The Effect of State Competitive Food and Beverage Regulations on Childhood Overweight and Obesity

Published in: Journal of Adolescent Health, [Epub November 2016]. doi:10.1016/j.jadohealth.2016.09.003

Posted on RAND.org on April 04, 2017

by Ashlesha Datar, Nancy Nicosia

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Research Question

  1. Are children more likely to have healthier weight and dietary behaviors in states with policies that restrict foods and beverages sold outside the school lunch program?

Purpose

Policy efforts for combating childhood obesity have sought stronger state policies for regulating competitive foods and beverages (CF&Bs) available in schools. However, the evidence linking state policies to children's overall diet and body weight outcomes is limited and mixed, and experts have called for more rigorous studies that are able to address concerns about selection bias. The present study leverages a rare natural experiment where children in military families are "assigned" to different state policies, due to their military parent's periodic relocation, to examine whether state CF&B policies were associated with children's body mass index (BMI) and overweight or obesity.

Methods

We analyzed data from 894 children (12–13 years old) in army families attending public schools located near 25 installations across 23 states in 2013. State CF&B policy measures from the Bridging the Gap project were linked to the child data. Primary outcomes included BMI z-scores and indicator for overweight or obesity. For a subsample of children with self-reported food frequency measures, we also examined the link between state CF&B policies and overall diet. All regression analyses adjusted for a rich set of child and family covariates.

Results

Having strong or weak policies was significantly associated with lower BMI z-scores, lower odds of overweight or obesity, and better dietary outcomes, relative to no policy.

Conclusions

A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity.

Key Findings

  • State policies—strong or weak—that regulate competitive foods and beverages (i.e., those sold outside the school lunch program) were associated with better body weight and dietary practices among students.
  • Children living in states with several policies on competitive foods and beverages had significantly lower BMI (body mass index) and odds of being overweight or obese.
  • Regulations significantly associated with better outcomes include those addressing fundraisers and vending machines, availability of whole foods, nutritional information for competitive food, and access to free drinking water outside meal time.
  • Policies were more likely to lower the odds of being overweight or obese than to reduce BMI.

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