September 26, 2023


Qualified food specialists

Healthy food legislation linked to reduced BMI in children

3 min read
Healthy food legislation linked to reduced BMI in children

February 17, 2023

2 min read


Baidal, Cheng and Fiechtner report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected].

The implementation of legislation that encourages healthy eating habits was associated with reduced BMI scores among youth in the United States, according to study findings published in JAMA Pediatrics.

It was the latest study to demonstrate positive effects of the Healthy, Hunger-Free Kids Act (HHFKA), passed by Congress in 2010, which authorized funding and set policy for the National School Lunch Program; the School Breakfast Program; and the Special Supplemental Nutrition Program for Special Supplemental Nutrition Program for Women, Infants, and Children, among other nutrition programs.


Data derived from Chandran A, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5828.

Co-author Aruna Chandran, MD, MPH a professor in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, said the study was partially inspired by her team’s involvement with the Environmental Influences on Child Health Outcomes, or ECHO consortium, a nationwide program of child cohort studies.

Aruna Chandran

“[My team] realized that the consortium is in an ideal situation where we had data for children all over the United States that represented a variety of different backgrounds,” Chandran said. “[We realized] that this was a really great opportunity to take a look at this issue.”

In a cohort study using data from the ECHO consortium, the researchers assessed 14,121 children and adolescents aged between 5 and 18 years, who constituted 26,205 BMI measurements collected between January 2005 and March 2020. Chandran and colleagues then used the consortium’s data on the patients’ height, weight, age and gender to calculate BMI z scores, which measures relative weight adjusted for child age and sex.

“We essentially evaluate over time what the BMI z score trajectory looks like prior to the intervention, what it would have looked like had nothing changed at that time, and then what we’re observing in the time period after the intervention,” Chandran said. “And then we see if there’s a difference.”

The authors observed a decrease in annual BMI z score in the period following the HHFKA taking effect compared with the period before implementation (0.041; 95% CI, 0.066 to 0.016).

“We were happy, first of all, that we were able to corroborate prior studies, which showed, a decreasing BMI trajectory among low children from low-income households,” Chandran said. “We were happy to see that there had been an overall decrease in excess weight gain among children. Finally, we were really happy to see an effect, particularly in children 12 to 18 years of age, given that this is an age at which children have more autonomy to purchase their own foods.”

The study was accompanied by a commentary cowritten by Jennifer Woo Baidal, MD, MPH, of New York-Presbyterian Morgan Stanley Children’s Hospital; Erika R. Cheng, PhD, MPA, of the Indiana University School of Medicine; and Lauren Fiechtner, MD, MPH, of MassGeneral Hospital for Children.

“While providing free or subsidized lunch to low-income students is certainly a worthy cause, it is unlikely to confer healthy outcomes in the absence of nutritional quality,” they wrote. “Therefore, the [National School Lunch and School Breakfast Programs] nutritional recommendations should be strengthened and updated to match the U.S. Department of Agriculture 2020-2025 Dietary Guidelines for Americans to limit juice and promote consumption of fruit in its whole form to increase dietary fiber intake. Finally, rollbacks to what was originally enacted and rooted in research and science should not occur as they would only lead to further obesity inequities.”


Chandran A, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5828.

Fiechtner L, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5834.