Obesity Prevention and Control: Supporting Healthier Snack Foods and Beverages Sold or Offered Combined with Physical Activity Interventions in Schools

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of combining interventions that increase the availability of healthier snack foods and beverages sold or offered with physical activity interventions in schools. Evidence was inconsistent for dietary, physical activity, and weight-related 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 full CPSTF Finding and Rationale Statement and supporting documents for Obesity Prevention and Control: Supporting Healthier Snack Foods and Beverages Sold or Offered Combined with Physical Activity Interventions in Schools are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions combine support for healthier foods and beverages with physical activity interventions.

Interventions supporting healthier snack foods and beverages 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:

Policies requiring competitive foods and beverages sold during the school day meet nutritional standards
Celebration rules encouraging healthy foods and beverages at classroom events
Policies encouraging nonfood rewards for academic achievement

Physical activity interventions engage students in physical activity each day. Interventions must include one or more of:

Physical education classes engaging students in physical activity
School policies providing physical activity opportunities during the school day
Environmental changes providing space, facilities, or equipment for physical activity

Interventions may also include healthy food marketing, educational programs, small-scale equipment, staff involvement, and family engagement.

About The Systematic Review

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

Study Characteristics

Included studies were:

Conducted in the United States (1 study), Sweden (1 study), Germany (1 study), and Italy (1 study)
Conducted in elementary schools (1 study), middle schools (1 study), or schools spanning elementary, middle, and high school (2 studies)

Summary of Results

Four studies were included in the review.

Weight-related Outcomes

Three studies reported weight-related outcomes. Two reported favorable findings, and one reported unfavorable results.

Physical Activity

Two of three studies reported favorable findings; one reported no change

Dietary-related Outcomes

Two studies reported inconsistent findings for fruits and vegetables, sugar-sweetened beverages, and low nutrient foods

Summary of Economic Evidence

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

Applicability

Applicability was not assessed because CPSTF did not have enough information to determine if the intervention works.

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?

Implementation Considerations and Resources

Implementation considerations not included because CPSTF did not have enough information to determine if the intervention works.