Elementary School Food and Beverage Policies and Childhood Obesity | Journal Scan

Study Questions:

Does the influence of school food and drink policies on student weight differ by neighborhood socioeconomic characteristics?


This was a cross-sectional study conducted from July 2013 to October 2014, which compared the prevalence trends in overweight and obesity before (2001-2005) and after (2006-2010) implementation of food and beverage policies among the public elementary schools in California. Additional factors examined included neighborhood income and education levels. The primary outcomes of interest were prevalence of overweight and obesity defined as a body mass index (BMI) at or greater than the 85th percentile for age and sex.


A total of 2,700,880 5th grade students (33% of students were white, 56.7% Hispanic, 4.7% black, and 5.5% Asian) from 5,362 public schools were included in this study. Rates of overweight/obesity were 43.5% in 2001 and 45.8% in 2010. The prevalence of overweight/obesity was slightly higher each year from 2001 and 2005, and stabilized thereafter. From 2005 to 2010, overweight/obesity prevalence leveled off among students from disadvantaged neighborhoods, but the prevalence declined in more advantaged neighborhoods. The annual percentage decline in the odds of overweight was 1.2% for females (95% confidence interval [CI], 0.4-1.9) and 1.0% for males (95% CI, 0.3-1.8) in highest income neighborhoods. Students in the lowest income neighborhoods had no or near-zero change in improvement of overweight/obesity over time. The annual percentage change in overweight/obesity odds was 0.1% for females (95% CI, −0.7 to 0.9) and −0.3% for males (95% CI, −1.1 to 0.5). Similar results were observed for school neighborhood education.


The investigators concluded that population-level improvements in the prevalence of childhood overweight/obesity were observed, which coincided with the period following implementation of statewide food and beverage policies (2005-2010). However, these improvements differed by the socioeconomic levels of the neighborhoods with the most improvement observed in the most advantaged neighborhoods.


These data support the need for more aggressive interventions, which target neighborhoods with less resources as well as continued evaluation of the effectiveness of policies.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement

Keywords: Beverages, Body Mass Index, Body Weight, Child, Cross-Sectional Studies, Food, Metabolic Syndrome X, Obesity, Overweight, Poverty, Prevalence, Primary Prevention, Socioeconomic Factors, Students

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