Can Eating Food Offered by Schools Have a Positive Influence on Nutritional Status of Children? An Example from Brazil
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Can Eating Food Offered by Schools Have a
Positive Influence on Nutritional Status of
Children? An Example from Brazil
Daniel H. Bandoni, PhD
Daniela S. Canella, PhD
Objective: Considering that the school environment can impact food consumption and
children’s weight, our aim was to evaluate the relationship between the origin of foods consumed
at school and children’s nutritional status. Methods: We used data from the nationally representa-
tive Brazilian Household Budget Survey of children under 10 years old. The relationship between
consumption of foods at school and its origin (offered by the school; taken from home; bought at
the canteens) and nutritional status were evaluated using linear (BMI-for-age) and logistic (excess
weight and obesity) regression models stratified by type of school (private or public). Results: A
total of 95.5% of children referred consumption of food at school, independent of its origin, and
28.0% had excess weight and 10.2% had obesity. In private schools, 70.7% of children ate food
taken from home, whereas in public schools, 90.6% of children ate food offered by the school
through a school food service program. According to adjusted analyses related to public schools,
consuming food offered by the school decreased BMI-for-age and the odds of having obesity. No
differences were verified among children from private schools. Conclusion: Eating food offered by
public schools seems to be better for Brazilian children’s nutritional status.
Key words: school health; food consumption; body mass index (BMI); child nutritional status; child health; health policy
Health Behav Policy Rev.™ 2021;8(3):202-211
DOI: https://doi.org/10.14485/HBPR.8.3.2
U
nhealthy dietary behaviors and obesity canteens or grocery stores near school and body
among children and adolescents constitute weight.9-12
one the most pressing public health points School food services programs that offer free or
in the world, given their high prevalence and as- subsidized meals in the school environment can
sociation with other negative health outcomes.1 In improve access to healthier food and show a posi-
this context, the school environment has been con- tive effect on diet quality, energy intake, and micro-
sidered strategic for promoting health and healthy nutrient status of school-aged children.13,14 These
eating by international organizations.2-4 Further- programs are, generally, funded and operated on a
more, there is evidence related to the importance large scale by government agencies. However, the
of the school environment in food consumption impact of school context and school food service
among children and adolescents.5-8 Studies show programs on body weight has been unclear.15,16
that having canteens, other outlets, and grocery In Brazil, the scenario concerning food at school
stores inside or near schools is associated with is different for public and private schools. Public
poorer diet quality among students, resulting in schools have a nutrition policy for school food ser-
higher consumption of soft drinks and fast foods. vices – Brazilian School Feeding Program (BSFP)
However, few studies find consistent relationships – which has been established to promote healthier
between consumption of food provided by school dietary habits in students. The BSFP offers free
Daniel H. Bandoni, Professor, Institute of Health and Society, Federal University of São Paulo, São Paulo, Brazil. Daniela S. Canella, Professor,
Institute of Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Correspondence Dr Canella; daniela.canella@uerj.br
202Bandoni & Canella
Table 1
Characterization of the Population Studied. Brazil, 2008-2009
Private school Public school
Brazil
N = 3761; 20.5% N = 16,496; 79.5%
Characteristics Percent Percent Percent
Sex
Male 51.2 49.6 51.6
Female 48.8 50.4 48.4
Age (years)
0-2 4.2 8.4 3.1
3-5 28.5 41.5 25.2
6 - 10 67.3 50.1 71.7
Race a
Mixed race 48.7 36.5 51.8
White 44.3 58.1 40.7
Black 6.3 4.8 6.7
Indigenous 0.4 1.9 5.1
Asian 0.3 0.4 0.2
Course (grade)
Daycare, preschool or literacy class 38.1 53.0 34.3
Elementary school 61.9 47.0 65.7
Region
North 9.4 6.6 10.2
Northeast 32.2 37.3 30.9
Southeast 38.2 37.7 38.4
South 13.2 11.6 13.6
Mid-West 7.0 6.8 7.0
Area
Urban 81.9 96.6 78.1
Rural 18.1 3.4 21.9
Consumption of food at school
Yes 95.5 94.8 95.7
Excess weight b
Yes 28.0 37.3 25.6
Obesity b
Yes 10.2 14.0 9.2
Note.
a
N = 20,242; b N = 20,153
meals to all students (pre-school through high food and to encourage the purchase of food from
school) enrolled in public schools, assisting over family farmers.18,19 On the other hand, there is not
40 million children and adolescents in the coun- any general regulation for private schools, and it is
try.17 Since the early 2000s, BSFP develops a series common for the school canteens or and the home
of regulations to promote the availability of fresh to be sources for food.20
Health Behav Policy Rev.TM 2021;8(3):202-211 DOI: https://doi.org/10.14485/HBPR.8.3.2 203Can Eating Food Offered by Schools Have a Positive Influence on Nutritional Status of Children? An Example from Brazil
Table 2
Distribution of the Origin of Food Usually Consumed at Private and Public Schools,
According to Sociodemographic Variables and Nutritional Status. Brazil, 2008-2009
Origin of food usually consumed at school
Private school Public school
Characteristics Taken from Offered or sold Bought at Taken from Offered by Bought at
home by the school the canteen home the school the canteen
Percent Percent Percent Percent Percent Percent
(95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI)
Sex
68.6 20.2 11.2 8.0 90.9 1.1
Male
(64.8; 72.2) (17.0; 23.8) (8.9; 14.0) (7.1; 9.1) (89.8; 91.8) (0.8; 1.4)
72.8 19.3 7.9 8.5 90.3 1.2
Female
(69.4; 75.9) (16.5; 22.6) (6.5; 9.5) (7.5; 9.6) (89.1; 91.4) (0.9; 1.6)
Age (years)
52.0 45.6 2.4 3.1 96.5 0.3
0-2
(43.2; 60.8) (36.9; 54.5) (1.1; 5.3) (1.8; 5.5) (94.0; 98;0) (0.0; 2.4)
73.0 23.3 3.7 8.1 91.5 0.5
3-5
(69.0; 76.7) (19.7; 27.3) (2.7; 5.2) (6.9; 9.5) (90.0; 92.7) (0.2; 1.0)
72.1 12.3 15.6 8.6 90.0 1.4
6-10
(68.7; 75.2) (10.2; 14.8) (13.0; 18.6) (7.7; 9.5) (89.0; 91.0) (1.1; 1.8)
Race
73.9 18.0 8.1 7.0 92.0 1.0
Mixed race
(70.0; 77.4) (14.7; 21.9) (6.5; 10.1) (6.1; 8.0) (91.0; 93.0) (0.7; 1.2)
70.5 21.1 10.3 9.7 88.8 1.5
White
(57.6; 80.8) (18.1; 24.5) (8.2; 12.9) (8.6; 11.0) (87.4; 90.0) (1.1; 2.1)
70.5 19.3 10.2 8.8 90.4 0.8
Black
(57.6; 80.8) (10.9; 31.7) (4.6; 21.4) (6.1; 12.5) (86.6; 93.2) (0.3; 2.3)
78.0 ( 3.1 18.9 4.0 96.0
Indigenous 0.0
43.5; 94.2) (3.9; 20.9) (4.3; 54.7) (1.3; 11.8) (88.2; 98.7)
87.9 2.9 9.2 18.5 81.0 0.5
Asian
(69,8; 95,8) (0.4; 18.9) (2.9; 25.9) (4.5; 52.4) (47.7; 95.2) (0.1; 4.0)
Course (grade)
Daycare, preschool or 70.5 26.0 3.5 7.9 91.6 0.5
literacy class (66.8; 73.9) (22.6; 30.0) (2.8; 4.8) (6.8; 9.0) (90.4; 92.7) (0.3; 0.9)
71.1 12.5 16.5 8.5 90.0 1.5
Elementary school
(67.5; 74.4) (10.2; 15.2) (13.7; 19.6) (7.6; 9.5) (89.0; 91.0) (1.2; 1.9)
Region
68.0 13.9 18.0 4.5 92.7 2.8
North
(61.9; 73.6) (10.7; 17.9) (13.8; 23.3) (3.4; 5.9) (90.9; 94.1) (2.0; 3.9)
83.1 7.0 9.8 9.6 89.6 0.8
Northeast
(80.4; 85.5) (5.4; 9.1) (8.1; 11.9) (8.3; 11.1) (88.1; 91.0) (0.5; 1.1)
65.3 27.3 7.3 9.1 89.9 1.0
Southeast
(59.4; 70;8) (22.1; 33.4) (4.6; 11.5) (7.6; 10.9) (88.0; 91.5) (0.6; 1.7)
47.7 43.4 8.9 7.1 91.7 1.3
South
(40.2; 55.3) (36.0; 51.0) (5.7; 13.7) (5.7; 8.8) (89.9; 93.2) (0.8; 2.0)
71.9 16.3 11.8 5.5 93.7 0.9
Mid-West
(66.4; 76;8) (12.6; 20.9) (8.6; 16.0) (4.2; 7.1) (92.0; 95.0) (0.6; 1.3)
Cont on next page
204Bandoni & Canella
Table 2 (cont)
Distribution of the Origin of Food Usually Consumed at Private and Public Schools,
According to Sociodemographic Variables and Nutritional Status. Brazil, 2008-2009
Origin of food usually consumed at school
Private school Public school
Characteristics Taken from Offered or sold Bought at Taken from Offered by Bought at
home by the school the canteen home the school the canteen
Percent Percent Percent Percent Percent Percent
(95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI)
Area
71.2 19.4 9.4 9.5 89.2 1.3
Urban
(68.5; 73;7) (17.0; 22.0) (7.9; 11.2) (8.6; 10.4) (88.2; 90.2) (1.1; 1.7)
58.2 30.3 11.6 4.0 95.5 0.5
Rural
(47.5; 68.2) (22.3; 39.5) (6.7; 19.1) (2.8; 5.7) (93.7; 96.8) (0.3; 0.8)
Excess weight
70.7 19.1 10.2 7.8 91.1 1.0
No
(67.7; 73.5) (16.5; 22.1) (8.4; 12.4) (7.0; 8.7) (90.2; 92.0) (0.8; 1.3)
71.1 20.4 8.6 9.5 89.0 1.5
Yes
(66.4; 75.3) (16.5; 24.9) (6.5; 11.3) (8.0; 11.2) (87.2; 90.6) (1.0; 2.2)
Obesity
70.8 19.1 10.1 8.0 90.8 1.2
No
(68.0; 73.4) (16.8; 21.7) (8.4; 12.0) (7.3; 8.9) (89.9; 91.6) (0.9; 1.5)
71.1 22.2 6.7 10.7 88.3 1.0
Yes
(63.9; 77.3) (16.2; 29.7) (4.6; 9.8) (8.2; 13.7) (85.1; 90.9) (0.5; 2.0)
70.7 19.8 9.5 8.3 90.6 1.1
Brazil
(68.1; 73.2) (17.5; 22.3) (8.1; 11.2) (7.5; 9.1) (89.7; 91.4) (0.9; 1.4)
The importance of the food school environment, de Geografia e Estatística – IBGE), between May
notwithstanding, most studies have been carried 2008 and May 2009. The analyses presented in this
out in the United States and in some European study were conducted in 2020.
countries; there have not been studies that have HBS is nationally representative and involved
compared the nutritional status of students who a probabilistic sample of 55,970 Brazilian house-
consume food from school food service programs holds, covering 5 macro-regions and urban and ru-
versus food bought in canteens versus food brought ral areas. The survey was based on a complex sample
from home. Therefore, the aim of this study was plan using 2-stage cluster sampling, with a random
to evaluate the relationship between the referred selection of census tracts during the first stage and
origin of foods consumed at school (taken from of households in the second stage. The selection of
home, from school canteens and offered by schools census tracts was preceded by an examination of
– by the Brazilian School Feeding Program in the the tracts of the Master Sample of Household Sur-
case of public schools) and the nutritional status of veys or Common Sample (containing the pool of
Brazilian children. the 12,800 tracts of the country) to obtain strata
of households with high geographic and socioeco-
METHODS nomic homogeneity.21
Characteristics of the Study
We used data from the Brazilian Household Bud- Variables of Study
get Survey (HBS) conducted by the Brazilian Insti- The main information of the HBS used in this
tute of Geography and Statistics (Instituto Brasileiro study referred to the consumption of foods at pri-
Health Behav Policy Rev.TM 2021;8(3):202-211 DOI: https://doi.org/10.14485/HBPR.8.3.2 205Can Eating Food Offered by Schools Have a Positive Influence on Nutritional Status of Children? An Example from Brazil
Table 3
Results of Linear Regression for the Relationship of the Origin of Food Usually Consumed
at Private and Public Schools and BMI-for-Age (z-score), Brazil, 2008-2009
Crude model Adjusted modela
Origin of food consumed at school
Coefficient 95% CI Coefficient 95% CI
Private school
Taken from home Ref. Ref.
Offered by the school 0.13 -0.07; 0.32 0.14 -0.07; 0.34
Bought at the canteen 0.12 -0.08; 0.32 0.10 -0.11; 0.30
Public school
Taken from home Ref. Ref.
Offered by the school -0.20 -0.34; -0.06 -0.17 -0.30; -0.03
Bought at the canteen 0.16 -0.12;0.44 0.17 -0.10; 0.44
Note.
a
Model adjusted by region, area, age, sex, race/color, course (grade) and per capita household income.
vate and public schools and the origin of food usu- eters with a 200 cm-long retractable tape measure,
ally consumed (offered by the school, taken from accurate to the nearest 0.1 cm.
home, bought at the canteen, and other sources, These values were used to calculated BMI-for-age,
which were grouped with canteens) for students expressed in z-scores, and to classify the nutritional
during the period of permanence in school. This status of children, following the recommendations
issue was restricted to individuals under 10 years proposed by the World Health Organization. Con-
old who attended school at the time of the research sidering these recommendations, individuals were
(N = 20,257). Additionally, the following variables classified as excess weight (overweight and obesity)
were used to characterize the population: type of when presented +2 z-score for children under 5
school (private or public), sex, age (grouped in 0-2 years or +1 z-score for children between 5 to 10
years old, 3-5 years old and 6-10 years old for de- years, and obesity when presented +3 z-score for
scriptive analyses), race/color (mixed race, white, children under 5 years or +2 z-score for children
black, indigenous, Asian), course (grade) (daycare/ between 5 to 10 years.22,23
preschool/literacy class or elementary school), re-
gion (North, Northeast, Southeast, South, Mid- Data Analysis
west), area (urban or rural), per capita household The proportion of children that consumed food
income and nutritional status. at school and distribution of the origin of food con-
To evaluate the nutritional status of children we sumed (offered by the school, taken from home,
used data of weight and height measured by trained bought at the canteen), and its 95% confidence
researchers using standard technique. Weight, ex- interval (95% CI), was calculated stratified by the
pressed in kilograms (kg), was collected using por- type of schools (private or public) and described
table electronic scales with a maximum capacity of according to the sociodemographic variables and
150 kilograms (kg), and graduations of 100 grams nutritional status.
(g). Height was expressed in centimeters (cm) us- Crude and adjusted linear regression models
ing recumbent length as the measure in children stratified by the type of school were used to evalu-
aged between zero and 23 months and stature in ate the relationship between BMI-for-age (out-
individuals aged 24 months or older. Length was come) and the origin of food consumed at school.
measured using infant anthropometers with a ca- Additionally, crude and adjusted logistic regression
pacity of up to 105 cm and a scale in millimeters, models also stratified by the type of school were
and stature was measured using portable stadiom- used to the relationship between excess weight
206Bandoni & Canella
Table 4
Results of Logistic Regression for the Relationship of the Origin of Food Usually Consumed
at Private and Public Schools and Excess Weight and Obesity. Brazil, 2008-2009
Excess weight Obesity
Origin of food consumed at Crude model Adjusted model1 Crude model Adjusted modela
school OR 95% CI OR 95% CI OR 95% CI OR 95% CI
Private school
Taken from home Ref. Ref. Ref. Ref.
Offered by the school 1.06 0.77; 1,44 1.03 0.73; 1.44 1.16 0.77; 1.74 1.03 0.68; 1.55
Bought at the canteen 0.83 0.58; 1.20 0.91 0.63; 1.31 0.66 0,42; 1.05 0.87 0.53; 1.41
Public school
Taken from home Ref. Ref.
Offered by the school 0.80 0.66; 0.98 0.83 0.67; 1.01 0.73 0.54; 0,98 0.72 0.53; 0.97
Bought at the canteen 1.20 0.76; 1.89 1.30 0.83; 2.04 0.68 0.32; 1.42 0.76 0.36; 1.63
Note.
a
Model adjusted by region, area, age, sex, race/color, course (grade) and per capita household income.
and obesity (outcomes) and the origin of food in private and public schools for all sociodemo-
consumed at school. Sociodemographic variables graphic variables, despite some differences in pri-
included in the adjusted model were region, area, vate schools for the proportion of food offered by
age, sex, race/color, course (grade), and per capita the school and bought at the canteen among aged
household income. 6 to 10 (12.3% vs 15.6%), elementary school
All analyses were carried out using the statistics (12.5% vs 16.5%), from the North (13.9% vs
package Stata/SE version 14.2 (Stata Corp, College 18.0%) and the Northeast (7.0% vs 9.8%) re-
Station, TX) using the survey module, which con- gions (Table 2).
siders the effects of complex sampling of the HBS According to linear adjusted analyses, the origin
and enables the extrapolation of the results for the of food consumed at public schools influenced
Brazilian population, considering a significance children’s BMI. Comparing to children who ate
level of 5%. food taken from home, children who consumed
food offered by the school presented a decrease
RESULTS of 0.17 unit in the z-score of BMI-for-age (β
The population studied was comprised mainly -0.17; 95% CI: -0.30; -0.03), whereas children
by public school students (79.5%), boys (51.2%), who bought food at the canteen presented a non-
children aged 6 to 10 years old (67.3%), mixed- statistically significant increment of 0.17 unit (β
race (48.7%) and white (44.3%), children from 0.17; 95% CI: -0.10; 0.44). No differences were
elementary school (61.9%) and 95.5% referred the verified among children from private schools (Ta-
consumption of any kind of food at school. Fur- ble 3).
thermore, 28% of the children presented excess A similar result was found when we analyzed the
weight and 10.2% obesity (Table 1). association between nutritional status and the ori-
Considering the origin of food consumed at gin of food consumed at public schools, consumed
school, in private schools, 70.7% of children ate food offered by the school protect against obesity
food taken from home, whereas in public schools, (OR = 0.72; 95% CI: 0.53; 0.97) and at the limit
90.6% of children ate food offered by the school of significance for excess weight (OR = 0.83; 95%
by the BSFP. The distribution of origin of food CI: 0.67; 1.01). No differences were verified among
consumed at school tended to follow this pattern children from private schools (Table 4).
Health Behav Policy Rev.TM 2021;8(3):202-211 DOI: https://doi.org/10.14485/HBPR.8.3.2 207Can Eating Food Offered by Schools Have a Positive Influence on Nutritional Status of Children? An Example from Brazil DISCUSSION ciated positively with the consumption of healthy The results of a nationally representative sample foods and was associated with lower consumption of Brazilian children show that almost all children of unhealthy foods.30 had the habit of consuming foods at school and Other studies, conducted in different coun- that the main origin of food varied according to tries, show a negative relationship between can- the type of school: children from private schools teen and eating habits, with more consumption mainly ate food taken from home, but in the public of unhealthy foods, like sugar beverages,24,27,31,32 school context, food offered by school was the most which confirms the relation of the school canteen referred. The results indicate that students who at- on children’s eating habits. Evidence concerning tended schools covered by the BSFP have a higher the effect of the school canteen on the BMI and probability of presenting a better nutritional status. weight status remains unclear,15,26,33 but our study This is the first study to show the influence of the is the first to reveal an advantage (BMI-related origin of food consumed during the period of chil- advantage) of a school food service program that dren stay in school at BMI and the positive influ- offers free meals for all students. In Brazil, the ence of a public-school food service policy. One of consumption of meals away from home may not the complexities of the school food environment be related to a poor diet, especially when eating in Brazil is related to the different possible origins a “Brazilian Traditional meal” that includes more of foods that children can be exposed to and the rice, beans, meat, roots and tubers, pasta, vegeta- possibility of combining food from different ori- bles and eggs;34 this type of meal is close to that gins in their diets. This context is similar in other offered in BSFP.29,30 countries, such as Australia,24 the United States,25 The introduction of healthy foods in the school Turkey,26 and Guatemala.27 environment is an important strategy to influence Socioeconomic status (SES) seems to impact food consumption and weight status of children; the origin of food consumed. We used the type of thus, public policies related to school food services, school (private or public) as a proxy of income in canteens, and food vending machines are impor- Brazil. In our study, most of the Brazilian children tant to monitor or regulate. In Minnesota, elemen- studying in public schools preferred to eat food of- tary and middle schools that prohibited junk food fered by the school, and those from private school in school vending machines and school canteens preferred foods taken from home or bought in the had less junk food consumed than schools that nei- canteens. In Australia, despite high frequencies of ther prohibited junk food or had no policy at all.11 bringing food from home and also the use of the In New York City, the revised nutrition standards school canteen, more children in the high SES for schools increase the availability of fruits and schools used the canteen, compared with those in vegetables, whole grains, and low-fat dairy prod- low SES schools.24 ucts, and decrease sugary beverages and foods high Verifying that children who ate food offered by in saturated fats and added sugars – the major con- school presented a lower frequency of excess weight tributors to calorie intake.25 and obesity, and lower BMI-for-age is a relevant The importance of the school environment for finding. In Brazil, schools commonly offer the stu- children’s health and health promotion2-4 is rein- dents’ regular meals, and not snacks and ultra-pro- forced by a systematic review that verified that a cessed foods, which tends to give them a healthier school environment offering healthy food is essen- nutritional profile,28 and aims to promote healthier tial to combatting the consumption of unhealthy dietary habits for all students.18,19 The provision food. Additionally, it was pointed out that modifi- of school meals via the BSFP was associated with cation of the food environment, such as regulation less consumption of industrialized/ultra-processed of canteens, could result in a positive impact on salty foods and soft drinks, whereas the presence of eating practices and body weight.35 a school cafeteria was related to higher consump- The main limitation of this study is related to the tion of industrialized/ultra-processed salty foods, absence of information on the kind of food con- sweets, and soft drinks.29 Additionally, regular con- sumed, independent of its origin, which makes it sumption of school meals offered in BSFP was asso- difficult to assess potential mediators of the rela- 208
Bandoni & Canella
tionship of nutritional status and origin of food • governments and schools can adopt specific
consumed at school. Unfortunately, we do not programs for school meals, including free-of-
have data related to the menu of foods at school, charge meals for students, if possible;
the list of foods sales at canteens, and even what • school food programs must have regulations
food the parents sent for children to eat at school. and laws that guarantee the offering of fresh
Future studies should evaluate foods consumed or or minimally processed foods and prohibit
at least food markers (such as fruit and vegetables ultra-processed foods;
and some ultra-processed foods and beverages) to • educators and policymakers should develop
have more elements to design interventions. On strategies that integrate education and pro-
the other hand, there are studies in Brazil and other motion of healthy eating;
countries that evaluated the quality of food offered • students should be encouraged to consume
in schools and in canteens,30,36-38 and we suppose meals offered at school;
that they may be similar in the context of this
study. Despite these limitations, to the best of our • national or local governments should regu-
knowledge, this is the first Brazilian study to evalu- late the sale of food in school canteens,
ate the relationship between the origin of the foods banning unhealthy items, such as ultra-pro-
consumed at school and the nutritional status of cessed foods, and encouraging the offering of
children. Moreover, we used a nationally represen- healthy food;
tative sample of children, and weight and height • the legislation of the Brazilian School Feed-
were directly measured to calculate BMI. ing Program, updated in 2020,19 can be used
Using representative data from Brazil, we veri- as an example for adoption in other locations,
fied that children commonly eat at school and that considering the different realities or contexts.
among children from public schools eating food
offered by schools attain better BMIs. These find- Acknowledgements
ings highlight the importance of school food ser- This research was supported by the Carlos Cha-
vice programs that offer healthy foods. gas Filho Foundation for Supporting Research in
the State of Rio de Janeiro (Fundação Carlos Chagas
IMPLICATIONS FOR HEALTH BEHAVIOR Filho de Amparo à Pesquisa do Estado do Rio de Ja-
OR POLICY neiro - FAPERJ, process n. E-26/202.667/2018),
School is defined by the World Health Orga- awarded to Daniela Silva Canella. An abstract re-
nization as a healthy social setting that should lated to this work was presented in the XVIII Con-
promote health, safety, and learning.39 Our study greso Latinoamericano de Nutrición (SLAN) 2018.
shows the importance of policies and programs
aimed at school food service. The Brazilian expe- Human Subjects Approval Statement
rience demonstrates that the provision of school Our study was approved by the Research Ethics
meals follows recommendations for the insertion Committee of School of Public Health, University
of fresh or minimally processed foods, and avoids of São Paulo (Process number 2292). We used sec-
ultra-processed foods in meals offered by schools, ondary data collected by the IBGE and available
contributes to better food choices and more opti- for public online consultation (https://www.ibge.
mal weight. gov.br/en/statistics/social/population/25610-pof-
This study is the first to compare the origin of 2017-2018-pof-en.html?=&t=microdados). Infor-
food and the nutritional status of students from mation contained in the database is confidential.
public schools (served by a school food service poli- Data identifying household members, address, and
cy) and private students (who do not have a specific telephone were excluded.
policy), indicating that there is a positive impact
on students’ nutritional status and body weight, Conflict of Interest Disclosure Statement
even considering that students eat only a fraction
of their meals at school. All authors of this article declare they have no
conflicts of interest.
Based on our findings, we recommend that:
Health Behav Policy Rev.TM 2021;8(3):202-211 DOI: https://doi.org/10.14485/HBPR.8.3.2 209Can Eating Food Offered by Schools Have a Positive Influence on Nutritional Status of Children? An Example from Brazil
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Health Behav Policy Rev.TM 2021;8(3):202-211 DOI: https://doi.org/10.14485/HBPR.8.3.2 211You can also read
