The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children☆

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Abstract

Objective

The objective of this study is to assess population-level trends in children's dietary intake and weight status before and after the implementation of a provincial school nutrition policy in the province of Nova Scotia, Canada.

Method

Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population-level study with grade 5 students in 2003 (n = 5215) and 2011 (5508), prior to and following implementation of the policy. We applied random effects regression methods to assess the effect of the policy on dietary and health outcomes.

Results

In 2011, students reported consuming more milk products, while there was no difference in mean consumption of vegetables and fruits in adjusted models. Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption. Despite significant temporal decreases in dietary energy intake and increases in diet quality, prevalence rates of overweight and obesity continued to increase.

Conclusion

This population-level intervention research suggests a positive influence of school nutrition policies on diet quality, energy intake and healthy beverage consumption, and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity.

Highlights

•

Study provides “real world” evidence on the role of school nutrition policies (SNP).
•

SNP implementation led to decreased intake of sugar-sweetened beverages (SSB).
•

SNP implementation led to improved dietary intake and reduction in energy in sample.

Related collections

Most cited references 40

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A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water.

Tracy Burrows, Rebecca J. Martin, Clare Collins (2010)

Measuring dietary intake in children enables the assessment of nutritional adequacy of individuals and groups and can provide information about nutrients, including energy, food, and eating habits. The aim of this review was to determine which dietary assessment method(s) provide a valid and accurate estimate of energy intake by comparison with the gold standard measure, doubly labeled water (DLW). English-language articles published between 1973 and 2009 and available from common nutrition databases were retrieved. Studies were included if the subjects were children birth to age 18 years and used the DLW technique to validate reported energy intake by any other dietary assessment method. The review identified 15 cross-sectional studies, with a variety of comparative dietary assessment methods. These included a total of 664 children, with the majority having <30 participants. The majority of dietary assessment method validation studies indicated a degree of misreporting, with only eight studies identifying this to a significant level (P<0.05) compared to DLW estimated energy intake. Under-reporting by food records varied from 19% to 41% (n=5 studies) with over-reporting most often associated with 24-hour recalls (7% to 11%, n=4), diet history (9% to 14%, n=3), and food frequency questionnaires (2% to 59%, n=2). This review suggested that the 24-hour multiple pass recall conducted over at least a 3-day period that includes weekdays and weekend days and uses parents as proxy reporters is the most accurate method to estimate total energy intake in children aged 4 to 11 years, compared to total energy expenditure measured by DLW. Weighed food records provided the best estimate for younger children aged 0.5 to 4 years, whereas the diet history provided better estimates for adolescents aged≥16 years. Further research is needed in this area to substantiate findings and improve estimates of total energy expenditure in children and adolescents. Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

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Health-enhancing physical activity and sedentary behaviour in children and adolescents.

Stuart J H Biddle, Trish Gorely, David J Stensel (2004)

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.

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A policy-based school intervention to prevent overweight and obesity.

Sandy Sherman, Shiriki Kumanyika, Kelley Borradaile … (2008)

The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity. The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (> 95.0th percentile) among children in grades 4 through 6 over a 2-year period. Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with > or = 50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach. The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years. A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.

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Author and article information

Journal

Journal ID (nlm-ta): Prev Med

Journal ID (iso-abbrev): Prev Med

Title: Preventive Medicine

Publisher: Academic Press

ISSN (Print): 0091-7435

ISSN (Electronic): 1096-0260

Publication date PMC-release: 1 December 2013

Publication date (Print): December 2013

Volume: 57

Issue: 6

Pages: 934-940

Affiliations

[a ]University of Alberta, School of Public Health, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta T6G 2T4, Canada

[b ]Dalhousie University, School of Health and Human Performance, 1318 Robie Street, PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada

[c ]IWK Health Centre, Perinatal Epidemiology Research Unit, Halifax, Nova Scotia, Canada

[d ]MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK

Author notes

[* ]Corresponding author at: Dalhousie University, School of Health and Human Performance, 1318 Robie Street, PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada. Sara.Kirk@ 123456dal.ca

Article

Publisher ID: S0091-7435(13)00268-5

DOI: 10.1016/j.ypmed.2013.07.016

PMC ID: 3842499

PubMed ID: 23891787

SO-VID: cdfa63a1-ec9d-429e-bc4f-b8a315128bbb

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