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Free School Meals—A Strategy to Reduce Trends in Pediatric Obesity?

March 25, 2024

Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Pediatric obesity is increasing in prevalence in the US, and it has been difficult for healthcare providers and policy-makers to find successful strategies to mitigate or reverse this trend. As obesity disproportionately affects children who are socioeconomically disadvantaged, and because school meals are generally more nutritious than alternative meal sources, universal free school meals (UFMs) represent a potential target for population-level intervention.

The Community Eligibility Provision (CEP) is a federal UFM program that allows eligible schools (based on level of student poverty) to provide free meals to all students, increasing access to free meals and decreasing the stigma of receiving them.

In a study entitled “Universal Free School Meals Policy and Childhood Obesity,” which is being early released in Pediatrics with an accompanying video abstract, Anna Localio, MPH, and colleagues from the University of Washington investigate the effect of CEP enrollment on school-level obesity in California between 2013 and 2019 (10.1542/peds.2023-063749). They collected data from 3,531 CEP-eligible schools. Annual physical fitness test BMI measurements for 5th, 7th, and 9th graders were used to determine baseline obesity prevalence. The authors compared trends in obesity prevalence in schools who adopted CEP to those who qualified for CEP but did not adopt it, by comparing each school’s yearly obesity prevalence to its own baseline obesity prevalence (for CEP schools, baseline was considered the year prior to CEP implementation).

Their findings are notable:

  • At baseline, school obesity prevalence was 25%, comparable to the CDC-reported national pediatric obesity prevalence of 19.7%.
  • Overall obesity prevalence increased over time for both CEP and non-CEP schools.
  • Schools that participated in CEP demonstrated a 0.60 percentage point net reduction in obesity prevalence (2.4% relative reduction in obesity prevalence) after CEP implementation, compared to eligible, non-participating schools.

Readers should note that this study population was 72% Hispanic (which is consistent with other studies of California populations with low incomes). While this is an important population, as both Hispanic ethnicity and low socioeconomic status are associated with increased risk of obesity, further studies are needed to determine if these results are generalizable to other populations.

While the relative reduction in obesity may seem modest, few population-level interventions have been successful in decreasing obesity prevalence.

The need for new strategies to address childhood obesity is reiterated by the fact that both cohorts demonstrated an overall increase in obesity prevalence during the study period, and studies have shown that rates of severe obesity in children from families with low income are continuing to rise. Universal free meals may be a valuable tool to use in conjunction with other interventions to reverse current trends in obesity.

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