title: Guatemalan school food environment: impact on schoolchildren's risk of both undernutrition and overweight/obesity.
abstract: Guatemala suffers the double burden of malnutrition with high rates of stunting alongside increasing childhood overweight/obesity. This study examines the school food environment (SFE) at low-income Guatemalan elementary schools and discusses its potential impact on undernutrition and overweight/obesity. From July through October 2013, direct observations, in-depth interviews with school principals (n = 4) and food kiosk vendors (n = 4, 2 interviews each) and also focus groups (FGs) with children (n = 48, 8 FGs) were conducted. The SFE comprises food from school food kiosks (casetas); food from home or purchased in the street; and food provided by the school (refacción). School casetas, street vendors and children's parents largely provide sandwiches, calorie-rich snacks and sugar-sweetened beverages. Refacción typically serves energy dense atol, a traditional beverage. The current school food program (refacción), the overall SFE and the roles/opinions of vendors and principals reveal persistent anxiety concerning undernutrition and insufficient concern for overweight/obesity. Predominant concern for elementary schoolchildren remains focused on undernutrition. However, by the time children reach elementary school (ages 6-12+), food environments should encourage dietary behaviors to prevent childhood overweight/obesity.
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 Zona 11, Apartado Postal 1188, Guatemala 01011, Guatemala Department of International Health, Human Nutrition Division, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA elisa.l.pehlke@gmail.com.
authors.forename: Elisa L
authors.initials: EL
authors.lastname: Pehlke
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 Zona 11, Apartado Postal 1188, Guatemala 01011, Guatemala.
authors.forename: Paola
authors.initials: P
authors.lastname: Letona
authors.affiliation: Department of International Health, Human Nutrition Division, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Hurley
authors.affiliation: Department of International Health, Human Nutrition Division, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
mesh_terms: D002648:Child; D005260:Female; D017144:Focus Groups; D005522:Food Services; D006166:Guatemala; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D050177:Overweight / Q000209:etiology*; D063766:Pediatric Obesity / Q000209:etiology*; D012307:Risk Factors; D012572:School Health Services / Q000458:organization & administration; D012574:Schools / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: Latin America; nutrition; primary schools; qualitative methods
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