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Obesity: Multicomponent Interventions to Increase Availability of Healthier Foods and Beverages in Schools

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What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review published in 2013 (Wang, 15 studies, search period search period through August 2012) combined with more recent evidence (20 studies, search period August 2012 – January 2017). Of the 35 studies, 9 evaluated multicomponent interventions to increase availability of healthier foods and beverages in schools.

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.

Context

Healthy eating during childhood is important for optimal growth (CDC , 1998; Dietary Guidelines Advisory Committee, 2010). Schools can play an important role in preventing obesity by providing nutritious and appealing foods and beverages available to students (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 9 studies.

Weight-related Outcomes:

  • The prevalence of overweight/obesity stopped increasing in 4 of the 6 studies that measured weight outcomes
  • BMIz score – 2 studies reported mixed findings

Diet Outcomes:

  • Energy intake – studies reported mixed findings
  • Sugar-sweetened beverage intake – 2 studies reported favorable findings
  • Fruit and vegetable intake – 4 studies reported no effect
  • Milk/dairy alternative intake – 3 studies reported significant increases

Summary of Economic Evidence

An economic review is pending.

Applicability

If the intervention is adapted to the target population and delivery context, findings should be applicable to the following:

  • Elementary, middle, and high school school-aged children
  • Girls and boys
  • Students from different racial and ethnic backgrounds
  • 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, competitive foods and beverages, class room celebrations, parties, or special events, nonfood items as rewards or combinations of these 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 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 randomized control trial (3 studies) repeat cross sectional (5 studies), and before-after (1 study).
  • Studies were conducted in the United States (5 studies), Canada (2 study), and the United Kingdom (2 studies).
  • Studies were conducted in schools alone (7 studies) or in schools plus one or more additional settings (2 studies).
  • Studies were conducted in elementary schools (3 studies), middle schools (1 study), or a combination of elementary, middle, or high schools (5 studies).
  • Studies were set in urban (3 studies), suburban (1 study), or a combination of urban, suburban or rural (3 studies) settings.

Publications

There are no publications for this systematic review.