Food practices and using food incentives in middle schools associated with overweight students

December 05, 2005

CHICAGO - Schoolwide food practices and policies that allow frequent snacking and consumption of foods and beverages high in calories and low in nutrients throughout the school day, and that permit use of food as incentives and rewards, were associated with higher body mass index in middle school students, according to an article in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"Obesity has become one of the more complex and challenging public health issues of this decade, affecting two thirds of adults and almost one third (30 percent) of children..." according to background information in the article. School environmental factors have been implicated in the rising childhood obesity rates. A la carte and vending programs that sell foods and beverages high in calories and low in nutrients are pervasive in schools, and other school food practices that may contribute to childhood obesity, such as fundraising and student incentives, are also documented.

Martha Y. Kubik, Ph.D., R.N., and colleagues from the University of Minnesota, Minneapolis, examined data from sixteen middle schools and their eighth-grade students (n = 3,088) to investigate the association between body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) in young adolescents and schoolwide food practices. BMI was calculated from students' self-reported height and weight. School administrators were interviewed about food-related school policies and practices, schoolwide food use guidelines and school-based health promotion activities. Based on interview answers, a food practice score was determined for each school, higher scores indicating more practices were allowed.

The researchers found that students' BMI increased ten percent for every additional food practice permitted in their school. Average BMI of the students was 21. Eight percent of students were classified as overweight, while fifteen percent were categorized as being at risk for overweight. The average number of food practices allowed was three (range, 0 - 7). Of the seven food practice scale items, the most prevalent was the use of food as incentive and rewards (69 percent) and in classroom fundraising (56 percent). Thirty-one percent of schools allowed food in the classroom, while 38 percent allowed beverages in the classroom. Nineteen percent of schools allowed beverages in hallways, while 31 percent allowed snacks in the hallway.

"Food choice at school includes more than the foods and beverages offered as a part of school meal programs, a la carte, and in vending machines. Similarly, opportunities for eating during the school day extend well beyond the school lunchroom and breakfast and lunch," the authors write. "Adolescence is a critical period for the development of obesity that persists into adulthood....School nutrition policies that consistently promote and support healthy dietary practices among young adolescents are urgently needed," they conclude. (Arch Pediatr Adolesc Med. 2005; 159: 1111 - 1114. Available pre-embargo to the media at
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