每天一个苹果：更健康的校餐对约旦儿童的影响

Policy Research Working Paper An Apple a Day The Impact of Healthier School Mealson Children in Jordan Simone LombardiniFlorence KondylisBenedetta LervaJonas HeirmanRoshni Khincha Policy Research Working Paper11208 Abstract Poor nutritional choices and unhealthy behaviors are con-sidered responsible for the rise in childhood overweight andobesity and may reinforce each other, creating a viciouscycle. This paper studies a primary school interventiondesigned to break the cycle early in life by replacing date Leveraging the randomized pilot of a menu change in Jor-dan’s national school feeding program, the study shows thatchildren consuming the alternative meals spend 8 percentless money to buy processed snacks, are more physically This paper is a product of the Development Impact Group, Development Economics. It is part of a larger effort by theWorld Bank to provide open access to its research and make a contribution to development policy discussions around theworld. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may becontacted at huckat@worldbank.org. A verified reproducibility package for this paper is available athttp://reproducibility. The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about developmentissues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry thenames of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those r○Simone Lombardini†Florence KondylisJonas Heirman†Roshni Khincha JEL Codes: I15, I25, O12, O15 1Introduction The type and quality of food we eat every day, especially during childhood, has short-and long-term consequences on almost every aspect of our life (Gertler and Gracner,2022). In addition to impacting physical health, nutrition also affects our behaviors (Listand Samek, 2015). Poor nutritional choices and unhealthy behaviors are often observed Overweight and obesity have documented individual and social costs.Individualswho are overweight or obese have poorer physical and mental health, lower learning, andlower incomes later in life (Cawley, 2004; Gertler and Gracner, 2022); societies with highincidence of overweight and obese citizens can expect higher health care expenditure and In this paper, we investigate whether meals with an improved macronutrient balancegive children a healthy start. Specifically, we document the causal link between the pro-vision of alternative meals, containing less sugar and fat and more protein, and outcomesincluding nutritional behaviors, physical activity, school attendance, and learning among primary school children in Jordan.Like most other low- and middle-income countries,Jordan is affected by the double burden of malnutrition characterized by both undernu-trition and high rates of overweight and obesity1(Popkin et al., 2020). The World FoodProgramme and World Bank partnered with Jordan’s Ministry of Education to layer arandomized controlled trial onto the pilot of a menu change in Jordan’s National School We combine survey and administrative data to showcase four main results.First,Healthy Meals increase pupils’ dietary diversity; children in schools that switch to HealthyMeals increase their dietary diversity by 5 percent (consuming 0.25 more food groups from a control mean of 5).The increase is driven by higher consumption of the veryfoods included in the meal. Importantly, children do not compensate for the lower sugarconsumption induced by Healthy Meals by buying more sugary snacks elsewhere; theyinstead bring less money to school, a decrease equivalent to the cost of one snack at theschool snack shop (which is where they would typically purchase processed snacks duringthe school day). Children are more satisfied with the Healthy Meal than the status quo (a7 percentage points increase from a meal satisfaction rate of 83%), suggesting that these Taken together, our results indicate that Healthy Meals alone (without additionalinterventions) can break the cycle of poor nutrition and unhealthy behaviors withoutcompromising children’s enjoyment of food; more broadly, they showcase a feasible strat- 2Experimental Design and Data Collection 2.1Design In 2022, the World Food Programme (WFP), in collaboration with Jordan’s Ministry ofEducation (MoE), launched a pilot to transition the school-feeding model from fortifieddate bars to a more diversifiedHealthy Mealmodel in public primary schools during the2022–2023 school year. The new model provided students with a freshly prepared mealconsisting of a cheese-filled pastry, fruit (apple or banana), and vegetable (a cucumber) To evaluate the impact of the pilot, we implemented a randomized controlled trialin 473 public schools (456 clusters, with schools within 50m of distance combined int