Title : Food environments as structural determinants of the double burden of malnutrition and cognitive outcomes among U.S. high school students: A post-COVID scoping review
Abstract:
The COVID-19 pandemic worsened structural vulnerabilities within U.S. school food environments and intensified the “double burden of malnutrition” the coexistence of food insecurity and obesogenic dietary behaviors. Although each independently relates to impaired cognitive function and poorer academic performance, existing literature lacks a synthesized framework integrating school food environments, the double burden of malnutrition, and cognitive outcomes specifically among post-COVID U.S. high school students. This review addresses this gap by treating school food environments as primary structural determinants of nutritional and cognitive inequities rather than secondary variables. Adhering to PRISMA-ScR guidelines, peer-reviewed studies were mapped from PubMed and Scopus (2020-2026), focusing on U.S. high school populations, school food environment factors, and malnutrition-related or academic results. Subsequently, three common trends were revealed from previous evidence. First, post-COVID school food environments often promote both undernutrition and calorie-dense food intake, indicating that structural exposure was a greater cause of the double burden more than individual choice. Second, food insecurity consistently predicts deficiency across multiple cognitive domains and reduced academic achievement. Third, while a high density of unhealthy food retailers near schools is associated with lower diet quality, existing research stops at weight-based outcomes and rarely extends to cognitive consequences. The continuous decline in fruit, vegetable, and breakfast consumption after the pandemic also highlights the depth of these structural scarcity. By establishing a conceptual framework that links modifiable school food environment factors to cognitive equity, this scoping review provides a missing synthesis for the field. These findings offer direct implications for nutrition policy and public health practice, further positioning adolescent cognitive equity as a central objective in post-COVID recovery efforts.
