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Childhood obesity in the U.S. has more than tripled since the 1970s. According to the latest data from the Centers for Disease Control and Prevention, nearly 1 in 5 school-age children and young people (6 to 19 years) in the United States is classified as obese. What’s more, studies show that most children and adolescents don’t meet dietary recommendations, and metabolic problems like diabetes and high blood pressure are showing up earlier than ever before. “Eating healthier from a younger age can help prevent the onset of diet-related disease,” says Renata Micha, PhD, a research associate professor at Tufts’ Friedman School of Nutrition Science and Policy who researches the impact of school food policies. “Most of our eating habits are developed early in life. The sooner you start eating healthier, the greater the health benefits you will accrue over time.”
Health promotion efforts in schools could have a broad impact on eating behaviors and risk of future disease. “Children spend most of their waking hours in school, getting up to 50 percent of their total calories from food consumed there,” says Micha, “so schools are a great setting to target and establish healthy eating habits early on.”
There have been a number of promising school food environment policies enacted in the last decade. For example, the U.S. Fresh Fruit and Vegetable Program provides free fruits and vegetables outside of usual school meals to students in elementary schools with the highest low-income enrollments. Another policy introduced standards for snacks and drinks sold in vending machines, including a restriction on sugar-sweetened beverages. The National School Lunch and School Breakfast Programs’ nutrition standards were also updated to be more consistent with U.S. Dietary Guidelines.
Researchers, led by Micha, set out to determine if policies like these, which regulate food and drinks in schools, are effective means of improving children’s dietary behaviors. According to the researchers, understanding the effects of food environment policies on children’s dietary habits, weight, and metabolic health is critical to estimating benefits of existing programs; determining if they should be expanded; and elucidating potential harms from their elimination.
The study, published in March of 2018 in the journal PLoS One, pooled the results from a large number of studies on a range of interventions to look for impact on the children’s dietary habits, weight, and metabolic risk factors like blood lipids, serum glucose levels, and blood pressure. The researchers found that policies aimed at improving the school food environment did indeed improve children’s diets. Providing fruits and vegetables directly to students increased intake; limiting vending machine offerings to more healthful choices reduced intake of sugar-sweetened beverages and unhealthy snacks; and school meal standards increased fruit intake.
Calorie intake was not affected by any of the interventions, and, in studies that evaluated weight, no significant decreases were identified. The authors point out that the lack of any observable weight loss does not mean the programs are not working, because improving diet quality can improve health and well-being even without weight loss. Few studies assessed metabolic factors, and those that did had mixed findings. “Although more research is needed on whether or not children’s health will be significantly impacted by school food policies, our results support the importance of schools as a setting to improve overall dietary habits of children,” says Micha. “Continued policy efforts to improve the school food environment are needed to improve children’s diets and lead to healthier lives.”
This study was a part of the Food-PRICE (Policy Review and Intervention Cost-Effectiveness) Project sponsored by the National Institutes of Health and run by Tufts’ Friedman School of Nutrition Science and Policy. “This collaboration of international researchers has the mission of improving the health of the U.S. population through improved diets, with a focus on population-level nutrition strategies and their relation to cardiovascular and cancer health outcomes,” says Dariush Mozaffarian, MD, DrPH, dean of Tufts’ Friedman School of Nutrition Science and Policy and editor-in-chief of Tufts Health & Nutrition Letter. “We want to identify the strategies that can have the greatest impact on improving the health of Americans.” It appears that school food policies have to potential to do just that.