Is Childhood Obesity Related to Participation in School Meals?

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DESCRIPTION (provided by applicant): Because many obese individuals are served by food assistance programs, there is concern that participation in these programs may be related to obesity. An Expert Panel convened in 03/2004 found no consistent evidence of a relationship between childhood obesity and participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP). Approaches recommended by that Panel to further investigate this relationship include 1) use natural opportunities for controlled trials; 2) add weight, height, and program participation to existing studies; 3) initiate smaller studies with specific populations; and 4) use existing data sets. Data for approaches 2, 3, and 4 are available from R01 HL074358 for which data collection has ended with 4th-grade children during 2 school years from a total of 18 schools in 1 district. R01 HL074358 (08/2003 - 07/2008) is a methodological validation study to investigate the relationship of dietary reporting accuracy to manipulation of target period and interview time; observations of SBP and NSLP meals were used to validate these meals in children's 24-hour recalls. After funding began, NHLBI approved the addition of weight/height measures for each child (n=1,264 due to over-recruitment which allowed random selection for observations and/or interviews), but no additional funding was provided for these measures (or these secondary analyses proposed). On consent forms, parental permission was obtained for the district to release to us administrative records about children's daily SBP and NSLP participation (i.e., obtained meal at school) on 180 possible days during 4th grade. The specific aim of this 2-year project is to use existing data from 1,264 4th-grade children from R01 HL074358 to provide cost-efficient preliminary evidence concerning a possible relationship between daily SBP and NSLP participation and childhood obesity. For a subset of 579 children, we will also investigate observed energy intake at school meals. The 5 research questions (RQs) are: RQ1 - What is the relationship between age/sex body mass index (BMI) percentile and daily SBP and NSLP participation during 4th grade? Does this differ for (a) SBP and NSLP participation separately versus combined, (b) sex, (c) breakfast location, and (d) school year? RQ2 - For a subset of children, what is the relationship between age/sex BMI percentile and observed energy intake at school meals? Does this differ for (a) breakfast and lunch separately versus combined, (b) sex, (c) breakfast location, and (d) school year? RQ3 - For a subset of children, what is the effect on RQ1 when observed energy intake at school meals is included in the analyses? RQ4 - To what extent do SBP and/or NSLP participation during 4th grade vary by (a) sex, (b) weekday, (c) month, and (d) school year? RQ5 - What is the effect on RQ1, RQ3, and RQ4a when SBP and/or NSLP participation is based on (a) daily administrative records, (b) parental responses on consent forms and (c) nametag records (for 10 to 29 days)? Results will inform the design of future controlled trials and/or cohort studies to understand pathways to obesity among children who participate in the SBP and NSLP. PUBLIC HEALTH RELEVANCE: There is concern that participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP) may be related to childhood obesity, but previous research has been unable to provide evidence of a consistent relationship. The secondary analyses in this project are a cost-efficient and prudent next step because results will add new knowledge and inform the design of future controlled trials and/or cohort studies aimed at understanding pathways to obesity among children who participate in SBP and NSLP. Features of our existing dataset that uniquely position us to examine this possible relationship include daily SBP and NSLP participation on 180 possible school days for each of 1,264 children; observed energy intake at school meals for a subset of 579 children (and with acceptable results from inter-observer reliability); avoidance of parental and/or children's reports of children's SBP and NSLP participation and/or children's dietary intake; and weight and height measurements for 1,264 children (and with acceptable results from inter-measurer reliability).