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JAMA Pediatr. 2014 Mar;168(3):279-86. doi: 10.1001/jamapediatrics.2013.4457.

Influence of school competitive food and beverage policies on obesity, consumption, and availability: a systematic review.

Author information

1
Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago.
2
Duke Global Health Institute, Duke University, Durham, North Carolina.

Abstract

IMPORTANCE:

The US Department of Agriculture recently issued an interim final rule governing the sale of foods and beverages sold outside of the school meal programs ("competitive foods and beverages" [CF&Bs]).

OBJECTIVE:

To examine the potential influence that the federal rule may have based on peer-reviewed published studies examining the relationship between state laws and/or school district policies and student body mass index (BMI) and weight outcomes, consumption, and availability of CF&Bs.

EVIDENCE REVIEW:

Keyword searches of peer-reviewed literature published between January 2005 and March 2013 were conducted using multiple databases. Titles and abstracts for 1160 nonduplicate articles were reviewed, with a full review conducted on 64 of those articles to determine their relevancy. Qualitative studies, studies of self-reported policies, or studies examining broad policies without a specific CF&B element were excluded.

FINDINGS:

Twenty-four studies were selected for inclusion. Studies focused on state laws (n = 14), district policies (n = 8), or both (n = 2), with the majority of studies (n = 18) examining foods and beverages (as opposed to food-only or beverage-only policies). Sixteen studies examined prepolicy/postpolicy changes, and 8 studies examined postpolicy changes. Study designs were cross-sectional (n = 20), longitudinal (n = 3), or a combination (n = 1). Outcomes examined included change in BMI, weight, probability of overweight or obesity (n = 4), consumption (n = 10), and availability (n = 13); 3 studies examined more than 1 outcome. The majority of studies primarily reported results in the expected direction (n = 15), with the remaining studies (n = 9) reporting primarily mixed or nonsignificant results.

CONCLUSIONS AND RELEVANCE:

In most cases, CF&B policies are associated with changes in consumption and/or availability in the expected direction; however, caution should be exercised, given that nearly all were cross-sectional. The influence of such policies on overall student consumption and BMI and weight outcomes was mixed. The findings hold promise for the likely influence of federal CF&B regulations on changes in student in-school consumption and in-school competitive food availability. Further research is needed to truly understand the association between these policies and overall consumption and weight outcomes.

[Indexed for MEDLINE]

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