A study says changes to the US school meal program helped reduce children’s body mass index

The Effect of Childhood Obesity on BMI and BMI in the U.S. After the Healthy, Hunger-Free Kids Act

The study shows that prior to the implementation of the Healthy, Hunger-Free Kids Act, the BMI increased in teenage years. After the changes in nutrition occurred, the trend reverses.

The study, published in JAMA Pediatrics, followed 14,121 US youths ages 5 to 18 from January 2005 to March 2020. The study didn’t include data following widespread school shutdowns due to the Covid-19 pandemic.

The Healthy, Hunger-Free Kids Act of 2010, championed by former first lady Michelle Obama, was the first national legislation to improve school meals in more than 20 years. It increased the quantity of fruits, vegetables and whole grains required in school meals.

According to the US Centers for Disease Control and Prevention, about 20% of children and adolescents ages 2 to 19 are obese, which can lead to lifelong health complications including high blood pressure, type 2 diabetes and breathing problems such as asthma and sleep apnea.

“I think when you’re looking at these population level, large scale evaluations, what might look like a small effect in any one child at any one moment, actually means a lot at the broader level over time,” said Dr. Aruna Chandran, an author of the study and epidemiologist at Johns Hopkins Bloomberg School of Public Health.

“I think the steps are at least in the right direction,” said Dr. Lauren Fiechtner, director of Nutrition at Mass General for Children Hospital who was not involved with the study.

Fiechtner called for further action including limiting juices and promoting the use of fruit in its whole form to increase fiber intake in his editorial.

Additionally, Fiechtner says that “continuing to invest in the National School Lunch Program is important because we know obesity costs the healthcare system a lot of money in the long term” and that a “reduction in obesity among children would also improve their health and their quality of life.”

Some researchers warned against making generalizations about the study’s findings. Some of the children included in the study might not have been enrolled in school meals programs, or their district may not have fully implemented the nutrition requirements, said Kendrin Sonneville, associate professor of nutritional sciences at the University of Michigan School of Public Health.

“With continual efforts to make improvements, we hope that this means that public health practitioners and policymakers, no matter where they’re from, what their political views might be, or what their personal ideas are, this is something we can come together on because this is an actionable place where we can make a difference in our obesity epidemic, which has felt so just intractable and so difficult to overcome,” Chandran said. We can make a difference now that we have the ability to think of this not as a foregone conclusion.

Whether the program has begun to turn the tide for the whole country, and not just the groups of kids studied, is still unclear. About 30 million children in the U.S. receive school lunches each day.

“You have the ability to really affect their excess weight gain over the course of their entire childhood,” Dr. Chandran said. She leads the study published in the journal.

The new study analyzed nationwide data from 50 cohorts of schoolchildren from January 2005 to August 2016, before the law took effect, and data from September 2016 to March 2020, after it was fully implemented. The researchers calculated the kids’ weight-to-height ratio.

One way to think of the change is that for a 10-year-old boy with an elevated body-mass index, the decline would amount to a 1-pound weight loss, noted Dr. Lauren Fiechtner, director of nutrition at MassGeneral Hospital for Children in Boston, who wrote an editorial accompanying the study.

She said that flattening is important and that even the BMI was likely important. Keeping kids’ weight steady will help keep them from being obese.

A slight reduction in those measures, she said, “doesn’t tell us whether the health, well-being, concerns related to food security of children participating in the school breakfast or lunch program improved.”