Drop the Hot Dog: Removing Processed Meat from School Meals Tools and Resources for School Programs PhysiciansComm itt ee for Responsible Medicine
Processed Meat: No Safe Amount Nearly a quarter of the meat products Americans consume are processed meat. Children eat on average 22 grams of processed meat per day. 1 Processed meat products include bacon, deli slices, sausage, hot dogs, and any other meat products that have been preserved with additives or otherwise manipulated to alter color, taste, and durability. Current dietary guidelines recommend limiting processed meat products, but eliminating them may be the safest option as scientific research continues to identify health hazards these products pose. The World Health Organization recently declared processed meats carcinogenic to humans. 2 The organization has classified processed meats in the same category as asbestos, tobacco products, and other carcinogens. The association of processed meat consumption and increased cancer risk is most notable for colorectal cancer. Colorectal cancer is the second-leading cause of cancer deaths in the United States. 3 The WHO report is based on research from more than 800 studies looking at the cancer-causing properties of processed meats. The authors highlighted a meta-analysis that found each 50 gram portion of processed meat approximately the size of a typical hot dog eaten daily increases the risk of colorectal cancer by 18 percent. As many as 49,700 cases of colorectal cancer per year in the United States could be prevented by avoiding processed meat. Serving processed meat on the menu even once a week increases a child s risk of colorectal cancer. Despite the scientific consensus about the cancer risks associated with processed meats, they are still widely consumed in the United States, especially by children. The American Cancer Society estimates there will be 95,270 new cases of colorectal cancer in the United States in 2016. Annually, more than 50,000 people in the United States die from colorectal cancer. Rates of colorectal cancer are increasing significantly among young adults. Researchers predict that by 2030 the incidence rates among people ages 20-34 years will increase by 90 percent for colon cancer and by 124 percent for rectal cancer. 4 Just as schools have moved to protect students from the dangers of tobacco and asbestos, schools have an important role to educate students about the risk of eating processed meat. By removing it from the menu, schools can stand together to prevent and protect our young people from the risk of colorectal cancer. 1. Daniel CR, Cross AJ, Koebnick C, Sinha R. Trends in meat products consumption in the USA. Public Health Nutr. 2011;14:575-583. 2. Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncology. Published online October 26, 2015. 3. Centers for Disease Control s Colorectal Cancer Statistics. https://www.cdc.gov/cancer/colorectal/statistics/ 4. Bailey CE, Hu CY, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg. 2015;150:17-22. Removing Processed Meat from School Meals: Tools and Resources for School Programs 2
What Is Processed Meat? T he USDA Dietary Guidelines define processed meat as meat, poultry, or seafood products preserved by smoking, curing or salting, or addition of chemical preservatives. Processed meat includes bacon, sausage, hot dogs, sandwich meat, packaged ham, pepperoni, and salami. On your menu, it might look like this: Deli Sandwich/Hoagie Pepperoni or Sausage Pizza Hot Dog or Turkey Hot Dog Corn Dog Ham and Cheese Sandwich Cobb Salad Glazed or Baked Ham or Turkey Ham Chef Salad Sausage Patty SWAP Your Recipes Ready to remove processed meat from your menu? Start with days when processed meat is the only option. Replace the processed meat entrées with new healthful, student-approved recipes and products from other school districts. Pepperoni Pizza Hot Dog SWAP SWAP Falafel Sandwich Powered-Up Pasta with Chickpeas Pancake Sausage Ham &Cheese SWAP SWAP Sandwich Golden Apple Oatmeal Sandwich Hummus Sandwich Removing Processed Meat from School Meals: Tools and Resources for School Programs 3
Falafel Sandwich 50 Servings Ingredients 8-1/3 quarts chickpeas, cooked or canned 5 cloves garlic cloves, pressed 2-1/3 tablespoons bread crumbs 1 quart celery, minced 3 cups onions, chopped 5 teaspoons cumin, ground 5 teaspoons turmeric 5 teaspoons cayenne pepper 4 cups, 3 tablespoons tahini 16 ounces (2 cups) lemon juice 16 ounces (2 cups) water 3/4 tablespoon black pepper 3/4 tablespoon basil 25 whole-wheat pitas, halved 1-1/2 gallons lettuce 100 slices tomato slices Directions 1. Mash the chickpeas. Mix well with garlic, bread crumbs, celery, onions, cumin, turmeric, and cayenne pepper. Roll into golf-ball size balls and fry in 350 F oil until golden. 2. Blend sauce ingredients until creamy paste is formed. 3. Fill each half pita with two falafel balls, 2 ounce ladle (1/4 cup) sauce, 1/2 cup lettuce, and 2 tomato slices. Nutrients Per Serving: Calories 412 kcal; Saturated Fat 2.5 g; Iron 6 mg; Protein 16 g; Cholesterol 0 mg; Calcium 163 mg; Carbohydrate 52 g; Vitamin A 635 IU; Sodium 169 mg; Total Fat 18 g; Vitamin C 11 mg; Dietary Fiber 13 g Meal component contribution: Each serving provides 2 ounce meat/meat alternate. SWAP Your Recipes Powered-Up Pasta with Chickpeas Makes 10 1-cup servings Ingredients 1 pound whole-grain spaghetti 3/4 cup chopped onions 3/4 cup chopped green peppers 3/4 cup chopped red tomatoes 1 tablespoon vegetable oil 2 teaspoons ground cumin 1 teaspoon garlic powder 1/2 teaspoon onion powder 1 teaspoon ground coriander 2 teaspoons paprika 3.5 15-ounce cans of garbanzo beans (chickpeas), drained 15-ounce can of tomato sauce 2 teaspoons soy sauce 1 teaspoon salt Directions 1. Cook pasta in salted, boiling water until al dente. Drain and reserve. 2. Heat oil in a large skillet over medium-high heat. Add onions, green pepper, and tomato and sauté until tender. 3. Add cumin, garlic powder, onion powder, coriander, paprika, and chili powder, and toss to coat. Cook for 1-2 minutes until aromatic. 4. Add drained chickpeas and toss to coat. 5. Add tomato sauce, soy sauce, and salt and mix to combine. Cook for 5-10 minutes until heated through. Reduce heat to low and allow to simmer. 6. Combine cooked pasta and chickpea tomato sauce and serve. Nutrients Per Serving: Calories 307 kcal; Total Fat 3.44 g; Saturated Fat 0.48 g; Trans Fat 0.00 g; Cholesterol 0.00 mg; Sodium 385.40 mg; Carbohydrate 60.87 g; Dietary Fiber 10.18 g; Sugars 2.80 g; Protein 12.44 g; Vitamin A 590.88 IU; Vitamin C 17.95 mg; Calcium 73.46 mg; Iron 3.81 mg Recipe from DC Central Kitchen Meal component contribution: Each serving provides 2 ounce meat/meat alternate. Removing Processed Meat from School Meals: Tools and Resources for School Programs 4
Golden Apple Oatmeal 50 servings Ingredients 1 1/2 gallons apples, fresh or canned, diced 1 gallon 100% apple juice, unsweetened 1 gallon water 2 tablespoons salt 1/4-1/2 cup ground cinnamon 2 teaspoons ground nutmeg 1 gallon uncooked rolled oats Directions 1. Combine apples, apple juice, and water in steam kettle or saucepan. Bring to boil. 2. Add salt, cinnamon, and nutmeg. 3. Stir in rolled oats and cook for 5 minutes, stirring occasionally until oats are soft and creamy. 4. Turn heat to low, cover oats and hold until ready to serve, or place into sprayed hotel pan for steam table. Serve 1 cup (8 ounces). Nutrients Per Serving: Calories 180; Percent Calories from Fat 10%; Total Fat 2.0 g; Saturated Fat 0 g; Trans Fat 0 g; Cholesterol 0 mg; Sodium 290 mg; Total Carbohydrates 37 g; Dietary Fiber 5 g; Sugars 16 g; Protein 4 g; Vitamin A (100 IU) 2%; Vitamin C (3.6 mg) 6%; Calcium 4%; Iron 10% Meal component contribution: Each serving provides 1 ounce equivalent grains and 1/2 cup fruit. Lemony Hummus 50 servings Ingredients 4 1/2 quarts plus 3/4 cup garbanzo beans, cooked or canned, low-sodium 2 1/2 ounces garlic cloves, smashed and macerated with salt 1 tablespoon plus 1/2 teaspoon salt (to macerate garlic cloves) 2 1/2 cups fresh lemon juice 2 1/2 cups olive oil 2 1/2 cups water 5 ounces tahini (optional) Directions 1. Make the hummus in a small food processor by combining all the ingredients and pulsing until smooth. 2. Add more water is needed. Serve with 6 ounce scoop. Nutrients Per Serving: Calories 222 kcal; Saturated Fat 1.15 g; Iron 1.42 mg; % of calories from fat 34.14%; Protein 7.78 g; Cholesterol 0 g; Calcium 35 mg; % of calories from saturated fat 4.55%; Carbohydrate 30.31 g; Vitamin A 2 mcg; Sodium 337 mg; % of calories from sugar 4.23%; Total Fat 8.69 g; Vitamin C 4.21 mg; Dietary Fiber 5.53 g Meal component contribution: Each serving provides 1 ounce meat/ meat alternate. Recipe adapted from Novato Unified School District and chef Hollie Greene. Recipe from Fruit and Veggie Quantity Cookbook Revised Edition Oct 2011, from NH Obesity Prevention Program, DHHS, DPHS SWAP Your Recipes Removing Processed Meat from School Meals: Tools and Resources for School Programs 5
SWAP Your Products Looking Hot Dogs for products? We ve got you covered: Falafel on Hot Dog Bun Purchase from Alle Processing Web: www.alleprocessing.com/alle/ Pepperoni Pizza Vegetarian Tacos Purchase from JTM Food Group Web: www.jtmfoodgroup.com Phone: 800-626-2308 Pancake Sausage Sandwich Purchase from Alle Processing Web: www.alleprocessing.com/alle/ Ham and Cheese Sandwich Plant-Based Breakfast Sausage Patty Malibu Veggie Burger Purchase from Kellogg s Web: www.kelloggsspecialtychannels.com Removing Processed Meat from School Meals: Tools and Resources for School Programs 6
Market Your New Options Studies illustrate that marketing affects students food choices. Taste Tests Many schools use taste tests to both introduce students to healthier options and to promote more nutritious foods. Taste tests allow schools to identify the foods students will accept and engender student interest in healthful choices. Serve sample-sized portions to students during lunch and share the results of the taste test when offering the new food item on the menu. Follow the Advice from Smarter Lunchrooms Smarter Lunchrooms, developed by the Cornell Center for Behavioral Economics in Child Nutrition Programs (BEN), applies principles from behavioral science to encourage children to make healthier food choices. Simple, cost-free changes that most lunchrooms can adopt such as physical adjustments to the cafeteria and appealing to children through marketing techniques are known to increase fruit and vegetable consumption. Fliers Gain attention for your new options and for why you ve taken processed meat off the menu with fliers and posters. Share these in newsletters and parent orientations. Post them in hallways and in the cafeteria. Announcements Promote your work over the school intercom. Remind students about the nutritious options they ve taste tested and why you ve added them to the menu. NO Amount Is Safe And the Risk Is REAL! Nearly 50,000 people die from colorectal cancer each year Processed Meats Pepperoni, hot dogs, sausages, bacon, salami, and deli meats are all considered carcinogens by the World Health Organization INCREASE RISK FOR COLORECTAL CANCER! NO AMOUNT IS SAFE DROP THE HOT DOG About one hot dog a day increases risk for colorectal cancer by 18% REDUCE YOUR RISK Physicians Committee for Responsible Medicine To learn more, visit DropTheHotDog.org Removing Processed Meat from School Meals: Tools and Resources for School Programs 7
Share with Your Stakeholders Get community buy-in for removing processed meat and replacing them with healthier options with these ideas. Train Staff Your new menu might introduce new flavors, foods, and knowledge to your staff. Share what you ve learned with them about the dangers of processed meats and possibly do taste tests of the new options. Get your staff on board with your decision because their enthusiasm is contagious to the students. Involve Parents For most parents, this information will be new. Send home a letter detailing why you ve made the decision to remove processed meats and give them a look at the meals replacing them. We ve got an example letter for you at the end of the toolkit. You might also choose to share the information at a PTA or school board meeting. Involve Advocates Collaborate with community partners who can support and publicize your new initiative. Send News Releases Send a news release to local newspapers or community newsletters to share why you ve removed processed meat from the menu. We ve got an example at the end of the toolkit. Removing Processed Meat from School Meals: Tools and Resources for School Programs 8
Celebrate Your Success Take some time to recognize the important work you ve done. Celebrate with Students Host an assembly. Invite students to participate in a cooking challenge with local chefs, creating a recipe that doesn t include processed meat. The student body can judge the winners. Share taste test results. Post the results to the taste tests you did with students before implementing the new recipes. Let students know you listened to them! Celebrate with Parents Invite parents to lunch or breakfast to check out the new menu. Share how the new menu has been accepted by students. Celebrate with Staff Promote the work you do by decorating your cafeteria with signs or posters. Take time to reflect on the work you ve done! Resources Research: World Health Organization report in Lancet Oncology on the carcinogenicity of consumption of processed meat. American Institute of Cancer Research s fact sheet on processed meat. American Cancer Society s information on colorectal cancer. Recipes: The Physicians Committee s recipes on HealthySchoolLunches.org. USDA s standardized recipes for school lunch. Event Ideas: Interested in more event ideas? The USDA s Team Nutrition has a Popular Events Idea Booklet. Learn how to promote your work with SNA s Promoting School Meal Programs webinar. Let us know if you re removing processed meat from your menu. We re happy to offer support. Contact hschoollunches@pcrm.org or 202-686-2210. Removing Processed Meat from School Meals: Tools and Resources for School Programs 9
Sample Parent Letter Dear parent, The World Health Organization recently declared processed meats such as pepperoni, hot dogs, bacon, sausage, and deli meats carcinogenic to humans. The organization has even classified processed meats in the same category as asbestos, tobacco products, and other carcinogens. The association of processed meat consumption and increased cancer risk is most notable for colorectal cancer the second-leading cause of cancer deaths in the United States. The WHO report, published in Lancet Oncology is based on research from more than 800 studies looking at the cancer-causing properties of processed meats. The authors highlighted a metaanalysis that found each 50 gram portion of processed meat approximately the size of a typical hot dog eaten daily increases the risk of colorectal cancer by 18 percent. As many as 49,700 cases of colorectal cancer per year in the United States could be prevented by avoiding processed meat. Even serving processed meat on the menu once a week increases a child s risk of colorectal cancer. Despite the scientific consensus about the cancer risks associated with processed meats, they are still widely consumed in the United States, especially by children. We re standing up to prevent and protect our students from the risk of colorectal cancer by removing processed meat from our school s menus. We ve replaced them with healthier, delicious options and have enclosed the new menu here. We re proud to make this change, and we appreciate your support! Sincerely, [Name]
Sample News Release NOTE: Highlighted GREEN portions should be updated accordingly. Oatmeal, Hummus, Falafel: School Name Adds Student-Approved Meals Doctor- and Dietitian-Developed Recipes Offer Healthful Alternative to Processed Meats HOMETOWN School Name will begin serving students healthful and delicious golden apple oatmeal, falafel sandwiches, powered-up pasta with chickpeas, and hummus sandwiches beginning DATE. The student-approved recipes developed by doctors and dietitians offer a healthful alternative to processed meats. Developed by the Physicians Committee for Responsible Medicine a nonprofit of 12,000 doctors and taste tested by students, the new menu items are a creative way for schools to help students increase consumption of fruits, vegetables, grains, and beans. Kid-tested recipes like golden apple oatmeal and powered-up pasta with chickpeas are a surefire way to get students to eat more fruits and veggies, says PRINCIPAL OR FOOD SERVICE DIRECTOR. We re thrilled to add these healthy and creative additions to the nourishing breakfast and lunch options we already provide our students. The recipes also help students reduce intake of processed meat products including bacon, deli slices, sausage, and hot dogs which have been declared carcinogenic to humans by the World Health Organization. Each 50 gram portion of processed meat the size of a typical hot dog eaten daily increases the risk of colorectal cancer by 18 percent. As many as 49,700 cases of colorectal cancer per year in the United States could be prevented by avoiding processed meat. Encouraging students to choose a hummus sandwich instead of a hot dog could be a lifesaver, says Physicians Committee dietitian Karen. Every day without processed meat is a day that could help prevent colorectal cancer in the long run.
Five Steps to Remove Processed Meat from Your School Lunch Menu Hot dogs and pepperoni pizza are common staples in school lunch rooms across the United States. But the World Health Organization recently declared these and other processed meats such as bacon, sausage, and deli meats carcinogenic to humans. The organization has even classified processed meats in the same category as asbestos, tobacco products, and other carcinogens. 1 Research links red and processed meats with increased risk for colorectal cancer, heart failure, and type 2 diabetes. Ready to take these foods off your school lunch menu? Here are five easy steps to replace processed meat: 1. HIGHLIGHT 2. REPLACE Replace the processed meat entrées with new healthful, student-approved recipes and products from other school districts. Highlight all the meals on your menu with processed meat hot dogs, ham, bacon, pastrami, salami, pepperoni, bologna, sausage, and luncheon meat, including turkey ham, turkey bacon, and turkey sausage, too. 3. MARKET 4. SHARE Market the new options to students. Taste tests and marketing materials create excitement and encourage students to try new healthful options. Share why you took processed meat off your trays with your community! Get all of your stakeholders--from teachers to parents--involved to promote student health. 5. CELEBRATE Celebrate your success! HealthySchoolLunches.org 1. Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncology. Published online October 26, 2015.