Obesity: Interventions to Support Healthier Foods and Beverages in Schools

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A young boy gets a plate including healthy fruits and vegetables from a school cafeteriaThe Community Preventive Services Task Force (Task Force) issued separate findings for four types of interventions to increase the availability of healthier meals, snacks, and beverages in schools.

  1. The Task Force recommends meal interventions and fruit and vegetable snack interventions to increase the availability of healthier foods and beverages provided by schools. This finding is based on sufficient evidence of effectiveness for increasing fruit and vegetable consumption and reducing or not changing the prevalence of obesity or overweight.
  2. The Task Force recommends multicomponent interventions to increase availability of healthier foods and beverages in schools (i.e., meal or fruit and vegetable snack interventions in combination with healthier snack foods and beverages). This finding is based on sufficient evidence of effectiveness for reducing or not changing the prevalence of obesity or overweight.
  3. The Task Force finds insufficient evidence to determine the effectiveness of interventions supporting healthier snack foods and beverages sold or offered as a reward in schools. Evidence is considered insufficient because too few studies evaluated comparable dietary and weight outcomes.
  4. The Task Force finds insufficient evidence to determine the effectiveness of interventions to increase water access in schools.

These recommendations are based on systematic reviews of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

What are “Interventions to Support Healthier Foods and Beverages in Schools”?

Interventions that support healthier foods and beverages in schools include one of the following:

1. Meal interventions and fruit and vegetable snack interventions to increase the availability of healthier foods and beverages provided by schools. Interventions must include one of the following:

  • School meal policies that ensure school breakfasts or lunches meet specific nutrition requirements (e.g., School Breakfast Program, National School Lunch Program).
  • Fresh fruit and vegetable programs that provide fresh fruits and vegetables to students during lunch or snack.

2. Multicomponent interventions to increase availability of healthier foods and beverages in schools must include one component from each of the following interventions:

  • Meal or fruit and vegetable snack interventions in combination with;
  • Healthier snack foods and beverages sold or offered as a reward in school.

3. Interventions supporting healthier snack foods and beverages sold or offered as a reward in schools must include one of the following:

  • Food and beverage policies that require foods and beverages sold during the school day, outside of school meal programs, meet established nutritional standards or guidelines.
  • Celebration and reward rules or policies that encourage healthy foods and beverages be served during classroom celebrations, parties, and special events or encourage rewards of nonfood items for academic achievement.

4. Interventions to increase water access in schools ensure students have access to safe, free drinking water during the school day.

Each intervention may also include one or more of the following:

  • Healthy food and beverage marketing strategies
    • Placing healthier foods and beverages where they are easy for students to select,
    • Pricing healthier foods and beverages at a lower cost,
    • Setting up attractive displays of fruits and vegetables,
    • Offering taste tests of new menu items, and
    • Posting signs or verbal prompts to promote healthier foods and beverages and new menu items.
  • Healthy eating learning opportunities such as nutrition education and other strategies that give children knowledge and skills to help choose and consume healthier foods and beverages.

Why are these Task Force Recommendations Important?

  • An estimated 1 in 3 school-aged children and adolescents are overweight or obese (Ogden et al. 2014).
  • Obese children are more likely to have risk factors associated with cardiovascular disease type 2 diabetes, and are more likely to become obese adults (Freedman et al. 2007; Rosenbloom et al. 1999; Biro & Wien 2010).
  • Schools can play an important role in preventing obesity because most U.S. children attend school six hours a day and consume as much as half of their daily calories at school (CDC 2016).
  • Schools can provide nutritious and appealing foods and beverages in cafeterias, vending machines, school stores, and concession stands (CDC 2011).

What are the Task Force and Community Guide?

  • The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, panel of public health and prevention experts. The Task Force works to improve the health of all Americans by providing evidence-based recommendations about community preventive programs, services, and other interventions to improve health. Its members represent a broad range of research, practice, and policy expertise in community prevention services, public health, health promotion, and disease prevention.
  • The Guide to Community Preventive Services (The Community Guide) is a collection of all the evidence-based findings and recommendations of the Community Preventive Services Task Force and is available online at www.thecommunityguide.org.

References

Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr 2010;91(5):1499s-505s.

Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR 2011;60(5):1-76.

Centers for Disease Control and Prevention. School Nutrition Environment. Atlanta (GA): 2016 [cited 2017 Jan 4]. Available from: https://www.cdc.gov/healthyschools/nutrition/schoolnutrition.htm.

Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150(1):12-7 e2.

Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311(8):806-14.

Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999;22(2):345-54

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