School-based obesity prevention programs: An evidence-based review

Objective: This review seeks to examine the effectiveness of school-based programs for reducing childhood overweight or obesity. Methods and Procedures: A systematic review of the research literature published since 1990 was conducted to identify experimental or quasi-experimental school-based curricular or environmental preventive interventions, with evaluation >= 6 months after baseline, which reported outcomes in terms of a measure of overweight. Results: Fourteen studies were identified, including one involving a nutrition-only program, two physical activity promotion interventions and eleven studies combining nutrition and physical activity components. Most studies (n = 10) offered weak (grade 2) quality evidence. One study offered strong (grade 4) evidence reducing the odds ratio for overweight in girls only, while four grade 2 studies reported significant improvements in BMI or at-risk-for overweight or overweight prevalence in boys, girls, or both. Twelve studies reported significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior. Discussion: Our ability to draw strong conclusions as to the efficacy of school-based obesity prevention programs is limited by the small number of published studies and by methodological concerns. Qualitative analysis suggests programs grounded in social learning may be more appropriate for girls, while structural and environmental interventions enabling physical activity may be more effective for boys. High-quality evaluation protocols should be considered essential components of future programs.