Healthy School Meals Decrease Overall BMI Among US Children

Implementation of The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) was associated with significant decreases in child and adolescent BMI, according to study findings published in Pediatrics in JAMA.

Researchers conducted a cohort study using data from the ECHO program, which contained demographic and geographic data from January 2005 to March 2020. Self-reported covariates of sociodemographic characteristics included sex, race, general educational development, and annual household income. Height and weight was used to calculate body mass index (BMI). Primary outcome measurements were youth-month level documented BMI z-score.

Study participants (N=14,121; 48% girls) were aged 5 to 18 years and had at least 1 height and weight measurement. A total of 26,205 measurements were analyzed in the study. A marked decrease in annual change in BMI was reported in the period following HHFKA intervention compared with the pre-intervention period (z, -0.041; 95% CI, -0.066 to -0.016). In age-related subgroup analysis, there was a decrease in BMI was observed in children aged 5 to 11 years (z, -0.34%; 95% CI, -0.059 to -0.009) as well as adolescents aged 12 to 18 years (z, -0.045; 95% CI, -0.071 to -0.018).

In the sex subgroup model, a significant decrease in BMI was found among girls (z, -0.046; 95% CI, -0.071 to -0.020) and boys (z, -0.037; 95% CI, -0.062 to -0012). Overall, implementation of HHFKA caused a 0.041 unit-per-year decrease in BMI compared with pre-HHFKA trends amongst school aged youths.

Limitations of the study include possible factors that influenced youth BMI that were not included in the study, as well unaffected youths who are home schooled or attend private schools.

The study authors concluded, “[S]chool meals and snacks represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of participation in school meal programs and the significant proportion of caloric intake that youths receive at school.”