Association Between State Laws Governing School Meal Nutrition Content and Student Weight Status: Implications for New USDA School Meal Standards.
ABSTRACT IMPORTANCE This study assessed whether stronger school meal nutrition standards may improve student weight status. Results have immediate implications because of the ongoing implementation of new nutrition standards for the National School Lunch Program. OBJECTIVE To determine if state laws with stricter school meal nutrition standards are inversely associated with adolescent weight status, while controlling for unmeasured state-level confounders. DESIGN Quasi-experiment. SETTING Public schools. PARTICIPANTS Four thousand eight hundred seventy eighth-grade students in 40 states. Students were categorized by type of school lunch they usually obtained (free/reduced price, regular price, or none). INTERVENTIONS State laws governing school meal nutrition standards. States with standards that exceeded US Department of Agriculture (USDA) school meal standards were compared with states that did not exceed USDA standards. The parameter of interest was the interaction between state laws and student lunch participant status, ie, whether disparities in weight status between school lunch participants and nonparticipants were smaller in states with stricter standards. MAIN OUTCOME MEASURES Body mass index percentile and obesity status. RESULTS In states that exceeded USDA standards, the difference in obesity prevalence between students who obtained free/reduced-price lunches and students who did not obtain school lunches was 12.3 percentage points smaller (95% CI, -21.5 to -3.0) compared with states that did not exceed USDA standards. Likewise, differences in mean body mass index percentile between those student populations were 11 units smaller in states that exceeded USDA standards (95% CI, -17.7 to -4.3). There was little evidence that students compensated for school meal laws by purchasing more sweets, salty snacks, or sugar-sweetened beverages from other school venues (eg, vending machines) or other sources (eg, fast food). CONCLUSIONS AND RELEVANCE Stringent school meal standards that reflect the latest nutrition science may improve weight status among school lunch participants, particularly those eligible for free/reduced-price lunches.
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ABSTRACT: Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a ‘policy’ component with seven domains on specific aspects of food environments, and an ‘infrastructure support’ component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.Obesity Reviews 10/2013; · 7.86 Impact Factor
- JAMA pediatrics. 04/2013;
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ABSTRACT: In 2005, the nutritional content of children's school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children's total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4-7 years (n = 385 in 2003-4; n = 632 in 2008-9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children's mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change -128 mg, 95% CI: -183 to -73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (-1.8%, -2.8 to -0.9) and saturated fat (-1.0%; -1.6 to -0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children's diet.PLoS ONE 10/2013; 8(10):e78298. · 3.53 Impact Factor