TY - JOUR
T1 - Changes in Body Mass Index among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010
AU - Chandran, Aruna
AU - Burjak, Mohamad
AU - Petimar, Joshua
AU - Hamra, Ghassan
AU - Melough, Melissa M.
AU - Dunlop, Anne L.
AU - Snyder, Brittney M.
AU - Litonjua, Augusto A.
AU - Hartert, Tina
AU - Gern, James
AU - Alshawabkeh, Akram N.
AU - Aschner, Judy
AU - Camargo, Carlos A.
AU - Dabelea, Dana
AU - Duarte, Cristiane S.
AU - Ferrara, Assiamira
AU - Ganiban, Jody M.
AU - Gilliland, Frank
AU - Gold, Diane R.
AU - Hedderson, Monique
AU - Herbstman, Julie B.
AU - Hockett, Christine
AU - Karagas, Margaret R.
AU - Kerver, Jean M.
AU - Lee-Sarwar, Kathleen A.
AU - Lester, Barry
AU - McEvoy, Cindy T.
AU - Niu, Zhongzheng
AU - Stanford, Joseph B.
AU - Wright, Rosalind
AU - Zimmerman, Emily
AU - Farzan, Shohreh
AU - Zhang, Zhumin
AU - Knapp, Emily
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/4/3
Y1 - 2023/4/3
N2 - Importance: The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals. Objective: To evaluate the association between the HHFKA and youth body mass index (BMI). Design, Setting, and Participants: This cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included. Exposures: Full implementation of the HHFKA. Main Outcomes and Measures: The main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models. Results: A total of 14121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (-0.041; 95% CI, -0.066 to -0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (-0.045; 95% CI, -0.071 to -0.018) and among youths living in households with a lower annual income (-0.038; 95% CI, -0.063 to -0.013). Conclusions and Relevance: In this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals..
AB - Importance: The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals. Objective: To evaluate the association between the HHFKA and youth body mass index (BMI). Design, Setting, and Participants: This cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included. Exposures: Full implementation of the HHFKA. Main Outcomes and Measures: The main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models. Results: A total of 14121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (-0.041; 95% CI, -0.066 to -0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (-0.045; 95% CI, -0.071 to -0.018) and among youths living in households with a lower annual income (-0.038; 95% CI, -0.063 to -0.013). Conclusions and Relevance: In this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals..
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U2 - 10.1001/jamapediatrics.2022.5828
DO - 10.1001/jamapediatrics.2022.5828
M3 - Article
C2 - 36780186
AN - SCOPUS:85151691615
SN - 2168-6203
VL - 177
SP - 401
EP - 409
JO - JAMA Pediatrics
JF - JAMA Pediatrics
IS - 4
ER -