Associations Between School Breakfasts and Weight Gain Among American Middle School Children Open Access
Romano, Sebastian (2012)
Abstract
An abstract of
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
In partial fulfillment of the requirements for the degree of
Master of Public Health
in Department of Global Epidemiology
2012
Abstract
Associations Between School Breakfasts and Weight Gain Among American Middle
School Children
Obesity has become a major public health problem in America. In
2012 roughly 16.9%
of children and adolescents ages 2-19 were at or above the 97th
percentile of the 2000
BMI-for-age growth curves, more than double the prevalence of 7% in
1980. Recently,
school meals have been given much attention because of their
ubiquity and potential to
give children well-balanced and healthy meals. This analysis will
present attempt to
determine whether there is a relationship between school breakfast
participation and child
weight status in fifth to eighth grade children. Using the
nationally representative Early
Childhood Longitudinal Study (ECLS-K) data set, initial
multivariable cross-sectional
models were conducted to test for associations between school
breakfast participation and
linear BMI z-score outcomes as well as logistic binary obese/ not
obese outcomes.
Prospective models were then used to test for associations between
school breakfast
participation and these outcomes over the three year study period.
This analysis provides
evidence that school breakfast participation was significantly
associated to higher BMI z-
scores. However no association was found between school breakfast
participation and
obesity. Results from the longitudinal analysis also found a
positive association between
school breakfast participation in the fifth grade and BMI z-scores
in the eighth grade.
Overall this analysis found evidence that school breakfasts are
positively associated with
BMI z-scores over time. However, there was no apparent association
between school
breakfast participation and the incidence of obesity. A
longitudinal analysis of children
at earlier developmental stages may provide differing results on
the effects of school
breakfasts. Also, an analysis of inter-school district policies for
school breakfast may
provide a more nuanced depiction the effects of the school
breakfast program.
Table of Contents
Table of Contents
INTRODUCTION.. 1
BACKGROUND.. 3
Obesity as a health problem.. 3
Skipping breakfast and obesity. 3
The school meal environment: regulation and practice. 7
The School Meal Environment: Associations to Weight Status. 9
Other factors affecting weight status in the school setting. 14
American family meal trends. 14
Qualitative associations to meal locations. 15
Controlling for away from home meals. 17
CONCEPTUAL FRAMEWORK.. 19
METHODS. 22
Descriptive Methods. 26
Analytic Methods. 27
Descriptive Statistics. 29
Analytic Results. 30
Other determinants of obesity. 32
DISCUSSION.. 34
Strengths and Weaknesses. 37
REFERENCES. 41
TABLES. 50
Table 1: 51
Table 2: 52
Table 3: 53
Table 4: 54
Table 5: 55
Table 6: 56
Table 7: 57
Table of Contents
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