School Meal Delivery Models and Students' Physical Growth and Fitness: Evidence From China.

BACKGROUND

School feeding programs are widely used to support child nutrition and health, but evidence on differences across meal delivery models is limited. Leveraging a quasi-natural experiment within China's Nutrition Improvement Program, this study examined associations between snack-based and school lunch models and students' physical growth and fitness.

METHODS

Using longitudinal data from rural primary school students in Henan Province, China, from 2017 to 2022, a difference-in-differences approach evaluated associations between meal delivery models and physical growth and fitness.

RESULTS

Compared with the snack-based model, the school lunch model was associated with higher height-for-age, weight-for-age, and BMI-for-age z-scores and lower stunting prevalence. Students receiving school lunches also had higher physical fitness pass rates, indicating attainment of basic fitness standards, but lower excellence rates, reflecting higher-level physical performance. Associations varied across sex and grade groups.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School meal policies should consider meal composition, students' developmental needs, school health objectives, and implementation capacity when selecting delivery models.

CONCLUSIONS

School lunch and snack-based models showed different associations with physical growth and fitness, highlighting the importance of considering multiple dimensions of student health when evaluating school feeding programs.