Would Making Plain Milk and Water the Default Beverage Options Help to Combat Childhood Obesity in New York City Public Schools?

by Deirdre Appel
Combatting Childhood Obesity

Abstract

This brief recommends a New York City (NYC) public school policy that would reduce the amount of sugar in school breakfast and lunch beverages. Compelling evidence is presented to demonstrate that childhood obesity is an epidemic in NYC, and that the excess sugar in both flavored milk (such as chocolate milk) and 100 percent fruit juice is a significant contributor to this epidemic.

The evidence will also show that plain water consumption helps combat childhood obesity and prevent type 2 diabetes, and that simply installing water jets — large, electronically powered jugs with a sensor or push button for dispensing water — in schools can triple the amount of water consumed by children.

School districts across the country are eliminating flavored milks while promoting the consumption of plain milk, such as 1 percent low fat and skim, and water. This policy brief urges NYC to join the fight for the health of our children by making school beverages healthier.

Overview

NYC public schools currently offer 1 percent low-fat and/or skim plain milk, fat-free chocolate milk, or 100 percent fruit juice at breakfast, depending on which one the principal chooses.[1] Plain 1 percent low fat and/or skim milk, as well as fat-free chocolate milk are also offered at lunch.

In an effort to reduce the consumption of excess sugar, combat childhood obesity and reduce the prevalence of type 2 diabetes in NYC children, this policy brief recommends that all NYC public schools, grades kindergarten through 12:

  • Eliminate flavored (chocolate) milk.
  • Make 100 percent fruit juice available only if requested by the student at breakfast.
  • Offer plain milk, preferably 1 percent low-fat and or skim, and water as the default beverages.
  • Install water jets in school cafeterias to encourage plain water consumption.

The Childhood Obesity Epidemic in NYC

According to the Centers for Disease Control (CDC), the national average rate of obesity in children ages 2-19 has tripled since the 1960s (see Figure 1)[2] and continues to increase .

Figure 1

By 2016 the national average rate of childhood obesity was 18.5 percent.[3] As of 2017, according to the New York City Youth Risk Behavior Survey, 13.5 percent of NYC students were obese and 16.4 percent were overweight but not obese.[4] And according to the NYC Department of Health and Mental Hygiene, one in five NYC kindergarten students is obese.[5]

Even though, according to the State of Obesity website’s 2019 report,[6] the current childhood obesity rate appears to have leveled off and even decreased slightly in some age groups, the NYC Department of Health and Mental Hygiene says that childhood obesity remains an epidemic in NYC.[7] Studies also show that obese children are at increased risk of becoming obese adults,[8] contributing to the risks for major health problems including type 2 diabetes, heart disease, high cholesterol, high blood pressure, stroke, cancer, asthma, and osteoarthritis.[9]

Statistics show that obesity is more prevalent in non-Hispanic blacks and Hispanics than in other ethnic groups (see Figure 2),[10] which impacts NYC since, according to the website Niche.com, it’s the fifth most diverse city in the United States.[11]

Figure 2

According to the U.S. Census Bureau, 24.3 percent of NYC’s population is non-Hispanic black and 29.1 percent is Hispanic.[12] That’s more than half of NYC’s 8.6 million residents.

Flavored Milk and 100 Percent Juice Consumption Are Linked to Obesity

Flavored milk has added sugars, oftentimes, according to the nonprofit news organization Chalkbeat, including high fructose corn syrup.[13] In fact, the added sugar in flavored milk alone, when consumed by children at both breakfast and lunch, often meets or exceeds the World Health Organization’s (WHO) recommendation that no more than 5 percent of a child’s daily 2,000 calories (about 25 grams) be in the form of added sugars.[14]

According to the NYC Health Department’s Center for Health Equity, a single 8-ounce serving of  the fat-free chocolate milk served in NYC public schools during both breakfast and lunch[15] contains 20 grams of sugar, 8 grams of which are added.[16] Eight ounces is a small portion, even for kids. According to the New York Times, 60 percent of the milk available in NYC schools each year is fat-free chocolate milk.[17] Research also shows that flavored milk is one of the top 10 sources of added sugars for adolescents and teens.[18]

In addition, the sugars in 100 percent fruit juice, lack fiber, and create an unnecessary sugar load (as compared to eating whole fruit). [19],[20],[21][22],[23]

There’s an increased prevalence of obesity in children who consume more than 12 ounces of 100 percent fruit juice a day.[24]

Benefits of Eliminating Flavored Milks in Schools

Researchers have shown the positive effects of eliminating flavored milk in schools. In a 2016 study conducted by the University of Connecticut’s Rudd Center for Food Policy and Obesity, researchers found that two years after removing flavored milk from schools, consumption of plain milk increased.[25] The study did note, however, that when 100 percent fruit juice was also an option, plain milk consumption decreased slightly.[26]

The National Dairy Council and other dairy industry supporters frame the issue to make it seem that if children don’t drink chocolate milk they’ll lack certain essential nutrients.[27] However, many health officials, public health advocates, and scientists argue that the added sugar in chocolate milk and other flavored milks poses more health risks than benefits.[28],[29],[30]

Schools That Are Considering Or Have Already Eliminated Flavored Milks

The following cities and counties throughout the country have considered eliminating or have already eliminated flavored milks:

  • 2006 – Berkeley, California, under the direction of Ann Cooper, Director of Nutrition Services for the Berkeley Unified School District, banned chocolate milk.[31]
  • 2009 – Boulder, Colorado, where Cooper then became the Director of Nutrition Services for the Boulder Valley School District, banned chocolate milk.[32]
  • 2010 – Washington, D.C. and Fairfax County, Virginia, both eliminated chocolate milk from their public schools.[33]
  • 2011- Los Angeles, California, removed all flavored milks throughout the Los Angeles Unified School District, becoming the largest school district in the country to do so.[34]
  • 2011 – Minneapolis, Minnesota public schools eliminated chocolate milk as an option at lunch to reduce calorie and sugar consumption in students.[35]
  • 2013 – Montgomery County, Maryland, banned strawberry milk from its schools. According to a senior scientist with the Center for Science in the Public Interest, the Red 40 and other artificial colorings it contained were linked to hyperactivity in children.[36]
  • 2014 – Connecticut considered removing chocolate milk from all schools in the entire state, but ultimately the governor did not sign the bill.[37]
  • 2017 – San Francisco, California, removed chocolate milk from all its schools. School district officials tested the concept in five schools and found that in two of those schools there was no decrease in the number of milk cartons students put on their trays, and in the remaining three there was only a slight dip.[38] Libby Albert, San Francisco’s Director of Student Nutrition Services, said that, “The kids grumbled about it for a couple of days, but for the most part, they just switched to white milk.”[39]

Other jurisdictions that have tried to remove flavored milk from their schools were eventually reversed. In the summer of 2018, the province of New Brunswick, Canada, banned both chocolate milk and 100 percent fruit juices from its schools.[40] But in December, after the fall elections, the policy was reversed.[41]

In 2011, Fairfax County, Virginia, after receiving a flood of letters and petitions from nutritionists and influential special interest groups, decided to bring back chocolate milk to its schools.[42] In addition, in 2016, the Los Angeles Unified School District loosened its district-wide ban on flavored milk, essentially reversing policy it instituted in 2011.[43]

Even with such setbacks, almost 63 percent of policies banning flavored milk throughout the country still remain in place:

Flavored Milk Removal Policy Tracking

Jurisdiction Implemented Year Reversal Year
Berkeley 2006
Boulder 2009
Washington, D.C. 2010
Fairfax Co. 2010 2011
Los Angeles 2011 2016
Minneapolis 2011
Montgomery Co. 2013
San Francisco 2017
New Brunswick 2018 2018

Industry-funded and influenced studies promote the nutritional benefits of flavored milk and argue that removing or limiting flavored milk options will dramatically reduce milk consumption among children.[44],[45],[46] For example, researchers in a 2009 study entitled “The Impact on Student Milk Consumption and Nutrient Intakes from Eliminating Flavored Milk in Schools,” found that “removing flavored milk from schools can have significant unintended consequences on children’s milk consumption,” and that “lower milk intake could result in a reduction inessential nutrient intake.”[47] The study was funded by the Milk Processor Education Program (MilkPEP).[48]

Dr. Marion Nestle, Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, Emerita, at New York University, dismissed the study, saying “It’s well known in nutrition research that sponsored studies yield results that favor the sponsor’s interests. This study was sponsored by the Milk Processors who have a vested interest in making sure that milk sales increase…the investigators designed the study to favor consumption of chocolate milk.”[49] In the fall of 2018, Dr. Nestle published her latest book, Unsavory Truth: How Food Companies Skew the Science of What We Eat, which is about industry-funded research and, according to Dr. Nestle, “how food, beverage, and supplement companies fund nutrition researchers and practitioners and their professional associations, with the ultimate goal of promoting sales.”[50]

Kate Adamick, nationally renowned expert on school food nutrition and advocate of eliminating flavored milk in schools, said of this study, “What a ‘shock’ that the folks who have the most to gain financially by convincing everyone that kids need to drink flavored milk came up with a study that says kids need to drink flavored milk.”[51]

The study was written by Erin E. Quann, who was, at the time, director of Regulatory Affairs at the Dairy Research Institute & National Dairy Council, and Doug Adams, president and owner of Prime Consulting, a consulting firm supporting the dairy industry as well as other food industry giants including Frito-Lay, Pepsi and Hostess Brands.[52]

In a 2008 study published in the Journal of the American Dietetic Association and funded by the National Dairy Council, researchers claim that drinking flavored milk was nutritious and didn’t cause weight gain.[53]

Former Washington Post food writer Ed Bruske says that this study was co-written by Rachel K. Johnson, is a “nutritionist who was dean of the College of Agriculture and Life Sciences at the University of Vermont, a state with deep roots in the dairy industry. Johnson specializes in child obesity issues with ‘an emphasis on the nutritional role of dairy foods,’ according to the university.”[54] According to Dr. Johnson’s curriculum vitae, she lists herself as a member of the Dairy Management Incorporated/National Dairy Council Nutrition Research Scientific Advisory Committee from 2006 to 2014, and the chair of that committee in 2007 and 2009.[55]

The dairy industry argues that flavored milk contains nine essential nutrients that all children need[56] and claim that eliminating chocolate milk will cause children to lack these essential nutrients and put them at risk for nutrient deficiency.[57] However, drinking plain milk, such as 1 percent low-fat and skim, provides the same nutrients. Or for that matter, children can get these nutrients from other foods.

Here are those nine essential nutrients kids can get from other foods:[58]

9 Essential Nutrients In Plain or Low-fat Milk Obtained From Other Foods

Nutrient Alternative Food
Calcium Leafy greens like collard greens, kale, spinach & bok choy
Vitamin D Salmon, tuna, egg yolks & cod liver oil
Phosphorous Pumpkin & sunflower seeds
Riboflavin Oats, beef, clams, mushrooms & almonds
Protein Beef, poultry, pork, fish, wild game & tofu
Vitamin B-12 Beans, lentils & peas
Potassium Potatoes, squash, beans, bananas & broccoli
Vitamin A Carrots, sweet potatoes, winter squash, cantaloupe, apricots, spinach & kale
Niacin Chicken, turkey, tuna, salmon, pork, beef, peanuts, avocado & brown rice

The Obama administration passed the Healthy, Hunger-Free Kids Act in 2010, requiring school meals to contain fewer flavored milk options, less salt and more whole grains.[59] But the Department of Agriculture reversed that policy last December, allowing them to serve more flavored-milk options, fewer whole grains, and more added salt.[60] According to Bloomberg Businessweek, the agency’s head, Secretary Sonny Perdue, “made his fortune in the grain business and was once a consultant to milk producers.”[61] Perdue’s policy reversal was a victory for the dairy industry, which has been struggling for years because of declining milk consumption.[62] Bloomberg Businessweek states that now big food companies “count on schools as a steady source of revenue and see them as an opportunity to shape the buying habits of future consumers.”[63]

Plain milk, preferably 1 percent low-fat and or skim, however, isn’t the only healthy beverage option in NYC public schools during breakfast and lunch. Plain water is another.

The Benefits of Increasing Plain Water Consumption in Schools

Many researchers have shown that promoting water consumption at schools leads to reduced calorie intake, improved hydration and improved cognitive function in students. The key reason to promote water consumption in schools is that, according to researchers, when there is an increase in water consumption, there is a decrease in consumption of sugary beverages.[64],[65]

In a 2009 U.K. study, researchers found that after installing water jets throughout the schools and having teachers promote water consumption for a year, there was a 31 percent reduction in the prevalence of overweight students.[66]

In another 2009 study conducted in the U.S., researchers found that replacing sugar-sweetened beverages with plain water led to a significant decrease in calories consumed by children and adolescents 2 to 19 years of age while whole milk, reduced-fat milk, and 100 percent juice increased calories in children 6 years and older.[67]

In 2017 the University of Illinois performed a cost-benefit analysis of having plain water available at lunchtime via water jets in NYC school cafeterias. Dr. Ruopeng An, Assistant Professor at the University of Illinois at Urbana-Champaign, has stated that the researchers had “adopted a societal perspective, so the cost saving pertains to the society as a whole.”[68] The analysis concluded that:

  • It would cost $18 per student to implement and maintain the water jets in NYC schools.
  • Implementing water jets in NYC schools would have an overall benefit savings to society of $174 per student.
  • If implemented nationwide, water jets in schools would prevent more than 500,000 childhood overweight cases and would save more than $13 billion by reducing medical costs associated with overweight and obesity.[69]

In a 2015 NYC study, researchers also found that plain water consumption at lunchtime almost tripled in schools where water jets were installed.[70] And a 2011 French study determined that drinking plain water can protect against the development of high blood sugar (hyperglycemia, which leads to type 2 diabetes).[71] The American Diabetes Association recommends plain water as the beverage of choice to stay hydrated and help regulate blood sugar levels.[72]

Rethink Your Drink Campaign

The California Department of Public Health launched the Rethink Your Drink campaign in 2012 to bring awareness to the benefits of drinking water rather than sugar-sweetened beverages.[73]

The program promotes water consumption in schools by using attention-grabbing marketing materials and engaging educational tools to encourage students to drink more water throughout the school day (Figure 3).[74]

Figure 3

The campaign has now spread not only throughout California but across the country.[75] The CDC has even incorporated it into their arsenal of education.[76]

California’s campaign decreased the sales of sugar-sweetened beverages and significantly increased unsweetened beverage sales in one San Diego children’s hospital, which created a stoplight system (Figure 4)[77] based on the Rethink Your Drink campaign to educate consumers about the amount of sugar in common beverages. Healthier beverages were physically positioned in coolers to encourage sales. The results showed a 36 percent decrease in the sale of drinks coded as red and a 241 percent increase in the sale of drinks coded as green.[78]

Figure 4

Conclusion

The evidence is clear: flavored milk should not be an option for students at any school, and 100 percent fruit juice should be limited. It’s also clear, based on evidence, that plain milk, preferably 1 percent low-fat and skim, and water should be the default beverages in school cafeterias. Cities across the country are promoting these options and trying to remove flavored milks from their schools in an effort to combat childhood obesity.

Just this month the New York Post reported that,[79] “Citing health concerns, including sugar content, [NYC] Schools Chancellor Richard Carranza and his team are pushing for a white-milk-only policy,”[80] and that state officials, including the Health, Agriculture and Markets commissioners, are already protesting the plan, stating in a letter to Carranza that, among other concerns, it would limit the support to New York State’s economy and its dairy farmers.[81]

Childhood obesity is an epidemic in NYC, and beverages offered in public schools, including flavored milk and 100 percent fruit juice, are significant contributors to this epidemic. School districts across the country are already taking action to eliminate flavored milks and promote plain water and plain milk, such as 1 percent low-fat and skim, consumption.

Plain water consumption helps to combat childhood obesity and prevent type 2 diabetes, and simply installing water jets in schools can triple water consumption rates among children.

This policy brief urges NYC to join the fight for the health of our children by eliminating flavored milks, limiting 100 percent fruit juice consumption, making plain milk, preferably 1 percent low-fat and skim, and water the default beverages, and installing water jets in NYC public schools.

This policy change would be a significant step toward making NYC school children healthier and would be an inspiration to others.

 

This policy brief “Would Making Plain Milk and Water the Default Beverage Options Help to Combat Childhood Obesity in New York City Public Schools?” was authored by David Lundquist, MPA. The views expressed are those of the author and do not necessarily represent those of Hunter College NYC Food Policy Center.  

References

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[48] Milk Processor Education Program Promotional PDF, “Chocolate Milk: Tasty Nutrition,” 2010, https://www.healthyeating.org/Portals/0/Documents/Milk%20Dairy/MilkPEPFlavMilkBro.pdf?ver=2012-11-29-141045-693, accessed December 9, 2018.

[49] Bruske, E., “School Nutrition Association steps up for its ‘patron,’ the dairy industry,” August 13, 2010, Grist, https://grist.org/article/school-nutrition-association-dances-to-dairy-industry-tune/, accessed September 22, 2019.

[50] Nestle, M. (2018). Unsavory Truth: How Food Companies Skew the Science of What We Eat. New York, NY: Basic Books. https://www.amazon.com/Unsavory-Truth-Food-Companies-Science/dp/1541697111/ref=sr_1_1?keywords=unsavory+truth&qid=1569291815&s=gateway&sr=8-1, accessed September 23, 2019.

[51] Bruske, E., “School Nutrition Association steps up for its ‘patron,’ the dairy industry,” August 13, 2010, Grist, https://grist.org/article/school-nutrition-association-dances-to-dairy-industry-tune/, accessed September 22, 2019.

[52] Prime Consulting website, https://www.primeconsulting.biz/team, accessed September 22, 2019.

[53] Murphy MM, Douglass JS, Johnson RK, Spence LA. Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents. J Am Diet Assoc. (2008) 108:631–9, https://www.healthyeating.org/Portals/0/Documents/Schools/SFS/Flavored_Milk_Study_JADA.pdf?ver=2012-11-16-112728-000, accessed September 22, 2019.

[54] Bruske, Ed, “Big Dairy Puts Big Scare Into Parents Over Chocolate Milk – But for How Long?”, The Slow Cook, April 28th, 2011, https://www.theslowcook.com/blog/2011/04/28/big-dairy-co-opts-science-to-push-chocolate-milk-in-schools-but-for-how-long/, accessed September 22, 2019.

[55] “Rachel Kline Johnson.” https://www.uvm.edu/sites/default/files/johnsoncv.pdf. Curriculum vitae, accessed September 22, 2019.

[56] The Dairy Council of California, “Chocolate Milk: Tasty Nutrition,” Milk Processor Education Program Promotional PDF, 2010, https://www.healthyeating.org/Portals/0/Documents/Milk%20Dairy/MilkPEPFlavMilkBro.pdf, accessed September 22, 2019.

[57] Milk Processor Education Program Promotional PDF, “Chocolate Milk: Tasty Nutrition,” 2010, https://www.healthyeating.org/Portals/0/Documents/Milk%20Dairy/MilkPEPFlavMilkBro.pdf?ver=2012-11-29-141045-693, accessed September 22, 2019..

[58] Rail, K., “How to Get Milk Nutrients Without Milk,” The San Francisco Chronicle, 19 Dec 2018, https://healthyeating.sfgate.com/milk-nutrients-milk-2287.html, accessed June 30, 2019.

[59] National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010, 7 C.F.R. § 210 2013, https://www.federalregister.gov/documents/2013/06/28/2013-15249/national-school-lunch-program-and-school-breakfast-program-nutrition-standards-for-all-foods-sold-in, accessed December 9, 2018.

[60] U.S. Department of Agriculture, Food and Nutrition Service, 2018, Final Rule: Child Nutrition Program Flexibilities for Milk, Whole Grains, and Sodium Requirements, RIN 0584-AE53, https://www.fns.usda.gov/school-meals/fr-121218, accessed September 25, 2019..

[61] Robison, P., Mulvany, L., “Big Dairy is About to Flood America’s School Lunches With Milk,” Bloomberg Businessweek, 9 Jan 2019, https://www.bloomberg.com/news/features/2019-01-09/big-dairy-is-about-to-flood-america-s-school-lunches-with-milk, accessed September 22, 2019.

[62] Moon, E., “Why the USDA Wants to Put Whole Milk Back in School Lunches,” Pacific Standard, 31 Jan 2019, https://psmag.com/news/why-the-usda-wants-to-put-whole-milk-back-in-school-lunches, accessed September 22, 2019.

[63] Robison, P., Mulvany, L., “Big Dairy is About to Flood America’s School Lunches With Milk,” Bloomberg Businessweek, 9 Jan 2019, https://www.bloomberg.com/news/features/2019-01-09/big-dairy-is-about-to-flood-america-s-school-lunches-with-milk, accessed September 22, 2019.

[64] Muckelbauer R., Libuda L., Clausen K., Toschke A.M., Reinehr T., Kersting M., “Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial,” Pediatrics. 2009;123:e661–e667,https://pediatrics.aappublications.org/content/123/4/e661.full, accessed September 23, 2019.

[65] Cradock AL, McHugh A, Mont‐Ferguson H, Grant L, Barrett JL, Wang YC, et al. Effect of school district policy change on consumption of sugar‐sweetened beverages among high school students, Boston, Massachusetts, 2004‐2006. Preventing Chronic Disease 2011;8(4):A74, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136975/, accessed September 23, 2019.

[66] Muckelbauer R., Libuda L., Clausen K., Toschke A.M., Reinehr T., Kersting M. “Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial.” Pediatrics. 2009;123:e661–e667, https://pdfs.semanticscholar.org/edde/c42d8dbce38c79e81c88f829e7fe4009f294.pdf?_ga=2.244209861.1976859779.1561687686-63245764.1561687686, accessed September 23, 2019.

[67] Wang Y.C., Ludwig D.S., Sonneville K., Gortmaker S.L.. “Impact of Change in Sweetened Caloric Beverage Consumption on Energy Intake Among Children and Adolescents.” Arch Pediatr Adolesc Med. 2009;163(4):336–343, https://jamanetwork.com/journals/jamapediatrics/fullarticle/381264, accessed June 27, 2019.

[68] Email response to this author’s question, seeking clarification on the net benefit of $174 savings per student. Email response July 25, 2019.

[69] An, R., Xue, H., Wang, L., Wang, Y. “Projecting the impact of a nationwide school plain water access intervention on childhood obesity: a cost-benefit analysis.” Pediatr. Obes.2018;13:715–723, https://onlinelibrary.wiley.com/doi/full/10.1111/ijpo.12236, accessed June 27, 2019.

[70] Elbel B, Mijanovich T, Abrams C, et al. “A water availability intervention in New York City public schools: influence on youths’ water and milk behaviors.” Am J Public Health. 2015;105(2):365–372, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318331/, accessed June 27, 2019.

[71] Roussel R., Fezeu L., Bouby N., et al. “Low water intake and risk for new-onset hyperglycemia.” Diabetes Care. 2011;34(12):2551–2554, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220834/, accessed June 27, 2019.

[72] American Diabetes Association. 20 Sept 2017. “What Can I Drink?” https://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html, accessed June 27, 2019.

[73] Roy, M., “Rethink Your Drink Seminar Encourages Ditching Soda,” The Current, 28 Mar 2019, https://www.arcurrent.com/scene/2019/03/28/rethink-your-drink-seminar-encourages-ditching-soda/, accessed June 29, 2019.

[74] Gutierrez, H., Hampton, K., Hecht, A., Patel, A., Parents Making Waves: A Toolkit for Promoting Drinking Water in Schools, University of California, San Francisco, California Food Policy Advocates, Enigami Ventures, 2016, pp.14-15, https://cfpa.net/Water/WaterToolkits/MakingWavesEnglish/ParentMakingWaves-Toolkit.pdf, accessed June 30, 2019.

[75] New York State Office of Temporary and Disability Assistance website, “Drink Healthy,” https://otda.ny.gov/programs/nutrition/drink-healthy.asp, accessed June 30, 2019.

[76] Centers for Disease Control and Prevention. (2019). Rethink Your Drink. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, https://www.cdc.gov/healthyweight/healthy_eating/drinks.html, accessed June 30, 2019.

[77] Rady Children’s Hospital. (2014, Winter). Rethink Your Drink: Best Practice Implementation. Community Health Brief. https://www.rchsd.org/documents/2016/03/community-health-briefs-rethink-your-drink-best-practice-implementation.pdf/, accessed June 30, 2019

[78] Hartigan P, Patton-Ku D, Fidler C, Boutelle KN. Rethink Your Drink. Health Promot Pract. 2017;18(2):238–244, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842354/, accessed June 30, 2019.

[79] Algar, S. “New York City Schools Want to Ban Chocolate Milk,” New York Post, 15 Sept 2019, https://nypost.com/2019/09/15/new-york-city-schools-want-to-ban-chocolate-milk/, accessed September 23, 2019.

[80] Ibid.

[81] Hogan, B. “Chocolate-milk ban: State officials attack NYC schools’ plan,” New York Post, 22 Sept 2019, https://nypost.com/2019/09/22/chocolate-milk-ban-state-officials-attack-nyc-schools-plan/, accessed September 23, 2019.

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