The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 authorizes funding for federal school meal and child nutrition programs and increases access to healthy food for low-income children. The legislation’s impact on childhood obesity is unknown. The act was passed to help ensure that every American child had access to the nutrition they need to grow into healthy adults.1 According to data from the National Institutes of Health, in the past three decades the prevalence of childhood obesity has more than doubled in children and tripled in adolescents.2 This is a major public health concern.

One goal of HHFKA is to help reduce America’s childhood obesity epidemic and reduce health risks for America’s children by helping schools make balanced meals so children have access to healthy foods during the school day. However, the article “Impact Of The Healthy, Hunger-Free Kids Act On Obesity” states that the legislation’s impact on childhood obesity is unknown. The authors analyzed obesity prevalence trends among ten to seventeen year olds, compared data from before and after implementing HHFKA, analyzed data from the National Survey of Children’s Health for ages 0-17 in all states, accounted for variables including individual states’ nutrition standards and policies for school meals.1

Click the download button above to get the PDF version of this article we are discussing.

The statistical analysis of this study created a model that predicts the odds of a study participant having obesity before HHFKA implementation and after HHFKA implementation. In this case, change is measured in average annual change which results in a trend for odds of obesity for each year. Data for all states and participants collectively was analyzed and recorded for trends; additionally, data analyzed in a manner that would separately examine participants based on poverty status to record trends to see if poverty is associated with a higher likelihood of eating school meals and thus may be associated with a larger likelihood of benefiting from HHFKA in relation to obesity and overall health.1 

Survey periods included 2003, 2007, 2011-2012, 2016, 2017, and 2018 and there were a total of 193,370 participants ages 10-17.1 Prevalence of obesity in the population was 15-16% across all survey years, with the lowest estimates in 2003 and 2018. Prior to HHFKA Implementation, only four states had pre-existing school lunch regulations specifying nutrition criteria similar to HHFKA. Results showed that for children in poverty, prior to HHFKA’s changes to school meals and snacks, the odds of having obesity had been gradually increasing. For children in poverty after HHFKA’s implementation, the odds of having obesity lowered by 9 percent. 

Without HHFKA, the data predicts a 47% higher risk of obesity for children in poverty.5  Results show that US children ages 10-17 in poverty benefit most from HHFKA. However, for the US children ages 10-17 population as a whole, this study found no significant association between the legislation and childhood obesity trends overall. See Exhibit A below for a graph of the found trends. In conclusion, implementation of HHFKA standards may aid in reducing the risk of obesity in children in poverty.1 This supports maintaining HHFKA and the possibility of strengthening it’s standards. The article states, “The Original 2010 HHFKA standards should be restored, and efforts to increase participation should be strengthened, to build on the law’s progress in reducing childhood obesity in the United States.”1 

         Exhibit A

In the words of President Obama, HHFKA is “A bill that is vitally important to the health and welfare of our kids and to our country.”3 This bill passed with bipartisan support and it has attained its goal of, simply put, positively impacting students and their households by providing balanced meals as a part of the National School Breakfast and Lunch and Smart Snacks programs. This action displays a scenario where despite how processes in Washington can be divided, influencers and decision makers of policy can still come together and agree on issues that matter for our childrens’ future and our future as a nation. HHFKA is one of the many efforts that have been taken to tackle pediatric obesity in the United States that have proven successful to some degree. 

 A nation rooted in freedom makes for a society that is “free” to choose the foods in which they consume and feed their families. Household income plays a vital role in food selection. Before implementing HHFKA, too many students did not have access to school meals. Children residing in impoverished homes often consume foods that are not as healthy or nutritious as they should be. HHFKA is about implementing nutrition standards so that what can be “controlled” can be controlled: meals and snacks offered at schools. What no policy has yet to determine nutrition standards for is what children and adolescents eat for meals within their own homes. Simply put, HHFKA has taken initiative to improve the meals that it feasibly can. 

The “Impact of The Healthy, Hunger-Free Kids Act on Obesity Trends” study provides reliable evidence and data because it includes the following and more: both statistical significance results and effect sizes when possible, research is based on the work of others, generalisable to other settings, based on logical rationale and tied to theory, adequate quantity of participants, factors for variables and uses controls, generates new questions, conclusions and recommendations that are both logical and consistent with findings, and the study can be replicated. These are qualities of sound academic research in which the findings are reliable. One particular strength of this study is that within this study’s methods, each state’s preexisting state-level nutrition policies were acknowledged and data was leveraged on these policies from the Classification of Laws Associated with School Students database to control for their influence prior to implementing HFFKA. 

HHFKA contains a variety of concepts and guidelines for reaching the goal of providing balanced meals to school children. This begs the question, how many schools are able to comply with HHFKA’s nutrition standards? In any circumstance, positive changes are only beneficial if they are able to be implemented and followed. The USDA reported promising results that over 90 percent of schools reported that they are successfully meeting the updated nutrition standards.4 The outcome of this is that students across the country are experiencing a healthier school environment with more nutrition food options. Following HHFKA implementation, school meals are providing children more whole grains, fruits, vegetables, lean protein and low-fat dairy, as well as less sugar, fat, and sodium.

The findings of the “Impact Of The Healthy, Hunger-Free Kids Act On Obesity” may not have yielded all that the researchers expected, but this study provided incredibly beneficial data and information for the field of public health nutrition. What is shown through the analysis of data is that policy, as it relates to public health nutrition, has the ability to improve the health of younger generations. While HHFKA may not have shown positive influence toward obesity for all 10-17 aged school children, it proved beneficial to children of this age group that are living in poverty. A hypothesis can be made that if one Act can benefit a specific population, then multiple acts with similar goals can collectively benefit several populations. 

Citations

1 Kenney, E. L., Barrett, J. L., Bleich, S. N., Ward, Z. J., Cradock, A. L., & Gortmaker, S. L. (2020). Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends. Health affairs (Project Hope), 39(7), 1122-1129. https://doi.org/10.1377/hlthaff.2020.00133

2 Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and Adolescent Obesity in the United States: A Public Health Concern. Glob Pediatr Health. 2019;6:2333794X19891305. Published 2019 Dec 1. doi:10.1177/2333794X19891305

3 The Obama White House, 2010. Signing The Healthy, Hunger-Free Kids Act. Available at: <https://www.youtube.com/watch?v=044rTqYp7ms&gt; [Accessed 29 October 2020].

4 USDA FACT SHEET: Healthy, Hunger-Free Kids Act School Meals Implementation | USDA-FNS. Fns.usda.gov. https://www.fns.usda.gov/pressrelease/2014/009814. Published 2020. Accessed October 29, 2020.

5 Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, Gortmaker SL. Simulation of growth trajectories of childhood obesity into adulthood. N Engl J Med. 2017;37(22):2145-54.