Objective: The purpose of this systematic review is to investigate the effectiveness of school lunch programs for reducing childhood obesity by examining changes to the Body Mass Index (BMI) as an outcome measure to compare and assess the effectiveness of different school lunch interventions. Background: Childhood obesity has a high likelihood of leading to obesity in adulthood and this negative effect is well documented. School lunches have been widely implemented in this decade for tackling childhood obesity. Many countries are following this trend to align school lunches with national or standard nutrition guidelines as part of the school policy. Since many schools have only recently started to provide school lunches, the impact of these programs in terms of reducing childhood obesity has yet to be fully explored. Methods: Published literature about school lunch and body mass index from 2008 to 2014 was collected through PubMed and ScienceDirect. Relevant studies, including cohort studies, cross-sectional studies, case control studies, and observational studies, were included if they involved interventions that measured BMI as an independent outcome. Results: Nine studies from USA and one from Norway were included in this systematic review. For measuring school lunch participation, 4 were associated with increased BMI after intervention, 1 was associated with decreased BMI and 3 were not statistically significant with BMI. For studies that included consumption or observed energy intake, 3 were associated with lower BMI and 1 study showed that higher consumption lowered initial BMI but increased BMI over time. Overall, the results were inconsistent, and this may be attributed to confounding factors such as different food environments, meal quality, and availability of school snacks. Conclusion: The implications for school lunch programs as a key factor in lowering childhood obesity are complicated. No solid conclusions can be inferred for the effectiveness of school lunch program for lowering childhood obesity, as certain studies show positive relationships and others show no association. Future research with primary data and longitudinal cohort with years follow up may be considered for studying the relationship of between the school lunch program and the trend of BMI of children change at each level of school. Research on extending observed energy intake should also be applied in order to provide guidance for policy change on the meal quality, food options, competitive foods availability as well as nutrition guidelines. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Dissertation submitted in fulfilment of the requirements of the Degree of Magister Technologiae: Food and Nutrition, Durban University of Technology, 2012. / There is lack of data on the dietary intake and patterns of Lindelani adolescents, which necessitates comprehensive nutritional assessment. Objectives: The objectives were to investigate the dietary intake and nutritional analysis of lunchbox contents of high school girls (13 -18 years of age) in Lindelani and evaluate its contribution to their dietary intake. Methodology: The study was of a descriptive nature with an analytical component, a convenience sample of 61 learners who brought lunchboxes from home and completed a socio- demographic questionnaire, QFFQ and two 24- hour recall questionnaire used for evaluation of their dietary intake. Anthropometric measurements, including body composition, were performed. Anthropometric data were captured on a Microsoft Excel spreadsheet and displayed on WHO growth charts to determine stunting, wasting, underweight and over-weight. . Lunchboxes were required and collected without informing participants to avoid bias, each lunch box was weighed and the content recorded and analysed using Food Finder 3 computer software program. It was analysed by selecting the mean intake of the group and comparing it to the Daily Recommended Intake (DRIs) for this group of individuals. Results: The results indicated that the food group most commonly consumed was carbohydrates. The lunchbox mean energy content was 90.14 kJ (>100% of DRIs) which is a big portion for a lunchbox since there are other meals of the day to be eaten too. The mean intake of fruit portion consumed was 135g which was only consumed by 1% in the top 20 food items compared to 141.82g consumed by 18% in 24- hour recall. Bread, margarine and polony were commonly consumed in QFFQ, Lunchboxes and 24- hour recall. Fat consumption for lunchboxes was 34.04% higher than the WHO nutrient intake goal which put these teenagers at risk of overweight. Fruit and vegetable intake was 106.95g (QFFQ), 107.27g (24-hour recall) and 109.49g (mean lunchbox content). This indicates poor intake of fruit and vegetables, being far lower than WHO recommendation of 400g per day. Dietary fibre was also found below 25g. Conclusion: Although the group seemed to consume all the nutrients but it is a small sample of the population. The study indicated that the majority of the respondents consume mostly IVcarbohydrate diets and the lunchboxes did not meet the basic requirements of a balanced diet. The lunchboxes contributed on average one third of the girl’s daily food intake.