Ambiente escolar, regulamentação das cantinas e obesidade: um recorte do estudo de riscos cardiovasculares em adolescentes

Abstract

Introduction: Obesity is a global public health issue that has been increasingly affecting younger individuals and that has significantly increased its prevalence in adolescents living in low- and middle-income countries. Based on an ecological perspective, obesity may result from interaction between individual and environmental factors. Since adolescents spend much of the day at school, this environment can influence their food intake and physical activity. Food and beverage sales’ regulation in school cafeterias is one of the strategies adopted to prevent obesity in school environments, as well as to improve the nutritional quality of food sold by them. Despite the scenario, the literature in this field has only few studies focused on evaluating school environment and its association with obesity in Brazilian adolescents. Objectives: To characterize the school environment and evaluating the association among municipal and/or state food and beverage trade regulation in school cafeterias, school environment, and school surrounding areas with obesity in Brazilian adolescents. Methods: Cross-sectional study focused on analyzing data from the Study of Cardiovascular Risks in Adolescents (ERICA) conducted in 2013 and 2014 with adolescents in the age group 12-17 years, who were enrolled in Brazilian public and private schools. Only ERICA school database (n=1,247 schools) was used for Article 1. The analyses included the chi-square test; they were stratified based on school's administrative dependence and on country's macro- region. A unique database comprising the sample of adolescents enrolled in schools in the Brazilian metropolis of Belo Horizonte, Minas Gerais State, Brazil (n=2,530 adolescents), as well as data about the food environment surrounding these schools, was created for Article 2. The density of food and beverage outlets for immediate consumption (snack bars, candy stores, bars, restaurants, bakeries, supermarkets, hypermarkets, and grocery stores) in the 800-meter buffer network surrounding the assessed schools was determined. Multilevel logistic models were carried out. Four models were proposed in the multivariate analysis: (1) empty model; (2) model only comprising individual variables; (3) model only comprising environmental variables; and (4) model comprising both individual and environmental variables. The association between municipal and/or state regulation (main effect), and obesity in adolescents from public and private schools in Brazilian state capitals (outcome) was estimated for Article 3 by using multilevel logistic models, which were stratified based on the administrative dependence of the investigated school. Significance level set at 5% was taken into consideration for all analyses. Results: Article 1: Food environment in private schools was more obesogenic than that observed in public schools. Based on the analysis stratified by macroregion, food environment was more obesogenic in public and private schools in the Northern region than public and private schools in the Southern region, and public schools in the Northeastern region. Article 2: The number of drinking fountains in schools was inversely associated with obesity in adolescents. On the other hand, the density of outlets selling food for immediate consumption in the 800-meter buffer network surrounding schools was directly associated with the obesity. Article 3: The presence of municipal and/or state food and beverage sales’ regulation in school cafeterias was associated with lower obesity odds in adolescents from public and private schools in Brazilian state capitals. Conclusion: Results have shown that food environment in schools may be obesogenic depending on their administrative dependence and on the region, they are located in, as well as that environment may be associated with obesity in Brazilian adolescents. Understanding the association between these factors may help developing effective interventions and advanced regulations aimed at controlling unhealthy food supply in the internal environment of public and private schools and in their surroundings.