School Nutrition Standards and Childhood  Obesity Prevention: Assessing Policy  Compliance and Long-term Health Effects in  Low-Income Communities in Pakistan : School Nutrition Policy and Obesity Prevention in Pakistan

Shahzad Rauf; Waseem  Ahmed; Umama Lakhani; Hira  Aamir; Muhammad Hammad  Mursaleen; Nusrat  Naseem

Authors

Shahzad Rauf International Medical Corps, Hyderabad, Pakistan https://orcid.org/0009-0001-7154-5564
Waseem Ahmed Sindh Institute of Cardiovascular Diseases (SICVD), Satellite Tando Mahammad Khan, Hyderabad, Pakistan
Umama Lakhani Body Experts, Karachi, Pakistan
Hira Aamir Iqra University, Chak Shahzad, Islamabad, Pakistan
Muhammad Hammad Mursaleen Benazir Shaheed Anti-Narcotics Force Model Addiction Treatment and Rehabilitation Center, Karachi, Pakistan
Nusrat Naseem Health Services Academy, Islamabad, Pakistan

Keywords:

Childhood Obesity, Low-Income Communities, Policy Compliance, School Nutrition Policy

Abstract

Background: Childhood obesity is an escalating crisis in Pakistan, exacerbated in low-income communities by obesogenic food environments. The national School Health and Nutrition (SHN) Strategy aims to create healthier school food spaces, but its real world effectiveness remains unassessed. This study investigated the relationship between compliance with the SHN Strategy and long-term changes in children's weight status in low-income schools in Karachi.

Methods: A three-year (2020-2022) longitudinal cohort study was conducted across 12 schools. Policy compliance was assessed using a validated tool, categorizing schools as High, Moderate, or Low Compliance. Anthropometric measurements (BMI z-scores) of 528 children were tracked annually. Mixed-methods included quantitative surveys and qualitative interviews with stakeholders.

Results: Only 16.7% of schools maintained High Compliance. A significant interaction was found between time and compliance group on BMI z-scores (p<0.01). Children in High Compliance schools showed a slight decrease in mean BMI z-score (-0.07), while those in Moderate and Low Compliance schools showed increases (+0.11 and +0.19, respectively). The prevalence of overweight/obesity remained stable in High Compliance schools (18.2% to 17.0%) but increased significantly in Moderate (21.4% to 26.4%) and Low Compliance schools (20.5% to 29.1%). Key barriers to compliance were financial pressures, student preferences, and lack of enforcement.

Conclusion: Faithful implementation of school nutrition standards is effective in mitigating unhealthy weight gain in children. Moving from voluntary guidelines to mandatory, monitored regulations with economic incentives is crucial for public health impact.

DOI: https://doi.org/10.59564/amrj/03.04/005

Author Biographies

Shahzad Rauf, International Medical Corps, Hyderabad, Pakistan

Medical Officer

Waseem Ahmed, Sindh Institute of Cardiovascular Diseases (SICVD), Satellite Tando Mahammad Khan, Hyderabad, Pakistan

Pharmacist

Umama Lakhani, Body Experts, Karachi, Pakistan

Physiotherapist

Hira Aamir, Iqra University, Chak Shahzad, Islamabad, Pakistan

Lecturer, Allied Health Sciences Department

Muhammad Hammad Mursaleen, Benazir Shaheed Anti-Narcotics Force Model Addiction Treatment and Rehabilitation Center, Karachi, Pakistan

Occupational Therapist

Nusrat Naseem, Health Services Academy, Islamabad, Pakistan

Assistant Professor

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