Measuring the Effect of the Food School Environment on Childhood Obesity: A Systematic Review

Background: Numerous factors such as the physical environment, family, school and community have been studied in an effort to better understand their contribution to childhood obesity.;Methods: This systematic review assesses the school food environment and its contribution to childhood obesity. Our goal is to 1) identify specific measures that have been shown to improve the nutritional value of food available in schools; and 2) describe the potential impact of these changes on childhood obesity. Articles published between 1998 and 2011 were obtained from PubMed, Scopus, Web of Science and Psych Info search databases. Articles met inclusion criteria if the outcomes measurements included 1) measurement of Body Mass Index; 2) a description of food available in schools; 3) information regarding access to vending machines or a la carte food items in the cafeteria; or a 4) description of school food policy. Of the 878 articles initially identified 22 studies met the inclusion criteria.;Results: Of the twenty-one studies reviewed, six studies (28%) demonstrated that vending machines in schools provide significant access to unhealthy food which appears to contribute to obesity. Three studies (14%) revealed that while the majority of the schools included in these studies have policies on wellness, they do not appear to be strictly enforced. In addition six studies (28%) demonstrated that food stores in the school environment and school cafeterias providing lunch, do not follow national guidelines on serving healthy food in school. Three studies (14%) were able to show that an increase in BMI of school children is dependent on the food in and around the school environment. One study (4%) discussed the association of activity in the school yard to BMI. In addition, two studies (9%) show the association of cognition to increase BMI and child hood obesity. (I do not understand this sentence) 4.;Conclusions: Available research on the school food environment reinforces the notion that numerous actionable factors in schools contribute to childhood obesity.;Recommendations: Based upon the current review the data would suggest that the removal of vending machines from schools, or alternatively, replacing them with cold vending machines offering fruits, yoghurts and vegetables, might possibly impact childhood obesity.