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

JAMA Pediatr. 2014 Mar;168(3):279-86. 
Authors: Chriqui JF, Pickel M, Story M.

Importance: The US Department of Agriculture recently issued an interim final rule governing the sale of food and beverages sold outside of the school meal programs ("competitive food 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 food and ebereage (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.

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