Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010

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Abstract

Importance

The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals.

Objective

To evaluate the association between the HHFKA and youth body mass index (BMI).

Design, Setting, and Participants

This cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included.

Exposures

Full implementation of the HHFKA.

Main Outcomes and Measures

The main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models.

Results

A total of 14 121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26 205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (−0.041; 95% CI, −0.066 to −0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (−0.045; 95% CI, −0.071 to −0.018) and among youths living in households with a lower annual income (−0.038; 95% CI, −0.063 to −0.013).

Conclusions and Relevance

In this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals.

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Most cited references 19

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies

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Using the School Environment to Promote Physical Activity and Healthy Eating

Howell Wechsler, Randolph S Devereaux, Margarett Davis … (2000)

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The association of the school food environment with dietary behaviors of young adolescents.

Martha Y Kubik, Leslie A Lytle, Peter J Hannan … (2003)

We examined the association between young adolescents' dietary behaviors and school vending machines, à la carte programs, and fried potatoes' being served at school lunch. Using a cross-sectional study design, we measured à la carte availability and the number of school stores, vending machines, and amounts of fried potatoes served to students at school lunch in 16 schools. Grade 7 students (n = 598) completed 24-hour dietary recall interviews. A la carte availability was inversely associated with fruit and fruit/vegetable consumption and positively associated with total and saturated fat intake. Snack vending machines were negatively correlated with fruit consumption. Fried potatoes' being served at school lunch was positively associated with vegetable and fruit/vegetable intake. School-based programs that aim to promote healthy eating among youths should target school-level environmental factors.

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Author and article information

Journal

Title: JAMA Pediatrics

Abbreviated Title: JAMA Pediatr

Publisher: American Medical Association (AMA)

ISSN (Print): 2168-6203

Publication date (Electronic): February 13 2023

Affiliations

[1 ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

[2 ]Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts

[3 ]Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington

[4 ]Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia

[5 ]Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

[6 ]Division of Pediatric Pulmonology, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York

[7 ]Vanderbilt University Medical Center, Nashville, Tennessee

[8 ]Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison

[9 ]Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison

[10 ]College of Engineering, Northeastern University, Boston, Massachusetts

[11 ]Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey

[12 ]Albert Einstein College of Medicine, Bronx, New York

[13 ]Massachusetts General Hospital, Harvard Medical School, Boston

[14 ]Lifecourse Epidemiology of Adiposity & Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado

[15 ]Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York

[16 ]Division of Research, Kaiser Permanente Northern California, Oakland

[17 ]Department of Psychological & Brain Sciences, The George Washington University, Washington, DC

[18 ]Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles

[19 ]Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

[20 ]Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

[21 ]Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York

[22 ]Avera Research Institute, Sioux Falls, South Dakota

[23 ]University of South Dakota, Sioux Falls

[24 ]Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

[25 ]Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing

[26 ]Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing

[27 ]Channing Division of Network Medicine and Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

[28 ]The Warren Alpert Medical School, Brown University, Providence, Rhode Island

[29 ]Oregon Health & Science University, Portland

[30 ]Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City

[31 ]Department of Pediatrics, University of Utah School of Medicine, Salt Lake City

[32 ]Icahn School of Medicine at Mount Sinai, New York, New York

[33 ]Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts

[34 ]Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison

Article

DOI: 10.1001/jamapediatrics.2022.5828

PubMed ID: 36780186

SO-VID: 0de9fcda-c764-4c83-91f0-db877e661644

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Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010

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Abstract

Importance

Objective

Design, Setting, and Participants

Exposures

Main Outcomes and Measures

Results

Conclusions and Relevance

Related collections

IODP Expedition 378: South Pacific Paleogene Climate

Most cited references 19

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Using the School Environment to Promote Physical Activity and Healthy Eating

The association of the school food environment with dietary behaviors of young adolescents.

Author and article information

Journal

Affiliations

Article

History

Comments

Comment on this article

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Cited by 7

Most referenced authors 410