SCHOOL-BASED INTERVENTIONS FOR 
                PROMOTING NUTRITION AND 
            PHYSICAL ACTIVITY & PREVENTING 
              OBESITY: OVERVIEW OF STUDIES 
                         AND FINDINGS  
                                          
         
         
         
        Contributors: Kelly Blondin, Pat Crawford, Dania Orta-Aleman, Hallie Randel-Schreiber, 
        Ron Strochlic, Karen Webb, Gail Woodward-Lopez 
                                
                                                        
        Produced by the Nutrition Policy Institute for the California Department of Public Health, with funding from the 
        United States Department of Agriculture’s Supplemental Nutrition Assistance Program – USDA SNAP. These 
        institutions are equal opportunity providers and employers. For important nutrition information, visit 
        www.CaChampionsForChange.net. 
        The content is solely the responsibility of the authors and does not necessarily represent the official views of CDPH 
        or USDA. 
         
                             Table of Contents  
                             EXECUTIVE SUMMARY ................................................................................................................................. iii 
                             1. Introduction .............................................................................................................................................. 4 
                             2. Methods .................................................................................................................................................... 5 
                                  2.1 Inclusion and exclusion criteria ........................................................................................................... 5 
                                  2.2 Evidence search .................................................................................................................................. 6 
                                  2.3 Evidence synthesis and analysis .......................................................................................................... 7 
                             3. Results ....................................................................................................................................................... 8 
                                  3.1 Numbers of studies and outcomes measured .................................................................................... 8 
                                  3.2 Effects of interventions ..................................................................................................................... 10 
                                  Group 1: PA only interventions ............................................................................................................... 12 
                                      Group 1.1: PE only interventions ........................................................................................................ 12 
                                      Group 1.2: PE plus other PA interventions (mainly PA promotion) .................................................... 13 
                                      Group 1.3: PA offered plus PA promotion .......................................................................................... 14 
                                      Group 1.4: PA promotion only ............................................................................................................ 15 
                                  Group 2: Nutrition only interventions .................................................................................................... 15 
                                      Group 2.1: School food changes only ................................................................................................. 17 
                                      Group 2.2: School food changes plus nutrition promotion ................................................................ 17 
                                      Group 2.3: Nutrition promotion only .................................................................................................. 18 
                                  Group 3: Nutrition + PA interventions .................................................................................................... 19 
                                      Group 3.1: PE and/or PA offered plus nutrition promotion and/or PA promotion ............................ 20 
                                      Group 3.2: After school PE plus school food changes ........................................................................ 21 
                                      Group 3.3: PE and/or PA offered plus school food changes plus nutrition promotion and/or PA 
                                      promotion ........................................................................................................................................... 22 
                                      Group 3.4: PA promotion plus nutrition promotion ........................................................................... 24 
                             4. Conclusions and implications for future interventions ........................................................................... 24 
                             Appendices .................................................................................................................................................. 28 
                             Appendix 1: Study descriptions .................................................................................................................. 29 
                             Appendix 2: Case examples of promising practices .................................................................................. 101 
                             Appendix 3. PubMed Boolean operator search strategy .......................................................................... 114 
                             Appendix 4. Selected definitions & acronyms .......................................................................................... 116 
                             References Cited ....................................................................................................................................... 117 
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                             EXECUTIVE SUMMARY 
                             School-based interventions for children should be a focal point for community obesity 
                             prevention efforts. Considerable evidence has been accumulating over the past two 
                             decades, indicating that high quality comprehensive interventions conducted at school 
                             sites can reduce the prevalence of overweight and obesity, prevent weight gain and 
                             improve child and adolescent food and Physical Activity (PA) behaviors. This review 
                             provides an updated assessment of school-based interventions which were designed to 
                             impact student nutrition, PA and clinical outcomes. Evidence reviews commencing in 2008 
                             and primary studies ending in 2018 were evaluated. The findings from this review support 
                             the use of comprehensive interventions that address physical activity (PA) and nutrition, 
                             including school physical education (PE), school food improvements, and nutrition and PA 
                             promotion for students and staff with curricula/classroom activities that match existing 
                             requirements, motivate student participation, and are easy and convenient for school staff 
                             to deliver. The findings from this review provide information that can be useful to update 
                             and enhance SNAP-Ed efforts in schools to promote nutrition, PA and healthy weight in 
                             childhood.                                                                        
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                             1. Introduction 
                             With one-third of children now classified as overweight or obese, the need is urgent for 
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                             obesity prevention interventions targeting children.  The Institute of Medicine’s Committee 
                             on Accelerating Progress in Obesity Prevention provided strong evidence supporting 
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                             schools as the focal point for preventing child obesity.  Schools provide an opportune 
                             setting to reach large numbers of children where they spend a significant proportion of 
                             their day and where many receive the bulk of their daily food intake. Schools also provide 
                             opportunities for students to participate in increased physicial activity (PA.).  
                             Public health professionals and policymakers have sought methods to promote healthy 
                             lifestyles in the school setting by improving children’s nutrition and PA. In 2016, the USDA 
                             strengthened regulations governing foods and beverages offered to children at school 
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                             through the Healthy Hunger-Free Kids Act.   
                             Research has informed and motivated many positive changes and continues to guide 
                             interventions in school settings. Many strategies have been empirically evaluated and a 
                             growing body of literature offers insights regarding promising approaches for addressing 
                             childhood obesity.  
                             With the intent of informing evidence-based practices for implementation through the 
                             California SNAP-Ed program, the Nutrition Policy Institute, University of California, 
                             Division of Agriculture and Natural Resources, conducted a review of the peer reviewed 
                             published literature on school-based strategies for nutrition and PA promotion and obesity 
                             prevention. This report presents the findings, which will be combined with those from 
                             future reviews to inform comprehensive SNAP-Ed programming across multiple settings. It 
                             first outlines the methods used to conduct the review, then presents descriptive and 
                             analytic findings, and concludes with a discussion and recommendations for California 
                             SNAP-Ed. 
                                                                                        
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