Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools

BACKGROUND: Our objective was to evaluate the effects of environmental, policy, and social marketing interventions on physical activity and fat intake of middle school students on campus. DESIGN: Twenty-four middle schools were randomly assigned to intervention or control conditions. Baseline measures were collected in spring 1997, and interventions were conducted during the 1997-1998 and 1998-1999 school years SETTING/PARTICIPATION: The schools had mean enrollments of 1109, with 44.5% nonwhite students.Over 2 years, physical activity interventions were designed to increase physical activity in physical education classes and throughout the school day. Nutrition interventions were designed to provide and market low-fat foods at all school food sources, including cafeteria breakfasts and lunches, a la carte sources, school stores, and bag lunches. School staff and students were engaged in policy change efforts, but there was no classroom health education. MAIN OUTCOMES MEASURES: Primary outcomes were measured by direct observation and existing records. RESULTS: Randomized regression models (N =24 schools) revealed a significant intervention effect for physical activity for the total group (p <0.009) and boys (p <0.001), but not girls (p <0.40). The intervention was not effective for total fat (p <0.91) or saturated fat (p <0.79). Survey data indicated that the interventions reduced reported body mass index for boys (p <0.05). CONCLUSIONS: Environmental and policy interventions were effective in increasing physical activity at school among boys but not girls. The interventions were not effective in reducing fat intake at school. School environmental and policy interventions have the potential to improve health behavior of the student population, but barriers to full implementation need to be better understood and overcome.     

What do middle school children bring in their bag lunches?

BACKGROUND: Limited documentation exists on nutritional characteristics of bag lunches, although about 30% of adolescents take them. This study describes: (a) the prevalence of different types of foods in bag lunches, (b) the number of kilocalories, percentage of kilocalories from fat, amount of total fat, saturated fat, cholesterol, and sugar, and (c) the differences related to gender and grade. METHODS: In 24 middle schools, observations were made on 1,381 bag lunches (about 58 per school) during one semester. RESULTS: The most common bag lunch components were beverages and sandwiches. Fruits were more common than vegetables; non-chip snacks and chips were more common than cookies, candy, and cakes/pies. Bag lunches averaged 596.2 kcal (29.7% from fat), 20.8 g of total fat, 6.2 g of saturated fat, 32.6 mg of cholesterol, and 21.3 g of sugar. Boys' bag lunches had significantly more kilocalories, total fat, saturated fat, cholesterol, and percentage of energy from fat than girls' lunches. Significant grade differences were found only for total fat and cholesterol, with seventh graders bringing more than sixth graders. CONCLUSION: More research on the nutritional quality of foods brought to school in bag lunches is important for gaining a better understanding about how to improve students' nutrition.     

The association of the school food environment with dietary behaviors of young adolescents

OBJECTIVES: We examined the association between young adolescents' dietary behaviors and school vending machines, à la carte programs, and fried potatoes' being served at school lunch. METHODS: Using a cross-sectional study design, we measured à la carte availability and the number of school stores, vending machines, and amounts of fried potatoes served to students at school lunch in 16 schools. Grade 7 students (n = 598) completed 24-hour dietary recall interviews. RESULTS: A la carte availability was inversely associated with fruit and fruit/vegetable consumption and positively associated with total and saturated fat intake. Snack vending machines were negatively correlated with fruit consumption. Fried potatoes' being served at school lunch was positively associated with vegetable and fruit/vegetable intake. CONCLUSIONS: School-based programs that aim to promote healthy eating among youths should target school-level environmental factors.     

Reducing fat and sodium in school lunch programs: the LUNCHPOWER! Intervention Study.

This study developed, implemented, and evaluated a healthful school lunch program that provided tasty food choices that were lower in fat and sodium. The LUNCHPOWER! Intervention Program was implemented in 34 elementary schools in four school districts that represented diverse geographic areas of Minnesota. A team of registered dietitians, foodservice directors, and cook managers reduced the fat and sodium content of school lunches by modifying recipes and food preparation methods and by identifying and selecting vendor products (prepared food products) that were lower in fat and sodium. Nutrition education messages for students and parents were developed for the 5-month intervention. Monthly menus were analyzed for fat, sodium, and energy content before and after the intervention. There was a significant decrease in both total grams of fat and percent of energy from fat between baseline and follow-up. At all 34 schools, mean daily amount of total fat in the lunch menu decreased 39% (from 32 g to 20 g) and percent of energy from fat decreased 29% (from 40% to 28%). We found that schools could serve lower-sodium and lower-fat meals and retain student participation in the school lunch program.     

Competitive Foods in Schools: Availability and Purchasing in Predominately Rural Small and Large High Schools

Objectives

Schools have an important role to play in obesity prevention, but little is known about the food environment in small, predominately rural schools. The primary purpose of this study was to compare the availability and student purchasing of foods sold outside of the reimbursable meals program through à la carte or vending (ie, competitive foods) in small (n=7) and large (n=6) Kansas high schools.

Methods

A cross-sectional observational study design was used to capture the number of à la carte and vending items available and purchased, and the fat and energy content of all available and purchased items on a single school day between January and May 2005.

Results

Small schools had significantly fewer vending machines than large schools (median 3.0 [range 2.0 to 5.0] vs 6.5 [range 4.0 to 8.0], P<0.01]. Vending and à la carte items at small schools contained a median of 2.3 fewer fat grams per item (P≤0.05), whereas vending products contained a median of 25 kcal fewer per item (P≤0.05) than at large schools. Significantly less fat (median −15.4 g/student) and less energy (median −306.8 kcal/student) were purchased per student from all competitive food sources and from à la carte (median −12.9 g fat and −323.3 kcal/student) by students in small schools compared to students in large schools (P≤0.05).

Conclusions

The findings, which highlight less availability and lower energy content from competitive foods at small compared to large schools, have implications for understanding how small schools support their foodservice programs with limited dependence on competitive foods and the influence that food and nutrition professionals can have on school environments by providing more oversight into the nutritional quality of foods available.     

Food environment in secondary schools: a la carte,vending machines,and food policies and practices

OBJECTIVES: This study described the food environment in 20 Minnesota secondary schools. METHODS: Data were collected on school food policies and the availability and nutritional content of foods in school à la carte (ALC) areas and vending machines (VMs). RESULTS: Approximately 36% and 35% of foods in ALC areas and in VMs, respectively, met the lower-fat criterion (< or = 5.5 fat grams/serving). The chips/crackers category constituted the largest share of ALC foods (11.5%). The median number of VMs per school was 12 (4 soft drink, 2 snack, 5 other). Few school food policies were reported. CONCLUSIONS: The availability of healthful foods and beverages in schools as well as school food policies that foster healthful food choices among students needs greater attention.     

Ethnic and Gender Differences in Request For and Use of Low/Non-Fat Foods in Bag Lunches

This study examined ethnic and gender differences in frequency of use and request for low-fat or non-fat foods in bag lunches, while controlling for socioeconomic status. Questionnaires were completed by 1,678 middle school students and their parents (72% response). Ethnic distribution included White (51%), Latino (17%), Asian (11%), Multi-ethnic (11%), and African American (8%). Forty-five percent of students (N = 712, 59% female) brought lunch to school a mean of 3.6 (SD = 1.5) days per week. Boys brought lunch more often (M = 3.8 days/week vs. 3.4, respectively), yet requested less low-fat foods than girls. Whites brought lunches with the most low/non-fat items. Ethnic differences also were found in the use of seven specific bag lunch foods and whether these items were regular or low-fat. Because of ethnic and gender differences, different strategies for reducing fat in bag lunches are needed for different groups.     

Quality of food eaten in English primary schools: school dinners vs packed lunches

OBJECTIVE: To compare the food and nutrient intakes of primary school children eating school dinners and packed lunches. SUBJECTS: Six-hundred and twenty-one 7-year-old children participating in the Avon Longitudinal Study of Parents and Children in South West England. METHODS: Diet was assessed by 3-day unweighed food record. RESULTS: The composition of both types of school meals compared unfavourably with dietary guidelines. Intakes of energy, non-starch polysaccharides (NSP), calcium, iron, folate, retinol equivalents, zinc, copper, magnesium, iodine and riboflavin were too low, and intakes of total and saturated fat were too high. However, children who ate school dinners had higher lunchtime intakes of protein, starch, NSP and most vitamins and minerals and lower intakes of sugar (14.2 and 20.9% of energy in school dinners and packed lunches, respectively, P<0.001) and saturated fat (12.0 and 16.2%, P<0.001). Only around half of the recommended amount of fruit and vegetables was eaten by children having either type of school meal. There were also differences in the whole day's nutrient intake according to school meal type. Children eating packed lunches had lower daily intakes of potassium and zinc, and higher intakes of sugar and saturated fat. Differences in nutrient intake were independent of maternal education. CONCLUSIONS: The food and nutrient content of both school dinners and packed lunches needed improvement. However, the standard of food brought from home by children was, if anything, worse than that served at school. Recent moves to improve school dinners will need to be complemented by education about what constitutes a healthy packed lunch.     

Demographic and financial characteristics of school districts with low and high à la Carte sales in rural Kansas Public Schools

Reducing à la carte items in schools—foods and beverages sold outside the reimbursable meals program—can have important implications for childhood obesity. However, schools are reluctant to reduce à la carte offerings because of the impact these changes could have on revenue. Some foodservice programs operate with limited à la carte sales, but little is known about these programs. This secondary data analysis compared rural and urban/suburban school districts with low and high à la carte sales. Foodservice financial records (2007-2008) were obtained from the Kansas State Department of Education for all public K-12 school districts (n=302). χ² and t tests were used to examine the independent association of variables to à la carte sales. A multivariate model was then constructed of the factors most strongly associated with low à la carte sales. In rural districts with low à la carte sales, lunch prices and participation were higher, lunch costs and à la carte quality were lower, and fewer free/reduced price lunches were served compared to rural districts with high à la carte sales. Lunch price (odds ratio=1.2; 95% confidence interval, 1.1 to 1.4) and free/reduced price lunch participation (odds ratio=3.0; 95% confidence interval, 1.0 to 9.8) remained in the multivariate model predicting low à la carte sales. No differences were found between urban/suburban districts with low and high à la carte sales. Findings highlight important factors to maintaining low à la carte sales. Schools should consider raising lunch prices and increasing meal participation rates as two potential strategies for reducing the sale of à la carte items without compromising foodservice revenue.     

Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches

Background New school meal standards are currently being phased in by the government in an attempt to improve the nutritional composition of school food. However, no standards are applied to packed lunches. The present study aimed to compare the food and nutrient intakes of primary school children eating a school meal with those taking a packed lunch. Methods A sample of 120 children, aged 6–11 years, was observed once at a lunch time and all items consumed were recorded. Nutrient analysis was performed, and differences in nutrient intake between those children consuming packed lunches and school meals were determined. Results Mean energy and protein intakes were similar. The amount of energy provided by starchy carbohydrate was also similar but, compared with school meals, packed lunches provided twice as much energy from sugar (P < 0.001). School meals on average provided more energy from fat (P < 0.001), but intakes of saturated fat were lower in the school meals group (P = 0.021). Packed lunches provided more sodium (P < 0.001), calcium (P < 0.001) and iron (P = 0.016) than the school meals. Very few packed lunches contained vegetables, and fruit intake was particularly low for those having a school meal. Conclusions Children taking a packed lunch to school were consuming approximately double the amount of sugar and 50% more sodium and saturated fat in their midday meal compared with those having a school lunch. However packed lunches were providing children with more calcium, iron and fruit.     

Schoolchildren's Consumption of Competitive Foods and Beverages,Excluding à la Carte*

BACKGROUND: Competitive foods/beverages are those in school vending machines, school stores, snack bars, special sales, and items sold à la carte in the school cafeteria that compete with United States Department of Agriculture (USDA) meal program offerings. Grouping à la carte items with less nutritious items allowed in less regulated venues may obfuscate analysis of the school competitive food environment. Excluding à la carte items from competitive foods, the objectives were to: (1) assess competitive food use by gender, ethnicity, eligibility for free or reduced-price meals, and participation in school meals programs, (2) determine differences between grade levels in energy intakes obtained from food sources, (3) determine the nutrient intake derived from competitive foods for students who consumed them, and (4) determine energy-adjusted differences in 24-hour nutrient intakes of protein, calcium, iron, and other selected nutrients between competitive food consumer and nonconsumers. METHODS: Competitive foods/beverages use, excluding à la carte items, was examined using the third School Nutrition Dietary Assessment Study (SNDA III), a nationally representative sample of 2309 schoolchildren in grades 1 to 12. Mean nutrient intakes were adjusted for energy intake and other covariates, and differences between consumers and nonconsumers of competitive items were determined using analysis of variance and sudaan . RESULTS: Excluding à la carte items, 22% of schoolchildren consumed competitive items in a representative school day and use was highest in high school. Consumers of competitive items other than à la carte had significantly higher mean energy, sugar intakes, and lower sodium, dietary fiber, B vitamins, and iron intakes than nonconsumers. CONCLUSIONS: Use of competitive foods/beverages, excluding à la carte, was detrimental to children's diet quality.     

Fat-sugar see-saw in school lunches: impact of a low fat intervention

PURPOSE: To determine the long-term effects of a low fat intervention on sugar content in school lunches METHODS: We calculated contributions of total sugars, 6 specific sugars, and selected nutrients in National School Lunch Program meals served in 56 former intervention, 20 randomly selected control schools that had participated 3 years before in a low fat intervention, and 12 additional schools from neighboring school districts that had never been exposed to the intervention, whose goal was the lowering of total fat to under 30% of calories and saturated fat to under 10% calories. Analysis of variance adjusted for region was used to compare treatment groups. Pearson partial correlations controlling for the effects of region and treatment group were used to assess the strength of sugar and fat relationships. RESULTS: Three years after the low fat intervention, former intervention, control and unexposed schools lunches were similar in mean total sugars (25% of calories), and "added" sugars (e.g. sucrose, glucose, galactose, and maltose) at 15% of calories; and differed only in their lactose content. As percent of calories from fat or saturated fat in lunches decreased, that from sugars increased. Lunches that met reduced saturated fat goals were significantly higher than those not meeting goals in percent of calories from sugars both in meals as offered (27.6 +/- 0.3% vs. 26.2 +/- 0.3 SE p =.004) and as served (26.5 +/- 0.4 vs. 23.9 +/- 0.4 p =.009). Lunches meeting reduced total fat goals were significantly higher only in percent of calories from sugars as served. Seventy-five percent of total sugar in lunches offered was from chocolate milk, fruit/fruit juices, and white milk. More "added" sugar came from high micronutrient foods, such as fruit, fruit juices, and chocolate milk than from desserts and entrees. CONCLUSIONS: The existence of a fat-sugar "see-saw" makes it important to emphasize substitutions of fat and saturated fat with starches and fiber in school lunches.     

Implementation of low-fat, low-sugar, and portion-controlled nutrition guidelines in competitive food venues of Maine public high schools

BACKGROUND: The prevalence of childhood "overweight" and "at risk for overweight" has become a major public health concern. School food environments can affect key nutritional risk factors, especially in high schools where foods of poor nutrient value are pervasive in à la carte and vending programs. This study examines à la carte and vending programs in Maine public high schools at baseline and following implementation of low-fat (defined as items相似文献   

Impact of portion-size control for school a la carte items: changes in kilocalories and macronutrients purchased by middle school students

We assessed the impact of a pilot middle school a la carte intervention on food and beverage purchases, kilocalories, fat, carbohydrate, and protein sold per student, and nutrient density of the foods sold. A la carte sales were obtained from six middle schools in three states for 1 baseline week and daily during the 6-week intervention. Intervention goals included reducing sizes of sweetened beverages and chips, and increasing the availability of water and reduced-fat/baked chips. Nutrients sold per day were computed and weekly nutrient means per student and per number of items sold were calculated and compared between baseline and week 6. Five schools achieved all goals at 6 weeks. Four schools showed increases in the percentage of kilocalories from protein and decreases in the amount of sweetened beverages sold; five showed substantial increases in water sales. Changes in regular chips varied by school. There were significant changes in energy density of foods sold. School foodservice changes in middle school snack bar/a la carte lines can be implemented and can lead to a reduction in the caloric density of foods purchased.     

Food Environment in Secondary Schools: À La Carte, Vending Machines, and Food Policies and Practices

Objectives. This study described the food environment in 20 Minnesota secondary schools.

Methods. Data were collected on school food policies and the availability and nutritional content of foods in school à la carte (ALC) areas and vending machines (VMs).

Results. Approximately 36% and 35% of foods in ALC areas and in VMs, respectively, met the lower-fat criterion (≤ 5.5 fat grams/serving). The chips/crackers category constituted the largest share of ALC foods (11.5%). The median number of VMs per school was 12 (4 soft drink, 2 snack, 5 other). Few school food policies were reported.

Conclusions. The availability of healthful foods and beverages in schools as well as school food policies that foster healthful food choices among students needs greater attention.

     

Dietary habits of adolescent females

The dietary intakes of 178 females (mean age was 12.8 ± 0.1 (S.E.M.)) were determined through 24‐hour diet recalls in both the fall and spring of one school year. The average subject consumed less than the recommended number of servings of three of the Basic Four food groups. Dietary intake at all meals but lunch, were similar in the fall and spring. Differences in the dietary intake at lunch may have occurred because fewer girls selected National School Lunch Program's Type A lunches in the spring than in the fall. Subjects who did select Type A lunches consumed more servings from the Basic Four groups than those subjects eating a la carte items or sack lunches. Subjects who selected Type A school lunches were significantly younger than those who selected d la carte items. Ninety percent of the subjects snacked at least once during the day. About half of the food consumed during snacks could not be classified as being representative of any of the Basic Four food groups.     

Nutrient intake of children consuming breakfast at school clubs in London

Introduction: Research into the effectiveness of breakfast clubs has most commonly focused on social benefits to the child and school, such as improved attendance at school, punctuality and improved concentration levels in the classroom ( UEA, 2002 ). Limited research has been undertaken to investigate the nutritional value of the breakfast foods on offer, or the nutritional content of foods consumed by the child. The aim of this study was to find out what children eat and drink at school breakfast clubs in London. Method: The sample population consisted of 98 children (39 boys and 59 girls) aged 5–11 years attending four primary schools in London. Data were collected about the food on offer and the pricing of different food items, demographic data about the children attending the school club, qualitative data on food preferences and a weighed food intake on two different occasions for each child. Statistical tests (anova and chi‐squared tests) and nutrient analysis using Comp‐Eat were carried out. Results: The average nutrient content of the breakfast meal consumed was 330 kcal, 12 g protein, 11 g fat and 49 g carbohydrate. Variation was seen between schools. Generally intakes of vitamin C, calcium and sodium were high and intakes of iron were average. anova between schools showed statistically significant results for a number of nutrients – protein, fat, saturated fat, carbohydrate, sugar, calcium and sodium. Boys were consuming statistically significantly more fat, saturated fat and calcium than girls. One in five children did not have a drink at breakfast. Menu options and pricing of food items varied between the schools and it was noted to influence children's food choice and consumption. Mean energy intakes equated to 18% of the estimated average requirement for boys and 20% for girls, with girls consuming more carbohydrate and sugar, and boys consumed more fat and protein. Discussion: The findings suggest that careful planning of menus should be undertaken with cereal‐based options being offered daily and cooked options only occasionally, and that healthier eating messages can be incorporated effectively into school clubs when supported by the whole school approach to healthy eating. Conclusion: Food offered at school breakfast clubs can contribute substantial nutrients to a child's daily intake and therefore a varied menu, and guided food choices, should be developed incorporating healthier nutrient rich options. This work was supported by Brooke Bond working in partnership with the BDA Community Nutrition Group.     

Contextual Factors Are Associated with Diet Quality in Youth with Type 1 Diabetes Mellitus

This study examined differences in diet quality by meal type, location, and time of week in youth with type 1 diabetes mellitus. A sample of youth with type 1 diabetes mellitus (n=252; 48% female) age 8 to 18 years (mean±standard deviation=13.2±2.8 years) with diabetes duration ≥1 year (mean±standard deviation=6.3±3.4 years) completed 3-day diet records. Multilevel linear regression models tested for differences in diet quality indicators by meal type, location, and time of week (weekdays vs weekends). Participants showed greater energy intake and poorer diet quality on weekends relative to weekdays, with lower intake of fruit and vegetables, and higher intake of total and saturated fat. Differences in diet quality were seen across meal types, with higher nutrient density at breakfast and dinner than at lunch and snacks. Participants reported the highest whole-grain and lowest fat intake at breakfast, but higher added sugar than at lunch or dinner. Dinner was characterized by the highest fruit intake, lowest added sugar, and lowest glycemic load, but also the highest sodium intake. The poorest nutrient density and highest added sugar occurred during snacks. Diet quality was poorer for meals consumed away from home than those consumed at home for breakfast, dinner, and snacks. Findings regarding lunch meal location were mixed, with higher nutrient density, lower glycemic load, and less added sugar at home lunches, and lower total fat, saturated fat, and sodium at lunches away from home. Findings indicate impacts of meal type, location, and time of week on diet quality, suggesting targets for nutrition education and behavioral interventions.