Understanding the School Food Environment and Anthropometric Indicators of Schoolchildren: A Census-Based, Cross-Sectional Study Using Primary Data in Rural Brazil

There is a gap in knowledge regarding the school food environment in small-sized municipalities. Thus, this study aims to analyze the anthropometric status of schoolchildren and the school and community food environments in a small Brazilian municipality. This is a cross-sectional, exploratory, and ecological study conducted in elementary schools and food retail outlets in Jerônimo Monteiro, Espírito Santo, Brazil. Anthropometric indicators were assessed using the students' weight and height. The school food environment was analyzed by evaluating the National School Feeding Program (PNAE) menu using the IQ-COSAN index, classifying foods brought in lunchboxes and sold at schools according to the Brazilian Dietary Guidelines, and auditing food retailers outside schools using the ESAO-S and ESAO-R instruments. Food establishments were categorized according to the Locais-Nova classification and scored using the Healthy Food Store Index (HFSI) and Healthy Meal Restaurant Index (HMRI). The study included 2 schools and 266 schoolchildren (5-11 years), of whom 33.1% had excess weight. The PNAE menu was classified as "needing improvement," and 81% of schoolchildren's lunchboxes contained processed/ultra-processed foods. In the external food environment around schools, low levels of access to healthy foods and predominance of ultra-processed food sales were observed.