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

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of multicomponent meal and snack interventions combined with a physical activity intervention in schools. Evidence was inconsistent for weight-related outcomes and only showed small improvements for dietary and physical activity outcomes.

The CPSTF recommends the following related interventions in school settings:

Healthy Eating Interventions Combined with Physical Activity Interventions

Meal or Fruit and Vegetable Snack Interventions Combined with Physical Activity Interventions in Schools

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 two 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: Multicomponent Interventions (Meal or Fruit and Vegetable Snack Interventions + Healthier Snack Foods and Beverages) Combined with a Physical Activity Intervention in Schools are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions aim to improve student health by combining meal or fruit and vegetable snack Interventions, interventions supporting healthier snack foods and beverages, and a physical activity intervention.

Meal or fruit and vegetable snack interventions are designed to provide healthier foods and beverages* that will be consumed by students, limit access to less healthy foods and beverages, or both. Interventions must include one of more of the following components:
- School meal policies that ensure school breakfasts or lunches meet specific nutrition requirements (e.g., School Breakfast Program, National School Lunch Program)
- Fruit and vegetable programs that provide fruits and vegetables to students during lunch or snack
Interventions supporting healthier snack foods and beverages sold or offered in school aim to provide healthier foods and beverages that will be consumed by students, limit access to less healthy foods and beverages, or both. Interventions must include one or more of the following components:
- Policies that require foods and beverages sold during the school day, outside of school meal programs, meet established nutritional standards or guidelines.
  - These are often referred to as “competitive foods and beverages” because they are sold in competition with school meal programs. They may be available through in-school fundraisers, la carte options, vending machines, school stores, and snack bars.
- Celebration rules or policies that encourage healthy foods and beverages be served during classroom celebrations, parties, and special events
- Rules or policies that encourage nonfood items as alternative rewards for academic achievement
Physical activity interventions engage students in physical activity each day. Interventions must include only one of the following components:
- Physical education classes that engage students in physical activity
- School policies or practices that allow opportunities for physical activity during the school day (e.g., recess and classroom physical activity)

Interventions may also include one or more of the following:

Healthy food and beverage marketing strategies
Educational programs that address nutrition or build knowledge and skills needed to maintain physically active lifestyles
Large-scale infrastructure changes that provide or improve space, facilities, or equipment to make physical activity easy and appealing (e.g., renovating a school playground)
Addition of small-scale equipment to promote physical activity (e.g., jump ropes, balls, cones, team vests, 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 that are low in saturated fats, salt, and added sugars, and have no trans fats. Less-healthy foods and beverages include those with more added sugars, fats, and sodium.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 14 studies (search period 1990 July 2017).

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.

Summary of Results

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

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

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?

Implementation Considerations and Resources

Despite the finding of insufficient evidence, the following are considerations for implementation drawn from the broader literature and expert opinion.

Program planners may want to use models to assist with program implementation. 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.