A 2010 federal law that boosted nutrition standards for school meals may have begun to help slow the rise in obesity among America’s children — even teenagers who can buy their own snacks, a new study showed.

The national study found a small but significant decline in the average body mass index of more than 14,000 schoolkids ages 5 to 18 whose heights and weights were tracked before and after implementation of the Healthy, Hunger-Free Kids Act of 2010.

The study is new evidence that improving the quality of school meals through legislation might be one way to help shift the trajectory of childhood obesity, which has been rising for decades and now affects about 1 in 5 U.S. kids. Whether the program has begun to turn the tide for the whole country, and not just the groups of kids studied, is still unclear. About 30 million children in the U.S. receive school lunches each day.

“You have the potential to really impact their excess weight gain over the course of their entire childhood,” said Dr. Aruna Chandran, a social epidemiologist with the Johns Hopkins Bloomberg School of Public Health. She led the study published Monday in the journal JAMA Pediatrics.

The Healthy, Hunger-Free Kids Act of 2010, championed by former first lady Michelle Obama, was the first national legislation to improve school meals in more than 20 years. It increased the quantity of fruits, vegetables and whole grains required in school meals.

The new study analyzed nationwide data from 50 cohorts of schoolchildren from January 2005 to August 2016, before the law took effect, and data from September 2016 to March 2020, after it was fully implemented. Researchers calculated kids’ body-mass index, a weight-to-height ratio.

It found that a body mass index for children, adjusted for age and gender, fell by 0.041 units per year, compared to before the law took effect. That amounts to about a quarter of one BMI unit per year, Chandran said. There was a slight decline in kids who were overweight or obese, too, the study showed.

One way to think of the change is that for a 10-year-old boy with an elevated body-mass index, the decline would amount to a 1-pound weight loss, noted Dr. Lauren Fiechtner, director of nutrition at MassGeneral Hospital for Children in Boston, who wrote an editorial accompanying the study.

“This is important as even BMI flattening over time is likely important,” she said. Holding kids’ weight steady as they grow can help keep obesity in check.

Previous studies have shown weight-related effects of the federal law among children from low-income families. The new study is the first to find lower BMI in kids across all income levels.

At the same time, significant decreases in BMI measures were seen not only in kids ages 5 to 11, but also in those age 12 to 18.

“That’s an incredible shift,” Chandran said. “These are kids who potentially have their own autonomy to buy their own snacks.”

The new results come within days of the release of updated standards for school meals, including the first limits on added sugars, decreased sodium and increased flexibility for whole grains. Agriculture Secretary Tom Vilsack said the study shows that healthy school meals are “critical for tackling diet-related conditions like obesity.”

But some researchers cautioned against interpreting the study’s findings too broadly. Some of the children included in the study might not have been enrolled in school meals programs, or their district may not have fully implemented the nutrition requirements, said Kendrin Sonneville, associate professor of nutritional sciences at the University of Michigan School of Public Health.

Significantly, measures like BMI, even when adjusted for children, “should not be used as a proxy for health,” she added.

A slight reduction in those measures, she said, “doesn’t tell us whether the health, well-being, concerns related to food security of children participating in the school breakfast or lunch program improved.”

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Children struggling with obesity should be evaluated and treated early and aggressively, including with medications for kids as young as 12 and surgery for those as young as 13, according to new guidelines released Monday.

The longstanding practice of “watchful waiting,” or delaying treatment to see whether children and teens outgrow or overcome obesity on their own only worsens the problem that affects more than 14.4 million young people in the U.S. Left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.

“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they’ll have (obesity) in adulthood.”

For the first time, the group’s guidance sets ages at which kids and teens should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavior and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital.

In general, doctors should offer adolescents 12 and older who have obesity access to appropriate drugs and teens 13 and older with severe obesity referrals for weight-loss surgery, though situations may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood weight, and a co-author of the guidelines.

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said.

Young people who have a body mass index that meets or exceeds the 95th percentile for kids of the same age and gender are considered obese. Kids who reach or exceed the 120th percentile are considered to have severe obesity. BMI is a measure of body size based on a calculation of height and weight.

Obesity affects nearly 20% of kids and teens in the U.S. and about 42% of adults, according to the Centers for Disease Control and Prevention.

The group’s guidance takes into consideration that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It predominately emerges from biological factors.”

The guidelines come as new drug treatments for obesity in kids have emerged, including approval late last month of Wegovy, a weekly injection, for use in children ages 12 and older. Different doses of the drug, called semaglutide, are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, made by Novo Nordisk, helped teens reduce their BMI by about 16% on average, better than the results in adults.

Within days of the Dec. 23 authorization, pediatrician Dr. Claudia Fox had prescribed the drug for one of her patients, a 12-year-old girl.

“What it offers patients is the possibility of even having an almost normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole different level of improvement.”

The drug affects how the pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.

“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to get because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about enhanced weight loss.

In addition, many insurers won’t pay for the medication, which costs about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”

One expert in pediatric obesity cautioned that while kids with obesity must be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.

“It’s not that I’m against the medications,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I’m against the willy-nilly use of those medications without addressing the cause of the problem.”

Lustig said children must be evaluated individually to understand all of the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, particularly ultraprocessed foods that are high in sugar and low in fiber.

Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she’d like more research about the drug’s efficacy in a more diverse group of children and about potential long-term effects before she begins prescribing it regularly.

“I would want to see it be used on a little more consistent basis,” she said. “And I would have to have that patient come in pretty frequently to be monitored.”

At the same time, she welcomed the group’s new emphasis on prompt, intensive treatment for obesity in kids.

“I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this – maybe the majority,” she said.

—- The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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NEW YORK (AP) — Jennifer Bergin was already obese and pre-diabetic before the pandemic, and learning she also had high blood pressure made her worry about how sick she might get with COVID-19. She began walking three hours a day, eventually losing 60 pounds.

“I just knew I was a prime candidate for getting it and not recovering,” said Bergin, a 50-year-old resident of Charlotte, North Carolina. Now 170 pounds and 5 feet, 4 inches tall, she is no longer considered obese, but would like to continue improving her health.

Since the early days of the pandemic, health officials have warned that obesity and related conditions such as diabetes were risk factors for severe COVID-19. It was another reminder of the many underlying health issues often signaled by obesity — as well as of how stubbornly difficult sustained weight loss can be. Even faced with such risks, it’s not clear how common Bergin’s dramatic weight loss may be.

Across the country, countless people of all body sizes have either gained or lost weight during the pandemic. For some like Bergin, no longer commuting to an office meant more time for walking, eating out less and greater control over what she ate.

But for others, being stuck at home meant moving less and eating more because of stress, anxiety, depression — or just proximity to the kitchen.

The spectrum of weight changes underscores the complexities of obesity, including how much of a role a person’s circumstances can play in their health, said Karen H. Yeary, an obesity researcher at the Roswell Park Comprehensive Cancer Center in Buffalo, N.Y. That’s contrary to the notion that losing weight is just a matter of willpower, she said.

“It takes a lot of effort and energy to eat healthy and then to lose weight,” Yeary said.

Another reason tackling obesity is so difficult: Weight gain often happens slowly over years, making it easier to dismiss as a health issue. In the U.S., an estimated one in four adults are considered obese, and another one in three are overweight.

It’s often not until a major health scare, like a heart attack or a notable deterioration in lifestyle, that people are motivated to lose weight, said Eric Plaisance, an obesity researcher at the University of Alabama at Birmingham.

And though the pandemic illuminated the risks of obesity, he said people were already used to hearing about how unhealthy it is to be overweight.

“It usually takes a much greater, life-changing event at a personal level,” he said of what often triggers successful weight loss for people.

That was the case for Mickey Beatima, a 29-year-old Seattle resident who started trying to lose weight a couple months before the pandemic, when his diabetes led to eye problems.

“That really hit me,” said Beatima, who is 5 feet, 8 inches tall and has gone from about 300 pounds to 170 pounds.

The pandemic accelerated his efforts by making weight loss easier. He was no longer getting takeout, going out with friends or gathering with his family for their customary feasts.

He also found solace in dancing to YouTube videos, and was motivated by the knowledge that getting healthier would reduce his risk for severe COVID-19.

“If I were to get it and I was still 300, I think it would be way more of a battle than if I got it today,” Beatima said.

Christian Hainds, a 42-year-old resident of Hammond, Indiana, also lost about 50 pounds during the pandemic, and at 180 pounds and 5 feet, 11 inches tall is no longer considered obese.

His weight had crept up over the years, peaking at around 230 pounds. But it wasn’t until he was diagnosed as diabetic around the start of the pandemic that he felt the urgency to make changes — especially since data was emerging that it was one of the conditions that was more likely to lead to severe coronavirus disease.

“All of those long-term scary things that can happen because of obesity no longer became long-term concerns,” Hainds said.

For many others, the spotlight the pandemic put on risks of obesity has faded as vaccines and treatments have dampened the threat of the virus, said obesity researcher Yeary. That might lessen the sense of urgency that was helping to motivate some people. The circumstances of the pandemic that made weight loss easier for some — more time for long walks, eating out less — are also going away.

Beatima, for example, is spending more time with his family again and has put some weight back on. But he’s not worried about it derailing his overall fitness goals, because, he said, the pandemic gave him perspective on how his weight was tied to what he valued, such as being healthy enough to spend time with his nieces and nephews for many years to come.

“That new ground is understanding the value of my physical health, my social health and my mental health,” he said.

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