Study: Free school meals associated with decrease in obesity
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Key takeaways:
- The Community Eligibility Provision provides free meals for schools in low-income areas.
- Schools participating in the program saw a 2.4% relative reduction in obesity prevalence.
Participation in a free school meals program was associated with a modest decrease in obesity prevalence among students at more than 3,500 California schools, according to research findings published in Pediatrics.
“In my previous work, colleagues and I had found that a policy called the Healthy, Hunger-Free Kids Act, which changed the nutrition standards for school lunch in public and charter schools, was associated with a very large improvement in schoolchildren’s diet quality,” Jessica C. Jones-Smith, PhD, MPH, RD, an associate professor of health systems and population health and epidemiology at the University of Washington School of Public Health, told Healio.
Jones-Smith began considering whether a related policy — the Community Eligibility Provision (CEP), which provides free breakfast and lunch in schools in low-income areas, amounting to breakfast for 15 million children and lunch for 30 million children every day — might have a positive impact on children’s body weight, through decreasing food insecurity and improving diets.
“School meals are a nutrition program that reach a very large number of children, and one that is predominantly serving lower income children,” Jones-Smith said. “If providing universal free school meals improves health outcomes, it could actually also potentially improve inequities in these health outcomes.”
The researchers studied a sample of 3,531 public and charter schools in California that were eligible for CEP in 2013 — a year before to the program’s availability in the state — and 2019. They also analyzed 3,546,803 BMI measurements from the schools and pulled data on the schools’ performance in the California physical fitness testing program to compare change in school-level obesity prevalence among children participating in CEP to eligible nonparticipating schools.
At baseline, 80% of all students in the schools were eligible for free or reduced-price meals, and the prevalence of obesity was 25%. In terms of demographics, 72% of students identified as Hispanic, 11% as white and 7% as Black.
School CEP participation was associated with a 0.6-percentage-point net decrease in obesity prevalence after policy adoption when compared with nonparticipant schools, corresponding to a 2.4% relative reduction from the baseline prevalence (95% CI, -4.28% to -0.56%).
“We observed that later adopting cohorts of schools who adopted the policy in 2017 and 2018 were associated with larger net reductions in obesity prevalence than earlier adopting cohorts, or those that adopted in 2014, 2015, or 2016,” Anna M. Localio, MPH, of the department of health systems and population health at the University of Washington, told Healio. “Later adopting cohorts had fewer students eligible for free or reduced-price meals before CEP adoption. Therefore, CEP likely resulted in a larger proportion of students switching to participation in school meals in these schools.”
Jones-Smith said many people, “potentially including clinicians, hold preconceptions about the healthfulness of school lunch, often assuming that it is unhealthy.”
“Literature over the past 3 years has shown school lunch to be the healthiest meal children eat in a day on average,” Jones-Smith said. “I think this information is important for clinicians to know as they advise patients on health behaviors and potential low-cost ways of feeding families and staying healthy. It also may be important for clinicians to know if the schools that serve their patients are providing universal free meals. If so, they might view this as a resource for their patients.”
Localio said several states have adopted free school meal policies for all schools, not just those in low-income areas, and that future studies could examine the effects of this.
“Research on whether, and by how much, these policies increase school meal participation and whether they lead to improvements in child health and well-being could be helpful for state policymakers deciding whether to implement this type of policy,” Localio said.
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