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Obesity: Meal and Fruit and Vegetable Snack Interventions to Increase Healthier Foods and Beverages Provided by Schools


What the Task Force Found

About The Systematic Review

In 2013, the Agency for Healthcare Research and Quality (AHRQ) conducted a meta-analysis on the effectiveness of childhood obesity prevention programs implemented in 6 intervention settings. The Task Force finding is based on a subset of studies from the review that focused on dietary-only approaches in schools (Wang et al., 2013; 15 studies, search period through August 2012) combined with more recent evidence (20 additional studies, search period August 2012 through March 8, 2016).

This review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to obesity prevention and control. The 2016 findings about school interventions to prevent obesity update and replace the 2003 Task Force findings on School-Based Programs Promoting Nutrition and Physical Activity pdf icon [PDF - 1.15 MB] and School-Based Programs to Prevent Obesity pdf icon [PDF - 679 kB].


Healthy eating during childhood is important (CDC , 1998; Dietary Guidelines Advisory Committee, 2010). Schools can play an important role in preventing obesity by providing nutritious and appealing foods and beverages (CDC, 2016a; CDC, 2011).

Summary of Results

More details about study results are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 859 kB].

The systematic review included 16 studies with 17 study arms.

Weight-Related Outcomes

  • Overweight/obesity prevalence – median decrease of 2.1 percentage points (5 studies)
  • BMI z-score – median increase of 0.01 (not significant; 3 studies)

Diet-Related Outcomes

  • Energy intake – median decrease of 161.9 kilocalories/day (3 studies)
  • Fruit or vegetable intake – increased in 11 of the 12 study arms that reported on this outcome

Summary of Economic Evidence

An economic review is pending.


Based on results for interventions in different settings and populations, findings should be applicable to the following:

  • Elementary and middle school-aged children
  • Girls and boys
  • Students from different racial and ethnic backgrounds
  • Students from different income levels
  • Urban, suburban, and rural environments

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • Which intervention activities, school breakfast or lunch, fresh fruit and vegetable programs, or combinations of activities are most effective? Which activities are critical to success?
  • What are the cumulative effects of adding intervention components? Is a single component equally effective?
  • In order to increase comparability what are the best measures for dietary intake outcomes?
  • Do children act as agents of change by discussing changes in the school environment with parents? Do parents incorporate healthier dietary habits at home?
  • How often do schools implement interventions with fidelity? What amount of training is needed for faculty?
  • Does effectiveness vary by students’ age group?
  • Are national, state, or local policies most effective?
  • For studies reporting on milk products and alternatives to dairy, what is the fat content of these foods and beverages?
  • Do interventions lead to other health benefits such as improvements in cholesterol or blood pressure?

Study Characteristics

  • Study designs included group randomized controlled trials (7 studies), group non-randomized (1 study), repeat cross-sectional with comparison (1 study), time series (1 study), single group before-after (4 studies), or post-test only with comparison (2 studies).
  • Studies were conducted in the United States (4 studies), Canada (2 studies), Norway (3 studies), the United Kingdom (1 study), the Netherlands (1 study), Spain (1 study), Australia (1 study), Denmark (1 study), Greece (1 study), and one study collected data from 3 countries (Norway, the Netherlands, and Spain).
  • Studies were conducted in schools alone (14 studies) or in schools plus one or more additional settings (2 studies).
  • Studies were conducted in elementary schools (3 studies), middle schools (6 studies), or a combination of elementary, middle, or high schools (7 studies).
  • Studies were set in urban (1 study), rural (1 study), or a combination of urban, suburban or rural (6 studies) settings.
  • About half of each study population was female (15 studies; 1 study did not provide information).
  • Six studies reported race/ethnicity with study populations identifying as white (median: 63.4%; 3 studies), black (median: 29.7%; 1 study), Hispanic (median: 17.0%; 1 study), and First Nation (100.0%; 2 studies).


There are no publications for this systematic review.