Behavioral Economic Approaches to Childhood Obesity Prevention Nutrition Policies: A Social Ecological Perspective.

Childhood obesity is a significant public health concern associated with the development of the leading causes of death. Dietary factors largely contribute to childhood obesity, but prevention interventions targeting these factors have reported relatively small effect sizes. One potential explanation for the ineffectiveness of prevention efforts is lack of theoretical grounding. Behavioral economic (BE) theory describes how people choose to allocate their resources and posits that some children place higher value on palatable foods (relative reinforcing value of food) and have difficulty delaying food rewards (delay discounting). These seemingly individual-level decision making processes are influenced by higher-level variables (e.g., environment/policy) as described by the social ecological model. The purpose of this manuscript is to provide a theoretical review of policy-level childhood obesity prevention nutrition initiatives informed by BE. We reviewed two policy-level approaches: (1) incentives-/price manipulation-based policies (e.g., sugary drink tax, SNAP pilot) and (2) healthful choices as defaults (Healthy Hunger Free Kids Act/National School Lunch Program, advertising regulations, default items). We review current literature as well as its limitations and future directions. Exploration of BE theory applications for nutrition policies may help to inform future theoretically grounded policy-level public health interventions.

A pilot study of a school lunchroom intervention in a predominantly Latinx sample.

OBJECTIVE: The purpose of the study was to assess the feasibility of an environmental school lunchroom intervention ('Smarter Lunchrooms') and test initial efficacy within a predominantly Latinx population. DESIGN: We collected baseline and intervention lunchroom food consumption and waste data in a pre-post, single group design. Meal consumption data was analyzed using Nutrition Data System for Research software to obtain estimates of nutritional content. MAIN OUTCOME MEASURES: Feasibility. SECONDARY MEASURES: Plate Waste, Nutrient Intake. RESULTS: Participants were 88 1st-4th graders (51% female; 77% Latinx). Our recruitment rate was 45%, we were able to implement 8 Smarter Lunchroom strategies, and we were able to collect 82 baseline plate photos (93%) and 80 intervention photos (90%) of school lunches. On average, students threw away more than half of their meals on both days. Fruit consumption and fiber per 1000 kcal were significantly poorer at intervention compared to baseline. CONCLUSIONS: Our findings highlight challenges in collecting consumption data in a real-world setting. We describe directions for future research taking into consideration our "lessons learned" from this formative work.

A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework.

Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.

Society of Behavioral Medicine position statement: retain school meal standards and healthy school lunches.

In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) altered nutrition standards in the U.S. National School Lunch Program in an attempt to promote healthy eating and improve children's overall health. However, it was reported that these nutrition standard changes were leading to lower consumption of meals and an increase in plate waste. Initial research was unable to validate these reports. Despite these unsubstantiated claims, the U.S. Department of Agriculture released a proposal to roll back some of the nutritional standards implemented by the HHFKA in 2017. An exploration of the current literature uncovered several new studies that further support the updated meal standards outlined in the HHFKA. Identifying and reviewing these studies was the aim of the current brief. Several new studies found that the implementation of the HHFKA standards led to healthier meals, increased fruit consumption, lower plate waste, and reductions in sodium and calories from saturated fats, to name a few. Given the continued evidence that the HHFKA standards improve dietary quality of school meals, policymakers, schools, and stakeholders are urged to continue to support the retention of the new meal standards.