California state school nutrition policies and federal policies for school meals have mixed impacts on childhood obesity in children of Pacific Islander (PI), Filipino (FI) and American Indian/Alaska native (AIAN) origins, according to a new study published this week in the open access journal PLOS Medicine by Mika Matsuzaki of Johns Hopkins Bloomberg School of Public Health, USA, and colleagues.
Children of PI, FI and AIAN origin are some of the most understudied subgroups experiencing high rates of overweight/obesity. California has enacted policies on foods and beverages available in schools through a series of standards beginning in 2004, and federal policies in 2010 also sought to improve school nutrition standards. In the new study, researchers used data on demographics, body composition and fitness that were collected by the California Department of Education on students in 5th and 7th grade each year between 2002 and 2016 as part of the state Physical Fitness Testing program.
Overall, the prevalence of overweight/obesity was higher among PI (39.5-52.5%), FI (32.9-36.7%), and AIAN (37.7-45.6%) children in comparison to White (26.8-30.2%) students. During the baseline period of the study, the overweight/obesity prevalence increased among nearly all students, with the steepest increases for PI and AIAN students. After California state policies went into effect, from 2002 to 2004, the overweight/obesity rates decreased for almost all groups, with the largest fall seen among PI girls in 5th grade (before: log odds ratio = 0.149 (95%CI 0.108 to 0.189; p<0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the California and federal nutrition policies were in effect, after 2010, additional declines in the overweight/obesity prevalence were seen among White and FI students but not for PI or AIAN students. As the study was only conducted in California, without a comparison group unaffected by the policies, the researchers could not establish that all changes in prevalence of overweight/obesity were solely attributable to the policies.
"There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers," the authors say. "Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations."
Peer reviewed; Observational study; Humans
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Funding: The study was supported by the Robert Wood Johnson Foundation (https://www.rwjf.org/ 74375, ESV), the National Heart, Lung, and Blood Institute of the National Institutes of Health (https://www.nhlbi.nih.gov/ K01HL115471 and 1R01HL136718, ESV; and R01-HL131610 and P01ES022844 BNS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Matsuzaki M, Sánchez BN, Rebanal RD, Gittelsohn J, Sanchez-Vaznaugh EV (2021) California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis. PLoS Med 18(5): e1003596. https://doi.org/10.1371/journal.pmed.1003596