Poor compliance with school food environment guidelines in elementary schools in Northwest Mexico: A cross-sectional study

Background: In Mexico, 35.5% of school-age children were overweight or obese in 2018. The school food environment is important because children spend a significant part of their time at school and consume one-third to one-half of their daily meals there. In 2014, a Federal Government guideline for the sale and distribution of food and beverages in Mexican schools was published (the AGREEMENT) but the extent of its implementation is not known. Methods: Descriptive cross-sectional study in a representative, random sample of elementary schools, using the tools of the INFORMAS network. Data collection included: a) an interview with a school authority; b) a checklist of items available in the school canteen; c) a checklist of the school breakfast menu; and d) an evaluation of the physical environment. The main indicators were: percentage of implementation (self-report) of the AGREEMENT and percentage of compliance (researcher verified) with the AGREEMENT (based on tools b and c). Results: 119 schools participated (response rate 87.5%), with 15.1% (95%CI 9.2–22.8) of the schools reporting having fully implemented the AGREEMENT. However, only 1% (95%CI 0–5.3) of the school canteens and 71.4% (95%CI 57.8–82.7) of the school breakfast menus fully complied with the AGREEMENT. A variety of sugar-sweetened beverages and energy-dense, nutrient poor products were found in the school canteens. Further, only 43.7% of the water fountains in schools were functional and 23.4% were clean. In only 24.4% of schools had the school authorities received formal training related to the AGREEMENT and in 28.6% of schools had the parents received information about the AGREEMENT. Conclusion: The AGREEMENT has been poorly implemented in elementary schools in Mexico. Actions are needed to encourage and support its full implementation to improve the food environment in Mexican schools.