Published: April 08, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerChildren residing in states with stringent nutritional standards for school meals had lower rates of obesity than those living in states with more lax regulations, researchers reported.
In states where school meal nutritional requirements fell below those currently recommended by the USDA, rates of obesity were doubled among children consuming reduced-price or free meals compared with children not eating school-provided lunches (26% versus 13.9%), according to Daniel R. Taber, PhD, and colleagues from the University of Illinois at Chicago.
In contrast, the difference in rates of obesity was much less pronounced in states exceeding the USDA nutritional standards (21.1% versus 17.4%), the researchers reported online in JAMA Pediatrics.
"In short, the study found an association between more stringent school meal standards and more favorable weight status, especially among low-income students," Marion Nestle, PhD, of New York University in New York City, wrote in an accompanying editorial.
More than 65 years ago, the National School Lunch Program was established to help meet the nutritional needs of children, and today some 30 million receive the lunches, either paying full price or at subsidized cost depending on family income.
In recent years, however, the program has been criticized for its quality, and some have argued that it has played a part in the pediatric obesity epidemic.
In answer to these challenges, the USDA established revised standards in 2012, calling for more vegetables, fruits, low-fat milk, and whole grains to be included in the meals, and for limits on calories and trans fats.
However, some states had already enacted laws requiring healthier meals. To see if those regulations had had any effect on childhood obesity rates, Taber's team compared 2006-2007 obesity rates in those states with rates in states with looser requirements.
Their analysis included 4,870 middle-school students in 40 states.
A total of 2,350 children paid full price for their lunches, 1,570 received the lunches at lower or no cost, and 950 didn't participate in the lunch program.
In an unadjusted analysis, the rate of obesity for those having a reduced-price lunch was 25.2%, while rates for those paying full price or not eating the school lunches were 16.3% and 14.3%, respectively.
Even after adjusting for socioeconomics, race, location, and other between-state variables, the prevalence was 3.7 points higher for the reduced-price group compared with children not participating in the lunch program.
Further analysis comparing obesity rates according to state nutrition requirements confirmed a decrease of 12.3 percentage points (95% CI −21.5 to −3) in the difference in obesity rates between children receiving subsidized lunches and those not eating school lunches in states exceeding USDA nutrition standards.
Similarly, the difference in mean percentile of body mass index between children in the reduced-price lunch group and nonparticipating children was lower in states with stringent requirements (β = −0.11, 95% CI −17.7 to −4.3).
The researchers also considered whether children in the more stringent states compensated by purchasing more unhealthy "competitive" sweet or salty snacks and sweetened beverages from widely available vending machines, and found little evidence to support this.
Nonetheless, they noted, "unless school meal laws are accompanied by nutrition education and initiatives to limit energy-dense competitive foods and beverages, then even the most stringent school meal standards may be undermined by competitive foods."
In her editorial, Nestle argued that some members of Congress have objected to the new USDA regulations on school meals -- largely at the behest of the food industry.
"Although the USDA based its nutrition standards on studies by the Institute of Medicine, when it comes to school food, politics trumps science," she wrote.
For instance, Congress has since forbidden the USDA from placing a limit on the number of servings of potatoes that are permissible and has insisted that the tomato sauce on pizza be considered a vegetable serving.
"Increasing evidence confirms that school-based dietary interventions can help promote healthier eating patterns and body weights, especially among children likely to bear the greatest consequences of obesity," Nestle observed.
"Objections to school nutrition standards must be recognized for what they do: place the financial health of food companies and their supporters in Congress above the health of the nation's children," she stated.
The study was limited by being cross-sectional and the possibility of confounding by factors at the state level.
The study was funded by the Robert Wood Johnson Foundation and the National Heart, Lung and Blood Institute.
The authors reported no conflicts of interest.
Primary source: JAMA Pediatrics
Source reference:
Taber D, et al "Association between state laws governing school meal nutrition content and student weight status: implications for new USDA school meal standards" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.399.
Source reference:
Taber D, et al "Association between state laws governing school meal nutrition content and student weight status: implications for new USDA school meal standards" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.399.
Additional source: JAMA Pediatrics
Source reference:
Nestle M "School meals: a starting point for countering childhood obesity" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.404.
Source reference:
Nestle M "School meals: a starting point for countering childhood obesity" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.404.
http://www.medpagetoday.com/Pediatrics/Obesity/38327
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