摘要：Objectives. We determined the impact of Breakfast in the Classroom (BIC) on the percentage of children going without morning food, number of locations where food was consumed, and estimated calories consumed per child. Methods. We used a cross-sectional survey of morning food consumed among elementary school students offered BIC and not offered BIC in geographically matched high-poverty-neighborhood elementary schools. Results. Students offered BIC (n = 1044) were less likely to report not eating in the morning (8.7%) than were students not offered BIC (n = 1245; 15.0%) and were more likely to report eating in 2 or more locations during the morning (51.1% vs 30%). Overall, students offered BIC reported consuming an estimated 95 more calories per morning than did students not offered BIC. Conclusions. For every student for whom BIC resolved the problem of starting school with nothing to eat, more than 3 students ate in more than 1 location. Offering BIC reduced the percentage of students not eating in the morning but may contribute to excess calorie intake. More evaluation of BIC’s impact on overweight and obesity is needed before more widespread implementation. Food insecurity and obesity are both serious concerns in urban, low-income communities, 1 particularly for children. Food insecurity occurs “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.” 2 According to the US Department of Agriculture, in 2010, 11.3% of US children lived in households with food insecurity (reporting mainly reductions in quality and variety of children’s meals), and 1.3% were affected by very low food security (termed “food security with hunger” before 2006). 3 Obesity is a major public health problem among children nationally 4,5 and in New York City (NYC). 6 Nearly 21% of public school students aged 5 to 14 years are obese. 6 Obesity levels are higher among low-income children who qualify for free school meals (23.4%) than among those who do not (18.9%). 7 Paradoxically, obesity often occurs among children with food insecurity. Therefore, any effort to address food insecurity should also address obesity. On any given day, between 12% and 34% of children and adolescents report skipping breakfast. 8 Eating breakfast may improve short-term memory and academic performance, particularly in undernourished children. 8 The national school breakfast program was established in 1966 and permanently authorized in 1975 to provide for students in need of adequate nutrition in the morning. 9 Through local departments of education, the school breakfast program provides meals to youths living below 130% of the federal poverty level. 9 However, breakfast consumption among youths has declined since 1965. 10 In NYC, more than 70% of public school students qualify for free or reduced-price meals. The NYC Department of Education serves more than 800 000 meals each day, using rigorous guidelines initiated in 2005, 11 and has introduced initiatives to increase participation in school meals, such as providing universal free breakfast in the cafeteria to all students, regardless of family income and, more recently, providing breakfast in the classroom (BIC) in some schools. BIC is a program intended to serve those who do not or are unable to take advantage of before-school breakfast in the cafeteria. BIC was piloted in selected public school classrooms in NYC at the discretion of school principals starting in January 2008. In the 2009–2010 school year, a number of elementary schools in low-income NYC neighborhoods initiated BIC, consisting of 4-item breakfasts delivered to classrooms and offered to students by their teacher. Breakfast items included milk, cereal, fruit or 100% fruit juice, and 1 additional item, such as carrot bread or string cheese. By January 2010, approximately 19% of approximately 1500 NYC schools served BIC in some or all classrooms. Given the coexisting problems of food insecurity and obesity, our goal was to determine the impact of BIC on the potential to both reduce breakfast skipping and increase calorie consumption. Specifically, we evaluated whether BIC was associated with any of the following changes in children’s morning food consumption: percentage who did not eat, eating locations, and estimated calories consumed.
