School nutrition programs are the first line of defense against diabetes

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Children having meals in school in Ghana. Photo: © Arne Hoel/The World Bank

April 7th is World Health Day, a day to highlight emerging global health concerns. The focus this year is raising awareness on the diabetes epidemic, and its dramatic increase in low- and middle-income countries.

With obesity and diabetes rates rising among children and adolescents globally, school nutrition programs can play an increasingly important public health role in supporting students’ health and well-being. School nutrition programs have traditionally been viewed as a method to reduce the vulnerability of poor children by encouraging school enrollment and regular attendance. But, with about one out of every five school children receiving a meal at school every day, we think that well-designed school nutrition programs can go beyond these aims to also serve as a powerful way to help meet students’ nutritional needs.
The school environment and the food served at school can influence children’s diet for better or for worse. For example, it is not unusual to see vendors selling salty or sugary snacks near school entrances in low-income countries or vending machines on school grounds in high-income countries. Advertising of nutrient-poor, energy-dense foods directed to children is common worldwide. Analysis shows that consumption of salty and sugary foods and of soda is higher among children in developing countries than among children in developed countries.
School nutrition programs can counteract these external influences by intentionally designing a balanced school meal menu that meets nutritional deficiencies. Often small changes – such as reserving half of your plate for fruits and vegetables – can result in large health benefits.
Habits formed early in life influence choices made throughout adulthood. Dietary habits and preferences are no exception. School nutrition programs have found incorporating local food traditions into its meals to be a valuable strategy; this approach, as done in Ghana, builds food markets for local farmers while simultaneously encouraging community members to design the school menu and instilling healthy habits with fresh foods.
In the short-term, school nutrition programs can increase opportunities to access nutritious meals, and can help children avoid obesity in the long-term by teaching them to make effective dietary choices from an early age. These programs may have spill-over benefits in communities where local caterers prepare the school meals, as done in Nigeria, and the health benefits that come with a lifetime of healthy eating habits can extend to subsequent generations as well.
More children than ever are overweight. In Latin America, it is estimated that between one in four to one in five people under age 19 are overweight or obese.  Adolescent girls, particularly in lower-economic strata, are most affected by the epidemic.
Malnutrition– understood as both underweight and overweight—has negative and long lasting consequences on health that can start in childhood and persist as children grow. Obesity increases the risk of type-2 diabetes, asthma, cardiovascular disease, and these conditions affect growth and psychosocial development in adolescence. 
In response to the obesity epidemic, many countries are redesigning policies to change norms and regulations. Policy interventions range from taxation on sugar-sweetened beverages in Mexico, regulations on food marketing in Peru, the “Let’s Move” campaign in the United States, and policies to improve the school food environment in Brazil. The World Bank has provided technical guidance to develop and scale-up national school nutrition programs for many years.
Brazil is one example of many where a country has incorporated health objectives into school nutrition programs. The national school feeding program is well established, nationally funded, and has policy on the nutritional standards that school meals are required to meet. In addition, Brazil now requires that 70% of ingredients be minimally processed and a minimum of 30% of the meal budget be dedicated to purchasing from local farmers. While the modality for meal provision may vary across states and municipalities, all are mandated to follow national nutritional standards. In 2015, the Pan American Health Organization (PAHO) published a plan of action for the prevention of obesity in children and adolescents, outlining fiscal and marketing regulations to halt the rise of obesity in the region.
Effectively addressing obesity in children and adolescents will require interventions that go beyond school meals. For example, combining food provision with behavior change messaging is more effective at improving nutritional choices at school and at home. Children who attend schools with clean drinking water have fewer incentives to purchase sweetened beverages from canteens. Incorporating local produce in school meals year-round requires a strong partnership with the agriculture sector, as exemplified in Kenya. School nutrition programs are just one approach of many that has the potential to help a generation achieve the highest attainable standard of health and thrive.

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Linda Brooke Schultz

Health Consultant, Health, Nutrition, and Population Global Practice

Andy Chi Tembon

Senior Health Specialist

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