One doesn’t so much meet Lorelei DiSogra as she appears before you… one would be tempted to say bubbling with enthusiasm, but that trivializes her presence. She is enthusiastic, deadly enthusiastic, a woman with a mission who has had several positions but only one job: To carry the torch of good health through increased produce consumption during the long marathon of building support in the public health and education communities, the journalistic, policy and regulatory communities and the legislature.
With the recent passage in the House of a bill to expand the USDA Fruit and Vegetable Snack Program to all 50 states, at least on a pilot basis, her career stands at a pinnacle and the dream she has nurtured for a generation appears within reach.
We asked Pundit Investigator and Special Projects Editor Mira Slott to speak with Lorelei at this crucial moment in both her career and in the use of produce as part of a public health initiative:
Dr. Lorelei DiSogra, EdD, R.D.
Vice President, Nutrition and Health
United Fresh, Washington, D.C.
A: We just reached two huge milestones on the Hill; one with the House Ag Committee unanimously voting for mandatory national expansion and funding for five years at $70 million a year to cover 35 schools per state in all 50 states. [Currently it covers 25 schools per state in 15 states].
Separately, House Ag Appropriations voted to broaden program funding to all 50 states. We were just asking for $3 million to protect the six states that had been part of the program in fiscal year 2006 that were out of money. But what we got was $500,000 to cover 25 schools in every state not currently funded.
Ag Approp just provides money for one year. This is bridge money in the interim until the Farm Bill is passed. Everyone expects it to be late with projections of four to six months beyond the Oct. 1 date.
Q: What happens now?
A: The Senate has to write its Farm Bill, pass it out of committee and onto the floor. Then the House and Senate versions go to conference to resolve differences. Once out of conference, it goes to the President for his signature. Our Farm Bill goal is to get $200 million in mandatory funding for 100 schools in every state. Now as we shift full time to the Senate, that will be the goal we promote.
Q: For perspective, if you reach this goal, what percentage of total schools will this cover?
A: There are an estimated 100,000 public schools the United States. But this news is huge. Considering we started from scratch in the House, this is significant progress.
After two years of work, we now have incredible bi-partisan support in the House and strong bi-partisan support in the Senate as well, but the Farm Bill legislation just hasn’t moved.
Q: Are there other factors driving support for FFVP?
A: In the last couple of years there has been tremendous concern of what to do for childhood obesity and improving dietary habits of children. Everything we do on the Hill and in the health community works within this broader context.
The focus for many of us in health and nutrition in the U.S., and within the last five or six years, has been a paradigm shift from just promoting increased consumption to targeting environmental and policy change. Now we have tangible results with FFVP that started as pilots and will soon be rolled out and funded nationally.
This is a massive policy change that will have broad implications globally. Our colleagues in New Zealand, Canada, Ireland, Norway, Denmark — countries that still have relatively small fruit and vegetable programs — will be able to use our policies as leverage to go to their governments for funding. We all help each other around the world. We work late into the night and on weekends. There’s a passion for what we do.
Q: Your expertise in the field of nutrition and health and in developing programs to increase produce consumption spans more than two decades. What works and what doesn’t work? How does one measure success?
A: I wouldn’t be in Washington now aggressively advocating expansion of USDA’s fresh fruit and vegetable snack program to all 50 states if I didn’t see this as the most effective strategy to increase children’s consumption of produce.
Fresh fruit and vegetable snacks in schools is now a global strategy labeled by the World Health Organization (WHO) as a program for reducing childhood obesity.
Q: Aren’t there many variables contributing to childhood obesity? How does FFVP markedly change eating behaviors, short-term and long-term?
A: The whole field of nutrition and public health has really evolved. We’re way beyond posters and flyers on nutritional education. For me and others in these leadership positions thinking outside the box, many of us realized the focus must be on changing behavior, and transforming environmental and policy strategies.
Q: Are you familiar with the Food Dudes program? The core components of the program are psychologically based.
A: This kind of work was started in the U.S. five or six years ago with the Ag Farm Bill. What we are doing here with FFVP and in many other countries where I’ve helped develop school health and nutrition programs is to transform the environment, penetrate the political structure so that children are provided access to fresh fruits and vegetables and the motivations they need to eat them.
These various programs are more similar than different in this regard. The main difference with Food Dudes is that it has a curriculum-education piece closely tied in to the environmental change.
When I was at Dole, we produced an interactive CD Rom in 1993 utilizing advanced technology that was innovative and way out of the box. Dole was ahead of its time in its approach to nutrition.
This is very different than traditional curriculum-based stuff. When I communicate with colleagues around the world, the issue is how do we get more fruits and vegetables in front of kids, how do we increase availability and access?
Q: A recent Associated Press article receiving wide media coverage reported that many school nutrition-education programs fail to produce the intended results. [You can read the original journal article that reviewed the 57 programs here. Other studies/editorials that may be of interest: here and here.] The four programs out of 57 that were shown to be at least somewhat effective were CATCH, Planet Health, SPARK and Gimme 5 High School. How do you respond to this negative publicity?
A: FFVP is not defined as curriculum or traditional education. The whole premise is changing the school environment so kids can experience a wide variety of delicious fruits and vegetables; a pear needs to be ready-to-eat, for example.
The strategy is to get more quality fruits and vegetables into schools so kids have access to them. This is a huge mind shift from five or six years ago. Kids start to try more fruits and vegetables, like them more, increase their produce consumption, and change their eating behavior. The effect is additive.
Within two to three months, what we’re seeing is the kids go home and tell their families about the snack program and the fruits and vegetables they’re eating in school; what they tried and like and ask their parents to buy them. We hear this from every single school participating in the program.
Q: How can you explain the negative evaluation of the FFVP pilot in the Mississippi district?
A: When that AP report broadcast failed scientific studies of school nutrition programs, I was fearful it would relate back to us based on CDC’s negative evaluation of the FFVP pilot in Mississippi.[The Mississippi FFVP pilot was originally funded in fiscal year 2004 through CDC, which conducted the evaluation, but later became permanent under the Child Nutrition and WIC Reauthorization Act. You can read details on the funding here.]
Implementing a program like this in Mississippi is hard because it is one of the most impoverished states in the country with poor infrastructure. The evaluation was an anomaly and not indicative of the program’s success elsewhere. Unfortunately that first year when we got started, there was not a lot of oversight or training in Mississippi, and the problems fell through the cracks. Money goes from USDA to state nutrition boards and then to the schools. Everyone at every level takes ownership.
We at the national level have to know what’s happening on the ground. In that case there were problems. I’m very upset with CDC because they were aware of the problems and kept them a secret. They should have notified the state, USDA and United and we would have gone there to fix things.
This is a major strategy initiative to increase fruits and vegetables. After two years of evaluation, CDC waited to show USDA and United the report only two days before it was released to the public. They told us they didn’t want to influence the results and that is why it was kept confidential.
At the very least, good training must be a prerequisite of making the program work. Apparently the snack program was not well implemented in some of those schools. Lots of people dropped the ball. And it was captured in the evaluation. That is the only place that ran into problems. In every other place it has worked very, very well.
There’s a lot of oversight. At the national level, we, USDA and CDC collaborate, identify any issues and resolve them. We do conference calls with the states every six weeks, USDA provides a guidebook and states do training. The states want this to work.
What happens in school is changing family eating habits. It even goes beyond this.
Q: In what ways? Are these stories all anecdotal or do you have studies that document these findings? Do you have evaluations that counteract the negative Mississippi report?
A: On the issue of evaluations, the very first is a report to Congress in 2003 here. It’s big. When this first started as a pilot in 2002, the Farm Bill funded four states for one year. Congress also allocated $200,000 to evaluate it, giving USDA the responsibility. This is the evaluation report that came from those funds. Every year the USDA has to report to Congress on how the program is doing. Updated evaluations here and here. More specific tables are available in the 2003 report because it was the first one. The USDA is constantly telling Congress the program is going great.
Equally as important is listening to the educators on the ground running these programs to learn about the benefits to children, and how the program serves as a catalyst for changing the school environment. We did this in a congressional hearing May 10 of this year: Addressing Childhood Obesity in the 2007 Farm Bill; benefits of FFVP and key nutrition policy priorities in the “Eat Healthy America Act.”
What principals, teachers, superintendents, school health providers and other administrators on the ground are telling us is how the program is changing the lives of their students. When you have school educators and parents in the 375 schools for which we have funding, all telling me this for five years, it has meaning. We’ve been hearing this since the second month when it got started in the 2002/2003 school year.
I drove the legislation over to USDA and got this up and running, and since that time the evidence of its effectiveness has been growing and growing. All you need to do is listen to the independent congressional testimonies from three different states — Texas here, Wisconsin here and Pennsylvania here.
For example, in Pennsylvania, FFVP impacted the whole school lunch program. Before the schools had the snack program, kids wouldn’t take the fruits and vegetables in the cafeteria. Now they are taking produce in the lunch line and eating it in addition to the snacks, leading to more consumption.
This is just one of the catalysts. Schools changed other school policies, building wellness programs, getting rid of vending machines, teachers eliminating junk food in the teachers’ lounge, creating walking trails and encouraging physical activities.
Q: How does FFVP work on the ground exactly?
A:. The school receives money to provide a fresh fruit and vegetable snack to all students every day. In elementary school, portions are counted and it is pretty much one item. The teachers would count out 22 bananas if there are 22 students in the class. In middle school and high school, the portions are not counted out. It’s generally implemented by setting up tables in central locations, and whatever the fruit or vegetable snack is that day, the kids are free to come and take whatever they want. What is reported to us is that middle school and high school kids are coming back for more.
Q: In that instance, do you know if all kids are participating? Perhaps some students are more health conscious or like produce more, while other kids are not taking any produce off the table at all?
A: When a school is funded, it’s viewed as a very special program to get. The allotted states can only fund 25 schools and the schools have to apply. The states get hundreds of applications. It is not unusual to get 800 to 1000 applications in a state. School educators express their hope of finally having an opportunity to improve children’s eating habits and understand this is the program that can do it. When they hear a state’s gotten funded, a lot of these educators have worked really hard to get their schools selected. When they do, they make a big, big deal about this and the kids feel they are getting something very special too. I don’t hear that only some kids are participating; I hear it’s very well received and kids are excited.
The best way to get a true understanding is to come on the ground with me. We’ll go on a trip to the different schools.
You can hear the enthusiasm from Dr. Cathy Booth, a superintendent in Central Texas who got three schools funded. She testifies in Congress of her experience with the program. Her kids are very poor, in a district with a high level of Hispanics. Some already have Diabetes 2.
She’s made fruit available in the morning. Then some people said to her that she’d never get kids to eat vegetables. She proved them wrong. She tells stories of kids running back to get more broccoli florets. She brought in special snack coolers, like the big ones you see in 7-Eleven convenience stores to generate excitement. Now these kids are eating all kinds of vegetables. Kids like the crunch. Our job is to get them to try them.
Q: The Food Dudes program is highly controlled in its methodology and implementation, from the number of days a particular type of produce is portioned out to the number of hours an adjoining video is watched. How does this compare to FFVP? Are there other overlapping health and nutrition programs that could be influencing the effectiveness of FFVP?
A: The states and the schools combine this FFVP program with nutrition education. But it’s going to be different in each state and at each school. When the state gets funded, it selects 25 schools and does its own training. A lot of states have curriculums already in use.
In the four states where we got started with 100 schools, you may be surprised to hear that kids didn’t know what a pear was. In many parts of the country, kids aren’t exposed to many fruits and vegetables. Parents don’t buy them. We know adults and kids are eating less than half of the recommended servings they should be, and within a very small repertoire of fruits and vegetables.
Q: So exposure and easy access to a large variety of fresh, quality fruits and vegetables will change that? What are the logistics of getting this variety into the individual schools?
A: The Pear Bureau saw the USDA snack program as a huge opportunity. They made sure schools knew about the wide variety of pears and worked with local distributors to be sure the kids got ready-to-eat-pears. Five varieties all taste slightly different. Pears became the most popular previously unfamiliar fruit. When the Pear Bureau came into town to do lobbying, they saw in those four states the benefit of the program, and they have been huge advocates of expanding the program.
A school food service person asked me if there were ways to get more apple varieties than Red Delicious. I gave her information so she could follow up with the produce supplier to bring in different kinds of apples. The way this program operates allows for variety.
Q: Are there certain FFVP requirements of what produce needs to be included? How consistent or flexible is this program?
A: A big plus with this program in the U.S. is that the chosen schools get $74 per student per year, or the equivalent of about 50 cents a day. The funding formula allows the schools to buy fruits and vegetables how and wherever they want. So they can buy locally in season from farmers, local coops, and supermarkets down the street.
A lot of vendors partner with schools to supply the fruits and vegetables. Say the school wants to do fresh pineapple. The supermarket will cut up the pineapple and send huge party platters to the classrooms. If it’s raw vegetables, the retailer works with the school to make an assortment with low fat dips. I’ve seen wholesalers doing special party platters for the schools as well.
Besides this is good for kids and increases consumption, the program has become a catalyst for other health and wellness initiatives. It’s a win-win for the industry, for wholesalers, distributors and retailers. The immediate benefit is that 90 percent of money the school gets must be used to buy the fruits and vegetables.
Q: Now the FFVP program is relatively small. Ultimately, you say there are some 100,000 public schools across the country, which would take the budget requirements to a completely different level. At some point, won’t there be a bigger demand for empirical evidence to justify that kind of money and get the needed support from Congress?
A: This program wasn’t designed to reduce body weight, but there is a reason why the WHO labeled the school fruit and vegetable snack program to target childhood obesity. We saw the program validated in Norway, which has incredible data.
Q: In the Norway study, at least short-term, the students’ increased produce consumption with the free fruits and vegetables coincided with a reduction of unhealthy snacks; although three years out this link is not so apparent. Have you seen this correlation between increased produce consumption and decreased junk food sales when FFVP is implemented in the schools?
A: In the U.S., back in 2002 when the pilot program started, it was first noted by the principals that kids were spending less money in the vending machines, buying less soda, candy and chips. The snack food and soda companies were watching their revenues going down and contacted the principals.
Q: While this sounds encouraging, I suppose it’s still difficult to assess what happens when they leave the school premises and if these behaviors can be maintained long-term.
A: Kids are overweight for many reasons. There isn’t one thing to change that. We have to do many things. The snack program is one, changing the lunch program is another, increasing physical activity another, and addressing what happens when kids are out of school. We have to take each one of these environments. The snack program is serving as a catalyst to all these other changes.
In May 2002, when President Bush signed the Farm Bill, out of hundreds of thousands of pages, the snack program wasn’t even two pages. I took those two pages and drove them over to USDA because funding went through it. I drove my little car over to the officials and said we’re going to make this little pilot work. I believed from the very beginning this was a big opportunity. I have a bottle of Champagne in my refrigerator for when it expands to 50 states.
When another challenge in Congress arises, when I see bumps in the road, I’m upset. We’ve got to persist in this effort.
Q: How close are you to popping that Champagne bottle? It sounds like you are politically savvy in addition to being passionate in pursuit of your goals.
A: Senator Harkin is the father of this. We built political support one congressional office at a time. And the same process is now beginning in the Senate. We try to create sound bites that resonate: $200 million every year for 100 schools in every state. It’s a pragmatic way to go about it.
I’ve used research from Norway, and the World Health Organization on the Hill, congressional briefings with experts and testimony from educators running the programs talking from their perspective of the benefits to kids, and families that really resonated. There is nothing better than hearing from people on the ground. I bring in reports but people aren’t always reading dry statistics. Charts and numbers don’t resonate.
No one has ever said to me, ‘We don’t have evidence.’ Evidence isn’t the problem. People believe the program is effective. It’s a money issue.
School nutritionist directors groups hit the hill in the beginning of March. Seven hundred came to Washington and one of their four top priorities was national expansion of the fruit and vegetable snack program.
I went to one very powerful congressman about trying to get that state funded. His response was that he had never heard from any of his constituents that they wanted this snack program. I called one advocate in that state, who in turn activated a grassroots effort, and the congressman had 1,700 phone calls requesting the program!
The childhood and nutrition advocacy groups and public health organizations want it and believe it works. Communities want it. The states and schools that have implemented the program within these past five years believe this is an important strategy to improve eating habits.
We have three Indian tribal organizations that have been funded as well. In 2004 the Pine Ridge reservation in South Dakota, which was dedicated as the most impoverished place in the U.S. during the Clinton administration, got funding for the program in the 2004/2005 school year. In the summer of 2005, the state director invited me to come to Pine Ridge, where I spent two days on reservation visiting 8 of 10 schools funded.
I wanted to see what quality and variety of produce was being served, and how the program was implemented. We drove hundreds of miles to a huge reservation wilderness and when I got there I was incredibly surprised, relieved and happy. I saw the program working incredibly well, kids loved getting fresh produce deliveries twice a week. In one school, kids were racing to the salad bar, one with raw vegetables, one with fresh fruit, piling up with broccoli florets and watermelon and cantaloupe. In other schools kids got snacks in the morning and afternoon. Every school ordered what they wanted.
If this program is working well in Pine Ridge, South Dakota, it can work anywhere. The schools there felt they received a blessing from heaven.
Q: Will there be any new evaluations coming out soon from schools immersed in the FFVP program to bolster your efforts?
A: Yes. Some evaluations are going on right now. Currently there are evaluations in Wisconsin at the University of Wisconsin, Eau Claire. The University is actually paying all the costs of the evaluation. The researchers started in February or March 2006, collecting their base line information, then again in three months, and final data at the end of 2007. They’re entering that data this summer and we expect they’ll have data released by December of this year.
I’ve been working with the 5-A-Day Director in Wisconsin and the Department of Education. Wisconsin has already seen the benefits to their schools. Preliminary data shows parents are seeing a huge change in kids’ attitudes and willingness to try new fruits and vegetables, and in eating behaviors in the school lunch programs.
Before the free snack program, the kids would have walked by the fruits and vegetables at lunch, but now they’re taking them in the lunch line in addition to the free snack time. The study is evaluating all 25 intervention schools and selected 15 control schools. This is the first one I’m aware of that has intervention and control schools. They promised the control schools they would get funding and that’s why they participated and provided all this data.
Q: Do you think the control school data could be influenced or biased by the promise of funding? For example, maybe the control school would want to find that their students ate a lot of junk food and few fruits and vegetables to demonstrate their need for the USDA program.
A: No. Data collection is very burdensome for control schools and they needed an incentive to participate. We were in constant contact with the Wisconsin team.
The other evaluation is in Iowa, funded by University of Iowa. I’m not sure when data will be released, but we expect it around the same time as Wisconsin.
At the end of day we’ll get national expansion in the Farm Bill. One of the things we’d like to see is dedication evaluation funding, which is not currently of the House version. We’ve been talking to the Harkin staff since day one to have money put into the Farm Bill for evaluations. We wanted to keep it straight-forward, but with the Senate, we will be pushing to include evaluation funding. We’re very aware of the need for evaluation studies.
Norway has had incredible funding for evaluations. Two researchers there have been doing all the evaluation work, and we have reached out to our international leaders and tied them into our conference calls with Senator Harkin. This is a global effort and we leverage the research with what we’re learning and apply it to policy. We all work together and cheer each other on, sending the word out to each when we receive additional funding. There is a network of us around the world.
Q: Tell us more about your global effort.
A: The summary statement 2007 relates to a hearing we all did, including the group in Ireland, in the European Parliament in April, asking for 100 million Euros to expand free produce programs and take them to the next level in Europe.
I’m hopeful here. It’s a powerful story. It’s a global issue. The support of the World Health Organization is great, but where do you find the money to do it? That is happening in the U.S. and on a global scale simultaneously.
Q: I wanted to get back to one thing you mentioned earlier. You still refer to meetings with state 5-A-Day Directors? I thought 5-A-Day was converted over to More Matters.
A: We’ve had state 5-A-Day Directors for all these years. They have changed their titles to Fruit and Vegetable Nutrition Coordinators. Unfortunately there is a learning curve. We are all trying to readjust to the title changes.
There is a transition period. Not every state has a license for More Matters yet. 5-A-Day was so clear. At least initially it causes some confusion with consumers. Five-A-day is very, very well known now. It’s been more than 19 years since I helped Sue Foerster start it in California, and 15 years nationally. It will take time to get that kind of traction with More Matters. 5-A-Day has a catchy ring to it.
Q: You played an influential role working with Susan Foerster to get 5-A-Day off the ground in California 19 years ago. That effort started through the National Cancer Institute, which gave grants to nine state health departments to change consumer diets for prevention of cancer and other chronic diseases.
California led the charge, bringing you in from the University of California Berkeley School of Health as nutrition director. How do you feel about the switch over to the More Matters campaign?
A: The five servings’ number wasn’t an accurate number for anyone; we definitely needed a new slogan and logo for many years now. Five-A-Day was irrelevant since the dietary guidelines changed. I’m optimistic that More Matters will catch on, but it will need a major push.
The program only just got launched in March. We won’t have a sense of its effectiveness until retailers, produce companies, all the state programs, voluntary health organizations, are all aggressively using it.
When we’ve been working on getting funding for health and nutrition programs in Congress, we have to refer to it as 5-A-Day or formerly 5-A-Day, because that’s what people know. We don’t want people to lose that reference point.
Sue [Foerster) and I both have been doing this fight for 19 years aggressively. It would be great to see other leaders trickle up. That’s what worries me. We need more people playing a leadership role on this.
The next big challenge is to get more produce in school breakfast and lunch programs. The policy opportunity is changing the Child Nutrition Authorization Act in 2009, which occurs every five years. We need to put more money in and change regulations for school meals. Many of us will start working on it this fall.
All of us worked two years to get the snack program up and running. We have to bring child advocacy and nutrition groups together, and do consensus building. We must work together to facilitate change.
Q: What can produce executives do?
A: The suppliers can weigh in with members of Congress. We need them to become politically engaged in the process. A senior person from Chiquita is on our government relations council and made Capital Hill visits with us during this important time.
Retailers, big wholesalers and growers, and regional organizations all have to become politically engaged in these efforts. They can carry incredible weight.
When you have paid your dues as Lorelei has, you are entitled to a moment to savor accomplishments and to lay before the industry your vision for success.
It has taken many years of single-minded focus to get us where we are, and the industry owes a huge tip of the hat to Lorelei and people like her. They get little fame or glory, no great financial remuneration, yet they do so much for our industry and the world.
We are tempted to leave Lorelei’s comments to stand on their own. But we will make one point: The very success of her long and enthusiastic effort to build these produce-focused programs puts them at risk.
When they don’t cost much money, these programs are not attractive targets for other industries to knock out in the hope of getting the funding. When we are talking about establishing trials or pilot programs, the general “good feelings” associated with fresh produce can lead people to want to back such programs to improve public health and to affiliate themselves with the positive fresh fruit and vegetable image.
However, the industry has to remember that Zeus’s lightning flies to level mountains, which means that when you become big, you also become a target.
Enthusiasm and dedication are all the industry has had to bring us to this threshold of success. To justify a national rollout, we will need not anecdotes, not testimony from schoolteachers, but hard evidence that we are actually accomplishing something important.
The only way to get this is with a solid research effort.
It is amazing how far Lorelei has flown and her flight has raised the whole industry, but to reach the next stage she will need some hard research wind beneath her wings. If we don’t make sure she has it — shame on us all.