Weight status among adolescents in States that govern competitive food nutrition content

Abstract

Objectives: To determine if state laws regulating nutrition content of foods and beverages sold outside of federal school meal programs ("competitive foods") are associated with lower adolescent weight gain.

Methods: The Westlaw legal database identified state competitive food laws that were scored by using the Classification of Laws Associated with School Students criteria. States were classified as having strong, weak, or no competitive food laws in 2003 and 2006 based on law strength and comprehensiveness. Objective height and weight data were obtained from 6300 students in 40 states in fifth and eighth grade (2004 and 2007, respectively) within the Early Childhood Longitudinal Study-Kindergarten Class. General linear models estimated the association between baseline state laws (2003) and within-student changes in BMI, overweight status, and obesity status. Fixed-effect models estimated the association between law changes during follow-up (2003-2006) and within-student changes in BMI and weight status.

Results: Students exposed to strong laws at baseline gained, on average, 0.25 fewer BMI units (95% confidence interval: -0.54, 0.03) and were less likely to remain overweight or obese over time than students in states with no laws. Students also gained fewer BMI units if exposed to consistently strong laws throughout follow-up (β = -0.44, 95% confidence interval: -0.71, -0.18). Conversely, students exposed to weaker laws in 2006 than 2003 had similar BMI gain as those not exposed in either year.

Conclusions: Laws that regulate competitive food nutrition content may reduce adolescent BMI change if they are comprehensive, contain strong language, and are enacted across grade levels.

FIGURE 1

Adjusted within-student BMI change, by 2003 state law* and 2003–2006 law change.^† *State middle school law in 2003. ^†Difference between mean rating for state elementary school laws in 2003 and middle school laws in 2006. No change–none: Equal mean rating (0). No change–weak: Equal mean rating (1–2). No change–strong: Equal mean rating (>2). New laws–weak: Mean higher for 2006 middle school laws (1–2). New laws–strong: Mean higher for 2006 middle school laws (>2). Weaker: Mean lower for 2006 middle school laws. ^‡Adjusted for race/ethnicity, gender, age, locale, SES, Census region, physical activity level, and 2003 state obesity prevalence. ^§Estimated from fixed-effect model, adjusted for SES and locale.