Associations between food environment around schools and professionally measured weight status for middle and high school students

Background: Obesity rates among school-age children remain high. Access to energy-dense foods at home, in schools, in stores, and restaurants around homes and schools is of concern. Research on the relationship between food environment around schools and students' weight status is inconclusive. This study examines the association between weight status of middle and high school students and proximity to a comprehensive set of food outlets around schools. Methods: Deidentified nurse-measured heights and weights data were obtained for 12,954 middle and high school students attending 33 public schools in four low-income communities in New Jersey. Geocoded locations of supermarkets, convenience stores, small grocery stores, and limited-service restaurants were obtained from commercial sources. Random-effect regression models with robust standard errors were developed to adjust for unequal variances across schools and clustering of students within schools. Results: Proximity to small grocery stores that offered some healthy options (e.g., five fruits, five vegetables, and low-fat/skim milk) and supermarkets was associated with healthier student weight status. Having a small grocery store within 0.25 mile of school and an additional such store within that radius was associated with a lower BMI z-score (p<0.05). An additional supermarket within 0.25 mile of schools was associated with a lower probability of being overweight/obese (p<0.05). Conclusions: Improving access to healthy food outlets, such as small stores, that offer healthy food options and supermarkets around middle and high schools is a potential strategy for improving weight outcomes among students.