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Obesity Prevention and Control: Supporting Healthier Snack Foods and Beverages Sold or Offered 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 four studies (search period 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. This gives schools a chance to offer students nutritious 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 snack foods and beverages and interventions that increase the amount of physical activity students get during the school day. 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 four studies.

Weight-related Outcomes

Of the three studies that reported weight-related outcomes, two reported favorable findings (one for Body Mass Index z-score [BMIz] and one for combined overweight/obesity prevalence), and one reported unfavorable results for BMIz.

Physical Activity

Of the three studies that reported physical activity outcomes, two reported favorable findings and one reported no change in physical activity.

Dietary-related Outcomes

Two studies reported on consumption of fruits and vegetables, sugar-sweetened beverages, and low nutrient foods (i.e., high-energy dense foods). Findings were inconsistent for the three dietary outcomes.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

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?)

  • Are these combined interventions effective?
  • Do these interventions lead to other benefits (e.g., academic achievement) or potential harms (e.g., body dissatisfaction or overexertion from physical activity)?
  • How effective are these interventions across different populations, including students with disabilities?

Study Characteristics

  • Included studies were conducted in the United States (1 study), Sweden (1 study), Germany (1 study), and Italy (1 study).
  • Included studies were conducted in elementary schools (1 study), middle schools (1 study), or schools that spanned across elementary, middle, and high school (2 studies).