Rates of overweight and obesity have increased dramatically during the past 2 decades. Children obtain a large fraction of their food energy while at school.
To estimate the relationship between participation in school meal programs and children's body mass index (BMI) and their likelihood of being overweight or obese, testing the hypothesis that school meal participation influences students' weight status, as measured by their BMI and indicators of overweight and obesity.
A cross-sectional design in which a regression model was used to estimate the association between participation in the School Breakfast Program and National School Lunch Program and children's BMI and risk of overweight or obesity, controlling for a wide range of student and school characteristics.
Participants included a nationally representative sample from the third School Nutrition Dietary Assessment Study of 2,228 students in grades 1 through 12 for whom height and weight measurements were obtained. These students, along with their parents, each completed a survey.
Multivariate regression models were used to examine the relationship between usual school meal participation and BMI and indicators of whether students were overweight or obese. These models controlled for students' demographic and socioeconomic characteristics, levels of physical activity, usual eating habits, screen time, and school characteristics.
No evidence was found of any relationship between usual school lunch participation and any of four different measures of weight status based on students' BMI. School breakfast participation was associated with significantly lower BMI, particularly among non-Hispanic, white students.
There was no evidence that either the school breakfast or lunch program is contributing to rising rates of childhood obesity. In fact, School Breakfast Program participation may be a protective factor, by encouraging students to consume breakfast more regularly.
"However, the evidence regarding the influence of school meals on childhood obesity is mixed. Gleason and Dodd (2009) found the consumption of school breakfast to be associated with lower BMI, while Schanzenbach (2009) reports that consumption of school lunch may in fact increase obesity. "
[Show abstract][Hide abstract] ABSTRACT: This paper examines the impact of the implementation of a universal free school breakfast policy on meals program participation, attendance, and academic achievement. In 2003, New York City made school breakfast free for all students regardless of income, while increasing the price of lunch for those ineligible for meal subsidies. Using a difference-indifference estimation strategy, we derive plausibly causal estimates of the policy's impact by exploiting within and between group variation in school meal pricing before and after the policy change. Our estimates suggest that the policy resulted in small increases in breakfast participation both for students who experienced a decrease in the price of breakfast and for free-lunch eligible students who experienced no price change. The latter suggests that universal provision may alter behavior through mechanisms other than price, highlighting the potential merits of universal provision over targeted services. We find limited evidence of policy impacts on academic outcomes.
"These results also differ from studies published in 1998  and 2010  that showed no significant relationship between school-meal participation (based on parental responses and daily administrative records, respectively) and BMI. In addition, these results conflict with a study published in 2009 that showed an inverse relationship between breakfast participation (based on student or parental responses) and BMI among White students  and with a study published in 1994 that showed a positive relationship between children who participated in school lunch (based on parental responses) and BMI . These conflicting results emphasize the need to consider the source of information concerning children's school-meal participation when investigating the relationship between school-meal participation and childhood obesity. "
[Show abstract][Hide abstract] ABSTRACT: This article investigated (1) parental response accuracy of fourth-grade children's school-meal participation and whether accuracy differed by children's body mass index (BMI), sex, and race, and (2) the relationship between BMI and school-meal participation (based on parental responses).
Data were from four cross-sectional studies conducted from fall 1999 to spring 2003 with fourth-grade children from 13 schools total. Consent forms asked parents to report children's usual school-meal participation. As two studies' consent forms did not ask about lunch participation, complete data were available for breakfast on 1,496 children (51% Black; 49% boys) and for lunch on 785 children (46% Black; 48% boys). Researchers compiled nametag records (during meal observations) of meal participation on randomly selected days during children's fourth-grade school year for breakfast (average nametag days across studies: 7-35) and for lunch (average nametag days across studies: 4-10) and categorized participation as "usually" (≥ 50% of days) or "not usually" (< 50% of days). Weight and height were measured. Concerning parental response accuracy, marginal regression was used with agreement between parental responses and nametag records as the dependent variable; independent variables were BMI, age, sex, race, and study. Concerning a relationship between BMI and school-meal participation, marginal regression was used with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, age, sex, race, and study.
Concerning breakfast participation and lunch participation, 74% and 92% of parents provided accurate responses, respectively. Parental response accuracy was better for older children for breakfast and lunch participation, and for Black than White children for lunch participation. Usual school-meal participation was significantly related to children's BMI but in opposite directions -- positively for breakfast and inversely for lunch.
Parental response accuracy of children's school-meal participation was moderately high; however, disparate effects for children's age and race warrant caution when relying on parental responses. The BMI results, which showed a relationship between school-meal participation (based on parental responses) and childhood obesity, conflict with results from a recent article that used data from the same four studies and found no significant relationship when participation was based on nametag records compiled for meal observations.
International Journal of Behavioral Nutrition and Physical Activity 03/2012; 9:30. DOI:10.1186/1479-5868-9-30 · 4.11 Impact Factor
"Being older and/or Jewish was associated with a higher OR for eating a healthy breakfast. A cross-sectional study estimated the association between participation in the School Breakfast Program and National School Lunch Program and children's BMI and risk of overweight or obesity; participants included 2228 students in grades 1 through 12. School breakfast participation, but not school lunch, was associated with significantly lower BMI, particularly among non-Hispanic, white students (Gleason and Dodd, 2009). Our analysis has several shortcomings and limitations: other variables included in the program were not evaluated (such as promoting physical activity and hygiene). "
[Show abstract][Hide abstract] ABSTRACT: The recent rapid increase in childhood obesity rates suggests that a consideration of the role of the schools in addressing this problem is necessary. 'Fits me' program functions to promote eating daily and healthy breakfast among elementary school children.
Separate children groups were sampled each year by clusters from seven regions around Israel. They filled a self-administered questionnaire at the beginning of 2003, before the program started, and in 2003-2005, after the program. A separate sample was collected in 2006 in a case-control structure. The answer to the question: 'what do you eat for breakfast?' considered as a healthy breakfast if it included one of the following food items: A sandwich (not including chocolate, jam or butter), cereals, vegetable, fruit, egg and dairy product.
As compared with 2003 before the program, more children reported eating daily breakfast over the years (51-65% before and until 2005, respectively, P for trend<0.01). Odds ratio (OR) and 95% confidence interval (95% CI) for eating a healthy breakfast, in 2006 in the intervention (n=417) vs controls (n=572), adjusted for sex and age were OR=1.53 (95% CI: 1.15-2.04). However, only a third of 75% of the children who ate a healthy breakfast in the intervention group estimated that they were eating a healthy breakfast.
After implementation an educational program to promote daily and healthy breakfast eating, the goal of a healthier breakfast was achieved. However, one should strive to define an exact definition of a healthy breakfast.
European journal of clinical nutrition 11/2010; 65(2):203-9. DOI:10.1038/ejcn.2010.247 · 2.71 Impact Factor
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