Publication year
2017
Citation Title
The effect of state competitive food and beverage regulations on childhood overweight and obesity.
Journal Name
Journal of Adolescent Health
Journal Volume
60
Issue Number
5
Page Numbers
520-527
DOI
10.1016/j.jadohealth.2016.09.003
Summary
Self-reported data from dependent children of Army Service members were used to examine the association between Body Mass Index (BMI), the odds of being overweight or obese, dietary outcomes, and state competitive food and beverages (CF&B) policies. Having any policy (i.e., weak or strong) was associated with lower BMI, odds of being overweight or obese, and better dietary choices for children of Army Service members compared to having no policy.
Key Findings
States that had seven or more policies, or at least two strong policies, had children with significantly lower BMIs and lower odds of being overweight or obese than states with five or fewer policies and no strong policies.
Having a weak policy regarding whole foods or either a weak or strong policy regulating fundraisers was associated with lower BMI compared to states with no policy.
Having a strong policy regarding vending compliance or fundraiser regulation was associated with lower odds of being overweight or obese compared to no policy. Compared to having no policy, having weak policies related to nutritional information, access to free drinking water, and vending regulations were associated with lower odds of being obese or overweight.
Policies regarding school stores and vending machines were associated with lower consumption of salty and sweet snacks and higher consumption of fruit.
Implications for Program Leaders
Provide education to Service members and their families regarding the importance of nutrition and making healthy food choices
Offer cooking classes to military families that teach healthy cooking skills
Promote the use of installation-based programs and resources that encourage physical activity for military youth
Implications for Policy Makers
Provide support for programs that teach military families about the importance of nutrition and/or offer healthy cooking classes
Develop and support installation-based physical activity programs for military children to promote exercise and reduce the risk of obesity among military youth
Encourage collaboration between DoD and community-based programs that provide activity-based programs for military families
Methods
Online survey data were collected during the Military Teenagers Environment Exercise and Nutrition Study.
Army personnel records were used to recruit families with children between the ages of 12-13 years located at 12 major Army installations.
State policy information was obtained from the Bridging the Gap State Wellness Policy Database.
Policies were coded as "weak" if they used vague terms, suggestions, and recommendations or allowed exceptions to following the policies; policies were coded as "strong" if they provided specific requirements and implementation guidelines.
Participants
A total of 894 children of Army Service members and one of their parents completed the online survey between spring 2013 and winter 2013-2014.
Forty percent of the sample was White, almost 47% of the sample were female, and the average age was 13 years.
A little over 40% of the military families lived on base.
Limitations
The sample was only comprised of children of Army Service members and therefore results may not generalize to the broader child population. Further, the findings may not extend to other military branches with installations located in different states than those included in this study.
Only state CF&B policies were examined; however, co-occurring state policies or other factors could have accounted for or influenced the results.
Children were only asked to report their dietary choices for the previous seven days which may not accurately assess their overall dietary choices.
Avenues for Future Research
Examine how state-level CF&B policies impact behavioral health outcomes in military children
Explore whether there are specific programs or policies within the military that address childhood obesity
Examine how well schools implement and follow the state CF&B policies
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
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. 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. 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. A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity.
Abstract Document
PRTW Document
Attach