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Obesity Prevention and Control: Meal or Fruit and Vegetable Snack Interventions Combined with Physical Activity Interventions in Schools


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 21 studies with 22 study arms (search period January 1990 – July 2017).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.


Most U.S. children ages 5 to 18 years attend school for an average of six to seven hours a day during the school year. Schools can provide students nutritious and appealing foods and beverages and opportunities for physical activity to help students get the recommended 60 minutes of physical activity each day (CDC 2011; DHHS, 2018).

While there are many approaches available to schools, this CPSTF finding focuses on the combination of interventions that provide students healthier meals or fruit and vegetable snack interventions and physical activity interventions. Read a summary of all CPSTF findings for school-based interventions to prevent or control obesity.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 21 studies with 22 study arms.

Overweight and Obesity Prevalence

The prevalence of overweight and obesity decreased by a median of 2.0 percentage points (7 studies).

Physical Activity

Physical activity increased by a median of 22 minutes per day (6 studies).

Students’ cardiorespiratory fitness measures improved (8 studies).

Fruit and Vegetable Consumption

Students consumed 12% more fruits and vegetables per day (4 studies).

The number of times per day students consumed fruits and vegetables increased by 3.0% (5 studies).

Summary of Economic Evidence

The CPSTF did not issue an economic finding for this intervention because only one study was identified in a search for evidence (search period 1990 through July 2017).


The CPSTF finding should be applicable to elementary schools (kindergarten through grade 6; single-sex or co-educational).

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What are the best measures for dietary intake, physical activity, and weight-related outcomes? Increased consensus on definitions would improve comparability and the ability to synthesize evidence.
  • Do these interventions lead to other benefits (e.g., academic achievement) or potential harms (e.g., body dissatisfaction)?
  • Are schools implementing interventions correctly?
  • What amount of training is needed for faculty?
  • Are interventions effective among middle and high school students?

Study Characteristics

  • Included studies were conducted in the U.S. (13 studies), Canada (1 study), Denmark (1 study), Greece (1 study), Iceland (1 study), New Zealand (2 studies), and Norway (1 study); one study took place in two countries (Germany and the Netherlands).
  • Study populations represented a range of racial/ethnic groups. Students were white (6 studies), black (8 studies), or Hispanic (8 studies). Four of the 14 studies were conducted with a predominant race/ethnicity: Native American (1 study), black (1 study), and predominantly Hispanic (2 studies).