The adherence to school meals is associated with a lower occurrence of obesity among Brazilian adolescents

This study aimed to verify the association between adherence to meals from the Brazilian National School Feeding Program (PNAE) and obesity indicators among adolescents. Data from 12,373 students attending public schools from the 2015 National Survey of School Health were used. Adherence to school meals was assessed using a self-administered questionnaire and classified as null (zero/rarely), low (1-2x/week), moderate (3-4x/ week), and high (5x/week). Weight and height were measured and classified based on the World Health Organization's reference for Z-scores of body mass index (BMI) for age, overweight ( + 1 Z-score) and obesity (> + 2 Z-score). Linear and Poisson regression models adjusted for potential confounding factors (gender, race/ ethnicity, age, region, goods score, maternal education, living with parents, eating outside of school profile and physical activity) were performed to assess the association between adherence to school meals and the indicators (Z-score, overweight and obesity). The prevalence of high adherence was 21.6% and obesity, 8%. An inverse and dose-response association were observed between adherence to the PNAE meals and obesity indicators. Adolescents with high adherence to school meals (5x/week) had a 0.10 lower BMI Z-score (coefficient = -0.10, CI -0.17;-0.03), 11% less prevalence of overweight (PR = 0.89, CI 0.80;0.99) and 24% less prevalence of obesity (PR = 0.76, CI 0.62;0.93) than those with a lower adherence (<5x/week). Our results showed that the adherence to PNAE meals may contribute to obesity prevention in Brazil.