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

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What the CPSTF Found

About The Systematic Review

The CPSTF 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 (36 studies, search period August 2012 – January 2017). Of the 51 studies, 11 evaluated multicomponent interventions to increase availability of healthier foods and beverages in schools.

This 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.

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

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 1.24 MB].

The systematic review included 11 studies.

Weight-related Outcomes:

  • The prevalence of overweight/obesity stopped increasing (5 studies)
  • BMIz score – no change (1 study)

Diet Outcomes:

  • Energy intake – mixed findings (3 studies)
  • Sugar-sweetened beverage intake – favorable findings (2 of 3 studies)
  • Fruit and vegetable intake – increases (3 of 4 studies)
  • Milk/dairy alternative intake – significant increases

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 1.24 MB].

The economic review included three studies (2 from the United States, 1 from United Kingdom). All monetary values are reported in 2016 U.S. dollars.

  • Intervention cost per student per year for multicomponent interventions
    • Increase fruit and vegetable consumption: $4.34 (1 study)
    • Improve nutrition content of school meals: $15.26 (1 study)
  • A survey of high school foodservice directors in Pennsylvania reported a mean revenue of $691 per school per day from à la carte sales (1 study)
  • No studies estimated cost-effectiveness or cost-benefit of the interventions.

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

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?)

  • 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?
  • What does the intervention cost to implement and what are the major drivers of cost?
  • What are long term benefits of averted healthcare cost and improved productivity in adulthood associated with interventions shown to improve nutrition and prevent obesity in childhood?

Study Characteristics

  • Study designs included group randomized control trial (3 studies) repeat cross sectional (5 studies), before-after (2 studies), and post-only with comparison (1 study).
  • Studies were conducted in the United States (6 studies), Canada (3 studies), and the United Kingdom (2 studies).
  • Studies were conducted in schools alone (9 studies) or in schools plus one or more additional settings (2 studies).
  • Studies were conducted in elementary schools (6 studies), middle schools (1 study), or a combination of elementary, middle, or high schools (4 studies).
  • Studies were set in urban (3 studies), suburban (1 study), rural (1 study), or a combination of urban, suburban or rural (4 studies) settings.

Publications

Wethington HR, Finnie RKC, Buchanan LR, et al. Healthier food and beverage interventions in schools: four Community Guide systematic reviews. American Journal of Preventive Medicine. 2020;59(1):e15-26.
Community Preventive Services Task Force. Healthier food and beverage interventions in schools: recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2020;59(1):e11-4.

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