The Effect of State Competitive Food and Beverage Regulations on Childhood Overweight and Obesity

Abstract

Purpose Policy efforts for combating childhood obesity have sought stronger state policies for regulating competitive foods and beverages (CF&Bs) available in schools. However, the evidence linking state policies to children’s overall diet and body weight outcomes is limited and mixed, and experts have called for more rigorous studies that are able to address concerns about selection bias. The present study leverages a rare natural experiment where children in military families are “assigned” to different state policies, due to their military parent’s periodic relocation, to examine whether state CF&B policies were associated with children’s BMI and overweight or obesity. Methods We analyzed data from 894 children (12–13 years old) in Army families attending public schools located near 25 installations across 23 states in 2013. State CF&B policy measures from the Bridging the Gap project were linked to the child data. Primary outcomes included BMI z-scores and indicator for overweight or obesity. For a subsample of children with self-reported food frequency measures, we also examined the link between state CF&B policies and overall diet. All regression analyses adjusted for a rich set of child and family covariates. Results Having strong or weak policies was significantly associated with lower BMI z-scores, lower odds of overweight or obesity, and better dietary outcomes, relative to no policy. Conclusions A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity.

Stakeholder perceptions of a school food policy ten years on

“…The current follow-up evaluation conducted a decade after the introduction of a school food policy in WA public schools provides further evidence that such policies can be valued by key stakeholders and can make a positive difference to food provision in the school environment (9)(10)(11)(12)(13)(14)22) . Large majorities of respondents agreed that the policy has made the foods provided in schools healthier (85 %) and that it constitutes a valuable opportunity to teach children about healthy eating (90 %).…”

“…An additional factor is likely to be the escalation in community concern about child obesity over the last decade (24) , which may have contributed to higher scores in the 2016 evaluation due to growing acceptance of the need for policy measures to address this issue. Previous research has found that school food policies can be associated with lower levels of child obesity (13,14) , highlighting the importance of such policies as a critical component of population-level child health strategies. Of note are the lower levels of policy compliance reported in the follow-up evaluation compared with the original evaluation (81 % v. 89 %).…”

“…While school food policies have been introduced in many countries (8) , relatively few have been independently and/or comprehensively assessed. Work to date suggests that such policies can be appropriately implemented by food-service providers (9)(10)(11)(12) and that policies that limit the supply of unhealthy 'discretionary' foods in schools can be associated with lower levels of student obesity (13,14) . Such evidence is critical for providing policy makers with the justification they require to introduce comprehensive school food policies (15,16) .…”

Leveraging the Public School System to Combat Adolescent Obesity: The Limits of Arkansas's Statewide Policy Initiative

“…What may matter for their effectiveness is the specific kinds of policies that states can reasonably implement with strong fidelity in local school settings. For instance, recent research on the impact of statewide policies that regulate foods and beverages in public schools-known as competitive food and beverage (CF&B) policies [29]showed that adolescents exposed to a range of CF&B policies, including regulations on vending machines and foods sold via school fundraisers, were strongly related to lowering the odds of being overweight or obese relative to having no policy at all [30]. Importantly, the number of policies mattered.…”

Statewide Policies on Competitive School Foods and Beverages: Broadening the Scope of School-Based Antiobesity Efforts

“…In this month's issue of the Journal of Adolescent Health, a new study by Datar and Nicosia [7] brings sharper focus to bear on how statewide policies can impact obesity. The study generates novel insights into how statewide policies that regulate foods and beverages in public schoolsdknown as competitive food and beverage (CF&B) policies [8]dhave impacted adolescents' obesity and obesity-related outcomes.…”