Offering breakfast in the classroom as an adaptation to the standard school breakfast program increased the number of students participating in the subsidized school food program but also increased incidence and prevalence of obesity, according to study results published in JAMA Pediatrics.1

Currently, school systems in the United States are facing 2 food-related issues: students with food insecurity and students being overweight or obese.2 The School Breakfast Program provides a subsidized breakfast to students in schools and to increase usage, many schools have started offering breakfast in the classroom to reach more students and avert stigma of eating a subsidized meal.2 To determine the effect of this initiative, researchers compared rates of overweight and obesity in urban low-income students attending schools offering breakfast in the classroom or control schools offering breakfast before classes in the cafeteria.1

The investigators conducted a randomized clinical trial involving 1362 students in 16 public schools (kindergarten through 8th grade; mean age, 10.8 years) randomly assigned to either breakfast program. In total, 1075 students (79%) qualified for free or reduced-price meals and 241 (18%) and 291 (21%) met criteria for overweight or obesity at baseline, respectively. There was no difference in student participation in breakfast programs at study origin.1

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After 2.5 years, the breakfast in the classroom program had more students participating (53.8% of days vs 24.9% of days), but the incidence (11.6% vs 4.4%) and prevalence (28.0% vs 21.2%) of obesity also increased compared with the standard breakfast program.1

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Overall, this study highlights a complex problem existing in the school system. The School Breakfast Program helps address child hunger and food insecurity but may contribute to childhood obesity. The researchers suggest that nutrition education for teachers and families might help encourage more nutritious meals and reduce the consumption of lower-quality breakfast items inside and outside of school.2

The researchers concluded that “[r]educing both child hunger and obesity are important, and we must do both, but it is essential to make sure that efforts to improve one outcome do not worsen the other.”2

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1. Polonsky HM, Bauer KW, Fisher JO, et al. Effect of a breakfast in the classroom initiative on obesity in urban school-aged children [published online February 25, 2019]. doi:10.1001/jamapediatrics.2018.5531

2. Cheng ER, Carroll AE. Offering breakfast in the classroom and children’s weight outcomes [published online February 25, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.5539