School of Education, University of California, Davis, California.
J Adolesc Health. 2018 Nov;63(5):561-567. doi: 10.1016/j.jadohealth.2018.06.006.
This study assessed the effectiveness of one of the earliest statewide policy initiatives to address obesity via schools-Arkansas's Act 1220 of 2003-on adolescent obesity. The Act required public schools in Arkansas to conduct body mass index (BMI) screening and reporting, restrict access to vending machines, and establish physical education and nutrition standards.
To determine the effect of Act 1220 as a whole, this study analyzed data representative of adolescents in grades 9-12 from the Youth Risk Behavior Survey using the quasi-experimental method of difference-in-differences. Changes in adolescents' weight outcomes in Arkansas before (1999 and 2001) and after (2005, 2007, and 2009) the implementation of Act 1220 were compared to changes in weight outcomes for adolescents from the neighboring state of Missouri across the same time period.
Arkansas's Act 1220 did not significantly influence adolescents' BMI-for-age z-scores (-.017; 95% confidence interval [CI] [-.097, .063]; p = .68). Further, the Act did not lead to significant reductions in BMI-for-age z-scores among adolescents who were either overweight (-.003; 95% CI [-.043, .036]; p = .86) or obese (-.010; 95% CI [-.070, .051]; p = .75). Results remain robust to adjustments for self-report bias in height and weight as well as a set of alternative comparison states.
Preventing adolescent overweight and obesity is unlikely to occur through such large-scale policy initiatives alone.
本研究评估了最早的全州范围内通过学校解决肥胖问题的政策举措之一——阿肯色州 2003 年的第 1220 号法案——对青少年肥胖的影响。该法案要求阿肯色州的公立学校进行体重指数（BMI）筛查和报告，限制自动售货机的使用，并制定体育和营养标准。
为了确定第 1220 号法案的整体效果，本研究使用差异中的差异的准实验方法，分析了来自青少年风险行为调查的代表 9-12 年级青少年的数据。在实施第 1220 号法案之前（1999 年和 2001 年）和之后（2005 年、2007 年和 2009 年），阿肯色州青少年体重变化情况与同一时期密苏里州相邻州的青少年体重变化情况进行了比较。
阿肯色州的第 1220 号法案并没有显著影响青少年的 BMI 年龄 Z 评分（-0.017；95%置信区间[CI] [-0.097，0.063]；p=0.68）。此外，该法案并没有导致超重（-0.003；95%CI [-0.043，0.036]；p=0.86）或肥胖（-0.010；95%CI [-0.070，0.051]；p=0.75）青少年的 BMI 年龄 Z 评分显著降低。结果在调整身高和体重的自我报告偏差以及一系列替代比较州后仍然稳健。
仅通过这种大规模的政策举措不太可能预防青少年超重和肥胖。
