# Do Higher-Quality Regulatory Measures Promote a Healthier School Food Environment?

## TL;DR

This study shows that higher-quality school food regulations in Brazil lead to healthier food environments by reducing ultra-processed foods and increasing nutrition education.

## Contribution

The study provides robust evidence that high-quality regulations significantly improve school food environments in Brazil.

## Key findings

- Canteens in areas with high-quality regulations had 1.73 times higher odds of implementing food and nutrition education.
- Canteens with higher-quality regulations had 36% lower odds of selling a higher variety of ultra-processed foods.
- Higher-quality regulations were associated with a lower frequency of advertising strategies for unhealthy foods.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study evaluates how the presence and quality of municipal and state regulations influence the school food environment, a central element in shaping the eating habits of children and adolescents.It shows that school canteens located in areas without regulation present greater availability and promotion of ultra-processed foods, increasing risks related to childhood obesity and non-communicable chronic diseases.

This study evaluates how the presence and quality of municipal and state regulations influence the school food environment, a central element in shaping the eating habits of children and adolescents.

It shows that school canteens located in areas without regulation present greater availability and promotion of ultra-processed foods, increasing risks related to childhood obesity and non-communicable chronic diseases.

Public health significance—Why is this work of significance to public health?
This study demonstrates, based on data from 2241 canteens across 27 Brazilian capitals, that higher-quality regulations are associated with greater implementation of food and nutrition education actions, lower sales of ultra-processed foods, and reduced use of advertising.It provides robust evidence reinforcing the essential role of well-structured public policies in promoting healthy eating environments within schools.

This study demonstrates, based on data from 2241 canteens across 27 Brazilian capitals, that higher-quality regulations are associated with greater implementation of food and nutrition education actions, lower sales of ultra-processed foods, and reduced use of advertising.

It provides robust evidence reinforcing the essential role of well-structured public policies in promoting healthy eating environments within schools.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
It recommends strengthening and expanding school regulations aligned with Federal Decree No. 11,821/2023, including active monitoring and mechanisms for social oversight.It highlights that the development of high-quality regulations can transform the school food environment, guiding managers and policymakers in building more effective and equitable strategies.

It recommends strengthening and expanding school regulations aligned with Federal Decree No. 11,821/2023, including active monitoring and mechanisms for social oversight.

It highlights that the development of high-quality regulations can transform the school food environment, guiding managers and policymakers in building more effective and equitable strategies.

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition education (implementation of actions promoting healthy eating), food commercialization (healthiness index, number of unprocessed, minimally processed or processed foods and culinary preparations based on these foods—UMPCP; ultra-processed foods and culinary preparations based on these foods—UpCP; comparison of UMPCP versus UpCP variety; and prohibition of food sales), and marketing communication strategies (advertising strategies for UMPCP and UpCP). The presence and quality of municipal and state regulations in force up to the month prior to data collection were assessed using a score, with a score ≥8 indicating higher quality. Analyses were conducted using binary logistic regression and adjusted generalized linear models in Stata 17.0. More than half of the canteens (51.1%) were located in areas without regulations, and only 17.8% had high-quality regulations. Canteens in areas with regulations, especially those with a score ≥8, had 1.73 times higher odds of implementing food and nutrition education actions, 2.49 times higher odds of prohibiting the sale of certain foods, and 36% lower odds of selling a higher variety of UpCP compared to UMPCP. The healthiness index was higher, the number of UpCP sold was lower, and the number of UMPCP sold was higher, while the adoption of advertising strategies was less frequent in canteens with higher-quality regulations. These findings indicate that the presence and particularly the quality of regulatory measures is associated with healthier school food environments, highlighting the positive impact of well-structured public policies.