Abstract
In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: −0.06, 95% CI: −0.12, −0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.
Highlights
In the United States, most schools sell “competitive” foods and beverages, which are described in this way because they are sold outside of the school meal program [1].These products are typically sold as à la carte options in cafeterias, in vending machines, and in school stores
State Laws and Student body mass index (BMI)-for-Age competitive foodsbetween and beverages in vending machines, Percentiles school stores, and à la carte, on average,Table and2were enrolled in schools with 7.5 unhealthy foodsmodel and beverages shows the results of a multivariable linear regression examiningavailable the association of state law and school and student characteristics with student
Having stronger state laws on competitive foods and beverages in vending machines, school stores, and à la carte was associated with lower student BMI-for-age
Summary
In the United States, most schools sell “competitive” foods and beverages, which are described in this way because they are sold outside of the school meal program [1]. These products are typically sold as à la carte options in cafeterias, in vending machines, and in school stores. Dighe and colleagues examined the relationship between the school nutrition and physical activity environment and student BMI in a sample of students from low-income areas of New Jersey [8] They found a significant association between the number of unhealthy items sold in school vending machines and student BMI z-scores [8]
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