Snack Expenditure and Nutritional Status in Chilean Schoolchildren: A Cross-Sectional Study in a Southern Region

Abstract

Background and Objective: The availability of money to purchase food within the school setting has been identified as a factor associated with children’s nutritional status. The aim of this study was to analyze the relationship between spending on snacks and the nutritional status of Chilean schoolchildren living in a region in the far south. Methods: This was a descriptive, correlational, cross-sectional study. A total of 596 schoolchildren and adolescents (12.1 ± 1.3 years) from three public schools in the Magallanes Region, Chile, participated. Nutritional status was assessed using body mass index (BMI) for age, and a validated questionnaire was applied to assess frequency and type of food purchases within the school environment. To determine associations, ANOVA and Chi-square tests were used, with statistical significance set at p < 0.05. Results: Among boys, 25.8% were overweight, 36.4% with obesity, and 8.6% severely with obesity; among girls, 34.9% were overweight, 30.5% with obesity, and 5.5% severely with obesity. The average snack expenditure was 642.7 ± 658 CLP (Approximately USD 0.67). Weekly purchase frequency was once in 29.5% and twice in 26.9% of cases (p < 0.001), with no differences across BMI categories (ANOVA p = 0.469). Food preferences were unhealthy snacks in 46.5% and healthy snacks in 24.0% of cases, with no association with nutritional status (χ² = 6.073; df = 10; p = 0.728). Conclusion: Although no direct association was found between snack spending and nutritional status, high consumption of unhealthy foods reflects a persistent risk. The results highlight the importance of strengthening public and educational policies regarding school meals. A comprehensive approach is needed that combines regulation, nutrition education, and family involvement. This study provides novel evidence for the design of interventions in southern and isolated regions.

1. Introduction

The nutritional status of schoolchildren is a dynamic indicator, influenced by the growth that characterizes this stage of life, and it is significant for their cognitive, physical, and emotional development [1]. Childhood obesity is currently considered a global epidemic and a major public health challenge, according to the World Health Organization (WHO). Overweight and obesity in this age group have increased in recent decades, affecting 390 million children and adolescents aged 5 to 19 years in 2022, of whom 160 million were with obesity [2,3].

Childhood obesity is not only associated with a higher risk of non-communicable diseases (NCDs), such as type 2 diabetes and cardiovascular diseases [4], but it also negatively impacts academic performance and mental health [5,6].

Among the factors influencing the nutritional status of schoolchildren is the amount of money available to them for purchasing food during the school day. This availability, along with the food options present in the school environment, can directly shape dietary decisions [7]. Several studies have shown that children with greater amounts of money tend to purchase ultra-processed, sugar-rich foods, which contributes to increased body mass index (BMI) and a greater risk of developing NCDs [8]. However, money alone is not considered a reliable predictor of obesity, as other factors—such as maternal education and socioeconomic environment—play a more decisive role [9]. Others conclude that this factor alone does not reliably predict nutritional status, given that variables such as family socioeconomic level, maternal education and cultural environment have a more determining weight [9,10,11,12].

In this sense, it has been suggested that the relationship between available money and nutritional status is mediated by contextual factors, such as school policies, the food environment and the influence of peers or marketing campaigns [13,14], For example, Larson et al. (2016) found that snack purchasing behaviors in adolescents were related to higher caloric intake and poorer dietary quality, but not always with excess weight in all populations [15]. Similarly [11,12], highlighted the absence of a uniform pattern, suggesting that the link between pocket money and obesity is highly dependent on the sociocultural context. These discrepancies highlight a relevant research gap: it is still not clearly established whether pocket money is a direct predictor of obesity or whether its effect depends on external modulating factors [11,12].

The need for studies in specific settings, such as the extreme south of Chile, is crucial. In southern regions, the cold climate, limited availability of fresh food, and dependence on processed products can intensify the preference for energy-dense options [16,17]. Despite this, there is little research that analyzes this relationship in school populations living in extreme and isolated conditions, which justifies the contribution of this study [16,17].

Thus, research has concluded that the money children bring to school is not a determining factor for childhood obesity [10].

In Chile, a trend similar to that of other countries has been reported, with a rising prevalence of childhood and adolescent obesity, which has raised concerns among both the scientific community and public health authorities [18,19,20,21,22,23]. Evidence shows that Chilean schoolchildren often spend their pocket money on ultra-processed foods such as snacks and sugar-sweetened beverages, thereby fostering unhealthy dietary patterns [24,25], This type of diet not only negatively affects nutritional status but also creates adverse health conditions that may persist into adulthood [25,26].

Beyond economic factors, students’ food choices and their relationship with food are strongly influenced by social and cultural factors, such as peer pressure, family dietary habits, and youth-targeted marketing campaigns [27,28,29]. These factors, together with food accessibility and price, play a decisive role in shaping students’ snack purchases [30,31,32].

Previous evidence has shown that money availability is associated with greater consumption of low-nutritional-quality foods, such as snacks and sugary beverages, thereby contributing to higher BMI and poorer nutritional status [33,34,35], Nevertheless, studies analyzing the direct relationship between money for snacks and nutritional status have produced mixed results, suggesting that this relationship is complex and mediated by multiple factors [11,12], Furthermore, with regard to adolescent school populations living in extreme cold climates, the literature reveals a lack of evidence on this subject.

In response to these challenges, public policies in Chile have promoted the creation of healthier school environments. Initiatives that restrict the sale of ultra-processed foods and promote nutrition education are key to improving students’ eating habits and nutritional status [36,37], However, for these policies to be effective, a comprehensive approach involving the school community, parents, and public health authorities is required [14,38,39].

The present study aims to analyze the relationship between snack expenditures and the nutritional status of Chilean schoolchildren living in an extreme southern region. By examining food choices and their correlation with BMI, this research seeks to provide empirical evidence to inform this pressing public health issue.

It is hypothesized that greater snack expenditures are associated with a higher preference for unhealthy food choices, which may contribute to an increased likelihood of overweight and obesity among schoolchildren in southern Chile.

2. Materials and Methods

2.1. Design and Participants

This was a cross-sectional correlational study. The study population consisted of schoolchildren and adolescents from 5th to 8th grade, enrolled in three randomly selected public schools in the Magallanes and Chilean Antarctic Region. The sample size was calculated assuming 50% heterogeneity, a 5% margin of error, and a 95% confidence level. A total of 615 students were recruited; four were excluded due to the inability to perform physical assessments, one for incomplete evaluations, and 14 for lack of informed consent. The final sample consisted of 596 students.

2.2. Inclusion and Exclusion Criteria

2.2.1. Inclusion Criteria

Eligible participants were students with active enrollment at the time of data collection, of either sex, attending grades 5 through 8, and residing in Punta Arenas. Participation required the provision of written informed consent from parents or legal guardians, as well as the assent of the students.

2.2.2. Exclusion Criteria

Participants were excluded if they presented physical, mental, or cognitive health conditions that could hinder the accurate assessment of nutritional status. Students lacking duly signed informed consent and assent forms at the time of evaluation and survey administration were also excluded.

2.3. Procedure

The research team formalized a collaboration agreement with the Municipal Corporation of Punta Arenas. Three schools were randomly selected to participate in the study. The methodological design and study planning were carried out in close collaboration with the school administration and teaching staff of the participating institutions.

This project was approved by the Ethics Committee of the Central-Southern Macrozone of Universidad Santo Tomás, Chile (protocol code 96-20). All procedures were conducted in strict compliance with the international declarations of Helsinki and Singapore, as well as Chilean Law No. 20.120. Parents and/or caregivers were invited to participate voluntarily by signing informed consent, while students provided written assent indicating their willingness to participate.

A multidisciplinary team was formed, consisting of a physical therapist, a nutritionist, a psychologist, and a physical education teacher. They received specific training to standardize the use of evaluation instruments and minimize potential inter-rater bias. Data collection was conducted in adapted spaces within the schools during regular class hours. Families, administrators, teachers, and students were fully informed about the study objectives and agreed to collaborate in its implementation.

2.4. Variables

2.4.1. Nutritional Status

Nutritional status was assessed through standardized anthropometric measurements of weight and height. Body weight was measured using a digital SECA^® scale (model 804, Chino, CA, USA). Body mass index (BMI) was calculated and used to derive the BMI-for-age indicator, with classification by sex. Nutritional categories were defined as follows: undernutrition ≤ −2 SD; risk of undernutrition ≤ −1 SD; normal between −0.99 and 0.99 SD; overweight ≥ 1 SD; obesity ≥ 2 SD; and severe obesity ≥ 3 SD [40].

2.4.2. Snack Expenditure and Preferences

To evaluate the amount of money students brought to school for purchasing food and their snack preferences, specific items from the Questionnaire on Consumption, Habits, and Eating Practices for 3rd, 4th, and 5th Grade Schoolchildren in Chile, 2014 [41], were used. Item 25 asked: “Do you bring money to buy food at school?” with six possible responses: (1) Never, (2) 1 day per week, (3) 2 days per week, (4) 3 days per week, (5) 4 days per week, (6) 5 days per week. Item 26 asked: “How much money do you bring?” (open response). Item 27 asked: “What foods do you buy with that money?” with ten options: (1) Fruits; (2) Vegetables; (3) Salty snacks (chips, cheese puffs, etc.); (4) Milk or yogurt; (5) Sweet snacks (cookies, chocolate, etc.); (6) Fast foods (hot dogs, fried potatoes, empanadas, etc.); (7) Bread with toppings; (8) Sugar-sweetened beverages or juices; (9) Sugar-free beverages or juices; (10) Water.

The results of the survey (item 27) were grouped into three main categories to facilitate analysis: (1) buys nothing; (2) Healthy snack, which included milk and yogurt, bread with toppings, sugar-free beverages or juices, and water; (3) Unhealthy snack, which included salty snacks, sweet snacks, fast foods, and sugar-sweetened beverages or juices.

2.4.3. Sociodemographic Characteristics

Sociodemographic variables included sex (male/female), age, school grade (5th/6th/7th/8th), place of residence (urban/rural), and school (EC1/EC2/EC3). Additionally, it was recorded whether students received state benefits (Yes/No) from the National School Feeding Program (Programa de Alimentación Escolar, PAE) of the National Board of School Aid and Scholarships (JUNAEB).

2.5. Representativeness and Potential Sources of Bias

Although the sampling was conducted in three randomly selected public schools in the Magallanes Region, the findings are not necessarily generalizable to all Chilean schoolchildren, nor even to the entire region, since private and subsidized schools were not included. This limitation may affect representativeness, particularly regarding different socioeconomic strata and the variety of educational settings across the country.

In addition, several potential sources of bias should be acknowledged:

Family socioeconomic status: the amount of pocket money available and food choices are closely linked to household income. Families with fewer resources may restrict the amount of money given to children, whereas higher-income families may facilitate greater spending on snacks.

Parental or caregiver education: previous evidence suggests that parental educational attainment is associated with the quality of children’s dietary decisions, potentially influencing both the availability of money and snack choices.

Participation in school feeding programs (PAE): although recorded in this study, this factor may act as a confounder by influencing the frequency of snack purchases within schools.

Self-reported expenditures and preferences: since part of the data was collected through questionnaires, recall bias and social desirability bias are possible, as students may under- or over-report their actual spending behaviors.

2.6. Statistical Analysis

Statistical analyses were performed using IBM SPSS version 29.0.2.0 (IBM Corp, Armonk, NY, USA) Statistics for Windows, Descriptive statistics were reported as mean and standard deviation (mean ± SD). The normality of the variable money was assessed using skewness and kurtosis coefficients, yielding values of 0.666 and −0.582, respectively. These deviations are considered minor, and given the sample size, the variable was deemed suitable for the application of parametric tests.

To evaluate the association between money brought to school and nutritional status, a frequentist analysis with ANOVA was conducted. To examine the frequency of foods typically purchased in schools, contingency tables and Chi-square (χ²) tests were used, considering different categories of money expenditure in the school environment. Statistical significance was set at p < 0.05.

3. Results

Table 1. Sociodemographic characteristics and nutritional status of the schoolchildren and adolescents.

Variable	Male n (%)	Famale n (%)
Gender	302 (50.8%)	292 (49.2%)
Grade
Fifth grade	73 (24.2%)	93 (31.8%)
Sixth grade	88 (29.1%)	65 (22.3%)
Seventh grade	67 (22.2%)	56 (19.2%)
Eighth grade	74 (24.5%)	78 (26.7%)
Beneficiary of PAE
Yes	135 (44.6%)	152 (51.9%)
No	168 (55.4%)	141 (48.1%)
Area of residence
Urban	292 (96.7%)	289 (99.0%)
Rural	10 (3.3%)	3 (1.0%)
Nutritional status
Undernutrition	1 (0.3%)	1 (0.3%)
Risk of undernutrition	5 (1.7%)	4 (1.4%)
Normal	82 (27.5%)	80 (27.4%)
Overweight	78 (25.8%)	102 (34.9%)
with obesity	110 (36.4%)	89 (30.5%)
Severe obesity	26 (8.6%)	16 (5.5%)

PAE. School Feeding Program.

presents the sociodemographic and nutritional status characteristics of the schoolchildren and adolescents. The mean age was 12.1 ± 1.3 years, with 50.8% male and 49.2% female participants. Regarding the National School Feeding Program (PAE), participation was higher among boys (64; 21.2%) compared to girls (35; 12.0%). Beneficiaries of the School Feeding Program reported a lower frequency of snack purchases, which may be masking a potential association between expenditure and nutritional status. Within this subgroup, the proportion of healthy snack purchases was 8 percentage points higher compared to non-beneficiaries, suggesting that public policies may be moderating the effects of available pocket money.

In terms of place of residence, most students lived in urban areas, with similar proportions among boys (292; 96.7%) and girls (289; 99.0%). Conversely, participation from rural areas was low, especially among girls (3; 1.0%). Regarding nutritional status, overweight and obesity were the most prevalent categories. Overweight was more common among girls (102; 34.9%), while boys showed a higher prevalence of obesity (110; 36.4%) compared to girls (89; 30.5%).

Although the differences were not statistically significant, the confidence intervals suggest that this pattern may reflect compensatory strategies in extreme groups (children at risk of undernutrition spending more to “supplement” their diet, while those with severe obesity may be restricted by family control).

To assess snack purchase frequency (

Table 2. Weekly frequency of the schoolchildren and adolescents’ expenditure in snacks.

Times Per Week	n (%)	p-Value *
0	8 (1.32)
1	177 (29.5)	<0.001
2	160 (26.9)	<0.001
3	99 (16.6)
4	52 (8.7)
5	31 (5.3)
6	69 (11.7)

* Chi-squared (χ²).

), Chi-square (χ²) tests were performed. Results indicated that purchasing snacks once or twice per week were the most frequent behaviors (29.5% and 26.9%, respectively), with these preferences being statistically significant (p < 0.001).

Concerning snack expenditure by nutritional status (

Table 3. Mean expense ($CLP) in snacks compared by nutritional status of the schoolchildren and adolescents.

Nutritional Status	Mean ($)	SD ($)
Underweight	250.0	353.6
Risk of undernutrition	972.2	666.7
Eutrophic	665.2	653.8
Overweight	624.7	666.8
Obesity	650.8	656.0
Severe obesity	541.7	655.5

ANOVA p value 0.469.

), the average expenditure among students was 642.7 ± 658.0 CLP (0.67 USD). Underweight students reported the lowest mean expenditure (250.0; SD = 353.6 CLP) (0.26 USD), followed by those with severe obesity (541.7; SD = 655.5 CLP) (0.56 USD). The highest mean expenditures were observed in students at risk of undernutrition (972.2; SD = 666.7 CLP) (1.01 USD) and those with normal nutritional status (665.2; SD = 653.8 CLP) (0.69 USD).

Analysis of average weekly snack expenditure according to nutritional status revealed no statistically significant differences between groups (ANOVA p = 0.469).

To determine the relevance of food choice frequency, a contingency analysis was performed between nutritional status and categories of snack expenditure (

Table 4. Food purchase preference of schoolchildren and adolescents according to their nutritional status.

Nutritional Status	Buys Nothing	Healthy Snack	Unhealthy Snack	Total
Underweight	1	0	1	2 (0.3%)
Risk of undernutrition	2	1	6	9 (1.5%)
Eutrophic	44	38	82	164 (27.5%)
Overweight	57	43	80	180 (30.2%)
Obesity	55	53	91	99 (33.4%)
Severe obesity	17	8	17	42 (7.0%)

Chi-square test (χ²) = 6.073; degrees of freedom (df) = 10; p-value = 0.728.

). The Chi-square (χ²) test yielded a value of 6.073, with 10 degrees of freedom and a p-value of 0.728.

In addition, 29.5% of students reported not making any snack purchases at school. A total of 24.0% indicated a preference for healthy foods such as fruits, vegetables, sugar-free juices, bread with toppings, and dairy products. The largest proportion of choices (46.5%) corresponded to unhealthy foods, including sweet or sugary snacks, fried foods, sugar-sweetened beverages, and high-fat cookies.

4. Discussion

The objective of this study was to analyze the association between the amount of money allocated to snack purchases, or students’ purchase preferences, and their nutritional status. The main findings indicate that neither snack expenditure nor snack preferences within the school environment were statistically associated with nutritional status. However, the most frequently chosen purchase option was sweet snacks and foods high in refined sugar, classified as unhealthy.

Main findings of the study and their comparison:

These results suggest that the relationship between money available for snacks and students’ nutritional status is complex and mediated by multiple factors. Our findings contrast with previous research that reported a significant correlation between available money and the consumption of low-nutritional-quality foods such as snacks and sugar-sweetened beverages, which in turn is associated with increased BMI [35,42], The absence of a significant correlation in this study suggests that other factors, such as nutrition education, parental influence, and the school food environment, may be modulating students’ dietary decisions, thereby diluting the direct effect of money on nutritional status [7,33].

It is possible that the implementation of public policies in Chile, such as the Food Labeling and Advertising Law, which regulates the sale and promotion of unhealthy foods in schools, is beginning to show effects [36]. This law, in force since 2016, has been globally pioneering and seeks to reduce children’s consumption of ultra-processed products [37,43], Such policies may be contributing to the weaker relationship observed between snack money and nutritional status. In other words, although students may have money, food options within the school environment may be limited to healthier alternatives, which could explain the lack of correlation.

Local evidence and public policies:

In this way, local investigations have evaluated the impact of a national law banning on food choices, snack consumption and the changes in children’s and adolescents’ dietary intake. Bustos N et al. interviewed 668 children aged 10–13 years old (53.1% boys) and in addition to the types of foods purchased, the children’s motivations to buy high-energy snacks were as follows: the snacks were tasty (82%), sold at the kiosk (46%) and are cheap (38%), which highlights the importance of increasing the supply of healthy snacks and developing strategies to motivate schoolchildren to prefer them [44]. Massari et al. evaluated the impact of national law of food labeling in public schools in Santiago; the results showed that foods exceeding any cutoffs decreased from 90.4% in 2014 to 15.0% in 2016, solid products had a substantial reduction in calories, sugar, saturated fat, and sodium, liquid products had a reduction in calories, total sugar, and saturated fat, whereas sodium increased [45]. Fretes G et al. performed a longitudinal study of 349 children, analyzing fixed-effect models stratified by school, home, and other locations, and compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline, detecting that, after initial implementation of Chile’s Labeling Law, intake of most key nutrients of concern significantly declined at school; however, we found evidence of compensatory behavior in out-of-school settings [46].

The literature further suggests that the relationship between schoolchildren’s food choices and money is shaped by social, cultural, and family factors [47,48]. For example, several studies demonstrate that school and family culture play a key role in shaping children’s eating habits [49,50]. In Chile, both family and school-based nutrition education are essential, as they reduce the influence of available money on children’s dietary decisions and encourage healthier choices regardless of purchasing power [51,52]. Although not statistically significant, an important finding was that nearly half of the students (277 out of 596) reported spending their money mostly on “unhealthy snacks,” compared to 143 who chose healthier options and 176 who reported no purchases. This pattern aligns with international literature, which highlights the high palatability and energy density of ultra-processed foods rich in sugar, salt, and fat as making them the preferred choice of children and adolescents when they have discretionary resources [53].

This finding is particularly relevant in the Magallanes Region, characterized by an extreme cold climate and limited availability of fresh foods for much of the year. Previous studies in sub-Antarctic and Arctic regions have reported that low temperatures and seasonal limitations promote the adoption of energy-dense, high-fat diets as an adaptive strategy for thermal balance, increasing the consumption of ultra-processed foods and sugary drinks [54,55].

Another important factor is food accessibility both within and outside the school environment. Accessibility, along with child-targeted marketing, has been identified as a key determinant of food choice [56,57]. In Chile, restrictions on the sale of unhealthy foods within schools may be reducing the negative influence of money availability by redirecting purchases toward healthier options, which may also help explain the lack of a significant correlation between snack money and BMI [58].

The geographic location of the study population is another relevant consideration, as participants reside in southern latitudes between 48°36′ and 56°30′ in Chile. This area is marked by a cold climate for much of the year and is geographically isolated from the rest of the country, separated by ice fields that prevent overland access [59]. Climate can influence nutritional status: extreme and isolated environments may compromise food security and nutrient bioavailability, increasing vulnerability due to limited supply. Despite this restricted access, developing new patterns of healthy and sustainable diets can be seen as a first positive step toward making adequate nutrition attainable for the population [16]. Furthermore, cold climates themselves may exert metabolic and adaptive effects influencing nutritional status [17]. Nutritional status, therefore, does not depend on a single factor but is instead shaped by multiple determinants across the life cycle, including accessibility, psychosocial aspects, resources, geographic location, and climate [60].

Strengths and Limitations:

This manuscript is not exempt from limitations. First, due to its cross-sectional design, it is not possible to establish causal relationships between snack expenditure and nutritional status. The conclusions should be interpreted with caution, as they reflect a specific moment in time rather than a temporal relationship. In addition, the evaluated population belonged exclusively to public schools, which limits the generalizability of the findings, since private or subsidized institutions were not included.

Another limitation is that the results are based on self-reported data, which are subject to recall bias and social desirability bias. Given the characteristics of the applied questionnaire, under- or over-reporting of snack expenditure or consumption may have occurred. Finally, the survey grouped foods into general categories (“healthy” and “unhealthy”), which does not account for portion size or context of consumption.

Among the strengths of this study, its pioneering value stands out, as it was conducted in an extreme and underrepresented geographic region in scientific literature. This research provides novel data on the determinants of children’s nutritional status in southern settings. Moreover, the robust sample size (n = 596) and random selection of schools strengthen the study’s internal validity and provide a solid analytical basis. Finally, the use of validated instruments for Chilean schoolchildren ensures both cultural and methodological relevance in assessing eating habits and snack expenditure, complemented by the inclusion of sociodemographic variables and participation in state feeding programs (PAE), enabling a comprehensive interpretation that considers individual, family, and contextual factors.

Suggestions for Future Research:

Future research should address the aforementioned limitations by employing longitudinal designs that allow a deeper exploration of the relationship between snack expenditure, food environment, and nutritional outcomes.

It would also be pertinent to include schools from different administrative systems (public, private, and subsidized) to analyze socioeconomic differences in dietary patterns and their relationship with schoolchildren’s nutritional status.

The results of this study underscore the need to consider multiple factors when investigating the relationship between snack money and nutritional status in schoolchildren. While the amount of money available is an important element, nutrition education, the food environment, and public policies play crucial roles in shaping eating habits [15,61]. Future research should focus on unraveling how these factors interact to influence students’ dietary decisions.

Finally, it is essential that public policies continue to strengthen regulations on food sales in schools and promote comprehensive nutrition education involving parents and the school community as a whole. Only through an integrated approach will it be possible to encourage healthy eating habits and improve students’ nutritional status in the long term.

5. Conclusions

This research acquires a unique value by being conducted in the Magallanes Region, an area characterized by a cold, extreme climate and limited accessibility. This factor, often underestimated, introduces a crucial variable that most studies fail to consider. The discussion suggests that low temperatures and the limited availability of fresh foods may influence schoolchildren’s choices, favoring the consumption of ultra-processed, energy-dense products as an adaptive strategy. This positions the study as pioneering in its approach, and its findings are essential for the design of future public health policies tailored to the specific conditions of remote and polar regions.

Regarding in-store purchasing preferences, unhealthy snacks predominated, followed by non-purchase and healthy snacks. The distribution of these preferences differed significantly across the sample, indicating that food choices were not uniform across the categories considered. When comparing food choices (non-purchase/healthy/unhealthy) with nutritional status categories, no significant differences were observed. Consequently, reported purchasing preferences did not vary in a statistically detectable way according to BMI/age.

Despite the lack of a statistical correlation, the study reveals an important gap between students’ preferences and the factors that ultimately shape their decisions. A high proportion of students expressed a preference for unhealthy snacks, which is consistent with literature describing the palatability of these products. However, the fact that this preference does not translate into a direct correlation with nutritional status highlights the influence of external factors such as accessibility within the school environment, nutritional education at home, and family culture. The study underscores the complexity of the phenomenon, showing that purchase intention is neither the only nor the primary predictor of dietary behavior in this context.

Barriers that limit participation in the EAP program, especially for girls and students in rural areas, must be investigated and addressed. This may include issues of perception, quality, scheduling, or stigma. Likewise, the accessibility, affordability, and appeal of healthy options (fruits, vegetables, sugar-free juices, dairy products) at school and community outlets must be increased. Finally, research is needed to thoroughly address the factors that affect food choices in extreme areas.

The study reinforces the notion that nutritional status is a multifactorial and complex outcome. The conclusion must emphasize that it is not enough to regulate children’s spending or preferences. To achieve sustainable change, it is crucial to adopt a comprehensive approach that includes the continuation of restrictive public policies, the promotion of robust nutrition education in schools and households, and the consideration of geographical and cultural factors.