelines for Americans, 2010,39 and guidelines issued by the IOM.40
*This number may be an overrepresentation as camps often operate multiple sessions for the season and children who attend multiple sessions are counted per session in the DOHMH database.
1 Centers for Disease Control and Prevention. Obesity in K-8 students: New York City, 2006-07 to 2010-11 school years. Morbidity and Mortality Weekly Report. 2011;60:1673-1678.
2 New York City Department of Health and Mental Hygiene. NYC Vital Signs: Childhood Obesity is a Serious Concern in New York City. June 2009. http://www.nyc.gov/html/doh/downloads/pdf/survey/survey-2009fitnessgram.pdf. Accessed May 17, 2012.
3 Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150:12-17.e2.
4 Hannon TS, Rao G, Arslanian SA. Childhood obesity and type 2 diabetes mellitus. Pediatrics. 2005;116:473-480.
5 Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375:1737-1748.
6 Dietz W. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics. 1998;101:518-525.
7 Biro FM, Wien M. Childhood obesity and adult morbidities. Am J ClinNutr. 2010;91:1499S-1505S.
8 Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;37:869-873.
9 Serdula MK, Ivery D, Coates RJ, Freedman DS. Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med. 1993;22:167-177.
10 National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 1998.
11 Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents: Nutritional consequences. J Am Diet Assoc. 1999;99:436-441.
12 Nielsen S, Popkin B. Changes in beverage intake between 1977 and 2001. Am J Prev Med. 2004;27:205-210.
13 Wang Y, Bleich S, Gortmaker S. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics. 2008;121:e1604-e1614.
14 Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc. 2010;110:1477-1484.
15 Welsh, J, Sharma A, Cunningham SA, Vos M. Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation. 2011;123:249-257.
16 Fiorito LM, Marini M, Francis LA, Smiciklas-Wright H, Birch LL. Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence. Am J ClinNutr. 2009;90:935-942.
17 Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. Lancet. 2001;357:505-508.
18 Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: A systematic review. Am J ClinNutr. 2006;84:274-88.
19 Mozaffarian D, Hao T, Rimm EB, Willett W, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392-2404.
20 Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, HU FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.JAMA.2004;292:927-34.
21 New York City Department of Health and Mental Hygiene, Child Health Survey 2009.
22 New York City Department of Health and Mental Hygiene, Youth Risk Behavior Survey 2009.
23 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010. http://www.health.gov/dietaryguidelines/. Accessed May 17, 2012.
24 American Heart Association. AHA Scientific Position: Dietary recommendations for healthy children. http://www.heart.org/HEARTORG/GettingHealthy/Dietary-Recommendations-for.... Accessed May 17, 2012.
25 USDA. Dietary Guidelines for Americans, 2010.
26 Bisset S, Gauvin L, Potvin L, Paradis G. Association of body mass index and dietary restraint with changes in eating behaviour throughout late childhood and early adolescence: a 5-year study. Pub Health Nutr. 2007;10(8):780-789.
27 Piernas C, Popkin BM. Trends in snacking among U.S. children. Health Affairs. 2010;29:398-404.
28 USDA, Dietary Guidelines for Americans.
29 Piernas et al. (2010)
30 IOM (Institute of Medicine). 2007. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington, DC: The National Academies Press.
31 IOM, Nutrition Standards for Foods in Schools.
32 Centers for Disease Control and Prevention. Children’s Food Environment State Indicator Report, 2011. http://www.cdc.gov/obesity/downloads/ChildrensFoodEnvironment.pdf. Accessed May 17, 2012.
33 Neumark-Sztainer D, French SA, Hannan PJ, Story M, Fulkerson JA. School lunch and snacking patterns among high school students: Associations with school food environment and policies. Int J BehavNutrPhys Act. 2005;2:14.
34 Center for Science in the Public Interest. Dispensing Junk: How School Vending Undermines Efforts to Feed Children Well. May 2004. http://www.cspinet.org/new/pdf/dispensing_junk.pdf. Accessed May 17, 2012.
35 24 RCNY Health Code 47 (2012).
36 New York City Department of Education. Wellness Policy. Issued June 2010.http://schools.nyc.gov/NR/rdonlyres/2B99376C-5BA2-4D97-9F85-1C5DA395EFF4.... Accessed May 17, 2012..
37 New York City Department of Education. Regulation of the Chancellor A-812.Issued February 25, 2010. http://schools.nyc.gov/NR/rdonlyres/381F4607-7841-4D28-B7D5-0F30DDB77DFA.... Accessed May 17, 2012.
38 New York City Department of Health and Mental Hygiene. New York City Food Standards. http://www.nyc.gov/html/doh/html/cardio/cardio-vend-nutrition-standard.s.... Accessed May 17, 2012.
39 USDA, Dietary Guidelines for Americans.
40 IOM, Nutrition Standards for Foods in Schools.