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Obesity Prevention and Control: Multicomponent Interventions (Meal or Fruit and Vegetable Snack Interventions + Healthier Snack Foods and Beverages) Combined with a Physical Activity Intervention in Schools


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 14 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 (National Center for Education Statistics, 2010). Schools can provide students nutritious and appealing foods and beverages and opportunities for physical activity to help students accumulate the recommends children and adolescents engage in 60 minutes of physical activity per day (CDC 2011; DHHS, 2018).

While there are many approaches available to schools, this CPSTF finding focuses on the combining meal or fruit and vegetable snack Interventions, interventions supporting healthier snack foods and beverages, and a physical activity intervention. 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 14 studies.

Weight-related Outcomes

The combined prevalence of overweight and obesity decreased by a median of 0.4 percentage points (6 studies).

Students’ body mass index z-scores (BMIz) increased by a median of 0.005 units (8 study arms).

Dietary Outcomes

Fruit and Vegetable Consumption

The number of servings of fruits and vegetables students consumed per day increased by 0.10 servings (6 study arms).

Other outcomes related to fruit and vegetable consumption showed either no change or small decreases (3 studies).

Sugar-sweetened Beverage Consumption

The number of glasses of sugar-sweetened beverages students consumed per day decreased by 0.08 glasses (5 study arms).

Other measures of sugar-sweetened beverage consumption showed inconsistent results (3 studies).

Physical Activity

Students increased time spent in physical activity (10 studies).

Other measures of physical activity (e.g., cardiorespiratory fitness or proportion of students active) showed inconsistent results (5 studies).

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 interventions effective?
  • Are programs implemented at some system levels (i.e., Federal, state, district, school, classroom) more effective than others?
  • How effective are these interventions across different populations, including students with disabilities?
  • Do interventions lead to body dissatisfaction?

Study Characteristics

  • Included studies were conducted in the United States (6 studies), Canada (2 studies), Australia (2 studies), Belgium (1 study), The Netherlands (1 study), New Zealand (1 study), and Sweden (1 study).
  • Study populations represented a range of racial and ethnic groups.