Collaborative ECHO research led by Aruna Chandran, MD, MPH and Emily Knapp, PhD of the Johns Hopkins Bloomberg School of Public Health, examines how the body mass index (BMI) trends of school-aged children have changed following the implementation of the 2010 Healthy, Hunger-Free Kids Act (HHFKA). Researchers analyzed height and weight data from over 14,000 children in the ECHO Program and found an overall decrease in BMI following the implementation of the HHFKA. These results suggest a reversal of the pre-implementation trends, which indicated that BMI was increasing from year to year, particularly among adolescents and children from lower-income families. This research, titled “Changes in Body Mass Index Among School-Aged Children Following Implementation of the Healthy, Hunger-Free Kids Act,” is published in JAMA Pediatrics.
“The National School Lunch Program and School Breakfast Program (NSLP) provides free or low-cost meals to over 30 million children annually, providing an estimated 50% of students’ caloric intake each school day,” said Dr. Chandran. “The Healthy, Hunger-Free Kids Act was the first legislation in nearly 3 decades aimed at improving the nutritional quality of breakfast, lunch, and snacks sold at schools.”
Childhood obesity is a serious health concern, affecting nearly 1 in 5 children in America, that has long-term consequences for health and quality of life. While many studies have already shown the success of the HHFKA in improving the quality of school meals, there are still gaps in understanding the effect of this policy on childhood BMI.
For this study, researchers analyzed height and weight measurements collected between January 2005 and March 2020 from children ages 5 to 18 years across 50 ECHO cohorts in the United States. They used these measurements to calculate each child’s BMI, then adjusted those measurements based on the child’s age and sex. Using this data, the researchers compared yearly BMI trends from before and after the implementation of the HHFKA.
The researchers found that increasing BMI trends from the decade before the HHFKA was implemented were reversed after the law was implemented. This effect was also observed in adolescents, who tend to have more autonomy in purchasing their own meals and snacks during the school day but still benefited from HHFKA implementation.
“School meals and snacks represent a key opportunity for intervention to combat the childhood obesity epidemic, given the high rates of participation in school meal programs and the significant proportion of caloric intake that children receive at school,” said Dr. Knapp. “This is particularly important for children in lower-income families, who are more likely to participate in the NSLP and are at higher risk of obesity.”
In the future, researchers should continue to the examine the effects of improving the nutritional quality of school meals on childhood obesity. Results from this study can also help policymakers evaluate future policies related to improving school meals and snacks.