The Biden administration on Friday announced more stringent nutrition standards for school meals, reviving efforts to improve the health of millions of public school students in the face of a staggering rise in childhood obesity and other diet-related diseases.

The new rules, which will be rolled out gradually over the next few years, will limit added sugars, including in flavored milks. They will also further bring down sodium levels and emphasize products that are primarily whole grain.

The new guidelines are part of the National Strategy on Hunger, Nutrition, and Health announced in September, which was developed in response to the persistent and worsening problem of childhood obesity.

Childhood obesity rates have tripled over the past three decades. The Centers for Disease Control and Prevention estimates that about 1 in 5 children and adolescents have obesity. That’s about 14.7 million children, or almost 20% of all those ages 2 to 19.

According to the American Academy of Pediatrics, it is one of the most common pediatric chronic diseases – associated with hypertension, sleep apnea, diabetes, fatty liver disease and depression. From 2001 to 2017, the number of people under age 20 living with type 2 diabetes grew by 95%, according to Centers for Disease Control and Prevention data. A poor diet increases a person’s risk of developing type 2 diabetes.

“We must all step up to support child health if we are to achieve the Biden-Harris Administration’s goal of ending hunger and reducing diet-related diseases by 2030,” Vilsack said in a statement. “Many children aren’t getting the nutrition they need, and diet-related diseases are on the rise.”

The new effort echoes actions by the Obama administration, which required school cafeterias to increase offerings of fruits and vegetables, serve only skim or low-fat milk, and cut trans fat from the menu altogether. They also required dramatic cuts in sodium in school cafeteria food as well as increases in whole-grain offerings.

The Trump administration chipped away at those Obama-era rules, arguing that healthier food was of no benefit if kids didn’t like it. Trump’s agriculture secretary Sonny Perdue cited food waste and nonparticipation as key rationales for the shift, even though an agency study failed to support that thesis.

Nutrition standards have remained lax during the pandemic, as school cafeterias struggled with supply-chain crises and labor shortages.

The new guidelines will be rolled out gradually. In the fall of 2024, school offerings will have to include primarily whole-grain foods, with only occasional products containing less healthy refined grains such as those used in white pasta and white breads.

In the fall of 2025, there will be a limit imposed on high-sugar products like sweetened yogurts and cereals, a reduction of weekly sodium limits by 10% for school breakfasts and lunches, and limits on added sugars for flavored milks such as chocolate milk. Further reductions in added sugar and sodium are slated for following years.

Industry groups are already pushing back against these limits, arguing that school meal participation is already slipping and this will further discourage students from eating at school. Republican politicians have also been critical of heavier regulation of school meals.

The International Dairy Foods Association has cautioned the USDA about reducing flavored milk options, citing a USDA advisory committee that found that 90% of all Americans and 79% of children 9 to 13 don’t consume the government’s recommended amount of dairy.

“Continuing to offer wholesome dairy products like low-fat flavored milk to students of all ages makes good sense because it’s an excellent source of 13 essential nutrients kids need for growth and development and has been shown to improve overall participation in school meals, increasing consumption of needed nutrients,” IDFA president Michael Dykes said Friday in a statement.

The dairy industry petitioned the Obama administration to allow sugar substitutes such as sucralose in school milks in order to adhere to reduced sugar mandates, but that has not yet been allowed. Many pediatrician discourage children’s consumption of low- and non-calorie sweeteners.

More than 70% of students who eat school meals qualify as low-income and are getting meals free or for a reduced price.

Low-income children and adolescents are more likely to be obese than their higher income counterparts, according to the CDC.

The new rules strike a balance between practical and tasty, going beyond the previous rules by adding sugar standards, said Geri Henchy, director of nutrition policy at the nonprofit Food Research and Action Center.

She said the food industry now offers plenty of low-sugar options that are appealing to kids.

“There were rules about fat but not about sugar, so food manufacturers would cut the fat and make up for it with sugar,” Henchy said. “By doing this they are going to ensure that the school breakfast and lunches are more consistent with the [federal government’s] dietary guidelines and helping to support a healthy weight for children.”