Impact of Competitive Foods in Public Schools on Child Nutrition: Effects on Adolescent Obesity in The United States An Integrative Systematic Literature Review

Abstract: Abstract Objective: To identify and analyse literature on the effects of competitive foods in public schools on adolescent weight (BMI), and possible impacts they may have on adolescent obesity in the United States. Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, Medline and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006-2017 from peer reviewed journals and published in English, with age parameters of adolescents 13-18 years in middle or high schools in the United States. Criteria for inclusion targeted at least one of 1) sugar-sweetened beverages (SSB), 2) competitive foods, 3) commercial foods, 4) vending machines, 5) al a carte venues, and 6) school stores, examining their associations with weight/Body Mass Index (BMI), using either BMI measurements or caloric intake analysis. Results: The total of 164 articles were detected with 89 full abstracts examined and assessed, for a final analysis of 34 full text articles based on the inclusion criteria for this literature review. Twenty-six articles met the inclusion criteria. Many of the articles addressed multiple areas of interest within their study. Aspects of interest most commonly found involved BMI/Obesity/Weight in 19 (73%) articles, 15 (58%) articles examined Calorie (Kcal) density or consumption, 20 (77%) articles discussed the Availability of competitive foods in schools, 14 (54%) articles included analysis of competitive food and beverage and nutrition policies, and 18 (69%) addressed Other effects (socio-economic status (SES), race, ethnicity, and sex). Conclusion: This systematic literature review found that although there is substantial evidence that competitive foods (foods sold to students which are not part of the regular school lunch programs) are highly available in middle, and especially high schools, there is still a lack of strong evidence that it is causal in increasing BMI/weight in adolescents. However, there is enough corroboration in the research which shows that higher caloric intake, as well as SES, race, ethnicity and sex are factors worthy of studying further and more in depth to determine how to better combat adolescent obesity in the United States. Additional longitudinal and higher quality research still needs to be done in this regard.