School Meal Delivery Models and Students' Physical Growth and Fitness: Evidence From China

School feeding programs are widely used to support child nutrition and health, but evidence on differences across meal delivery models is limited. Leveraging a quasi-natural experiment within China's Nutrition Improvement Program, this study examined associations between snack-based and school lunch models and students' physical growth and fitness.

Using longitudinal data from rural primary school students in Henan Province, China, from 2017 to 2022, a difference-in-differences approach evaluated associations between meal delivery models and physical growth and fitness.

Compared with the snack-based model, the school lunch model was associated with higher height-for-age, weight-for-age, and BMI-for-age z-scores and lower stunting prevalence. Students receiving school lunches also had higher physical fitness pass rates, indicating attainment of basic fitness standards, but lower excellence rates, reflecting higher-level physical performance. Associations varied across sex and grade groups.

School meal policies should consider meal composition, students' developmental needs, school health objectives, and implementation capacity when selecting delivery models.

School lunch and snack-based models showed different associations with physical growth and fitness, highlighting the importance of considering multiple dimensions of student health when evaluating school feeding programs.