Breakfast patterns among low-income, ethnically-diverse 4th-6th grade children in an urban area
Hannah G Lawman
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Heather M Polonsky
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Stephanie S Vander Veur
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Michelle L Abel
Sandy Sherman
Katherine W Bauer
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Tim Sanders
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Jennifer O Fisher
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Lisa Bailey-Davis
Janet Ng
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Gretchen Van Wye
Gary D Foster
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Center for Obesity Research and Education, Temple University School of Medicine
,
3223 N. Broad Street suite 175, Philadelphia, PA 19140
,
USA
Background: Increasing school breakfast participation has been advocated as a method to prevent childhood obesity. However, little is known about children's breakfast patterns outside of school (e.g., home, corner store). Policies that increase school breakfast participation without an understanding of children's breakfast habits outside of school may result in children consuming multiple breakfasts and may undermine efforts to prevent obesity. The aim of the current study was to describe morning food and drink consumption patterns among low-income, urban children and their associations with relative weight. Methods: A cross-sectional analysis was conducted of data obtained from 651 4th-6th graders (51.7% female, 61.2% African American, 10.7 years) in 2012. Students completed surveys at school that included all foods eaten and their locations that morning. Height and weight were measured by trained research staff. Results: On the day surveyed, 12.4% of youth reported not eating breakfast, 49.8% reported eating one breakfast, 25.5% reported eating two breakfasts, and 12.3% reported eating three or more breakfasts. The number of breakfasts consumed and BMI percentile showed a significant curvilinear relationship, with higher mean BMI percentiles observed among children who did not consume any breakfast and those who consumed 3 breakfasts. Sixth graders were significantly less likely to have consumed breakfast compared to younger children. A greater proportion of obese youth had no breakfast (18.0%) compared to healthy weight (10.1%) and overweight youth (10.7%, p = .01). Conclusions: When promoting school breakfast, policies will need to be mindful of both over- and under-consumption to effectively address childhood obesity and food insecurity. Clinical trial registration: NCT01924130 from http://clinicaltrials.gov/.
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Background
The documented benefits of childrens regular intake of
breakfast include increased concentration and improved
academic performance and behavior [1]. Thus,
increasing participation in the national School Breakfast
Program (SBP) is a common goal of federal efforts such as
End Hunger in America and the Healthy, Hunger-Free
Kids Law [2,3], state-level initiatives, and school districts
[4,5]. Among schools that offer the National School
Lunch Program, the number that also participate in the
SBP has grown from 48.8% in 1990 to 91.2% in 2011 [4].
However, only half (50.4%) of low-income children that
participate in the National School Lunch Program also
participate in the SBP [4]. To encourage students
participation in school breakfast, school boards in major
cities including Chicago, Houston, Memphis, Philadelphia,
and Washington D.C. have adopted programs to offer
breakfast in the classroom [5]. This is seen as a way to
combat stigma associated with school breakfast
participation [6], to address logistical challenges with breakfast
served before school, and to fight food insecurity [7] and
childhood obesity [5].
Providing breakfast at school for children who would
not otherwise have one is valuable, especially to address
food insecurity and improve academic performance.
There are less data to support the notion that school
breakfast has any impact on childhood obesity [1,8].
Public concerns have been raised over the possibility
that breakfast in the classroom could unintentionally
increase energy intake and undermine obesity prevention
efforts among children who are already consuming one
or more breakfasts outside of school [9]. One recent
study found that 30.0% - 51.1% of 3rd -5th graders in
New York City reported early morning eating in
multiple locations including home, school, and corner stores
(also known as bodegas) [10]. Only two studies with
elementary aged children have examined the patterns of
breakfast consumption across multiple locations [10,11].
However, the relationship between number and locations
of breakfasts and relative weight were not assessed.
Previous research on breakfast consumption has focused
on comparing breakfast consumption with no breakfast
consumption rather than the patterns and quality of
breakfast consumed [1]. Studies have examined a variety
of breakfast contexts independently including breakfast
prepared at home versus away from home [12], school
breakfast consumption across the year [13], and breakfast
that was self-prepared or consumed in the presence of
others [14]. Other influences including mode of
transportation to school and previous nights dinner consumption
may affect breakfast consumption patterns. Children who
do not usually eat breakfast have been shown to be less
likely to have had r (...truncated)