School lunch, policy, and environment are determinants for preventing childhood obesity: Evidence from a two-year nationwide prospective study (original) (raw)
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2014
In investigating the association between the school lunch programs and children's body weight, this study focuses on the school lunch programs in Taiwan. Using a national representative dataset of elementary schoolchildren, we estimate a mixed multinomial logit model to cope with the potential endogeneity issue, and examine how different types of food preparations for school meal programs may affect children's weight in different ways. The results indicate that children who go to schools which serve lunch meals prepared by school kitchens tend to have lower weight on average. In contrast, children who go to schools offering lunch boxes purchased from outside restaurants tend to have higher weight on average. From a policy standard point of view, our findings could shed some light on how school lunch policy can be designed to help prevent children's obesity.
2009
Does eating school meals influence children’s dietary habits or chances of being overweight or obese? This study addressed these questions using data from the School Nutrition Dietary Assessment III Study. National School Lunch Program participants had lower intakes of sugar-sweetened beverages and a lower percentage of calories from low-nutrient energy dense foods and beverages than did nonparticipants. Overall, however, participation was not significantly related to students’ BMI. School Breakfast Program participants had significantly lower BMI than did nonparticipants, possibly because participants were more likely to eat breakfast and ate more at breakfast, spreading calorie intake more evenly over the course of the day.
Journal of the American Dietetic Association, 2009
Background With the ongoing interest in implementing school policies to address the problem of childhood obesity, there is a need for information about the relationships between school food environments and practices and children's weight status. Objective To examine the association between school food environments and practices and children's body mass index (BMI; calculated as kg/m 2). Design The study used data from the third School Nutrition Dietary Assessment Study, a cross-sectional study that included a national sample of public school districts, schools, and children in the 2004-2005 school year. Data on school food environments and practices were collected through on-site observations and interviews with school principals, and children were weighed and measured by trained data collectors. Subjects/setting The study included 287 schools and 2,228 children in grades 1 through 12. Statistical analyses performed Ordinary least squares regression was used to estimate the associations between school food environments and practices and BMI z scores and logistic regression was used to estimate associations between school food environments and practices and the likelihood of obesity (defined as BMI-forage Ն95th percentile). Models included controls for sociodemographic characteristics of schools and children, to control for potential endogeneity of school environments and practices, as well as controls for children's dietary and physical activity behaviors outside of school. Results Among elementary school children, offering french fries and similar potato products in subsidized school meals more than once per week and offering dessert more than once per week were each associated with a significantly higher likelihood of obesity. Among middle school children, the availability of low-nutrient, energy-dense foods in vending machines in or near the foodservice area was associated with a higher BMI z score, and the availability of such foods for à la carte purchase in the cafeteria was associated with a lower BMI z score. Conclusions Findings from this analysis suggest that limiting children's access to low-nutrient, energy-dense foods at school may hold promise as a tactic for reducing children's total calorie intake and controlling children's BMI.
School Nutrition Programs and the Incidence of Childhood Obesity
Journal of Human Resources, 2010
In light of the recent rise in childhood obesity, the School Breakfast Program (SBP) and National School Lunch Program (NSLP) have received renewed attention. Using panel data on over 13,500 primary school students, we assess the relationship between SBP and NSLP participation and (relatively) long-run measures of child weight. After documenting a positive association between SBP participation and child weight, and no association between NSLP participation and child weight, we present evidence indicating positive selection into the SBP. Allowing for this is su¢ cient to alter the results, suggesting a negative (positive) causal e¤ect of the SBP (NSLP) on child weight. JEL: C31, H51, I18, I28
JAMA pediatrics, 2015
The latest US Department of Agriculture school meal and competitive venue standards (USDA standards) aim to improve student nutrition and health. However, significant opposition has been raised to their implementation. To examine (1) the percentages of US middle and high school students who currently attend schools that have specific components of the USDA standards; (2) evidence that the identified USDA standard components may be associated with student overweight/obesity; and (3) evidence of sociodemographic differences in the observed associations. We used data from annual nationally representative cross-sectional studies of students and school administrators in US public middle and high schools from the 2007-2008 through 2011-2012 school years. Administrator-reported school meal and competitive venue food and beverage availability. Body mass index and overweight/obesity calculated from student self-reported height and weight. Analytical samples included 22 716 eighth grade stude...
School Food Environments and Practices Affect Dietary Behaviors of US Public School Children
Journal of the American Dietetic Association, 2009
Background Changes to school food environments and practices that lead to improved dietary behavior are a powerful strategy to reverse the childhood obesity epidemic. Objectives To estimate the effects of school food environments and practices, characterized by access to competitive foods and beverages, school lunches, and nutrition promotion, on children's consumption of sugar-sweetened beverages, low-nutrient energy-dense foods, and fruits/ vegetables at school. Design Cross-sectional study using data from the third School Nutrition Dietary Assessment Study, a nationally representative sample of public school districts, schools, and children in school year 2004-2005. Data from school principals and foodservice directors, school menu analysis, and on-site observations were used to characterize school food environments and practices. Dietary intake was assessed using 24-hour recalls. Subjects/setting The sample consists of 287 schools and 2,314 children in grades one through 12. Statistical analyses performed Ordinary least squares regression was used to identify the association between school food environments and practices (within elementary, middle, and high schools) and dietary outcomes, controlling for other school and child/family characteristics. Results Sugar-sweetened beverages obtained at school contributed a daily mean of 29 kcal in middle school children and 46 kcal in high school children across all
Public Health Nutrition
Objective: To examine associations of school food availability with student intake frequency and BMI, and whether the number of neighborhood food outlets modifies these associations. Design: Baseline assessment of a nationally representative cohort study of U.S. 10th graders. Students reported intake frequency of fruits and vegetables (FV), snacks, and soda. BMI was calculated from measured height and weight. Administrators of 72 high schools reported the frequency of school availability of FV, snacks, and soda. The number of food outlets within 1 km and 5 km were linked with geocoded school addresses. Data were analyzed using adjusted linear and logistic mixed models with multiple imputation for missing data. Setting: U.S. 2009-2010. Participants: 2,263 U.S. 10th graders from the Next Generation Health Study (NEXT). Results: Greater school FV availability was positively associated with student FV intake. Food outlets within 5 km of schools (but not 1 km) attenuated the association ...
Obesity
Study Importance What is already known? ► Many factors (biology, built environment, social environment) influence food intake. ► The food environment may play a role in shaping childhood obesity in the United States. What does this study add? ► This study examines the relationship between the food environment and childhood obesity by using a large data set with detailed address information that more fully considers neighborhood selection and confounding. How might these results change the direction of research? ► Data such as these may inform the development of future health policy. Objective: This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes. Methods: A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects. Results: Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types. Conclusions: Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.