{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T20:39:42Z","timestamp":1793479182796,"version":"4.5.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"Importance<\/jats:title>The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association between the HHFKA and youth body mass index (BMI).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Full implementation of the HHFKA.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was annual BMI z<\/jats:italic>-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 14\u202f121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26\u202f205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (\u22120.041; 95% CI, \u22120.066 to \u22120.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (\u22120.045; 95% CI, \u22120.071 to \u22120.018) and among youths living in households with a lower annual income (\u22120.038; 95% CI, \u22120.063 to \u22120.013).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2022.5828","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T16:01:20Z","timestamp":1676304080000},"page":"401","source":"Crossref","is-referenced-by-count":35,"title":["Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010"],"prefix":"10.1001","volume":"177","author":[{"given":"Aruna","family":"Chandran","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, 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