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

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends school-based interventions that combine meal or fruit and vegetable snack interventions with physical activity interventions to improve health among elementary school students (through grade 6).

Evidence shows these combined interventions increase students’ physical activity, modestly increase their fruit and vegetable consumption, and decrease the prevalence of overweight and obesity. There were not enough studies to determine whether these interventions work for middle and high school students.

The CPSTF recommends the following related intervention approaches:

Healthy Eating Interventions Alone

Physical Activity Interventions

The CPSTF finds insufficient evidence for two other intervention approaches that focus on healthy eating in schools alone and three other intervention approaches that focus on healthy eating combined with physical activity in schools. Read a summary of the findings from reviews of school-based interventions to prevent obesity.

The full CPSTF Finding and Rationale Statement and supporting documents for Obesity Prevention and Control: Meal or Fruit and Vegetable Snack Interventions Combined with Physical Activity Interventions in Schools are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions combine meal or fruit and vegetable snack interventions and physical activity interventions to improve student health.

Meal or fruit and vegetable snack interventions provide healthier foods and beverages* consumed by students, limit access to less healthy options, or both. Interventions include one or more of:

  • School meal policies ensuring breakfasts or lunches meet specific nutrition requirements (e.g., School Breakfast Program, National School Lunch Program)
  • Fruit and vegetable programs providing fruits and vegetables to students during lunch or snack

Physical activity interventions engage students in physical activity each day and include one or more of:

  • Physical education classes that engage students in physical activity
  • School policies or practices providing opportunities for physical activity during the school day (e.g., recess, classroom breaks)
  • Large-scale environmental changes that provide or improve space, facilities, or equipment (e.g., renovating playgrounds)

Interventions may also include:

  • Healthy food and beverage marketing strategies
  • Educational programs addressing nutrition or building skills for physically active lifestyles
  • Small-scale equipment to promote physical activity (e.g., jump ropes, balls, pedometers)
  • Staff involvement
  • Family and community engagement

*Healthier foods and beverages include fruits, vegetables, whole grains, low-fat or fat-free dairy, lean meats, beans, eggs, nuts, and items low in saturated fats, salt, and added sugars, with no trans fats.

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).

Study Characteristics

  • Studies 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 in two countries (Germany and the Netherlands)
  • Study populations represented a range of racial/ethnic groups: white (6 studies), black (8 studies), Hispanic (8 studies). Four studies conducted with a predominant race/ethnicity: Native American (1), black (1), predominantly Hispanic (2)

Summary of Results

The systematic review included 21 studies with 22 study arms.

  • Prevalence of overweight and obesity decreased by a median of 2.0 percentage points (7 studies)
  • Physical activity increased by a median of 22 minutes per day (6 studies)
    • Students’ cardiorespiratory fitness measures improved (8 studies)
  • Students consumed 12% more fruits and vegetables per day (4 studies)
  • 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).

Applicability

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

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?

Implementation Considerations and Resources

  • Program duration: Most evaluated interventions ran for two or more school years
  • Intervention guidelines: Most schools used existing guidelines such as the National School Lunch Program for dietary interventions; physical activity interventions varied
  • Education programs: Typically included an educational component emphasizing the importance of nutrition and physical activity for chronic disease prevention
  • Staffing: Studies relied primarily on existing school staff (e.g., teachers, food service staff), though some included outside professionals (e.g., registered dietitians)
  • Existing models: The Whole School, Whole Community, Whole Child model, promoted by CDC, provides information about the school nutrition environment, nutrition services, physical education, and physical activity

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.