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BACKGROUND: The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID‐19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS: Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS: The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. Conclusion: Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adoption of the Whole School, Whole Community, Whole Child (WSCC) model has been slowed by a lack of available tools to support implementation. The Wellness School Assessment Tool (WellSAT) WSCC is an online assessment tool that allows schools to evaluate the alignment of their policies with the WSCC model. This study assesses the usability of the WellSAT WSCC. METHODS: Using a convergent mixed methods design, we collected qualitative and quantitative data from 5 school‐based participants with roles in development and evaluation of policy. Participants explored the platform while engaging in a think‐aloud procedure and scored a sample policy using the platform. They also completed the System Usability Scale and responded to open‐ended questions about the usability of the platform. RESULTS: Participants rated the WellSAT WSCC as an above‐average user experience, but data suggested several areas for improvement, including improved instructions, enhanced visual design of the platform, and guidance for subsequent policy changes. CONCLUSION: The WellSAT WSCC provides an above‐average user experience but can be improved to increase user experience. These improvements increase the potential for greater use to facilitate integration of the WSCC model into school policy. [ABSTRACT FROM AUTHOR]

Objective: Family‐based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family‐based weight stigma among adult members of a weight‐management program living in Australia, Canada, France, Germany, the UK, and the US. Methods: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self‐rated health. Results: Family‐based weight stigma, especially from mothers (49%‐62%), spouses/romantic partners (40%‐57%), and fathers (35%‐48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08‐0.13|). Conclusions: Findings highlight the need for weight stigma‐reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight‐stigmatizing communication. Future research should examine the prevalence and correlates of family‐based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non‐Western countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model offers a comprehensive framework for creating safe, healthy, and supportive school environments. However, few studies to date have examined the degree to which school policies represent a comprehensive and integrated approach to this goal beyond nutrition and physical activity. Therefore, the purpose of this study was to provide a baseline evaluation of the alignment of district‐level policies with the WSCC model within one state. METHODS: Fifty‐four Connecticut public school districts' policies were evaluated using the WellSAT WSCC, a new measure of how well district‐level policies address topic areas within each domain of the WSCC model. The comprehensiveness and strength of each district's policies were calculated and then averaged across districts to assess areas of strength and need. RESULTS: Districts' policies were most comprehensive in the domains of Social and Emotional Climate; Behavioral Supports (Counseling, Psychological, and Social Services); and Family Engagement. Policies were strongest for Safe Environment (Physical Environment); Behavioral Supports; and Health Services. CONCLUSIONS: School district policy coverage of the WSCC model within Connecticut varies by domain and is often fragmented. Comprehensive and coordinated policies modeled from WSCC domains are needed to better support safe, healthy, and supportive school environments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stakeholders increasingly recognize the role of policy in implementing Whole School, Whole Community, Whole Child (WSCC) frameworks in schools; however, few tools are currently available to assess alignment between district policies and WSCC concepts. The purpose of this study was to expand the Wellness School Assessment Tool (WellSAT) for evaluation of policies related to all 10 domains of the WSCC model. METHODS: Developing the WellSAT WSCC was an iterative process that involved (1) identifying items for each domain based on key concepts and best practice recommendations; (2) expert review of the draft measure; (3) cognitive pre‐testing; (4) developing scoring criteria; and (5) pilot‐testing the measure. RESULTS: Ratings from expert reviewers indicated that the tool included items that were both relevant and important to each of the 10 WSCC domains. Results of cognitive pre‐testing indicated that the items were understood as intended. Feedback from expert reviews, cognitive pre‐testing, and pilot‐testing was used to further revise and refine the measure and develop a final version of the tool. Acceptable interrater reliability was established for the final selection of items. CONCLUSIONS: The WellSAT WSCC provides a reliable means for assessing integration and alignment between WSCC model concepts and district policies. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study tested the hypothesis that written district wellness policies are associated with higher rates of implementation of nutrition and physical activity practices. METHODS: Written wellness policies and building level practices were assessed for schools (N = 295) within high‐need districts (N = 70) in New York State. The relationship between policies and practices was measured using multi‐level mixed‐effects logistic regressions. RESULTS: Overall, stronger written district policies significantly increase the likelihood of practice implementation in schools. This relationship is strongest for physical education and physical activity items, followed by nutrition standards for competitive foods in middle and high schools. Most elementary schools implemented nutrition practices with or without a policy and there were differences in implementation rates between elementary and middle/high schools. When examined separately, policies were for the most part not significantly associated with implementation of corresponding practices. CONCLUSIONS: Strong and comprehensive written policies are associated with higher rates of practice implementation overall, but the consistency of this relationship varies by policy‐practice domain. The newer policy topics areas of school wellness promotion and marketing were less frequently included in written policies. Future research should examine whether districts that strengthen their written policies achieve greater implementation over time. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: In this study, we applied behavioral economics to optimize elementary school lunch choices via parent‐driven decisions. Specifically, this experiment tested an optimal defaults paradigm, examining whether strategically manipulating the health value of a default menu could be co‐opted to improve school‐based lunch selections. METHODS: The design was a randomized comparison of optimal versus suboptimal (standard) default lunch menus for all first‐graders in a school district for a period of 1 week. We hypothesized that making the default lunch option healthier, while providing parents the opportunity to access and choose from the standard school menu for their child, would yield more frequent selection of healthier items than when the default option was suboptimal. RESULTS: Overall, 127 (93%) first‐grade children's families participated. Among those families randomized to receive the nutritionally optimized default menu, all but one remained with these options; of those parents randomized to the standard menu (suboptimal default), all parents remained with these options (Χ2 = 123.06, df = 1, p < .001). CONCLUSIONS: The mere positioning of choices, without restricting options, significantly affected which menu items the children received during the test period. Results are proof of concept for a strategy to increase health‐promoting school lunch content, procedures, and policies. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHFKA) directed the US Department of Agriculture ( USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain insight into implementation recommendations. METHODS We conducted 5 focus groups with high school students (N = 15) from high schools across 9 states. We also conducted follow-up interviews to further explore personal experiences. Focus groups and interview transcripts were coded and organized in Atlas.ti v7 by analysts, following principles of constant comparative analysis. RESULTS Students reported overall positive perceptions of the revised school meal standards and supported continued efforts to improve the food environment. Recommendations to improve the food environment included engaging students, focusing on the quality and palatability of meal items, moving toward scratch-cooking, and addressing cafeteria infrastructure. CONCLUSIONS Students' recommendations point to opportunities where school districts, as well as local, state, and federal organizations can work to improve the school food environment. Their insights are directly relevant to USDA's recently released Local School Wellness Policy final rule, of which school meal standards are one provision. [ABSTRACT FROM AUTHOR]

Objective: Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated."Methods: In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment.Results: Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms.Conclusions: To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences. [ABSTRACT FROM AUTHOR]

Objectives To assess levels of two types of anti-fat bias in obesity specialists, explicit bias, or consciously accessible anti-fat attitudes, and implicit bias, or attitudes that are activated outside of conscious awareness, were examined. This study also assessed changes over time by comparing levels of bias in 2013 to published data from 2001. Methods In 232 attendees at the ObesityWeek 2013 conference, we measured explicit anti-fat bias and conducted the Implicit Association Test. These data were compared to those from a study conducted at the 2001 meeting of this group. Results Participants exhibited significant implicit and explicit anti-fat/pro-thin bias. Positivity of professional experience with obesity, but not type of professional experience, was correlated with lower explicit anti-fat bias. Compared to 2001, the 2013 sample had lower levels of implicit bias and higher levels of explicit bias. Conclusions Although implicit anti-fat attitudes appeared to decrease from 2001 to 2013, explicit anti-fat attitudes increased. Future research should examine whether increasing positive experiences with obese patients reduces anti-fat bias among health professionals. Together, these results suggest that despite the current climate of widespread anti-fat bias, there are pathways toward understanding and ameliorating this bias. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school-level implementation and practices. METHODS: School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school-level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district-level demographics. RESULTS: Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies. CONCLUSIONS: Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies. [ABSTRACT FROM AUTHOR]

BACKGROUND: This article seeks to inform state and local school food policies by evaluating the impact of Connecticut's Healthy Food Certification (HFC), a program which provides monetary incentives to school districts that choose to implement state nutrition standards for all foods sold to students outside reimbursable school meals. METHODS: Food service directors from all school districts participating in the National School Lunch Program (NSLP) (N = 151) in Connecticut were surveyed about the availability of competitive foods before and after the 2006-2007 implementation of HFC. Food categories were coded as healthy or unhealthy based on whether they met the Connecticut Nutrition Standards. Data on NSLP participation were provided by the State Department of Education. Changes in NSLP participation and availability of unhealthy competitive foods in elementary, middle, and high schools were compared pre- and post-HFC across districts participating (n = 74) versus not participating (n = 77) in HFC. RESULTS: On average, all districts in Connecticut reduced the availability of unhealthy competitive foods, with a significantly greater reduction among HFC districts. Average NSLP participation also increased across the state. Participating in HFC was associated with significantly greater NSLP participation for paid meals in middle school; however, implementing HFC did not increase overall NSLP participation beyond the statewide upward trend. CONCLUSION: The 2006-2007 school year was marked by a significant decrease in unhealthy competitive foods and an increase in NSLP participation across the state. Participation in Connecticut's voluntary HFC further reduced the availability of unhealthy competitive foods in local school districts, and had either a positive or neutral effect on NSLP participation. [ABSTRACT FROM AUTHOR]

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch. Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school. [ABSTRACT FROM AUTHOR]

Background: Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This review provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject. Methods: A systematic review of the literature was conducted. Four peer-reviewed papers and 3 state-based reports were identified that assessed the impact on revenues of either targeted policy changes or overarching, district-wide changes in food-related policies. Results: Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses. Conclusions: A renewed focus on school policies related to health provides the opportunity for researchers to investigate how nutrition-related policy change can affect, if at all, food service and overall school revenues. [ABSTRACT FROM AUTHOR]

Objective: This study examines the impact of presenter identity on the intended and unintended effects of an eating disorder educational program. Method: High school students viewed one of two identical videotaped discussions about eating disorders. In one condition, the presenter was identified as an “eating disorder specialist”; in the other condition, she was identified as a “recovered patient.” Before and after watching the video, participants reported on their awareness of various eating disorder symptoms, their beliefs about individuals with eating disorders, and their opinion of the presenter. Results: At Time 2, both groups reported increased knowledge about eating disorders. There was also evidence of increased endorsement of a number of implicit messages, particularly among those in the “recovered patient” group (e.g., “Girls with eating disorders are very pretty”; “It would be nice to look like” the presenter). Conclusion: The unintended effects of eating disorder educational programs should be investigated before implementation because of their potential to undermine program efficacy. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the relationship between internalization of negative weight-based stereotypes and indices of eating behaviors and emotional well-being in overweight and obese women. It used the Myers and Rosen's Stigmatizing Situations Inventory to assess experiences of weight stigma among overweight individuals. Binge eating behaviors were analyzed using the Questionnaire on Eating and Weight Patterns-Revised. It found that internalization of bias was linked with eating behaviors.

Presents information on a study which assessed the specific psychopathology of binge eating disorder (BED) as compared to anorexia nervosa (AN) and bulimia nervosa (BN). Several ways in which obese individuals with BED differ from non-BED obese individuals; Impact of patient weight on the Eating Disorders Examination (EDE) subscale scores within the BED sample; Methodology; Results and discussion.

Food insecurity, or limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways, affects more than 10% of Americans. The U.S. Department of Agriculture's 18‐item Household Food Security Survey Module (HFSSM) is the most common measure used in the United States to assess food insecurity. This measure is to be completed by one adult who reports on the severity of disruptions in the quality and quantity of the household food supply. Recent work suggests that men and women might respond differently to some of the items in this measure. Therefore, the aim of the current study was to further explore how men and women interpret each of the items and specific concepts in this measure. Pairs (n = 25) of low‐income and food‐insecure mothers and fathers of children aged 2.5–10 years participated in one‐on‐one interviews to answer the HFSSM questions using the think‐aloud method. The data were analyzed using basic inductive qualitative methods, and the findings suggest that gender is related to interpretation of key concepts relevant to food insecurity including "household," "balanced meal," and "worry." These findings have policy implications for the use of this measure as a national benchmark of food insecurity such as the potential need for an additional, complementary instrument to include several male reference questions with different terminology. [ABSTRACT FROM AUTHOR]