Assessing the existing evidence base on school food and nutrition policies: a scoping review

Assessing the existing evidence bAse on school Food And nutrition Policies: A scoping review

Assessing the existing evidence bAse on school Food And nutrition Policies: A scoping review Assessing the existing evidence base on school food and nutrition policies: a scoping review ISBN 978-92-4-002564-6 (electronic version) ISBN 978-92-4-002565-3 (print version) © World health organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Designed by minimum graphics iii Contents Acknowledgements iv Executive summary v 1. Background 1 2. Rationale and objectives 5 3. Methods 6 3.1 Inclusion and exclusion criteria 6 3.2 Information sources and search strategy 6 3.3 Study selection and data charting 7 3.4 Assessment of methodological quality 8 3.5 Synthesis of results 8 4. Results 9 4.1 Search results 9 4.2 Description of included studies 10 4.2.1 Study design 11 4.2.2 Number of included primary studies 11 4.2.3 Population and setting 12 4.2.4 Types of interventions 15 4.2.5 Comparators 20 4.2.6 Outcomes 21 4.2.7 Conflict of interests and funding 24 4.2.8 Gaps in the evidence base 24 4.2.9 Implementation reviews 25 5. Discussion 26 6. Strengths and limitations 28 7. Conclusions 29 References 30 Annexes 38 Annex 1. Search strategies 38 Annex 2. Characteristics of included studies 41 Annex 3. Characteristics of excluded studies 70 Annex 4. Systematic reviews awaiting assessment 81 iv Acknowledgements This scoping review was prepared by Solange Durão, Jenna Patterson, Tamara Kredo and Eugene Lee Davids from Cochrane South Africa, South African Medical Research Council. The development and implementation of the search strategies for this scoping review was undertaken by Joy Oliver (Cochrane SA, SA Medical Research Council). Comments on the protocol were provided by Lisa Bero (Senior Editor, Cochrane Public Health and Health Systems Network), Luke Wolfenden (Joint Coordinating Editor, Cochrane Public Health) and Vivian Welch (Editor in Chief, Campbell Collaboration). External peer review was provided by Dr Daniela Küllenberg de Gaudry (Nutritional Scientist, Cochrane) and Prof. Ernesta Kunneke (Head of Department, Department of Dietetics, Faculty of Community and Health Sciences, University of the Western Cape, South Africa). Neither reviewer had any conflicts of interest related to this publication to declare. The scoping review was commissioned by the Safe, Healthy and Sustainable Diet Unit of the Department of Nutrition and Food Safety (NFS) under the guidance of Dr Chizuru Nishida and Dr Katrin Engelhardt. The review was presented to the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Policy Actions at their second meeting held in December 2019. Subsequent to the NUGAG meeting, and drawing on the scoping review’s findings, the Expert Advisory Group developed a set of research questions relating to school food and nutrition policies that remain to be answered by future systematic reviews. Technical editing of the document was undertaken by Ann Morgan, and cover design and formatting of the document was undertaken by Sue Hobbs. Solange Durão and Tamara Kredo are partly supported by the Research, Evidence and Development Initiative (READ-It) project. READ-It (project number 300342-104) is funded by the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies. vExecutive summary The prevalence of overweight and obesity among children and adolescents is rising globally, with more than two thirds of overweight children now living in low-and middle-income countries (LMICs). School food and nutrition policies that address key areas such as the school community, curriculum, food and nutrition environment and/or nutrition and health services have the potential to address the rise in prevalence of overweight, obesity and diabetes, as well as to prevent and reduce undernutrition. This report presents the results of a scoping review conducted in 2019 to identify and map existing evidence on the effects of school food and nutrition policies on health-related outcomes in children of school age. For the purposes of this exercise, and in order to align with WHO’s Nutrition-friendly Schools Initiative (NFSI) framework, school-based food and nutrition interventions were assessed in terms of the impacts in all four key policy areas, namely – the school community, the school curriculum, the school food and nutrition environment, and school nutrition and health services. Three electronic databases were searched for systematic reviews meeting the eligibility criteria: the Cochrane Library, Epistemonikos and PubMed. All systematic reviews published since 2012 in English on school food and nutrition policies that promote healthy diets among learners in primary and secondary school through interventions that address either the school community, the curriculum, the food environment or nutrition and health services were considered. Inclusion criteria relating to outcomes were kept deliberately wide and included both health outcomes (e.g. BMI) and non-health outcomes (e.g. consumption and purchasing behaviour). All titles and abstracts of records identified through the database searches were screened by one reviewer against the eligibility criteria. One reviewer was also responsible for screening all the potentially eligible full texts and for charting the data for the included studies using a pre-specified and piloted form. Results were tabulated and described narratively. After excluding duplicates and obviously irrelevant titles, the titles and abstracts of 2,569 records, and then 258 full texts, were screened. A total of 173 records were excluded at the full-text screening stage, leaving 69 reviews to form the basis of the scoping review – including 64 completed systematic reviews and two systematic review protocols which assessed the effectiveness of policies or interventions, and three completed systematic reviews that focused on strategies for implementing policies or interventions. Most of the effectiveness reviews reported on children aged between 5 and 18 years (n = 20/66) or children under 5 up to the age of 18 years (n = 17/66), that is, pre-schoolers as well as primary- and secondary- school-aged children. Approximately half of the effectiveness reviews assessed nutrition interventions only (n = 28/66), and a roughly equal proportion assessed the impact of a broader set of interventions, for example, interventions which addressed physical activity as well as nutrition (n = 31/66). The effectiveness of interventions which addressed the school curriculum was assessed in 48 reviews, while interventions that focused on modifying the school food and nutrition environment were the subject of 39 reviews. The most reported outcomes were anthropometric (in 47 of 66 reviews) and diet-related (in 40 of 66 reviews). vi Assessing the existing evidence bAse on school Food And nutrition Policies This scoping review identified and mapped the evidence provided by existing reviews on the topic of school food and nutrition policies. This work has helped to outline the scope of new WHO guidelines on school food and nutrition policies, which are currently under development. By identifying the types of interventions that the new guidelines will need to address, the scoping review has fulfilled one of its main aims. It has also identified key gaps in the existing evidence base on school food and nutrition policies, in terms of both primary and synthesized research. The main primary research needs have been identified as: more studies in lower income countries; greater inclusion of theoretical models to support the implementation of interventions; more studies which make comparisons between interventions with and without parental participation, as well as across socioeconomic divides; extension of outcomes of interest beyond physical outcomes to include cognitive and academic outcomes, as well as environmental determinants; and more studies which assess the cost-effectiveness and sustainability of interventions. Longer term follow-up studies were also identified as a research need going forward. Finally, this scoping review identified a set of research questions relating to school food and nutrition policies which remain to be addressed by future systematic reviews. 11. Background Currently, millions of children worldwide are not reaching optimal growth and development, and there is evidence that the prevalence of delays in children’s cognitive, language, social and emotional development is rising almost everywhere (1). These developmental delays have been shown to have profound implications for health and well-being later in life. Nutrition is at the cornerstone of optimal growth and development during childhood and adolescence (2–4). Poor nutrition and unhealthy diets have been associated with diminished outcomes in both children and adolescents (3, 4), and are major risk factors for mortality and morbidity (5). While global efforts to address undernutrition have led to declines in the prevalence of stunting and wasting, rates remain high in many low-income settings (2, 4, 5). Estimates for 2019 suggest that, globally, 38.3 million children under the age of 5 are overweight or obese, an increase of 8 million since 2000. Almost half of all overweight children under 5 live in Asia and one quarter in Africa (6). The school setting provides an environment in which the health of children, as well as that of the wider school community, can be protected and promoted. In terms of implementing interventions to address all forms of malnutrition in children and adolescents, the school setting is therefore an important one to consider. Where they have been introduced, school food and nutrition policies often address one or more of the following areas or “elements”: "" the school community, "" the school curriculum, "" the school food and nutrition environment, and "" the school nutrition and health services (7, 8). Within each of these elements, different types of interventions or actions may be implemented to improve nutrition (Table 1). These interventions or actions, when implemented as part of comprehensive school food and nutrition policies, have the potential to address the rise in prevalence of overweight, obesity and diet-related noncommunicable diseases (NCDs), as well as to prevent and reduce undernutrition. Implementing food and nutrition policies within the school setting offers the additional benefit of providing more equitable access to improved health outcomes for children from various socioeconomic backgrounds (9). Fig. 1 depicts the pathways through which school-based nutrition interventions may improve health and educational outcomes in children and adolescents. Outputs associated with these interventions include changes in knowledge, attitudes and behaviours about healthy diets at the individual level; changes in norms, policies and food environment at the school level; and changes in norms and access to healthier foods at the family and community level. These changes would then influence behaviours related to diet, hygiene, cooking and food hygiene skills, as well as concentration and participation in the school environment. These behaviour changes would ultimately result in desirable health and educational outcomes, such a reduction of all forms of malnutrition and improved academic performance, among others. Recognizing the importance of schools in promoting population health, WHO launched its Global School Health Initiative in 1995 with the aim of improving the health of students and 2Assessing the existing evidence bAse on school Food And nutrition Policies the school community through strengthened health promotion and educational activities. This initiative established healthy nutrition as an essential element of a “health-promoting school” (11), a concept that was further championed by WHO’s Global Strategy on Diet, Physical Activity and Health, published in 2004 (12). Launched in 2006, the Nutrition-friendly School Initiative (NFSI) reaffirmed the pivotal role of nutrition in the context of health-promoting schools and took a further step towards the development of integrated policy action by providing a framework for ensuring that school-based programmes address the double burden of malnutrition, namely overweight and obesity, and undernutrition. The importance of policy actions in schools was reiterated in the report of the WHO Commission on Ending Childhood Obesity (13). Building on the above-mentioned work, the Second Joint WHO/FAO International Conference on Nutrition (ICN2), held in 2014, called for healthy diets to be fostered in preschools and schools (14). More specifically, a recommendation was made to “implement nutrition education and information interventions based on national dietary guidelines and coherent policies related to food and diets, through improved school curricula”. Despite the numerous calls to action to protect, promote and support good nutrition and healthy diets in the school environment and despite evidence supporting the efficacy of the NFSI, there has been a notable weakening in programming for school health and nutrition over the past decade. Comparisons between the reported outcomes of the second Global Nutrition Policy Review (GNPR2), conducted 2016–2017, and those of the first GNPR (2009– table 1. school food and nutrition policy elements and examples of interventions/actions Policy elements examples of interventions/actions School community Education of teachers, parents and larger community on healthy eating School curriculum Nutrition education included in the school curriculum Provision of extracurricular nutrition education (e.g. workshops) School vegetable gardens School food and nutrition environment Standards and rules for foods and beverages available at school or sold in schools (i.e. through school canteens or vending machines) School food procurement policy, including policies to restrict provision and/or sales of foods and non-alcoholic beverages in schools (underpinned by school food standards) Pricing policies (e.g. policies to promote healthier alternatives; may include reducing the price of healthier options/ increasing price of less healthy options) Policies to restrict marketing of foods and non-alcoholic beverages in and around schools Standards for the marketing of foods and non-alcoholic beverages in schools Provision of food at school (e.g. school meals, fruit and vegetable schemes, milk schemes) School nutrition and health services Growth monitoring Deworming Water and sanitation programmes (e.g. safe drinking water available free of charge) Micronutrient supplementation The school community element refers to the education of all agents who are part of the school system (i.e. students, parents, teachers, supporting staff and the wider school community) with regards to healthy nutrition. The school curriculum element refers to the provision of nutrition education to children and adolescents attending school, either as part of the school curriculum or through extracurricular activities, and which aims to improve their nutritional and diet choices. The school food and nutrition environment element refers to the quality of food and drink available in the school setting. The school nutrition and health services element encompasses the support services that enable detection of nutrition problems or that provide a channel to deliver specific nutrition interventions in the school setting. Sources: adapted from WHO, 2018 (7) and WHO Regional Office for Europe, 2006 (8). 3A scoping review Fi g. 1 n l og ic m od el d ep ic ti ng p at hw ay s fr om s ch oo l f oo d an d nu tr it io n po lic ie s to h ea lt h an d ed uc at io na l o ut co m es In pu ts In te rv en tio n O ut pu ts O ut co m es In te rv en tio n Pa rt ic ip an ts M ed ia to rs He al th o ut co m es He al th b eh av io ur s Re so ur ce s "• Sc ho ol re so ur ce s "• Co m m un ity re so ur ce s St ak eh ol de rs "• Ot he r s ch oo l s ta ff (e .g .ca te rin g) "• Sc ho ol g ov er na nc e st ru ct ur es "• Pa re nt s/ gu ar di an s "• Co m m un ity or ga ni za tio ns (in te rn at ion al an d na tio na l) Po lic y co nt ex t "• In te rn at io na p ol ici es "• Na tio na l p ol ici es "• Sp ec ifi c- sc ho ol po lic ie s Po lic ie s o r i nt er ve nt io ns sh ou ld a dd re ss a t l ea st on e of th e fo llo wi ng : 1. S ch oo l c om m un ity e. g. e du ca tin g te ac he rs , fa m ili es , l ar ge r co m m un iti es o n he al th y ea tin g 2. S ch oo l c ur ric ul um e. g. n ut rit io n ed uc at io n (c ur ric ul um /e xt ra - cu rr icu la r); sc ho ol g ar de ns 3. S ch oo l f oo d an d nu tri tio n en vi ro nm en t e. g. m ar ke tin g re st ric tio ns ; fo od p ro cu re m en t; fo od pr ov isi on 4. S ch oo l n ut rit io n an d he al th s er vi ce s e. g. w at er a nd sa ni ta tio n; m icr on ut rie nt su pp le m en - ta tio n Sc ho ol st ud en ts Sc ho ol st aff Pa re nt s Co m m un ity In di vi du al le ve l: Ch an ge s i n: Kn ow le dg e At tit ud es Be ha vi ou r/s ki lls So cia l n or m s Sc ho ol le ve l: Ch an ge s i n: Sc ho ol -w id e no rm s Po lic ie s Fo od e nv iro nm en t Ac ce ss to h ea lth y f oo d St aff a nd st ud en t be ha vi ou rs Fa m ily /c om m un ity le ve l: Ch an ge s i n: Fa m ily n or m s Co m m un ity n or m s In cr ea se d ac ce ss to he al th ie r f oo d Ó H ea lth y d ie t Ó O ve ra ll he al th & de ve lo pm en t Ó H yg ie ne Ó Co ok in g & fo od h yg ie ne sk ill s Ó Pa rti cip at io n wi th sc ho ol e nv iro nm en t Ed uc at io na l o ut co m es Ed uc at io na l b eh av io ur s Ó Co nc en tra tio n Ô O ve rw ei gh t/o be sit y Ô Un de rn ut rit ion Ô D ia be te s/ NC D ris k fa ct or s Ó A ca de m ic pe rf or m an ce Ó Sc ho ol a tte nd an ce So cio de m og ra ph ic an d en vi ro nm en ta l f ac to rs (s oc ia l c ap ita l, so cia l i ne qu ity , g en de r, et hn ici ty , o th er ) N C D , n on co m m un ic ab le d is ea se S ou rc e: a da pt ed f ro m L an gf or d et a l., 2 01 4 (1 0) . 4Assessing the existing evidence bAse on school Food And nutrition Policies 2010) supports this negative trend (7). This situation suggests that here is an underused opportunity to create enabling school food environments and underscores the urgent need for evidence-informed guidelines in this important public health policy area. To meet this need, WHO’s Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Policy Actions is currently working towards developing a new set of WHO guidelines on school food and nutrition policies. These guidelines are designed to help more countries to accelerate policy actions to protect, promote and support healthy diets in schools.1 WHO has been actively engaged in, and committed to, developing more robust evidence- informed policy guidelines through its guideline development process, a process which it first introduced in 2010. The present scoping review was conducted to inform NUGAG’s discussion and support its guideline development work by assessing the extent of the existing evidence base on school- based food and nutrition policies. Scoping reviews are a type of knowledge synthesis that follow a systematic approach in order to map evidence on a given topic and to identify the main concepts, theories, information sources and knowledge gaps (15). From the perspective of guideline development, scoping reviews are valuable in a number of ways, including the identification of the key questions for new systematic review(s) that may need to be conducted in order to support guideline development (16). 1 See: (https://www.who.int/nutrition/topics/guideline-development/nugag_policyactions/en/). 52. Rationale and objectives The rationale for conducting a scoping review at this time is to inform the development of WHO’s proposed guidelines on school food and nutrition policies, in particular, by identifying critical gaps in the evidence base. The objectives of this scoping review may be specified as follows: 1. to identify and map the scope of available evidence from systematic literature reviews on the effects of school food and nutrition policies on important health-related outcomes; 2. to identify gaps in the existing evidence base and to identify new systematic review questions that would need to be answered in order to support the development of the planned WHO guidelines on school-based food and nutrition policies; and 3. to identify existing systematic reviews that may be used to inform the planned WHO guidelines, if available. 63. Methods A systematic approach, based on the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines (15), was used to conduct and report this scoping review. The review protocol was developed a priori. 3.1 inclusion and exclusion criteria Inclusion and exclusion criteria for the scoping review were developed based on the recommended PICOS elements (Population, intervention, comparator, outcomes, study design) for systematic and scoping reviews (17) and are outlined in Table 2. Any published systematic review, as well as any systematic review protocol, published between 2012 and 2019 that met these eligibility criteria was considered for inclusion. For the purposes of this scoping review, a systematic review was defined as a review of primary studies that had pre-determined objectives and pre-determined criteria for inclusion, had searched at least two data sources (at least one of which was an electronic database), and had performed data extraction and a risk of bias assessment (18). Systematic reviews (and protocols) that assessed either the effectiveness of policies or of policy implementation strategies were considered eligible for inclusion. Reviews of the latter type typically employ implementation research, which studies strategies designed to integrate health policies, practices or programmes within specific settings, for example, continuous quality improvement, educational materials, performance monitoring, local consensus processes and educational outreach visits. As this review aimed to explore and map the scope of the existing evidence base relating to school-based food and nutrition policies, the definition of a “policy” was kept intentionally broad. Thus, any review that included interventions that were either specifically referred to as policies, or that addressed at least one of the policy elements listed in Table 1 and could thus, in theory, be incorporated into school policy, was considered eligible. No reviews were excluded on the basis of the type of comparison group used to assess the effectiveness of interventions (see Table 2). While reviews that included studies from any geographic region were deemed eligible for inclusion, the scoping review only considered systematic reviews that were published in English. 3.2 information sources and search strategy Three electronic databases – the Cochrane Library, Epistemoniko and PubMed – were searched for potentially relevant systematic reviews published in the last eight years (2012– 2019), using a comprehensive search strategy. The search period was defined to ensure maximum coverage within practical limits due to time restrictions for carrying out the scoping review. The search strategy was developed by a Cochrane information specialist with input from researchers with relevant expertise. The search strategy was developed in the first instance for use in PubMed, and then refined and adapted for conducting searches in the other two databases (see Annex 1). 7A scoping review 3.3 study selection and data charting All titles and abstracts of records identified through the database searches, and then all potential full texts, were screened by one reviewer against the eligibility criteria (see Table 2). Title and abstract screening was performed using the Rayyan platform.1 Endnote software was used for full-text screening, as well as for reference management. Reasons for the exclusion of any potential reviews at the full-text screening stage were documented. A second author checked a 10% random sample of the records excluded at both screening stages for quality control, and any disagreements were resolved through discussion. Data charting of the eligible systematic reviews (or systematic review protocols) was performed by one reviewer. Relevant data were charted using a pre-specified and piloted data charting form, using Excel software. Charted data included: author(s), publication date (year), countries in which the included primary studies were conducted, and the number of primary studies included in the systematic review and their study design(s) (including information on comparator or control groups, if available). In addition, for each eligible systematic review included in the scoping review, details of the study question under investigation and the pre-defined PICOS elements (including the duration of the interventions) were also extracted. Finally, an adapted version of the EPICOT framework (Evidence, Population, Intervention, Comparison, Outcome, Timestamp), which is widely used for making research recommendations, was used to extract information on research gaps that were identified and reported in the included systematic reviews (19). 1 https://rayyan.qcri.org/welcome table 2. scoping review eligibility criteria for systematic reviews and review protocols item inclusion criteria exclusion criteria Population Learners in primary and/or secondary school Reviews involving policies/interventions aimed at school-age children but applied exclusively outside of a school setting Interventions, approaches or exposures of interest School food and nutrition policies that promote healthy diets and lifestyles through interventions/activities Interventions which address one or more of the policy elements listed in Table 1 (i.e. the school community, curriculum, food environment, nutrition and health services) Policies implemented at national, subnational (e.g. district, province) or school level were eligible for inclusion Reviews that assessed the effectiveness of the policies or of policy implementation strategies were eligible Policies linked to “physical activity programmes”, unless this was an integrated component of the school food and nutrition policy being evaluated Comparison Systematic reviews that compared the intervention/ policy with any relevant control group, including comparisons with no policy or a less comprehensive policy Not applicable Outcomes Any health (e.g. BMI) and non-health (e.g. consumption and purchasing behaviour) outcomes measured in primary/secondary school learners Not applicable Study design Systematic reviews and systematic review protocols assessing the effectiveness of school food and nutrition policies published since 2012 in English Primary studies Systematic reviews of qualitative studies 8Assessing the existing evidence bAse on school Food And nutrition Policies Given that this review is aimed at assessing the scope of the existing evidence base relating to the effectiveness of school-based food and nutrition policies as opposed to assessing the evidence itself, data was largely extracted from the Methods sections of the included systematic reviews. Where the information in the Methods section was missing or unclear, information was extracted from elsewhere in the systematic review. This was typically the case for information relating to the number of included primary studies, participant populations and the duration of the interventions. If included systematic reviews described studies in which interventions were applied in a range of settings, extracted data were limited to school-based interventions; information relating to interventions applied in other settings was not extracted and analysed as part of this scoping review, except in cases where this information was not reported separately for different settings included in a systematic review. 3.4 Assessment of methodological quality Since this scoping review did not aim to determine the effects of school-based interventions on nutrition-related outcomes in school-aged children, the methodological quality of the included systematic reviews was not assessed. 3.5 synthesis of results The charted data were analysed descriptively, using tabulations or graphs where appropriate, in order to present a synthesis of key findings according to the scoping review objectives outlined in Section 2. The narrative synthesis of the extracted data was based on the five PICOS items (population, interventions, comparators, outcomes and study design), as well as a number of other characteristics related to each of these elements, including as geographic location of primary studies, schooling level and duration of interventions. Information relating to the interventions was summarized in accordance with the policy elements and examples of interventions/actions listed in Table 1. Results of the systematic reviews that assessed the effectiveness of policy implementation strategies were summarized separately. 94. Results 4.1 search results Fig. 2 describes the study selection process. The database searches retrieved a total of 5,101 records, of which 1,083 were duplicates and thus excluded. A further 1,449 records were discarded after title screening, a step which excluded obviously irrelevant records that were not in any way related to the topic of interest, for example, reviews of physical exercise in people with cirrhosis, and reviews of multiple micronutrient supplementation in breastfeeding women. After these exclusions, 2,569 deduplicated records were available for title and abstract screening against the eligibility criteria, after which a further 2,311 records were excluded. The full texts of 258 potentially relevant records were then screened, of which 69 met all the eligibility criteria for inclusion in the scoping review. Of these, 67 were completed systematic reviews and two were systematic review protocols. A random selection of 10% of the studies that had been excluded at the title and abstract screening stage were checked by a second reviewer; only one review that had been excluded was subsequently included. A 10% random Fig. 2 n PrisMA flowchart of study selection process No. of records identified through database searching: 5101 No. of records for title and abstract screening: 2569 No. of duplicate records discarded: 1083 No. obviously ineligible records excluded: 1449 No. of records excluded: 2311 No. of full-texts screened: 258 No. of records excluded, with reasons: 173 Wrong study design n = 102 Wrong participants n = 16 Wrong intervention n = 47 Published before 2012 n = 1 Non-English full-text n = 5 Duplicate n = 2 No. of full-texts awaiting assessment: 16 (no full-text access) No. of reviews included: 69 64 completed reviews – effects 2 protocols – effects 3 completed reviews – implementation 10 Assessing the existing evidence bAse on school Food And nutrition Policies sample of excluded full texts (n = 14) was likewise checked, and this time there were no disagreements. Annex 2 summarizes the key characteristics of the 69 included systematic reviews and systematic review protocols (10, 20–87), detailing the author(s), the year of publication, the stated aim and the pre-specified PICOS items for the review. Annex 3 lists the studies that were excluded at the full-text screening stage and the reasons for their exclusion. Of these 173 excluded reviews, 102 were excluded on account of not having the right study design (i.e. did not meet the definition of a systematic review), 47 were excluded because they did not address an eligible intervention, and another 16 were rejected because they did not include eligible participants (i.e. schoolchildren). Five were excluded because the full text was not in English, two were identified as duplicates during the data extraction process, and one review was published before 2012. A further 16 reviews were classified as awaiting assessment, as the full-text versions could not be readily accessed (Annex 4). 4.2 description of included studies Of the 69 included reviews (67 completed systematic reviews and two protocols), 66 (96%) assessed the effects of school-based policies or interventions (10, 20–84) and three (4%) assessed the factors influencing the implementation of interventions (85–87) (see Annex 2). A total of 41 studies were published during the latter years covered by this scoping review (2016–2019); this compares with a total of 28 for the four-year period, 2012–2015, and suggests a strong and continuing interest in this area of research (Fig. 3). The focus of the narrative synthesis presented here is on the 66 studies which assess the effect of policies and interventions on health-related outcomes and behaviours in school- aged children. Of these, 64 are completed systematic reviews and two are systematic review protocols. The three systematic reviews which address implementation are discussed separately (see section 4.2.9) Fig. 3 n Year of publication of included systematic reviews (total number of reviews = 69) 11 A scoping review 4.2.1 Study design While most systematic reviews specified which types of primary studies would be considered for inclusion (as part of their eligibility criteria), a third (n = 22) did not provide a clear description of their study design inclusion criteria as part of their Methods (Fig. 4). Among the 66 included reviews of effects, the most commonly-specified study design was a randomized controlled trial (RCT) (n = 41/66), followed by non-RCTs or “quasi-randomized” designs (n = 31/66). Ten reviews limited their inclusion criteria to RCTs only and 15 permitted either RCTs or non-RCTs. Other types of study designs that were specified included natural experiments (n = 6/66), controlled before-and-after studies (n = 6/66), pre- and-post designs (n = 5/66), repeated measures or interrupted time series studies (n = 4/66), cross-sectional studies (n = 4/66), observational studies (n = 4/66), qualitative and mixed methods studies (n = 1/66) and cross-over designs (n = 1/66). Fig. 4 n types of study design specified as part of the inclusion criteria of included reviews (total number of reviews = 66) cbA, controlled before-and-after; non-rct non-randomized controlled trial; rct, randomized controlled trial; rMs/its, repeated measures or interrupted time series 4.2.2 Number of included primary studies Of the 64 completed reviews which assessed the effectiveness of school-based food and nutrition policies and interventions (i.e. excluding the two included protocols), none were based on less than five primary studies. The majority (n = 43/64 or 67%) included between 10 and 40 primary studies. Very few reviews were based on more than 50 primary studies (n =1 0/64 or 16%). In most cases, not all the included primary studies were conducted exclusively in the relevant setting (i.e. schools) and included a nutrition-related intervention (Table 3). For instance, 24 reviews were based on between 10 and 20 primary studies, but of these just 11 – less than half – were reviews in which all the included primary studies were conducted in a school setting and involved a nutrition intervention. Thus, a significant proportion of the reviews included in this scoping review addressed broader questions, involving other settings and other types of interventions, typically those aimed at addressing physical activity or other behaviours such as alcohol and tobacco consumption. 12 Assessing the existing evidence bAse on school Food And nutrition Policies table 3. distribution of the number of primary studies included in the subset of 64 completed reviews number of primary studies included total number of reviews number of reviews in which all primary studies were conducted in the school setting and involved a nutrition intervention 5–10 8 3 10–20 24 11 20–30 8 6 30–40 11 6 40–50 2 2 50–60 3 0 60–70 1 0 70–80 2 0 80–90 1 1 >90 3 1 4.2.3 Population and setting Participant characteristics Most reviews identified their population of interest as children aged between 5 and 18 years (n = 20/66) or children aged up to 18 years of age, that is, schoolchildren as well as children enrolled in pre-school educational settings such as nurseries (n = 17/66) (Fig. 5). Ten reviews did not specify an age-based criterion; these reviews merely mentioned children of “all age groups”, “schoolchildren” or did not mention the age of participants as part of their eligibility criteria. The majority of the 66 included reviews did not specify any other characteristics beyond the age of participants, save for the four that had ethnicity-based inclusion criteria and nine that stipulated the health status of their would-be eligible participants (Table 4). For those reviews Fig. 5 n Age categories of participants in included reviews (total number of reviews = 66) 13 A scoping review that specified ethnicity, two restricted their participants to Latino/Hispanic populations, one to African populations, and one to Chinese participants. Of those that specified the health status of their participants (n = 9/66), most stipulated “healthy populations” (n = 6), while just two restricted their participants to overweight or obese children. One review specified children who were “overweight, obese or of normal weight” as part of its participant inclusion criteria. table 4. ethnicity and health status of participants ethnicity number of reviews health status number of reviews Not specified 62 Not specified 57 Hispanic/Latino 2 “Healthy”/“good health” 6 African 1 Overweight/obese 2 Chinese 1 Normal/overweight/obese 1 total 66 66 Number of participants in the included primary studies The level of detail in the reporting of the participant numbers in each of the included primary studies varied across the 64 included completed reviews. Some reviews reported numbers of pupils in each included primary study, while others only provided this information for some included primary studies; some studies only reported the numbers of schools involved. Overall, two thirds of the included completed reviews did not clearly report participant numbers (n = 44/64). Based on an analysis of the 20 completed reviews in which this type of information was provided as part of the reporting of the key characteristics of the included primary studies, it is evident that there is a large variation in participant numbers across the primary studies. Nine of these 20 reviews reported an average sample size, which ranged from 2,384 to 152,001 participants. The remaining 11 reviews, which provided more detailed information on participant numbers, were based on primary studies which included as few as 20 to 238 participants at the lower end of the scale, up as many as 416 to 20,166 at the upper end. Geographical location of the included primary studies Fig. 6 shows to what extent the major world regions are represented in the 64 completed reviews that were analysed as part of this scoping review. More than two thirds of the completed reviews (n = 46/64) included at least one primary study that was conducted in North America (i.e. in Canada, Mexico or the United States of America), and two thirds (n = 42/64) included at least one primary study from Europe. Of the 42 systematic reviews that included primary studies from European countries, 19 included at least one study from the United Kingdom. Perhaps unsurprisingly, the other world regions were generally less well represented (Fig. 6). Studies conducted in Australia dominated the group of 27 reviews which included one or more primary study(ies) from the Australasian region (n = 20/27); six of these 27 reviews included at least one primary study from New Zealand. It is evident from these breakdowns that the majority of included primary studies are conducted in high-income countries (HICs), suggesting a developed country bias in the evidence base. Despite clear guidance from PRISMA to the contrary, around one fifth of completed systematic reviews did not clearly identify the countries in which their included primary studies were conducted (n = 11/64), neither in the main publication nor in the supplementary material. 14 Assessing the existing evidence bAse on school Food And nutrition Policies Settings and schooling level Just over half (n = 36) of the 66 systematic reviews and systematic review protocols which assessed the effectiveness of food and nutrition policies were based exclusively on primary studies in which interventions were delivered in the school setting only. The remaining reviews (n = 30) used broader eligibility criteria which allowed primary studies conducted in multiple settings, i.e. beyond schools, to be included. In this latter group of 30 reviews, the community setting was the most frequently specified non-school setting (n = 18/30), followed by the home or family (n = 10/30) (Fig. 7). Community settings were typically defined as recreation centres, out-of-school youth groups, as well as church, village and counselling groups. A small number of reviews specified the healthcare or primary care setting (n = 4/30); two mentioned the workplace, and one included food outlets (supermarkets, restaurants, cafes) in their eligibility criteria. Eight reviews did not clearly Fig. 6 n representation of major world regions in the completed included reviews (total number of reviews = 64) Fig. 7 n types of settings in included reviews which also considered non-school settings, i.e. multiple settings (total number of reviews = 30) 15 A scoping review Fig. 8 n specification of schooling level in included reviews (total number of reviews = 66) specify which non-school settings would be considered eligible in their Methods section but as these reviews were based on primary studies which also included the school setting, they were considered eligible for inclusion in this scoping review. At least two thirds of the included reviews did not mention schooling level as part of their eligibility criteria (n = 45/66 or 67%). Of those that did apply such eligibility criteria (n = 20), half specified the primary school setting only (n = 10) and just two reviews focused solely on the impact of food and nutrition polices in secondary schools (see Fig. 8). The remaining eight reviews included both primary and secondary school settings as part of their inclusion criteria; only one review specified the highest level of education (i.e. tertiary). 4.2.4 Types of interventions Just under half (42%) of the 66 included systematic reviews and protocols set out to address the effectiveness of nutrition policies or interventions on obesity-related outcomes in schoolchildren in isolation. The remaining reviews (n = 38/66) aimed to assess the impact of a wider set of policies or interventions, predominantly those which simultaneously address nutrition and physical activity (PA) (n = 31/38) or less commonly, interventions designed to address diet, physical activity and other health-related NCD risk factors such as mental health, tobacco and alcohol consumption (n = 5/38). Two reviews addressed handwashing interventions (Fig. 9). Of the 66 included reviews, only five specifically assessed policies, that is the term “policy” was mentioned in the review title or its objectives. The other 61 reviews did not necessarily assess policies per se but addressed interventions that could be part of a comprehensive nutrition policy, such as menu labelling in school cafeterias. In the analysis that follows, no distinction has been made between reviews assessing policies (in the strict sense) and those that assess interventions, i.e. the results of the five reviews of policies have been combined with the results of the 61 identified reviews on interventions. Fig. 10 categorizes all of the 66 included reviews in terms of the four key food and nutrition policy elements they address (see Table 1). Most, 48 out of 66, set out to assess policies 16 Assessing the existing evidence bAse on school Food And nutrition Policies or interventions that addressed the school curriculum (i.e. nutrition education); a similar number (n = 39/66) examined policies or interventions designed to influence the school food and nutrition environment. Roughly a third of the included reviews (n = 22/66) assessed the impact of policies or interventions aimed at the wider school community. All policies or interventions that addressed the school community were part of a broader approach addressing the school curriculum, where parent and community outreach was part of the nutrition education intervention component. Fewer reviews, just 10 out of the total of 66, addressed the fourth policy area, namely school nutrition and health services, of which only two were policy reviews. Fig. 9 n types of interventions addressed by included reviews: nutrition-only versus multiple intervention types (total number of reviews = 66) PA, physical activity Fig. 10 n Policy elements addressed in included reviews (total number of reviews = 66) Reviews either addressed a single or multiple policy elements; the data reflect the total number of reviews addressing a given policy element, either alone or in combination. 17 A scoping review Some included reviews focused their attention on a single policy element (data not shown). Of those with a single policy element focus, most chose to assess policies or interventions that addressed the school curriculum, that is, the provision of nutrition education to school children (n = 15). Ten reviews focused exclusively on policies or interventions aimed at modifying the school food and nutrition environment. Nearly a fifth of reviews (n = 13/66) addressed three policy elements (the school community, school curriculum, and the school food and nutrition environment). Reviews that addressed both the school curriculum and the food nutrition environment policy elements were also relatively common (n = 11/66). Table 5 summarizes the charted information on the types of interventions assessed by the 66 included reviews, categorized according to the key policy element addressed. This tabulation shows that nutrition education interventions were delivered in many different ways. Of the 48 reviews which addressed aspects of the school curriculum, 18 described a range of educational activities aimed at schoolchildren which formed part of the formal school curriculum; a much larger proportion (n = 34/66 or 52%) mentioned nutrition education interventions but without specifying if they were included in the formal school curriculum. A relatively small number of reviews assessed the impact of school garden programmes (n = 7/66). Of the group of reviews which addressed the food and nutrition environment (n = 39/66), around half examined interventions related to the direct provision of food in the school setting (n = 21/40). A similar proportion of reviews were concerned with food procurement policy actions, i.e. changing the quality of the food available in the school setting (n = 19/40). In contrast, other nutrition policy options, including the use of food and nutrient standards and pricing policies, were the subject of only a handful of reviews. table 5. types of interventions assessed in included reviews (total number of reviews = 66) Policy element no. of reviews examples of interventions school community 22 Parent education 22 School newsletters, pamphlets and posters aimed at increasing parent knowledge Homework tasks Workshops for parents/parent outreach School Nutrition Policy Initiativea Teacher education 8 Staff/teacher education/training School Nutrition Policy Initiativea Wider community involvement 3 School Nutrition Policy Initiativea school curriculum 48 Nutrition education in the curriculum 18 Educational games and classroom activities introduced as part of the curriculum Health/well-being topics included in the curriculum Nutrition education through videos, computer modules, games or activities School gardening interventions combined with curriculum components Curriculum strategies including health/nutrition classes, body image and healthy eating Fostering linkages between nutrition-related curriculum activities and school catering services 18 Assessing the existing evidence bAse on school Food And nutrition Policies Policy element no. of reviews examples of interventions Nutrition education unspecified (i.e. nutrition education mentioned but not that it was incorporated into the curriculum) 34 Education component for children involving videos, games, curriculum or activities Provision of nutrition information/education to children (e.g. in the classroom with or without tasks) Theatre with inclusion of technology in education (e.g. SMS messages) Nutrition instruction using hand puppets and focusing on the education of the food pyramid Nutrition classes delivered by experts (in person or web or Internet-based) School gardens 7 School gardening interventions/programmes Multicomponent interventions which combined gardening with cooking classes and nutrition education integrated within the wider curriculum, and promoted the use of garden produce in school catering and promoted community involvement Wellness projects that included growing gardens Social marketing 6 Social marketing interventions or approaches used to design and implement interventions Food and nutrition environment 39 Standards and rules for food and beverages 5 Nutrition standards for competitive foods/beverages and school meals Food-based and nutrient-based standards Procurement 19 Increased availability of healthier food options in canteens/vending machines (e.g. more nutrient-dense) Reduced availability of unhealthier options (e.g. sugar-sweetened beverages, including fruit juice, energy-dense foods, desserts) in canteens/vending machines Modification/improvement of menus or approved by nutritionists in canteens/ cafeterias Reduced availability of hot food take-ways in/around schools Competitive food sales Pricing 3 Lower prices for water bottled in canteens and vending machines Pricing strategies for cafeteria sales of fruit and vegetables Free/reduced-price for healthful foods or beverages outside of usual school meals Direct food provision 21 Food and drink provision in schools outside of usual school meals including clean drinking water (e.g. installing coolers; hand out water bottles) or other canned non-sugar sweetened beverages; distribution of free vegetables; breakfast programme (e.g. distribution of ready to eat cereal); school fruit programme; free school and vegetable distribution; school lunch/breakfast programmes Not specified 3 “Policies targeting school food services” “Changes to school environment” or “environmental components” nutrition & health services 10 Health checks 3 Regular physical examinations Communication about the health status of children WASHb 2 Hand hygiene interventions Not specified 2 Child nutrition services component “Nutrition and health services” 19 A scoping review Policy element no. of reviews examples of interventions Counselling 2 Provision of one-on-one counselling (mostly by home visits, or telephone counselling) Dietetic consultations Growth monitoring 1 BMI screening a The School Nutrition Policy Initiative (SNPI) is a multicomponent programme aimed at preventing overweight and obesity among children in aged between 8 and 10 years over a two-year period. Components include training teachers and other staff to integrate interactive nutrition education into regular subjects in the curriculum, ensuring all food sold at school meets healthy food requirements, promoting consumption of healthy snacks, and involvement of families and local community groups in nutrition education activities. b Water sanitation and hygiene. Fig. 11 n duration of interventions in included reviews (total number of reviews = 64) Intervention duration Twenty, or around one third, of the 64 completed reviews (i.e. not considering the two protocols) included in this scoping review did not report information about the duration of interventions (Fig. 11). Among the remaining 44 reviews which did report this information, there was evidence of a wide range of intervention durations. Twenty-four reviews included at least one primary study in which the duration of the interventions was less than 3 months; at the other end of the scale, 14 reviews included one or more primary studies in which the duration of the interventions examined exceeded 3 years. Among the 24 systematic reviews that included primary studies involving interventions of less than 3 months duration, the shortest reported duration was 1 week; one review included a primary study which described an intervention with a duration of just 1 hour. Of the subset of 14 reviews which included at least one primary study describing a longer-term intervention (i.e. longer than 3 years), the longest reported intervention duration was 10 years. A total of three reviews investigated the effectiveness of cooking and other culinary interventions and reported intervention duration in terms of the number of classes attended. One of these reviews included primary studies which assessed the impact of at least two 20 Assessing the existing evidence bAse on school Food And nutrition Policies cooking classes; the other was based on a set of primary studies that had a median of 10 structured sessions (range: 2–12 sessions); and the third included primary studies in which intervention “length” ranged from 1 to 15 lessons, delivered over a period that ranged from 1 day up to 36 months. The two included protocols did not specify intervention duration as part of their eligibility criteria. 4.2.5 Comparators The type of comparator or control group was specified by the majority of reviews, that is to say, 49 (75%) of the 66 included reviews and protocols that assessed the effectiveness of interventions stipulated the nature of the comparator as part of their eligibility criteria. The remaining 17 reviews (25%) did not specify clear eligibility criteria for comparator groups in their Methods section; in this subset of reviews, comparator groups were either not mentioned at all, or the specification of criteria was limited to “had to have a control group” but without additional information describing which type(s) of control group was deemed acceptable (Fig. 12). Those reviews which were restricted to certain study designs (e.g. only considered RCTs or non-RCTs/quasi-experimental designs) were more likely to also specify comparator group eligibility criteria. Among the 49 reviews that clearly specified eligible comparator groups, many listed more than one type of control. By far the most common type of control specified was “no intervention”, which was cited by 40 reviews. Other types of controls that were specified by included reviews were “alternative interventions” (n = 18), “standard practice” (n = 16) and “same group pre-and-post intervention comparisons” (n = 16). Five reviews specified “delayed” or “wait list” controls, two “attention controls” or placebo, and one review included historical controls as part of its list of acceptable comparator groups (Fig. 12). Fig. 12 n types of comparisons in included reviews (total number of reviews = 66) 21 A scoping review 4.2.6 Outcomes All but one of the 66 included reviews and protocols assessing effectiveness clearly identified the outcomes of interest as part of their eligibility criteria. For the purposes of this scoping review, specified outcomes have been divided into five broad categories: anthropometric measures (e.g. body mass index or BMI), diet-related outcomes (e.g. fruit and vegetable intake), biochemical measures (e.g. blood lipids), clinical outcomes (e.g. diabetes) and “other” outcomes (e.g. physical activity). Anthropometric measures were a specified outcome in a large proportion of reviews (n = 46/66), as were the diet-related outcomes (n = 39/66). Clinical outcomes were investigated by nearly a third of all reviews (n = 19/66), but very few reviews reported on the effectiveness of food and nutrition interventions on biochemical outcomes (n = 4/66) (see Fig. 13). Fig.13 n types of outcomes reported in included reviews (total number of reviews = 66) Table 6 provides further details and examples of the types of outcomes investigated by the included reviews. Among the 47 reviews which set out to assess the impact of interventions on anthropometric measures, 31 included BMI as an outcome of interest, and 21 included measures of overweight or obesity (e.g. prevalence of overweight and/or obesity in the target population). BMI was included as the primary outcome of interest in 24 of these 47 reviews. Among the reviews which investigated diet-related outcomes (n = 40/66) around half listed diet-related knowledge, practices, attitudes and behaviour among their outcomes of interest (n = 18/40) while nearly three quarters focused on various dietary intake measures (n = 29/40). Within this latter category, fruit and vegetable intake and consumption of sugar-sweetened beverages (SSBs) ranked among the most commonly studied diet-related outcomes, specified by 11 and 8 reviews, respectively. Levels of physical activity was a frequently-mentioned outcome of interest among the group of reviews reporting on “other outcomes”, investigated in 16 reviews in total. Adverse or unintentioned outcomes such as stigmatization was a stated outcome of interest in seven reviews, and acceptability of interventions was explored in five reviews. Of the wide range of clinical outcomes mentioned, mental health was listed as an outcome of interest by seven reviews; six reviews specified health risk factor prevention (three 22 Assessing the existing evidence bAse on school Food And nutrition Policies mentioned blood pressure) and two purported to be interested in oral health outcomes (Table 6). Impacts on biochemical outcomes were evaluated in only four reviews, where the focus of interest was on blood lipids (n = 4/4); only one systematic review specified blood glucose levels as a possible outcome of interest. table 6. summary of outcomes reported in included reviews (total number of reviews = 66) outcomes no. of reviews examples (where applicable) Anthropometric measures 46 Body mass index (BMI) 31 BMI, BMI z-score, BMI percentiles Overweight/obesity 21 Prevalence of overweight, obesity, overweight/obesity combined Waist circumference 12 Weight 8 Skin-fold thickness 6 Malnutrition 1 Prevalence of wasting, stunting Percent body fat 1 biochemical measures 4 Blood lipids 4 Total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein- cholesterol and/or triglycerides Blood glucose 1 clinical outcomes 19 Mental and emotional health 7 Prevalence of anxiety, depression, suicide or self-harm, body image disorders, low self-esteem Other psychosocial variables Morbidity 9 Physical health measures and outcomes (e.g. type II diabetes) Health status measures (morbidity, premature mortality, mortality, hospital admissions) Standardized measures of physical health Cardiovascular disease risk factors and health risk factors Blood pressure 3 Infectious diseases 3 Incidence of diarrhoea, gastrointestinal infections Incidence of respiratory illnesses Hand cleanliness (e.g. number of microorganisms on the hands) Quality of life 2 Health-related quality of life Quality of life indicators Oral health 2 Prevalence of dental caries Developmental 2 Child growth and development measures Cognitive function Iron-deficiency anaemia 1 23 A scoping review outcomes no. of reviews examples (where applicable) diet-related outcomes 39 Knowledge, attitudes and behaviours 18 Dietary/food consumption behaviours or change Nutritional knowledge Fruit, vegetable and sugar preferences or attitudes Changes in attitude towards healthy eating Awareness of nutrition information on menus and menu boards Self-reported use of labels when purchasing food Menu-labelling format preferences Cooking and food-related knowledge Food literacy Dietary intake 29 Nutrient intakes (e.g. fat intake) Caloric/energy intake Change in serving portions Reduced sugar consumption or preference Dietary change/changes in food consumption (e.g. intakes of fruit & vegetables, consumption of sugar-sweetened beverages) Food purchasing 3 Purchasing and consumption patterns Sales data Meal nutrient content 2 In-school meal nutrient content Mean calories selected per participant Total fat content of food Food environment 2 Food and vegetable supply Change in food environment (e.g fruit and vegetable disappearance/food transition) Environmental measures such as food availability other outcomes 31 Physical activity 16 Physical activity and sedentary behaviours Screen time Adverse outcomes 7 Adverse/unintended events Stigmatization, dependency Decreased total family expenditure on food Intervention acceptability 5 Attitudes or level of public approval Themes, concepts and metaphors relating to the experience and meaning of school gardens Target group perceptions and views of the intervention Attitudes and perceptions of food literacy programmes aimed at students and teachers Educational 4 School absenteeism Educational attainment and employment Future success Substance use 2 Alcohol misuse Tobacco use Substance use Economic 2 Measures of financial and economic viability Socioeconomic effects 24 Assessing the existing evidence bAse on school Food And nutrition Policies 4.2.7 Conflict of interests and funding Of the 66 included reviews and protocols which examined the effectiveness of school-based nutrition policies and interventions, 55 (83%) provided a conflict of interest (COI) statement. In the majority of cases where COI information was reported (in 48 reviews), authors stated that they had no conflicts of interest to disclose; in only seven of 55 reviews did authors declare any conflicts of interest. In this latter group, the authors of three reviews reported receiving funding or payments from, or belonging to advisory boards of, commercial organizations such as Unilever UK, companies making consumer products, drug companies producing slimming products, Nestle, Danone and Sugar Nutrition UK. In the remaining four cases where COIs were declared, the authors reported affiliations to academic or government institutions. A similarly high proportion of reviews provided information relating to funding sources; authors of 51 reviews (77%) detailed the source of the funding for their work. In the majority of cases where authors listed their funding sources, funding was received from a governmental, nongovernmental or institutional source (n = 41/51). 4.2.8 Gaps in the evidence base Most of the completed intervention reviews included in this scoping review commented on gaps in the primary research base and made recommendations for the direction of future research studies. These identified gaps are presented in Table 7, according to the items included in the EPICOT framework. The need for more well designed and well implemented RCTs, with long-term follow-up periods which also assessed the cost-effectiveness and sustainability of school-based food and nutrition interventions, was highlighted by many included reviews. Calls for studies which extended their outcomes of interest beyond the physical outcomes to include cognitive outcomes, academic outcomes and environmental determinants were also made by a significant proportion of the reviews. Many of the included systematic reviews commented on the paucity of theoretical modelling in primary research studies and identified this shortcoming as an impediment to the development and implementation of effective school- based nutritional interventions. table 7. description of gaps reported in included reviews according to the ePicot framework (total number of reviews = 66) ePicot items description of gaps reported in reviews Evidence There is a paucity of high-quality evidence on the effectiveness of school- based nutritional interventions and policies Population Need for research in lower-income countries, beyond North America and Europe Intervention Need for inclusion of theoretical models to support implementation of interventions Comparison Need to include comparisons between interventions with and without parental participation as well as across socio-economic divides Outcomes Need to extend outcomes of interest beyond physical outcomes to include cognitive outcomes, academic outcomes and environmental determinants as well as the cost-effectiveness and sustainability of interventions Timestamp Longer-term follow-up studies are needed 25 A scoping review 4.2.9 Implementation reviews Three of the 69 included reviews did not address the question of the effectiveness of school food and nutrition policies or interventions but instead focused on the strategies for implementing such policies and interventions (85–87). The stated aim of one of these three implementation reviews was to “identify current methods used to operationalise, measure and report measures of fidelity” of school-based obesity prevention programmes. Another sought to “examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programmes or practices to address child diet, physical activity, obesity, tobacco or alcohol use”. The objective of the third review in this category was to assess the engagement of children and youth in interventions that address lifestyle-related childhood obesity that have been designed through child or youth efforts and involvement. All three implementation reviews specified a relatively wide age range for their target population, that is, children and adolescents from the age of 4 or 5 years up to 18 years or until “college-age”. All reviews considered the implementation of policies and interventions within the school setting. Primary outcomes ranged from an assessment of the fidelity of the interventions, policy and intervention uptake, as well as changes in weight, dietary behaviours and physical activity. Changes in health behaviours and attitudes were assessed in one review, as a secondary outcome. The duration of the interventions described in the primary studies covered by these three reviews ranged from 5 weeks up to 4 years. One set of authors declared that they had no conflicts of interest, while the authors of other two implementation reviews made no mention of COIs. Two of these reviews were funded by governmental institutions and one did not report their funding source. 26 5. Discussion This scoping review identified a total of 69 systematic reviews and protocols on the topic of school-based food and nutrition policies and interventions. The volume of identified evidence suggests that there exists a solid base of primary studies that have been conducted in the school setting, involving the population that is the target of WHO’s planned guidelines on school food and nutrition policies, namely schoolchildren. Few systematic reviews could be described as addressing food and nutrition policies specifically – that is to say, the word “policy” was not mentioned in either the title or the stated objectives. However, many identified reviews that examined school-based food and nutrition interventions or programmes included primary studies which assessed policies. On this basis, when formulating the criteria for future systematic reviews on the theme of food and nutrition policies aimed at children, it does not seem advisable to employ strict search criteria based on the term “policies”, as the likelihood of retrieving studies based on a such a narrow definition may be low. Use of a broader definition, as was the strategy adopted in this scoping review (see Methods), will likely lead to the identification of a much greater pool of relevant studies and so generate a robust body of evidence regarding the range of interventions that could form part of a comprehensive school food and nutrition policy. Further support for adopting a wider search strategy (i.e. not limited to “policies”), comes from the recently published overview of the Nutrition-friendly School Initiative (NFSI), which returned only one systematic review that met essential criterion 1.1 (“having a written policy addressing the five components” (88). Interventions addressing the school food and nutrition environment fall into several categories, which for the most part have been covered by the existing body of work identified by this scoping review. While it might seem desirable to conduct separate systematic reviews to assess each category or type of intervention, this scoping review has found that many primary studies address multicomponent interventions. For example, interventions related to the school community almost invariably went hand in hand with those that addressed the school curriculum. In other words, no intervention or policy which was directed at parents, teachers or the wider school community was implemented without also involving educating schoolchildren about healthy eating and/or other behaviours. Therefore, any future systematic review, and indeed policy initiative, should address these components together and consider parents as well as the wider school community as part of the population of interest, in addition to the children themselves. Likewise, it would be prudent to assess the role and impact of the introduction of nutrient- or food-based standards in the school setting alongside procurement policies, as the latter are often underpinned by the former. This scoping review exercise also revealed that many programmes and interventions are aimed at preventing unhealthy lifestyles and habits that lead to overweight and obesity, and as such also include interventions which address physical activity. This should be taken into consideration when defining the eligibility criteria for both the “intervention” and “outcome” elements of future systematic reviews; these criteria will need to reflect the high likelihood that many programmes and interventions address physical activity as well as nutrition. 27 A scoping review In terms of gaps in the evidence base, this scoping review found relatively few reviews of policies or interventions that addressed school nutrition and health services, such as nutrient supplementation, growth monitoring or deworming. However, this may be a consequence not so much of a paucity of primary research in this area (studies and reviews have addressed these topics) but rather more of the fact that nutrient supplementation, growth monitoring and other health services tend not to be studied in the school context but in broader contexts and settings, such as primary care and community outreach clinics. We found just two policy reviews which addressed the health services element (out of a total of five (20–24), but neither of these reviews included primary studies which assessed the impact of food and nutrition policies per se, but rather assessed the health interventions on their own and not as part of an overall policy. It has been noted elsewhere (8), that in some countries, notably those in Europe, existing school food and nutrition policies recommend the inclusion of health services as part of the school environment; typically such services provide growth and developmental monitoring, followed by referral when necessary. The scoping review identified a number of other areas of potential interest, at least from the perspective of the planned WHO guidelines, that are currently underserved by the existing evidence base. For instance, this scoping review did not identify any reviews that assessed the effectiveness of policies to restrict the marketing and availability of unhealthy foods in or around schools. It was also noticeable that the evidence base assessed in this scoping review is dominated by questions related to obesity and overweight; there were no reviews that assessed undernutrition outcomes such as underweight, stunting or wasting. This is perhaps a reflection of the fact that most studies were conducted in high-income countries, particularly in North America, Europe and Australia, where this is the most pressing problem to address. 28 6. Strengths and limitations Although this scoping review was conducted according to the PRISMA-ScR guidelines, a few minor modifications to the recommended process were necessary, some of which may have introduced bias. For instance, for pragmatic reasons and time constraints, it was not possible to carry out independent and duplicate first and second stage screening, or data abstraction. It was also necessary to limit the database searches to systematic reviews published in the last eight years (2012–2019). However, a number of measures were taken in order to minimize bias. Firstly, a random sample of the records excluded at the title-and-abstract and full-text screening stages were checked in an attempt to reduce the risk of missing relevant reviews. Secondly, a list of all the studies that were excluded at the full-text screening stage is attached to this report as Annex 3, for scrutiny by the reader. Finally, some of the data extraction was cross-checked during the data analysis stage in order to ensure accurate representation of the key characteristics of the included reviews. The eligibility criteria included a strict definition of a systematic review, requiring evidence of searching across more than one database and appraisal of the quality included primary studies (i.e. risk of bias assessment). The application of these criteria may have increased the likelihood that higher quality systematic reviews were included. Included reviews were not subjected to a quality assessment, a step that is generally considered essential to ensure the credibility of the findings of any systematic review. Nor was an assessment of whether the included reviews assessed the level of confidence in the review findings (for example by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach or another tool). However, given that the primary aim of this scoping review was to determine the scope of future review questions – not to inform decisions about effectiveness of policies and programmes – this omission is less of a concern. The English language restriction is likely to be another limitation of the present scoping review. The relative paucity of systematic reviews on the topic of nutrition-related health services, including reviews on deworming or nutrient supplementation was not anticipated. As previously stated, this may be due to these types of reviews often pertaining to settings beyond the school, and thus were either not identified through the search or were excluded on the grounds of being conducted in the “wrong setting”. This suggests a gap in the evidence base, at least in terms of assessing the effectiveness of these interventions in the school setting in the context of a broad school food and nutrition policy, and a need for this topic to be considered during the guideline panel scoping process. 29 7. Conclusions This scoping review has identified and mapped the available evidence from published and planned systematic reviews on the effects of school food and nutrition policies on important health and educational outcomes in school-aged children. It has also identified key gaps in the existing evidence base as it relates to effectiveness and implementation of school-based food and nutrition policies. The present review was commissioned and conducted in order to support the development of WHO guidelines on school food and nutrition policies. A set of potential policy elements and associated interventions was identified a priori (Table 1), and the existing evidence base mapped against this framework. This process has facilitated the identification of the evidence needed to shape and inform the planned WHO guidelines – in terms of understanding what policy elements and interventions are important and should be addressed by the guidelines, which research questions have already been answered in the literature and where there are still gaps. In particular, the scoping review has helped to identify gaps in the evidence base pertaining to those interventions that will form part of the policy framework but for which no systematic reviews appear to have been conducted. Based on the findings of the scoping review a set of potential systematic review questions were proposed, which were structured in accordance with the PICO format (Table 8). These questions have since been discussed and refined by the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Policy Actions, and a new systematic review has been commissioned to underpin the guideline’s recommendations on school food and nutrition policies. table 8. Proposed research questions for future systematic reviews research question PICO 1 What are the effects of school nutrition education interventions or policies, including or excluding involvement of parents and teachers compared with no intervention or an alternative intervention for schoolchildren (aged 5–18 years)? PICO 2 What are the effects of Nutrition standards or procurement policies that determine the quality of food available in schools compared to no intervention or an alternative intervention for school children (aged 5–18 years)? PICO 3 What are the effects of interventions or policies to restrict marketing of unhealthy foods and non- alcoholic beverages (FNABS) in and around schools compared to no intervention or an alternative intervention for school children (aged 5 – 18 years)? PICO 4 What are the effects of pricing policies or interventions in the school setting to promote healthier alternatives compared to no intervention or an alternative intervention for school children (aged 5–18 years)? PICO 5 What are the effects of direct food provision in schools (e.g. meal programmes; vegetable and fruit distribution) compared to no intervention or an alternative intervention for school children (aged 5–18 years)? PICO 6 What are the effects of school nutrition and health services interventions or policies compared to no intervention or an alternative intervention for school children (aged 5–18 years)? 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Geneva: World Health Organization; 2021 (https://www.who.int/ publications/i/item/9789241516969, accessed 12 March 2021). 38 Annexes Annex 1. search strategies database Cochrane Library (2012–2019) date 16 September 2019 id search hits #1 [mh schools] OR school:ti,ab,kw or [mh child] or child:ti,ab,kw or schoolchild*:ti,ab,kw or “school-based”:ti,ab,kw or [mh adolescent] or adolescen*:ti,ab,kw (Word variations have been searched) 228 303 #2 [mh “diet, food and nutrition”] or nutrition or [mh diet] or diet:ti,ab,kw or dietary:ti,ab,kw or “energy intake”:ti,ab,kw or [mh food] or food:ti,ab,kw or fruit:ti,ab,kw or vegetable:ti,ab,kw or [mh beverages] or beverage:ti,ab,kw or “drinking water”:ti,ab,kw or micronutrient*:ti,ab,kw (Word variations have been searched) 139 692 #3 [mh “health education”] or [mh “school health services”] or “school health”:ti,ab,kw or [mh “health promotion”] or (health next promotion*):ti,ab,kw (Word variations have been searched) 22 317 #4 [mh hygiene] or hygiene:ti,ab,kw or handwash*:ti,ab,kw or (hand near/3 (wash* or clean* or disinfect* or sterility)):ti,ab,kw (Word variations have been searched) 8568 #5 [mh “water supply”] or “water supply”:ti,ab,kw or (water near/3 (filt* or purif* or treat* or consum* or drink* or decontaminat* or disinfect* or improv* or clean* or quality)):ti,ab,kw (Word variations have been searched) 3501 #6 [mh sanitation] or sanit*:ti,ab,kw or toilet:ti,ab,kw or lantrine:ti,ab,kw or “septic tank”:ti,ab,kw or urinal:ti,ab,kw or privy:ti,ab,kw or lavator*:ti,ab,kw or “water closet”:ti,ab,kw or ablution:ti,ab,kw (Word variations have been searched) 41 715 #7 policy:ti,ab,kw or guideline:ti,ab,kw or standard:ti,ab,kw or educat*:ti,ab,kw or program:ti,ab,kw or programme:ti,ab,kw or regulation:ti,ab,kw or intervention:ti,ab,kw or teach:ti,ab,kw or teaching:ti,ab,kw (Word variations have been searched) 568 988 #8 [mh “nutrition policy”] 386 #9 #2 OR #3 OR #4 OR #5 OR #6 191 911 #10 #7 OR #8 569 014 #11 #1 AND #9 AND #10 with Cochrane Library publication date Between Jan 2012 and Sep 2019, in Cochrane Reviews 496 Abbreviations: mh = indexing term; ti = title field; ab = abstract field; kw = keyword field 39 A scoping review database PubMed (2012–2019) date 16 September 2019 id search hits #1 (Schools[mh] OR school[tiab] OR schools[tiab] OR child[mh] OR child[tiab] OR children[tiab] OR schoolchild*[tiab] OR school- based[tiab] OR adolescent[mh] OR adolescen*[tiab]) 3 433 822 #2 (diet,food and nutrition[mh] OR nutrition*[tiab] OR diet[mh] OR diet[tiab] OR diets[tiab] OR dietary[tiab] OR energy intake[tiab] OR food[mh] OR food[tiab] OR foods[tiab] OR fruit[tiab] OR fruits[tiab] OR vegetable*[tiab] OR beverages[mh] OR beverage[tiab] OR beverages[tiab] OR drinking water[tiab] OR micronutrient*[tiab]) 1 515 274 #3 (health education[mh] OR school health services[mh] OR school health[tiab] OR health promotion[mh] OR health promotion*[tiab]) 267 669 #4 (hygiene[mh] OR hygiene[tiab] OR handwash*[tiab] OR hand wash*[tiab] OR hand clean*[tiab] OR hand disinfect*[tiab] OR hand sterility[tiab]) 83 858 #5 (water supply[mh] OR water supply[tiab] OR water filt*[tiab] OR water purif*[tiab] OR water treat*[tiab] OR water consum*[tiab] OR water drink*[tiab] OR water decontaminat*[tiab] OR water disinfect*[tiab] OR water improv*[tiab] OR water clean*[tiab] OR water quality[tiab]) 67 598 #6 (sanitation[mh] OR sanitat*[tiab] OR toilet[tiab] OR toilets[tiab] OR latrine*[tiab] OR septic tank*[tiab] OR urinal*[tiab] OR privy[tiab] OR lavator*[tiab] OR water closet*[tiab] OR ablution*[tiab]) 111 788 #7 (#2 OR #3 OR #4 OR #5 OR #6) 1 940 602 #8 (policy[tiab] OR policies[tiab] OR guideline[tiab] OR guidelines[tiab] OR standard[tiab] OR standards[tiab] OR educat*[tiab] OR program[tiab] OR programs[tiab] OR programme[tiab] OR programmes[tiab] OR regulation*[tiab] OR intervention*[tiab] OR teach [tiab] OR teaching[tiab]) 3 957 683 #9 (nutrition policy [mh]) 10216 #10 (#8 OR #9) 3 962 365 #11 (#1 AND #7 AND #10) 122 794 #12 (Systematic review[pt] OR review[ti] OR meta-analysis[pt] OR meta-analys*[ti]) 542 894 #13 ((#11 AND #12) NOT (animals[mh] NOT humans[mh]))) AND (“2012/01/01”[Date - Publication] : “2019”[Date - Publication]) 2947 Abbreviations: mh = indexing term; tiab = title or abstract field; pt = publication type 40 Assessing the existing evidence bAse on school Food And nutrition Policies database Epistemonikos (2012–2019) date 16 September 2019 id search hits #1 (advanced_title_en:(school* OR “school-based” OR child* OR adolescen*) OR advanced_abstract_en:(school* OR “school- based” OR child* OR adolescen*)) --- #2 (advanced_title_en:(nutrition* OR diet* OR “energy intake” OR food* OR fruit* OR vegetable* OR beverage* OR “drinking water” OR micronutrient*) OR advanced_abstract_en:(nutrition* OR diet* OR “energy intake” OR food* OR fruit* OR vegetable* OR beverage* OR “drinking water” OR micronutrient*)) (advanced_title_en:(policy OR policies OR guideline OR guidelines OR standard OR standards OR educat* OR program OR programs OR programme OR programmes OR regulation* OR intervention* OR teach OR teaching) OR advanced_abstract_en:(policy OR policies OR guideline OR guidelines OR standard OR standards OR educat* OR program OR programs OR programme OR programmes OR regulation* OR intervention* OR teach OR teaching)) --- #3 [Filters: protocol=no, classification=systematic-review, cochrane=missing, min_year=2012, max_year=2019] --- #4 #1 AND #2 AND #3 1431 Abbreviations: en = English language; min = minimum; max = maximum database Epistemonikos (2012–2019) date 17 September 2019 id search hits #1 (advanced_title_en:(school* OR “school-based” OR child* OR adolescen*) OR advanced_abstract_en:(school* OR “school- based” OR child* OR adolescen*)) --- #2 (advanced_title_en:(hygiene OR “hand washing” OR handwashing OR (hand AND (clean* OR disinfect*)) OR (water AND (filt* OR purif* OR treat* OR consum* OR improv* OR clean*)) OR “water quality” OR sanitation OR toilet* OR latrine* OR “septic tank” OR “septic tanks” OR urinal* OR privy OR lavator* OR “water closet” OR “water closets” OR ablution) OR advanced_abstract_en:(hygiene OR “hand washing” OR handwashing OR (hand AND (clean* OR disinfect*)) OR (water AND (filt* OR purif* OR treat* OR consum* OR improv* OR clean*)) OR “water quality” OR sanitation OR toilet* OR latrine* OR “septic tank” OR “septic tanks” OR urinal* OR privy OR lavator* OR “water closet” OR “water closets” OR ablution)) --- #3 (advanced_title_en:(policy OR policies OR guideline OR guidelines OR standard OR standards OR educat* OR program OR programs OR programme OR programmes OR regulation* OR intervention* OR teach OR teaching) OR advanced_abstract_en:(policy OR policies OR guideline OR guidelines OR standard OR standards OR educat* OR program OR programs OR programme OR programmes OR regulation* OR intervention* OR teach OR teaching)) --- #4 [Filters: protocol=no, classification=systematic-review, cochrane=missing, min_year=2012, max_year=2019] --- #5 #1 AND #2 AND #3 AND #4 226 Abbreviations: en = English language; min = minimum; max = maximum 41 A SCOPING REVIEW A nn ex 2 . c ha ra ct er is ti cs o f i nc lu de d st ud ie s s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s P o li c ie s B ra m an te 20 19 (2 0) S ys te m at ic re vi ew o f n at ur al ex pe ri m en ts fo r ch ild ho od ob es it y pr ev en ti on a nd co nt ro l To e va lu at e th e eff ec ti ve ne ss of p op ul at io n - le ve l p ol ic ie s an d pr og ra m m es f ro m na tu ra l e xp er im en ts fo r ch ild ho od o be si ty pr ev en ti on C hi ld re n an d ad ol es ce nt s ag ed 10 –1 8 ye ar s ol d S ch oo l a nd /o r co m m un it y- ba se d pr og ra m m es o r po lic ie s ai m ed a t co m ba tt in g pa ed ia tr ic o be si ty C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: B M I m ea su re s (c ha ng e in B M I; B M I z- sc or e; B M I p er ce nt ile ; B M I c la ss ifi ca ti on ac co rd in g to a ge ) S ec on da ry : P hy si ca l ac ti vi ty ; d ie ta ry be ha vi ou rs (f ru it a nd ve ge ta bl e in ta ke ; i nt ak e of s ug ar -s w ee te ne d be ve ra ge s) N at ur al ex pe ri m en ts w it h a co m pa ri so n gr ou p M an sfi el d 20 17 (2 1) E ff ec t o f s ch oo l w el ln es s po lic ie s an d th e H ea lt hy , H un ge r- Fr ee K id s A ct o n fo od - co ns um pt io n be ha vi or s of s tu de nt s, 20 06 –2 01 6: a sy st em at ic re vi ew To a ss es s w he th er po lic y ch an ge s im pa ct ed f oo d- co ns um pt io n be ha vi ou rs o f s tu de nt s du ri ng p er io ds w he n (1 ) sc ho ol w el ln es s po lic ie s w er e im pl em en te d (2 00 6 –2 00 7) ; ( 2) th e H ea lt hy , H un ge r- Fr ee K id s A ct w as p as se d (2 01 0 –2 01 2) ; a nd (3 ) th e H ea lt hy , H un ge r- Fr ee K id s A ct w as im pl em en te d (2 01 2– pr es en t) C hi ld re n an d ad ol es ce nt s ag ed 5 –1 8 ye ar s N at io na l S ch oo l L un ch P ro gr am m e C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: F oo d- co ns um pt io n be ha vi ou rs S ec on da ry : N ot s pe ci fi ed R C Ts ; c oh or t st ud ie s; c ro ss - se ct io na l s tu di es ; ca se –c on tr ol st ud ie s; p re - an d po st -i nt er ve nt io n st ud ie s; ot he r qu as i- ex pe ri m en ta l st ud ie s 42 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s P o li c ie s M ic ha 2 01 8 (2 2) E ff ec ti ve ne ss of s ch oo l f oo d en vi ro nm en t po lic ie s on ch ild re n’ s di et ar y be ha vi or s: A sy st em at ic re vi ew a nd m et a- an al ys is To s ys te m at ic al ly re vi ew a nd q ua nt if y th e im pa ct o f s ch oo l f oo d en vi ro nm en t p ol ic ie s on di et ar y ha bi ts , a di po si ty an d m et ab ol ic r is k in ch ild re n H ea lt hy c hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs S ch oo l f oo d en vi ro nm en t po lic ie s pr om ot in g he al th fu l f oo d an d be ve ra ge s C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: C ha ng e in ha bi tu al c on su m pt io n of th e ta rg et ed f oo d, be ve ra ge o r nu tr ie nt , ev al ua te d by r ep or te d in ta ke s or o bj ec ti ve sa le s/ pu rc ha se s da ta a s a pr ox y fo r co ns um pt io n S ec on da ry : I n -s ch oo l m ea l n ut ri en t c on te nt ; nu tr ie nt in ta ke ; to ta l c al or ic in ta ke ; ad ip os it y; p re va le nc e of ov er w ei gh t, o be si ty a nd ov er w ei gh t/ ob es it y co m bi ne d; m et ab ol ic m ea su re s (e .g . b lo od li pi ds , b lo od gl uc os e, b lo od p re ss ur e) R C Ts ; q ua si - ex pe ri m en ta l in te rv en ti on al st ud ie s S in gh 2 01 7 (2 3) Im pa ct o f s ch oo l po lic ie s on n on - co m m un ic ab le di se as e ri sk fa ct or s – a sy st em at ic re vi ew To id en ti fy , c ol la te , a nd sy nt he si ze e vi de nc e on th e eff ec ti ve ne ss of s ch oo l p ol ic ie s on re du ct io n of N C D r is k fa ct or s C hi ld re n an d ad ol es ce nt s ag ed 6 –1 8 ye ar s S ch oo l p ol ic ie s th at m od if y th e fo ur id en ti fi ed ri sk f ac to rs (u nh ea lt hy di et , p hy si ca l i na ct iv it y, al co ho l a nd to ba cc o us e) C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: B M I; w ai st ci rc um fe re nc e; ov er w ei gh t; o be si ty ; ph ys ic al a ct iv it y; to ba cc o us e; a lc oh ol u se ; o th er re le va nt o ut co m es S ec on da ry : K no w le dg e an d at ti tu de s R C T; c on tr ol le d be fo re - an d- af te r st ud ie s; q ua si - ex pe ri m en ta l in te rv en ti on al st ud ie s; in te rr up te d ti m e se ri es s tu di es ; co ho rt s tu di es ; cr os s- se ct io na l st ud ie s 43 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s W ill ia m s 20 13 (2 4) S ys te m at ic re vi ew a nd m et a- an al ys is o f th e as so ci at io n be tw ee n ch ild ho od ov er w ei gh t a nd ob es it y an d pr im ar y sc ho ol di et a nd p hy si ca l ac ti vi ty p ol ic ie s To e va lu at e th e eff ec ts of p ol ic ie s re la te d to d ie t a nd p hy si ca l ac ti vi ty in s ch oo ls , ei th er a lo ne , o r as pa rt o f a n in te rv en ti on pr og ra m m e on th e w ei gh t s ta tu s of ch ild re n ag ed 4 to 1 1 ye ar s C hi ld re n ag ed 4 –1 1 ye ar s N at io na l, re gi on al a nd sc ho ol s pe ci fi c po lic ie s re la te d to d ie t o r ph ys ic al ac ti vi ty d ur in g pr im ar y ed uc at io n C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: B M I; B M I z- sc or e or s ta nd ar d de vi at io n sc or e; pe rc en ta ge o f b od y fa t; w ai st c ir cu m fe re nc e; w ai st -t o- hi p ra ti o; w ai st - to -h ei gh t r at io ; s ki n pi nc h/ sk in f ol d th ic kn es s S ec on da ry : N ot s pe ci fi ed R C Ts ; c on tr ol le d be fo re -a nd - af te r st ud ie s; in te rr up te d ti m e se ri es s tu di es ; co ho rt s tu di es ; cr os s- s ec ti on al st ud ie s in te r v en ti o n s A ce ve s- M ar ti ns 20 16 (2 5) E ff ec ti ve ne ss o f so ci al m ar ke ti ng st ra te gi es to r ed uc e yo ut h ob es it y in E ur op ea n sc ho ol -b as ed in te rv en ti on s: a sy st em at ic re vi ew a nd m et a- an al ys is To a ss es s th e eff ec ti ve ne ss o f E ur op ea n sc ho ol -b as ed in te rv en ti on s to p re ve nt ob es it y re la ti ve to th e in cl us io n of s oc ia l m ar ke ti ng b en ch m ar k cr it er ia d om ai ns in th e in te rv en ti on C hi ld re n an d ad ol es ce nt s ag ed 5 –1 7 ye ar s ol d in E ur op ea n co un tr ie s S ch oo l- ba se d di et ar y or p hy si ca l a ct iv it y in te rv en ti on s th at us ed s oc ia l m ar ke ti ng be nc hm ar k ap pr oa ch es C on tr ol g ro up w it h in te rv en ti on n ot in cl ud in g so ci al m ar ke ti ng b en ch m ar k cr it er io n P ri m ar y: D ie ta ry be ha vi ou r; p hy si ca l ac ti vi ty ; B M I; pr ev al en ce of o ve r- w ei gh t a nd ob es it y S ec on da ry : N ot s pe ci fi ed R C Ts ; n on -R C Ts A do m 2 01 7 (2 6) P ro to co l f or sy st em at ic re vi ew o f sc ho ol -b as ed in te rv en ti on s to p re ve nt a nd co nt ro l o be si ty in A fr ic an le ar ne rs To c on du ct a s ys te m at ic re vi ew o f t he p ub lis he d lit er at ur e to id en ti fy a nd ch ar ac te ri ze s ch oo l- ba se d in te rv en ti on s th at fo cu se d on p ro m ot in g he al th y ea ti ng a nd ph ys ic al a ct iv it y am on g le ar ne rs a ge d 6 –1 5 ye ar s in A fr ic a to p re ve nt c hi ld ho od ob es it y, a s w el l a s to id en ti fy f ac to rs th at le ad to s uc ce ss fu l C hi ld re n an d yo un g ad ol es ce nt s ag ed 6 –1 5 ye ar s in A fr ic an c ou nt ri es D ie ta ry /n ut ri ti on an d ph ys ic al a ct iv it y in te rv en ti on s im pl em en te d in s ch oo l se tt in g b ut w it h co m m un it y- a nd f am ily - ba se d co m po ne nt s C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: N ut ri ti on an d ph ys ic al a ct iv it y kn ow le dg e, a tt it ud es an d se lf -e ffi ca cy ; B M I; ph ys ic al a ct iv it y; f ru it an d ve ge ta bl e in ta ke ; su ga r- sw ee te ne d be ve ra ge c on su m pt io n S ec on da ry : N ot s pe ci fi ed A ny c on tr ol le d st ud y de si gn of a t l ea st 1 2 w ee ks d ur at io n w it h or w it ho ut ra nd om iz at io n, in cl ud in g pr e- ex pe ri m en ta l, qu as i- ex pe ri m en ta l, ex pe ri m en ta l pr e- an d po st -t es t, an d co ho rt s tu dy de si gn s 44 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s in te rv en ti on s or po te nt ia l b ar ri er s to s uc ce ss o f t he se pr og ra m m es w it hi n th e A fr ic an c on te xt , as r ep or te d in s tu di es pu bl is he d be tw ee n Ja nu ar y 20 00 a nd J un e 20 16 A l- K hu di ar y 20 17 (2 7) D ie t, p hy si ca l ac ti vi ty a nd be ha vi ou ra l in te rv en ti on s fo r th e tr ea tm en t of o ve rw ei gh t or o be se ad ol es ce nt s ag ed 1 2 to 1 7 ye ar s (R ev ie w ) To a ss es s th e eff ec ts of d ie t, p hy si ca l a ct iv it y an d be ha vi ou ra l in te rv en ti on s fo r th e tr ea tm en t o f o ve rw ei gh t or o be se a do le sc en ts ag ed 1 2 to 1 7 ye ar s O ve rw ei gh t o r ob es e ad ol es ce nt s ag ed 12 –1 7 ye ar s B eh av io ur -c ha ng in g in te rv en ti on s ai m ed at tr ea ti ng o ve rw ei gh t or o be si ty th at in cl ud e an y fo rm o f d ie ta ry , ph ys ic al a ct iv it y or be ha vi ou ra l t he ra py , or a ny c om bi na ti on o f th es e, d el iv er ed in s ch oo l, co m m un it y or h ea lt hc ar e se tt in gs N o tr ea tm en t/ w ai t l is t c on tr ol ; u su al ca re ; a lt er na ti ve co nc om it an t t he ra py P ri m ar y: B M I; bo dy w ei gh t; a dv er se e ve nt s S ec on da ry : H ea lt h - re la te d qu al it y of li fe ; se lf -e st ee m ; a ll -c au se m or ta lit y; m or bi di ty ; an th ro po m et ri c m ea su re s ot he r th an B M I; be ha vi ou ra l c ha ng e; pa rt ic ip an ts v ie w s of th e in te rv en ti on ; so ci oe co no m ic e ff ec ts ; pa re nt in g sk ill a nd re la ti on sh ip s R C Ts A nd ra de 20 18 (2 8) S ys te m at ic re vi ew : fr am ew or ks us ed in sc ho ol -b as ed in te rv en ti on s, th e im pa ct on H is pa ni c ch ild re n’ s ob es it y- re la te d ou tc om es To e xa m in e th e fr am ew or ks u se d w it hi n sc ho ol - ba se d in te rv en ti on pr og ra m m es in th e U ni te d S ta te s an d M ex ic o th at s ho w ed im pr ov em en ts in ob es it y- re la te d ou tc om es a m on g H is pa ni c ch ild re n H is pa ni c ch ild re n ag ed 6 –1 2 ye ar s S ch oo l- ba se d in te rv en ti on s ai m ed at r ed uc in g ob es it y un de rp in ne d by a fr am ew or k or in co rp or at in g as pe ct s of a fr am ew or k C on tr ol g ro up w it h no n -c om m un it y- ba se d in te rv en ti on P ri m ar y: D ie ta ry be ha vi ou rs ; an th ro po m et ri c m ea su re s S ec on da ry : N ot s pe ci fi ed E xp er im en ta l ( i.e . in te rv en ti on al ) st ud y de si gn s 45 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s A nt w i 2 01 2 (2 9) E ff ec ti ve ne ss of w eb -b as ed pr og ra m m es o n th e re du ct io n of c hi ld ho od ob es it y in sc ho ol -a ge d ch ild re n: a sy st em at ic re vi ew To id en ti fy th e be st av ai la bl e ev id en ce on th e eff ec ti ve ne ss of w eb -b as ed in te rv en ti on s on th e re du ct io n of c hi ld ho od ob es it y in s ch oo l- ag ed ch ild re n C hi ld re n an d ad ol es ce nt s ag ed 4 –1 8 ye ar s W eb -b as ed p ro gr am m es us in g, a m on g ot he r pl at fo rm s, th e In te rn et , so ci al n et w or ki ng m ed ia , I nt er ne t m ob ile ap pl ic at io ns , a nd e m ai l ai m ed a t t he r ed uc ti on o f ob es it y am on g sc ho ol - ag e ch ild re n C on tr ol g ro up w it h no n - w eb -b as ed in te rv en ti on P ri m ar y: M ea su re s of ov er w ei gh t a nd o be si ty (in cl ud in g bu t n ot li m it ed to B M I, bo dy w ei gh t a nd w ai st c ir cu m fe re nc e) S ec on da ry : N ot s pe ci fi ed R C Ts ; p se ud o- R C Ts A ve ry 2 01 5 (3 0) A s ys te m at ic re vi ew in ve st ig at in g in te rv en ti on s th at c an he lp r ed uc e co ns um pt io n of s ug ar - sw ee te ne d be ve ra ge s in ch ild re n le ad in g to c ha ng es in bo dy f at ne ss To d es cr ib e in te rv en ti on s th at re du ce th e co ns um pt io n of s ug ar -s w ee te ne d be ve ra ge s in c hi ld re n, an d to d et er m in e w he th er r ed uc ti on in th e co ns um pt io n of s ug ar -s w ee te ne d be ve ra ge s le ad s to su bs eq ue nt c ha ng es in ch ild b od y fa tn es s C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs S ch oo l- a nd h om e- ba se d ed uc at io na l p ro gr am m es an d en vi ro nm en ta l ch an ge in te rv en ti on s ai m ed a t r ed uc in g th e co ns um pt io n of s ug ar - sw ee te ne d be ve ra ge s C on tr ol a rm w it ho ut in te rv en ti on P ri m ar y: s ug ar - sw ee te ne d be ve ra ge co ns um pt io n S ec on da ry : B od y co m po si ti on in di ca ti ve of b od y fa tn es s (e .g . B M I, pr ev al en ce o f ov er w ei gh t o r ob es it y, ri sk o f b ei ng o ve rw ei gh t, sk in fo ld th ic kn es s, w ai st ci rc um fe re nc e) S tu di es w it h bo th in te rv en ti on a nd co nt ro l d at a B ag he rn iy a 20 18 (3 1) O be si ty in te rv en ti on pr og ra m s am on g ad ol es ce nt s us in g so ci al co gn it iv e th eo ry : a sy st em at ic lit er at ur e re vi ew To e va lu at e th e effi ca cy of in te rv en ti on s tu di es ba se d on s oc ia l co gn it iv e th eo ry in re du ci ng o r pr ev en ti ng ov er w ei gh t a nd o be si ty in a do le sc en ts A do le sc en ts a ge d 12 –1 8 ye ar s S oc ia l c og ni ti ve th eo ry in te rv en ti on s ai m ed a t im pr ov in g di et ar y ha bi ts an d/ or p hy si ca l a ct iv it y of s tu dy p ar ti ci pa nt s de liv er ed in th e sc ho ol se tt in g, c ou ns el lin g gr ou ps a nd /o r re cr ea ti on ce nt re s C on tr ol g ro up w it ho ut in te rv en ti on o r in te rv en ti on s w it ho ut so ci al c og ni ti ve th eo ry P ri m ar y: M ea su re s of ov er w ei gh t a nd o be si ty S ec on da ry : N ot s pe ci fi ed R C Ts ; q ua si - ex pe ri m en ta l in te rv en ti on al st ud ie s 46 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s B ai le y 20 19 (3 2) Fo od li te ra cy pr og ra m m es in s ec on da ry sc ho ol s: A sy st em at ic lit er at ur e re vi ew an d na rr at iv e sy nt he si s of qu an ti ta ti ve an d qu al it at iv e ev id en ce To s yn th es iz e th e lit er at ur e on f oo d lit er ac y in te rv en ti on s am on g ad ol es ce nt s in s ec on da ry s ch oo ls , th e at ti tu de s an d pe rc ep ti on s of f oo d lit er ac y in te rv en ti on s in se co nd ar y sc ho ol s, a nd th ei r eff ec ts o n di et ar y ou tc om es A do le sc en ts a ge d 10 –1 9 ye ar s ol d S ch oo l- ba se d fo od lit er ac y in te rv en ti on s ai m ed a t i m pr ov in g di et ar y ha bi ts , h ea lt hy fo od c ho ic es , n ut ri ti on kn ow le dg e an d co ok in g sk ill s C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: F oo d lit er ac y S ec on da ry : A do le sc en ts ’ at ti tu de s an d pe rc ep ti on s of f oo d lit er ac y pr og ra m m es an d th e to pi c of h om e ec on om ic s; h om e- ec on om ic s te ac he rs ’ pe rs pe ct iv es o n fo od lit er ac y pr og ra m m es an d th e to pi c of h om e ec on om ic s C ro ss -s ec ti on al st ud ie s; m ix ed - m et ho ds s tu di es ; qu an ti ta ti ve st ud ie s; qu al it at iv e st ud ie s B la ck 2 01 7 (3 3) H ow e ff ec ti ve ar e fa m ily -b as ed an d in st it ut io na l nu tr it io n in te rv en ti on s in im pr ov in g ch ild re n’ s di et an d he al th ? A s ys te m at ic re vi ew To a ss es s th e im pa ct of f am ily -b as ed a nd sc ho ol /p re sc ho ol nu tr it io n in te rv en ti on s on th e he al th o f ch ild re n ag ed 1 2 or yo un ge r, in cl ud in g th e su st ai na bi lit y of th es e im pa ct s an d th e re le va nc e to s oc io - ec on om ic in eq ua lit ie s C hi ld re n ag ed 0 –1 2 ye ar s in h ig h - in co m e co un tr ie s S ch oo l a nd f am ily - ba se d in te rv en ti on s to co m pl em en t i ns ti tu ti on al nu tr it io n pr og ra m m es to im pr ov e th e nu tr it io n an d he al th o f y ou ng c hi ld re n in h ig h -i nc om e co un tr ie s C on tr ol g ro up w it ho ut in te rv en ti on , d el ay ed in te rv en ti on o r al te rn at iv e in te rv en ti on P ri m ar y: N ut ri ti on al in ta ke ; h ea lt h st at us (in cl ud in g m or ta lit y, m or bi di ty , h os pi ta l a nd em er ge nc y de pa rt m en t ad m is si on s, a nd c hi ld gr ow th a nd d ev el op m en t ou tc om es ); lo ng er te rm e ff ec ts f ol lo w in g pr og ra m m e co m pl et io n; ad ve rs e ou tc om es [s ti gm at is at io n, de pe nd en cy , d ec re as ed to ta l f am ily e xp en di tu re on f oo d (in cl ud in g su bs id y) , i nc re as e in co ns um pt io n of h ig h fa t/ hi gh s ug ar f oo ds (in cl ud in g ta ke aw ay fo od ), an d ob es it y or ex ce ss iv e w ei gh t l os s] S ec on da ry : N ot sp ec ifi ed R C Ts 47 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s B le ic h 20 13 (3 4) S ys te m at ic re vi ew o f co m m un it y- ba se d ch ild ho od ob es it y pr ev en ti on st ud ie s To a ss es s th e im pa ct of c om m un it y- ba se d ob es it y pr ev en ti on in te rv en ti on s C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs in th e U ni te d S ta te s of A m er ic a S ch oo l- , f am ily - an d co m m un it y- ba se d in te rv en ti on s de si gn ed to co m pl em en t i ns ti tu ti on al nu tr it io n pr og ra m m es to im pr ov e th e nu tr it io n an d he al th o f y ou ng c hi ld re n in a h ig h - in co m e co un tr y C on tr ol g ro up w it h us ua l c ar e, a no th er di ff er en t i nt er ve nt io n, or n o in te rv en ti on P ri m ar y: B M I; B M I z- sc or e; p re va le nc e of ob es it y an d ov er w ei gh t; pe rc en t b od y fa t; w ai st ci rc um fe re nc e; s ki nf ol d th ic kn es s S ec on da ry : E ne rg y in ta ke ; f ru it a nd ve ge ta bl e in ta ke ; f at ty fo od in ta ke ; i nt ak e of s ug ar -s w ee te ne d be ve ra ge s; p hy si ca l ac ti vi ty ; s ed en ta ry be ha vi ou r R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; n at ur al ex pe ri m en ts B le ic h 20 18 (3 5) In te rv en ti on s to pr ev en t g lo ba l ch ild ho od ov er w ei gh t an d ob es it y: a sy st em at ic re vi ew To s yn th es iz e th e ex is ti ng g lo ba l ev id en ce o n ch ild ho od ov er w ei gh t a nd o be si ty in te rv en ti on s in s ch oo l, pr es ch oo l, co m m un it y, an d ho m e se tt in gs C hi ld re n an d ad ol es ce nt s ag ed 2– 19 y ea rs S ch oo l- , f am ily - an d co m m un it y- ba se d In te rv en ti on s to p re ve nt or m an ag e w ei gh t g ai n in ch ild re n an d ad ol es ce nt s us in g co m po ne nt s ta rg et in g di et o r ph ys ic al ac ti vi ty , o r bo th C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: N ot s pe ci fi ed S ec on da ry : N ot s pe ci fi ed R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; n at ur al ex pe ri m en ts w it h co nt ro l g ro up B ro w n 20 16 (3 6) A s ys te m at is ed re vi ew o f pr im ar y sc ho ol w ho le c la ss ch ild o be si ty in te rv en ti on s: eff ec ti ve ne ss , ch ar ac te ri st ic s, an d st ra te gi es To e xa m in e th e eff ec ti ve ne ss o f s ch oo l- ba se d in te rv en ti on s th at f oc us o n ch an gi ng di et ar y in ta ke a nd ph ys ic al a ct iv it y le ve ls to r ed uc e ch ild ho od ob es it y P ri m ar y sc ho ol - ag ed c hi ld re n S ch oo l- ba se d in te rv en ti on s th at f oc us on c ha ng in g di et ar y in ta ke a nd p hy si ca l ac ti vi ty le ve ls to r ed uc e ch ild ho od o be si ty C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: B M I; B M I- st an da rd d ev ia ti on sc or e; Z -s co re S ec on da ry : P hy si ca l ac ti vi ty ; f ru it in ta ke ; ve ge ta bl e in ta ke ; se de nt ar y ti m e; s cr ee n ti m e; in ta ke o f s ug ar - sw ee te ne d be ve ra ge s R C Ts ; n on -R C Ts 48 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s C ai 2 01 4a (3 7) E ff ec t o f ch ild ho od ob es it y pr ev en ti on pr og ra m s on bl oo d pr es su re : A s ys te m at ic re vi ew a nd m et a- an al ys is To a ss es s th e eff ec ts of c hi ld ho od o be si ty pr ev en ti on in te rv en ti on s on b lo od p re ss ur e an d ad ip os it y- re la te d ou tc om es C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea r in h ig h - in co m e co un tr ie s S ch oo l- , f am ily - an d co m m un it y- ba se d In te rv en ti on s ta rg et in g di et , p hy si ca l a ct iv it y or th e co m bi na ti on o f t he tw o, in a ny o ne s et ti ng o r co m bi na ti on o f s et ti ng s (i. e. s ch oo l, ho m e an d/ or c om m un it y se tt in gs , in cl ud in g ch ild a nd d ay ca re a nd p ri m ar y he al th ca re f ac ili ti es ) C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: S ys to lic b lo od pr es su re ; d ia st ol ic b lo od pr es su re S ec on da ry : A di po si ty m ea su re s R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; n at ur al ex pe ri m en ts C ai 2 01 4b (3 8) E ff ec t o f ch ild ho od ob es it y pr ev en ti on pr og ra m m es on b lo od li pi ds : A s ys te m at ic re vi ew a nd m et a- an al ys is To a ss es s th e eff ec ts of c hi ld ho od o be si ty pr ev en ti on in te rv en ti on s on b lo od li pi ds a nd ad ip os it y m ea su re s C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs in h ig h - in co m e co un tr ie s S ch oo l- , f am ily - an d co m m un it y- ba se d in te rv en ti on s ta rg et in g di et , p hy si ca l a ct iv it y or th e co m bi na ti on o f t he tw o, in a ny o ne s et ti ng o r co m bi na ti on o f s et ti ng s (i. e. s ch oo l, ho m e an d/ or c om m un it y se tt in gs , in cl ud in g ch ild a nd d ay ca re a nd p ri m ar y he al th ca re f ac ili ti es ) C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: T ot al ch ol es te ro l ; lo w de ns it y lip op ro te in - ch ol es te ro l; hi gh d en si ty lip op ro te in -c ho le st er ol ; tr ig ly ce ri de s S ec on da ry : A di po si ty m ea su re s R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; n at ur al ex pe ri m en ts C al ve rt 20 18 (3 9) D el iv er in g in -s ch oo l in te rv en ti on s to im pr ov e di et ar y be ha vi ou rs am on gs t 1 1- to 16 -y ea r- ol ds : A s ys te m at ic re vi ew To r ev ie w t yp es of in te rv en ti on s de liv er ed , d ie ta ry be ha vi ou rs t ar ge te d, an d in te rv en ti on s’ eff ec ti ve ne ss in im pr ov in g di et ar y be ha vi ou r an d as so ci at ed in te rv en ti on co m po ne nt s A do le sc en ts a ge d 11 –1 6 ye ar s S ch oo l- ba se d he al th y ea ti ng in te rv en ti on s ai m ed to c ha ng e di et ar y be ha vi ou rs P re - an d po st - in te rv en ti on co m pa ri so ns P ri m ar y: D ie ta ry be ha vi ou rs S ec on da ry : C ha ra ct er is ti cs a nd m od er at or s th at m ay co nt ri bu te to th e eff ec ti ve ne ss o f d ie ta ry be ha vi ou r ch an ge R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; c oh or t st ud ie s 49 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s C ha m pi on 20 17 (4 0) A s ys te m at ic re vi ew o f s ch oo l- ba se d eH ea lt h in te rv en ti on s ta rg et in g al co ho l us e, s m ok in g, ph ys ic al in ac ti vi ty , d ie t, se de nt ar y be ha vi ou r an d sl ee p am on g ad ol es ce nt s: a re vi ew p ro to co l To s ys te m at ic al ly re vi ew th e lit er at ur e on sc ho ol -b as ed e H ea lt h in te rv en ti on s de si gn ed to t ar ge t t w o or m or e of th e fo ll ow in g lif es ty le ri sk b eh av io ur s am on g ad ol es ce nt s: a lc oh ol us e, s m ok in g, p oo r di et , p hy si ca l i na ct iv it y, se de nt ar y be ha vi ou r an d sl ee p A do le sc en ts a ge d 11 –1 8 ye ar s eH ea lt h sc ho ol -b as ed in te rv en ti on s to r ed uc e si x un he al th y lif es ty le be ha vi ou rs C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: P re ve nt io n, de la y in th e on se t, o r re du ct io n of a ny o f th e si x lif es ty le r is k be ha vi ou rs t ar ge te d in th e in te rv en ti on : sm ok in g, a lc oh ol u se , ph ys ic al in ac ti vi ty , p oo r di et , p oo r sl ee p pa tt er ns an d se de nt ar y be ha vi ou r S ec on da ry : K no w le dg e, at ti tu de s f ut ur e in te nt io ns a nd s el f- effi ca cy to e ng ag e/ no t en ga ge in th e lif es ty le ri sk b eh av io ur s; m en ta l he al th o ut co m es (e .g . an xi et y, d ep re ss io n, su ic id e or s el f- ha rm ); ph ys ic al h ea lt h ou tc om es (e .g . o be si ty , ty pe II d ia be te s, pr em at ur e m or ta lit y) ; ed uc at io na l a tt ai nm en t an d em pl oy m en t R C Ts ; c lu st er R C Ts da S ilv ei ra 20 13 (4 1) Th e eff ec t o f pa rt ic ip at io n in s ch oo l- ba se d nu tr it io n ed uc at io n in te rv en ti on s on bo dy m as s in de x: a m et a- an al ys is of r an do m iz ed co nt ro ll ed co m m un it y tr ia ls To e va lu at e th e eff ec ti ve ne ss o f sc ho ol -b as ed nu tr it io n ed uc at io n in te rv en ti on s in re du ci ng o r pr ev en ti ng ov er w ei gh t a nd o be si ty am on g ch ild re n an d ad ol es ce nt s C hi ld re n an d ad ol es ce nt s ag ed 5 –1 8 ye ar s S ch oo l- ba se d nu tr it io n ed uc at io n (e du ca ti on al ga m es , c la ss ro om ac ti vi ti es , s ch oo l nu tr it io n po lic ie s, pa re nt al in vo lv em en t) in te rv en ti on s ad m in is te re d by h ea lt h pr of es si on al s or s ch oo l te ac he rs C on tr ol a rm o f R C T (c la ss ro om o r sc ho ol w it h no in te rv en ti on ) P ri m ar y: B M I S ec on da ry : N ot s pe ci fi ed C om m un it y R C Ts 50 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s de M ed ei ro s 20 19 (4 2) P ro to co l f or sy st em at ic re vi ew s of s ch oo l- ba se d fo od an d nu tr it io n ed uc at io n in te rv en ti on fo r ad ol es ce nt he al th p ro m ot io n To c om pr eh en si ve ly re vi ew th e qu an ti ta ti ve an d qu al it at iv e lit er at ur e on th e eff ec ts of s ch oo l- ba se d fo od an d nu tr it io n ed uc at io n in te rv en ti on s on ad ol es ce nt h ea lt h pr om ot io n th ro ug h he al th y ea ti ng h ab it s A do le sc en ts a ge d 10 –1 9 ye ar s S ch oo l- ba se d in te rv en ti on s to p ro m ot e ad ol es ce nt h ea lt h th ro ug h ch an ge s in fo od c on su m pt io n, bi ol og ic al o r bi oc he m ic al pa ra m et er s in a n in te rv en ti on g ro up N on -s ch oo l- ba se d co m pa ra to rs P ri m ar y: C ha ng es in a do le sc en t f oo d co ns um pt io n S ec on da ry : C ha ng es in b io lo gi ca l pa ra m et er s (B M I, w ai st ci rc um fe re nc e, w ai st - to -h ei gh t r at io , t ot al bo dy f at ); bi oc he m ic al pa ra m et er s (g ly ce m ia , tr ig ly ce ri de s, to ta l ch ol es te ro l, lo w d en si ty lip op ro te in -c ho le st er ol ; hi gh d en si ty li po pr ot ei n - ch ol es te ro l) ; q ua lit at iv e ev id en ce th at s up po rt s or e xp la in s th e eff ec t of s ch oo l- ba se d fo od a nd n ut ri ti on ed uc at io n in te rv en ti on s on a do le sc en t f oo d co ns um pt io n R C Ts ; c lu st er R C Ts ; n on -R C Ts ; co nt ro ll ed b ef or e- an d- af te r st ud ie s do A m ar al E M el o 20 17 (4 3) N ut ri ti on al in te rv en ti on s fo r ad ol es ce nt s us in g in fo rm at io n an d co m m un ic at io n te ch no lo gi es (IC Ts ): A sy st em at ic re vi ew To id en ti fy te ch no lo gi es an d th ei r m ai n ch ar ac te ri st ic s us ed f or nu tr it io na l i nt er ve nt io ns fo r ad ol es ce nt s, a nd to e va lu at e th ei r eff ec ti ve ne ss A do le sc en ts in hi gh - in co m e co un tr ie s N ut ri ti on al in te rv en ti on s th at u se in fo rm at io n an d co m m un ic at io n te ch no lo gi es C on tr ol g ro up w it ho ut in te rv en ti on o r no n - IC T in te rv en ti on ; pr e- in te rv en ti on co m pa ri so n gr ou p P ri m ar y: T ec hn ol og ie s an d th ei r ch ar ac te ri st ic s us ed f or in te rv en ti on s S ec on da ry : Q ua lit y of in cl ud ed s tu di es a nd eff ec ti ve ne ss o f i nc lu de d in te rv en ti on s R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; ob se rv at io na l st ud ie s 51 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s D ri es se n 20 14 (4 4) E ff ec t o f ch an ge s to th e sc ho ol f oo d en vi ro nm en t on e at in g be ha vi ou rs a nd / or b od y w ei gh t in c hi ld re n: a sy st em at ic re vi ew To s ys te m at ic al ly re vi ew th e ev id en ce re la ti ng to in te rv en ti on s th at c ha ng e th e sc ho ol fo od e nv ir on m en t, w it h ou tc om es in cl ud in g bo th f oo d- re la te d be ha vi ou rs (p ur ch as in g, co ns um pt io n) a nd b od y w ei gh t C hi ld re n an d ad ol es ce nt s S ch oo l- ba se d in te rv en ti on s in w hi ch a m at er ia l c ha ng e w as m ad e to th e sc ho ol f oo d en vi ro nm en t, w it h or w it ho ut a r el ev an t s ch oo l po lic y di re ct in g th is C on tr ol g ro up w it ho ut in te rv en ti on ; pr e- in te rv en ti on co m pa ri so ns P ri m ar y: B od y w ei gh t; B M I; w ai st ci rc um fe re nc e S ec on da ry : P ur ch as in g an d co ns um pt io n of fo od s N ot p re -s pe ci fi ed D ud le y 20 15 (4 5) Te ac hi ng ap pr oa ch es a nd st ra te gi es th at pr om ot e he al th y ea ti ng in p ri m ar y sc ho ol c hi ld re n: a sy st em at ic re vi ew a nd m et a- an al ys is To : 1 ) p er fo rm a sy st em at ic r ev ie w o f ra nd om iz ed c on tr ol le d, qu as i- ex pe ri m en ta l an d cl us te r co nt ro ll ed tr ia ls e xa m in in g th e sc ho ol -b as ed te ac hi ng in te rv en ti on s th at im pr ov e th e ea ti ng ha bi ts o f p ri m ar y sc ho ol ch ild re n; a nd 2 ) p er fo rm a m et a- an al ys is to de te rm in e th e eff ec t o f th os e in te rv en ti on s P ri m ar y sc ho ol - ag ed c hi ld re n Te ac hi ng a nd s ch oo l- ba se d el em en ta ry s ch oo l in te rv en ti on s de liv er ed by te ac he rs o r te ac he r su bs ti tu te s th at s ou gh t to b ri ng a bo ut p os it iv e nu tr it io na l c on su m pt io n, pr ef er en ce o r kn ow le dg e ch an ge in p ri m ar y sc ho ol ch ild re n P re - in te rv en ti on co m pa ri so n gr ou p P ri m ar y: F oo d co ns um pt io n an d en er gy in ta ke ; f ru it a nd ve ge ta bl e co ns um pt io n or p re fe re nc e; s ug ar co ns um pt io n or pr ef er en ce ; n ut ri ti on al kn ow le dg e S ec on da ry : N ot s pe ci fi ed R C Ts ; c lu st er - co nt ro ll ed tr ia ls ; q ua si - ex pe ri m en ta l st ud ie s Ev an s 20 12 (4 6) S ys te m at ic re vi ew a nd m et a- an al ys is of s ch oo l- ba se d in te rv en ti on s to im pr ov e da ily f ru it a nd ve ge ta bl e in ta ke in c hi ld re n ag ed 5 to 1 2 ye ar s To q ua nt if y th e im pa ct of s ch oo l- ba se d in te rv en ti on s on f ru it an d ve ge ta bl e in ta ke in c hi ld re n ag ed 5 –1 2 ye ar s ol d C hi ld re n ag ed 5 –1 2 ye ar s; s ch oo l se tt in gs (p ri m ar y) S ch oo l- ba se d di et ar y in te rv en ti on s de si gn ed to in cr ea se f ru it a nd ve ge ta bl e in ta ke C on tr ol g ro up w it ho ut in te rv en ti on o r us ua l pr ac ti ce P ri m ar y: T ot al w ei gh t in g ra m s of f ru it a nd ve ge ta bl es c on su m ed da ily , se pa ra te ly a nd co m bi ne d (e xc lu di ng po ta to es ) S ec on da ry : N ot s pe ci fi ed R C Ts ; n on -R C Ts 52 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s G an an n 20 14 (4 7) E nh an ci ng nu tr it io na l en vi ro nm en ts th ro ug h ac ce ss to f ru it a nd ve ge ta bl es in s ch oo ls an d ho m es am on g ch ild re n an d yo ut h: a sy st em at ic re vi ew To e xa m in e th e eff ec ts of in te rv en ti on s de liv er ed in th e ho m e, s ch oo l a nd ot he r nu tr it io na l en vi ro nm en ts d es ig ne d to in cr ea se f ru it a nd ve ge ta bl e av ai la bi lit y am on g 5 - to 1 8- ye ar -o ld s C hi ld re n an d ad ol es ce nt s ag ed 5 –1 8 ye ar s, th ei r pa re nt s an d te ac he rs , a s w el l as o th er m em be rs of th e lo ca l co m m un it y In te rv en ti on s an d po lic ie s ta rg et in g or ga ni za ti on al nu tr it io n en vi ro nm en ts (in cl ud in g th e ho m e, sc ho ol s an d ot he r co m m un it y se tt in gs ) an d ai m ed a t m od if yi ng th e fr ui t a nd v eg et ab le en vi ro nm en t t hr ou gh fr ui t a nd v eg et ab le pr ov is io n an d/ or ed uc at io n; p ro vi si on o f ec on om ic s up pl em en ts an d su bs id ie s fo r th e pu rc ha se o f f ru it a nd ve ge ta bl es , a s w el l as o th er c om m un it y pr og ra m m es a nd en vi ro nm en ta l in te rv en ti on s N ot s pe ci fi ed P ri m ar y: F ru it a nd ve ge ta bl e su pp ly (i .e . m ar ke t i nv en to ry ); ch an ge in f oo d en vi ro nm en t ( e. g. a t ho m e, in s ch oo ls ); fr ui t a nd v eg et ab le di sa pp ea ra nc e/ fo od tr an si ti on (c af et er ia a nd gr oc er y st or e sa le s) S ec on da ry : C on su m pt io n of f ru it a nd v eg et ab le s; aw ar en es s of im po rt an ce /i m pa ct of f ru it a nd v eg et ab le co ns um pt io n am on g ta rg et ed in di vi du al s; at ti tu de s to w ar ds co ns um pt io n of f ru it an d ve ge ta bl e; g en er al he al th m ea su re s (in cl ud in g ch an ge s in w ei gh t) ; a nd a ny re po rt ed a dv er se ou tc om es o r un in te nd ed co ns eq ue nc es R C Ts ; n on - R C Ts (i nc lu di ng cl us te r- co nt ro ll ed tr ia ls , c on tr ol le d ti m e se ri es ); st ud ie s w it h in te rr up te d ti m e se ri es d es ig ns (t o as se ss c ha ng es th at o cc ur o ve r ti m e) ; co nt ro ll ed be fo re -a nd -a ft er st ud ie s (in cl ud in g hi st or ic al co nt ro ls ) G or i 2 01 7 (4 8) E ff ec ti ve ne ss of e du ca ti on al an d lif es ty le in te rv en ti on s to p re ve nt pa ed ia tr ic ob es it y: sy st em at ic re vi ew a nd m et a- an al ys es o f ra nd om iz ed a nd no n -r an do m iz ed co nt ro ll ed tr ia ls To u pd at e th e re su lt s of a p re vi ou s m et a- an al ys is (p ub lis he d in 20 11 b y W at er s et a l.) ;a to c on fi rm a nd d efi ne th e eff ec ti ve ne ss o f sp ec ifi c in te rv en ti on s st ra ti fy in g by p at ie nt ag e, a nd in te rv en ti on se tt in g an d du ra ti on ; an d to c on du ct su bg ro up a na ly se s to ex pl or e th e eff ec ts o f sp ec ifi c in te rv en ti on s in ea ch a ge g ro up O be se a nd ov er w ei gh t ch ild re n an d ad ol es ce nt s E du ca ti on al , l if es ty le an d he al th p ro m ot io n in te rv en ti on s in cl ud in g ps yc ho lo gi ca l a nd m ot iv at io na l i nt er ve nt io ns di re ct ed a t c hi ld re n/ ad ol es ce nt s an d/ or th ei r fa m ili es , f oc us in g on d ie t an d/ or p hy si ca l a ct iv it y N ot s pe ci fi ed P ri m ar y: C ha ng e in st an da rd iz ed B M I S ec on da ry : N ot s pe ci fi ed R C Ts ; n on -R C Ts 53 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s G ra y 20 19 (4 9) S ch oo l- le ve l f ac to rs as so ci at ed w it h ob es it y: A s ys te m at ic re vi ew o f lo ng it ud in al st ud ie s To d et er m in e th e cu rr en t e vi de nc e on eff ec ts o f s ch oo l- le ve l fa ct or s on o be si ty ou tc om es in lo ng it ud in al st ud ie s S ch oo l- ag ed ch ild re n or ad ol es ce nt s S ch oo l- ba se d ob es it y pr ev en ti on in te rv en ti on s N ot s pe ci fi ed P ri m ar y: B M I; w ai st ci rc um fe re nc e; o be si ty pr ev al en ce S ec on da ry : N ot sp ec ifi ed Lo ng it ud in al ob se rv at io na l st ud ie s G re ch 2 01 5 (5 0) A s ys te m at ic lit er at ur e re vi ew of n ut ri ti on in te rv en ti on s in v en di ng m ac hi ne s th at en co ur ag e co ns um er s to m ak e he al th ie r ch oi ce s To d et er m in e th e effi ca cy o f n ut ri ti on in te rv en ti on s in ve nd in g m ac hi ne in pr om pt in g di et ar y be ha vi ou r ch an ge to im pr ov e di et q ua lit y or w ei gh t s ta tu s of th e co ns um er s of v en de d sn ac ks c om pa re d w it h cu st om er s of v en di ng m ac hi ne s w he re th er e is n o ch an ge to th e pr od uc ts t yp ic al ly s ol d P ar ti ci pa nt s w ho ha ve a cc es s to ve nd in g m ac hi ne s in a ny s et ti ng in cl ud in g sc ho ol s, un iv er si ti es a nd w or k si te s A ll in te rv en ti on s tr at eg ie s ai m ed a t im pr ov in g th e nu tr it iv e co nt en t o f sn ac ks a nd b ev er ag es pu rc ha se d fr om v en di ng m ac hi ne s N ot s pe ci fi ed P ri m ar y: D ie ta ry be ha vi ou r ch an ge (e .g . sa le s da ta , d ie ta ry in ta ke o r B M I) S ec on da ry : N ot s pe ci fi ed E xp er im en ta l tr ia ls in cl ud in g R C Ts , c lu st er R C Ts , q ua si - ex pe ri m en ta l co nt ro ll ed s tu di es an d p re -a nd -t es t st ud ie s G ui m ar ãe s 20 15 (5 1) E ff ec ti ve ne ss of in te rv en ti on pr og ra m s in sc ho ol s to re du ce h ea lt h ri sk f ac to rs in ad ol es ce nt s: a sy st em at ic re vi ew To c on du ct a s ys te m at ic re vi ew o f i nt er ve nt io n pr og ra m m es w it h pl an ne d ph ys ic al ac ti vi ty a nd /o r nu tr it io n ed uc at io n ac ti on s to re du ce h ea lt h -r el at ed ri sk f ac to rs in B ra zi lia n ad ol es ce nt s tu de nt s ag ed 1 0 –1 9 ye ar s A do le sc en ts a ge d 10 –1 9 ye ar s in B ra zi l P ro gr am m ed p hy si ca l ac ti vi ty a nd /o r nu tr it io n in te rv en ti on s co nd uc te d in p ub lic a nd /o r pr iv at e sc ho ol s ai m ed a t re du ci ng h ea lt h ri sk fa ct or s (i. e ov er w ei gh t/ ob es it y an d m et ab ol ic pr ofi le a lt er at io ns ) P re - in te rv en ti on g ro up P ri m ar y: B M I S ec on da ry : N ot s pe ci fi ed P re -a nd -p os t- te st st ud ie s an d tr ia ls 54 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s H am el 2 01 2 (5 2) C om pu te r- a nd w eb -b as ed in te rv en ti on s to pr om ot e he al th y ea ti ng a m on g ch ild re n an d ad ol es ce nt s: a sy st em at ic re vi ew To : (1 ) d et er m in e th e eff ec t o f c om pu te r- an d w eb -b as ed in te rv en ti on s on im pr ov in g ea ti ng be ha vi ou r an d/ or d ie t- re la te d ph ys ic al o ut co m es am on g ch ild re n an d ad ol es ce nt s; a nd (2 ) e xa m in e if p ar ti cu la r el em en ts o f t he se in te rv en ti on s in cr ea se d su cc es s C hi ld re n an d ad ol es ce nt s ag ed 6 –1 8 ye ar s C om pu te r- o r w eb - ba se d he al th y ea ti ng in te rv en ti on s w it h or w it ho ut a p hy si ca l a ct iv it y in te rv en ti on f or c hi ld re n (6 – 11 y ea rs o f a ge ) o r ad ol es ce nt s (1 2– 18 y ea rs of a ge ) i m pl em en te d in sc ho ol s, c am p an d ho m e se tt in gs C on tr ol g ro up w it ho ut in te rv en ti on o r us ua l pr ac ti ce P ri m ar y: E at in g be ha vi ou r (e .g . in cr ea si ng f ru it a nd ve ge ta bl e co ns um pt io n; de cr ea si ng f at co ns um pt io n) a nd /o r di et -r el at ed p hy si ca l ou tc om es (e .g . B M I) S ec on da ry : N ot sp ec ifi ed R C Ts , q ua si - ex pe ri m en ta l de si gn s, o r st ud ie s w hi ch h ad a co nt ro l/ co m pa ri so n gr ou p an d pr ov id ed qu an ti ta ti ve re su lt s H en dr ie 20 12 (5 3) C om bi ne d ho m e an d sc ho ol o be si ty pr ev en ti on in te rv en ti on s fo r ch ild re n: w ha t be ha vi or c ha ng e st ra te gi es a nd in te rv en ti on ch ar ac te ri st ic s ar e as so ci at ed w it h eff ec ti ve ne ss ? To : ( a) e xa m in e th e eff ec ti ve ne ss o f co m bi ne d- se tt in g (s ch oo l o r co m m un it y ce nt re s an d th e ho m e) ob es it y pr ev en ti on in te rv en ti on s to ch an ge c hi ld re n’ s w ei gh t- re la te d di et ar y, ac ti vi ty , a nd s ed en ta ry be ha vi ou rs a nd r is k of ob es it y; a nd (b ) d et er m in e w he th er th er e is a n as so ci at io n be tw ee n th e eff ec ti ve ne ss o f th es e co m bi ne d- se tt in g in te rv en ti on s an d th e fo od a nd a ct iv it y be ha vi ou rs ta rg et ed a nd th e be ha vi ou r ch an ge te ch ni qu es (B C Ts ) u se d C hi ld re n an d ad ol es ce nt s ag ed 1– 1 8 ye ar s an d at le as t o ne p ar en t C om m un it y- ba se d (e .g . ch ild c ar e, c om m un it y ce nt re s) o r sc ho ol - ba se d in te rv en ti on s th at in cl ud ed a n ut ri ti on or a ct iv it y co m po ne nt A N D a b eh av io ur c ha ng e co m po ne nt t ar ge ti ng an in cr ea se in p hy si ca l ac ti vi ty , d ec re as e in se de nt ar y be ha vi ou r, ch an ge in n ut ri ti on in ta ke o r w ei gh t s ta tu s in c hi ld re n A N D in vo lv ed pa re nt s or c ar eg iv er s C on tr ol g ro up w it ho ut in te rv en ti on o r us ua l pr ac ti ce P ri m ar y: C hi ld ’s ad ip os it y (e .g . B M I- z sc or e or p er ce nt ov er w ei gh t) o r he al th ri sk f ac to rs (e .g . ch ol es te ro l) ; s el f- re po rt ed m ea su re s of ch ild ’s d ie ta ry in ta ke o r ac ti vi ty b eh av io ur s S ec on da ry : D et er m in an ts o f ch ild re n’ s lif es ty le be ha vi ou rs , f oc us in g on pa re nt al c ha ra ct er is ti cs su ch a s kn ow le dg e; pa re nt a nd c hi ld in te ra ct io ns s uc h as fe ed in g pr ac ti ce s; en vi ro nm en ta l m ea su re s su ch a s fo od a va ila bi lit y; a nd pr ed ic to rs o f b eh av io ur ch an ge s uc h as s el f- effi ca cy A ny s tu dy d es ig n th at e va lu at ed th e eff ec ti ve ne ss o f an in te rv en ti on ru n in p ar al le l w it h a co nt ro l/ co m pa ri so n gr ou p w it h ou tc om es m ea su re d at ba se lin e an d po st -i nt er ve nt io n 55 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s H er sc h 20 14 (5 4) Th e im pa ct o f co ok in g cl as se s on f oo d- re la te d pr ef er en ce s, at ti tu de s, a nd be ha vi or ’s o f sc ho ol -a ge d ch ild re n: a sy st em at ic re vi ew o f t he ev id en ce , 20 03 –2 01 4 To a ss es s th e la te st ev id en ce c on ce rn in g ch ild ho od c oo ki ng pr og ra m m es a nd th ei r as so ci at io n w it h ch ild re n’ s fo od -r el at ed pr ef er en ce s, a tt it ud es , an d be ha vi ou rs ; t o in fo rm f ut ur e eff or ts ; an d to id en ti fy g ap s in th e lit er at ur e C hi ld re n ag ed 5 –1 2 ye ar s C oo ki ng e du ca ti on pr og ra m m e or in te rv en ti on d el iv er ed in a sc ho ol o r co m m un it y se tt in g th at in vo lv ed f oo d pr ep ar at io n le ss on s C on tr ol g ro up w it ho ut in te rv en ti on o r us ua l pr ac ti ce P ri m ar y: F oo d pr ep ar at io n sk ill s; di et ar y in ta ke ; c oo ki ng co nfi de nc e; f ru it a nd ve ge ta bl e pr ef er en ce s; at ti tu de s to w ar d fo od an d co ok in g; a nd f oo d- re la te d kn ow le dg e S ec on da ry : N ot s pe ci fi ed R C Ts a nd q ua si - ex pe ri m en ta l st ud ie s w hi ch in cl ud ed p re - an d po st -a ss es sm en t H ol ub 2 01 4 (5 5) S ch oo l- w id e pr og ra m s ai m ed at o be si ty a m on g L at in o yo ut h in th e U ni te d S ta te s: a r ev ie w of th e ev id en ce To e xa m in e th e eff ec ts of e vi de nc e- ba se d re se ar ch o f o be si ty - re la te d in te rv en ti on s on L at in o ch ild re n in sc ho ol s in th e U ni te d S ta te s C hi ld re n of a ny a ge at te nd in g sc ho ol s in th e U S A w it h a hi gh p ro po rt io n of L at in o pu pi ls (a t le as t 5 0% ) S ch oo l- , h om e- a nd co m m un it y- ba se d ob es it y in te rv en ti on s (in te rv en ti on s ha d to in cl ud e at le as t o ne sc ho ol -b as ed c om po ne nt ) N ot s pe ci fi ed P ri m ar y: O be si ty -r el at ed ou tc om es (e .g . B M I z- sc or e, w ei gh t, w ai st ci rc um fe re nc e, p er ce nt bo dy f at , p re va le nc e of ov er w ei gh t a nd o be si ty ) S ec on da ry : N ot s pe ci fi ed R C Ts , g ro up ra nd om iz ed tr ia ls , n on - ra nd om iz ed tr ia ls an d pr e- a nd po st a ss es sm en t st ud ie s K on g 20 16 (5 6) Li m it at io ns of s tu di es o n sc ho ol -b as ed nu tr it io n ed uc at io n in te rv en ti on s fo r ob es it y in C hi na : a sy st em at ic re vi ew a nd m et a- an al ys is To r ev ie w th e ex is ti ng lit er at ur e w it h re ga rd to sc ho ol -b as ed n ut ri ti on ed uc at io n ai m ed a t pr ev en ti ng o be si ty in pr im ar y sc ho ol s tu de nt s in C hi na P ri m ar y- sc ho ol ag ed c hi ld re n in th e P eo pl e’ s R ep ub lic of C hi na N ut ri ti on e du ca ti on in te rv en ti on s ai m ed at r ed uc in g ob es it y de liv er ed v ia s ch oo l- ba se d pr og ra m m es N ot s pe ci fi ed P ri m ar y: B M I; pr ev al en ce o f o be si ty S ec on da ry : N ot s pe ci fi ed N ot p re -s pe ci fi ed 56 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s L an gf or d 20 14 (1 0) Th e W H O H ea lt h P ro m ot in g S ch oo l fr am ew or k fo r im pr ov in g th e he al th a nd w el l- be in g of st ud en ts a nd th ei r ac ad em ic ac hi ev em en t (C oc hr an e re vi ew ) To r e- as se ss th e eff ec ti ve ne ss o f t he H ea lt h P ro m ot in g S ch oo ls (H P S ) fr am ew or k in im pr ov in g th e he al th a nd w el l- be in g of s tu de nt s an d th ei r ac ad em ic ac hi ev em en t C hi ld re n an d ad ol es ce nt s ag ed 4 – 18 y ea rs at te nd in g sc ho ol s or c ol le ge s In te rv en ti on s w hi ch in vo lv ed a ct iv e en ga ge m en t i n th re e do m ai ns : t he s ch oo l cu rr ic ul um ; c ha ng es to s ch oo l’s e th os a nd / or e nv ir on m en t; a nd en ga ge m en t w it h fa m ili es an d/ or c om m un it ie s S ch oo ls n ot o ff er ed in te rv en ti on , s ta nd ar d pr ac ti ce , o r an al te rn at iv e in te rv en ti on in cl ud in g on ly o ne or t w o of th e th re e do m ai ns P ri m ar y: H ea lt h ou tc om es in cl ud in g ov er w ei gh t/ ob es it y, ph ys ic al a ct iv it y an d se de nt ar y be ha vi ou rs , nu tr it io n, to ba cc o us e, al co ho l u se , s ub st an ce us e, s ex ua l h ea lt h, m en ta l h ea lt h, v io le nc e, bu lly in g, in fe ct io us di se as e (e .g . d ia rr ho ea , re sp ir at or y in fe ct io ns ), sa fe ty a nd a cc id en t pr ev en ti on , b od y im ag e/ ea ti ng d is or de rs , s un sa fe ty , a nd o ra l h ea lt h; ed uc at io na l o ut co m es su ch a s ac ad em ic ac hi ev em en t ( e. g. st an da rd iz ed te st s co re s or s ch oo l- le ve l a ca de m ic ac hi ev em en t) S ec on da ry : S ch oo l at te nd an ce ; o th er sc ho ol -r el at ed o ut co m es (e .g . s ch oo l c lim at e or at ta ch m en t t o sc ho ol ) C lu st er R C Ts , w he re ra nd om iz at io n to ok p la ce a t t he le ve l o f s ch oo l, di st ri ct o r ot he r ge og ra ph ic al a re a Li m a- S er ra no 20 14 (5 7) Im pa ct o f sc ho ol -b as ed he al th p ro m ot io n in te rv en ti on s ai m ed a t di ff er en t be ha vi ou ra l do m ai ns : a sy st em at ic re vi ew To s um m ar iz e ch ar ac te ri st ic s an d eff ec ts o f s ch oo l- ba se d in te rv en ti on s le ad in g to b eh av io ur s su ch as n ut ri ti on , p hy si ca l ac ti vi ty , m en ta l a nd ho lis ti c he al th , a nd ri sk p re ve nt io n (e at in g di so rd er s, s ub st an ce us e, s ex ua lit y, v io le nc e an d ro ad s af et y) H ea lt hy ad ol es ce nt s ag ed 11 –1 7 ye ar s S ch oo l- ba se d ph ys ic al ac ti vi ty a nd n ut ri ti on in te rv en ti on s de si gn ed to im pr ov e th e sc ho ol en vi ro nm en t a nd m ak e it m or e co nd uc iv e to ph ys ic al a ct iv it y an d he al th y nu tr it io n C on tr ol g ro up w it ho ut in te rv en ti on or u su al p ra ct ic e, or p re -i nt er ve nt io n co m pa ri so n gr ou p P ri m ar y: H ea lt h nu tr it io n an d ph ys ic al a ct iv it y (e .g . h ou rs o f p hy si ca l ac ti vi ty , f ru it a nd ve ge ta bl e pr ov is io n) ; m en ta l a nd h ol is ti c he al th ; r is k pr ev en ti on S ec on da ry : N ot s pe ci fi ed Q ua nt it at iv e ex pe ri m en ta l o r ob se rv at io na l st ud ie s in w hi ch an in te rv en ti on gr ou p w as co m pa re d at le as t tw ic e (i. e. p re -t es t an d po st -t es t) 57 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s Lo be lo 2 01 3 (5 8) S ch oo l- ba se d pr og ra m s ai m ed at th e pr ev en ti on an d tr ea tm en t of o be si ty : ev id en ce -b as ed in te rv en ti on s fo r yo ut h in L at in A m er ic a To e xa m in e th e eff ec ti ve ne ss o f s ch oo l- ba se d in te rv en ti on s ai m ed a t p re ve nt in g or tr ea ti ng o be si ty a m on g yo ut h in L at in A m er ic a C hi ld re n ag ed 6 – 14 .5 y ea rs in L at in A m er ic an c ou nt ri es P ro gr am m es th at h ad a t le as t o ne s ch oo l- ba se d in te rv en ti on f oc us ed o n ob es it y- re la te d to pi cs (a s op po se d to g en er al he al th p ro m ot io n) C on tr ol g ro up w it ho ut in te rv en ti on or p re -i nt er ve nt io n co m pa ri so n gr ou p P ri m ar y: B M I; w ei gh t; w ai st c ir cu m fe re nc e; pe rc en t b od y fa t; ov er w ei gh t; o be se S ec on da ry : N ot s pe ci fi ed R C Ts (i nc lu di ng cr os so ve r de si gn s) ; n on - R C Ts ; p re - an d po st -s tu dy de si gn s M ar ti n 20 18 (5 9) P hy si ca l a ct iv it y, di et a nd o th er be ha vi ou ra l in te rv en ti on s fo r im pr ov in g co gn it io n an d sc ho ol ac hi ev em en t in c hi ld re n an d ad ol es ce nt s w it h ob es it y or o ve rw ei gh t (C oc hr an e re vi ew ) To a ss es s w he th er lif es ty le in te rv en ti on s (in th e ar ea s of d ie t, ph ys ic al a ct iv it y, se de nt ar y be ha vi ou r an d be ha vi ou ra l th er ap y) im pr ov e sc ho ol ac hi ev em en t, c og ni ti ve fu nc ti on (e .g . e xe cu ti ve fu nc ti on s) a nd /o r fu tu re su cc es s in c hi ld re n an d ad ol es ce nt s w it h ob es it y or o ve rw ei gh t O be se o r ov er w ei gh t ch ild re n an d ad ol es ce nt s ag ed 3 –1 8 ye ar s S ch oo l- ba se d be ha vi ou ra l a nd li fe st yl e in te rv en ti on s ai m ed a t re du ci ng o be si ty S ta nd ar d ca re ; w ai ti ng -l is t c on tr ol ; n o tr ea tm en t; a tt en ti on pl ac eb o co nt ro l g ro up P ri m ar y: S ch oo l ac hi ev em en t; c og ni ti ve fu nc ti on ; a dv er se ou tc om es S ec on da ry : F ut ur e su cc es s; o be si ty in di ce s R C Ts a nd q ua si - R C Ts M ba ka ya 20 17 (6 0) H an d hy gi en e in te rv en ti on st ra te gi es to re du ce d ia rr ho ea an d re sp ir at or y in fe ct io ns a m on g sc ho ol ch ild re n in d ev el op in g co un tr ie s: A sy st em at ic re vi ew To id en ti fy h an d hy gi en e in te rv en ti on st ra te gi es to r ed uc e in fe ct io us d is ea se s su ch a s di ar rh oe a an d re sp ir at or y tr ac t in fe ct io ns a m on g sc ho ol ch ild re n in de ve lo pi ng c ou nt ri es C hi ld re n ag ed 6 –1 2 ye ar s in d ev el op in g co un tr ie s M ul ti -l ev el s ch oo l- a nd co m m un it y- b as ed in te rv en ti on s an d st ra te gi es a im ed a t im pr ov in g ha nd -w as hi ng pr ac ti ce s C on tr ol g ro up w it ho ut in te rv en ti on o r us ua l pr ac ti ce P ri m ar y: in ci de nc e of di ar rh oe a; in ci de nc e of re sp ir at or y ill ne ss es ; sc ho ol a bs en te ei sm ; cl ea nl in es s of h an ds du e to th e im pa ct s of ha nd h yg ie ne ; r ed uc ti on in th e nu m be r of m ic ro or ga ni sm s on th e ha nd s S ec on da ry : N ot s pe ci fi ed R C Ts ; c lu st er R C Ts 58 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s M uz aff ar 20 18 (6 1) N ar ra ti ve r ev ie w of c ul in ar y in te rv en ti on s w it h ch ild re n in s ch oo ls to p ro m ot e he al th y ea ti ng : D ir ec ti on s fo r fu tu re r es ea rc h an d pr ac ti ce To c ri ti ca lly e va lu at e cu lin ar y sk ill in te rv en ti on s in sc ho ol s to id en ti fy sp ec ifi c pr og ra m m es an d pr og ra m m at ic fa ct or s as so ci at ed w it h im pr ov em en t i n ou tc om es C hi ld re n ag ed 5 –1 2 ye ar s 9a nd th ei r pa re nt s) S ch oo l- ba se d pr og ra m m es d es ig ne d to te ac h “h an ds -o n” c ul in ar y sk ill s ei th er a s a st an d- al on e in te rv en ti on o r as pa rt o f a c om pr eh en si ve pa ck ag e of in te rv en ti on s C on tr ol g ro up w it ho ut in te rv en ti on or p re -i nt er ve nt io n co m pa ri so n gr ou p P ri m ar y: D ie t- re la te d be ha vi ou rs (e .g . f ru it a nd ve ge ta bl e co ns um pt io n, fr eq ue nc y of c oo ki ng ); w ei gh t s ta tu s; a tt it ud es to w ar d he al th y ea ti ng S ec on da ry : N ot s pe ci fi ed R C Ts ; q ua si - ex pe ri m en ta l in te rv en ti on al st ud ie s in cl ud in g pr e- a nd p os t- te st de si gn s N at ha n 20 19 (6 2) Th e eff ec ti ve ne ss of lu nc hb ox in te rv en ti on s on im pr ov in g th e fo od s an d be ve ra ge s pa ck ed a nd co ns um ed b y ch ild re n at ce nt re -b as ed ca re o r sc ho ol : a sy st em at ic re vi ew a nd m et a- an al ys is P ri m ar y ai m : t o as se ss th e eff ec ti ve ne ss o f lu nc hb ox in te rv en ti on s ai m in g to im pr ov e th e fo od s an d be ve ra ge s pa ck ed a nd c on su m ed by c hi ld re n at te nd in g ce nt re -b as ed c ar e or sc ho ol S ec on da ry a im : to a ss es s th e eff ec ti ve ne ss o f t he se in te rv en ti on s on c hi ld ad ip os it y or w ai st ci rc um fe re nc e C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs A ny e du ca ti on al , ex pe ri en ti al , h ea lt h pr om ot io n an d/ or f am ily or s tr uc tu ra l o r po lic y or le gi sl at iv e in te rv en ti on th at t ar ge te d fo od pr ov id ed f ro m h om e fo r co ns um pt io n by c hi ld re n du ri ng a tt en da nc e at sc ho ol o r ce nt re -b as ed ca re A ny p ar al le l co m pa ri so n gr ou p P ri m ar y: N um be r or pr op or ti on o f s er ve s, po rt io ns o r gr am s of f oo d pr ov id ed o r co ns um ed , a s m ea su re d by d ir ec t o bs er va ti on , su rv ey s or w ei gh ed f oo d in lu nc hb ox es S ec on da ry : A nt hr op om et ri c m ea su re s in cl ud in g B M I, B M I p er ce nt ile , w ai st m ea su re m en ts o r bo dy c om po si ti on (e .g . pe r ce nt b od y fa t, p er ce nt le an b od y m as s or sk in f ol ds ) R C Ts ; n on -R C Ts ; co nt ro ll ed c lin ic al tr ia ls N ør nb er g 20 15 (6 3) C ho ic e ar ch it ec tu re in te rv en ti on s fo r in cr ea se d ve ge ta bl e in ta ke an d be ha vi ou r ch an ge in a sc ho ol s et ti ng : A s ys te m at ic re vi ew To a ss es s th e pr ev al en ce a nd q ua lit y of e xi st in g st ud ie s on th e eff ec t o f c ho ic e ar ch it ec tu ra l n ud ge in te rv en ti on s pr om ot in g th e in ta ke o f v eg et ab le s am on g ad ol es ce nt s in a s ch oo l c on te xt an d to id en ti fy s tu di es es ti m at in g ad ol es ce nt s’ at ti tu de s to w ar ds ar ch it ec tu ra l n ud ge in te rv en ti on s H ea lt hy ad ol es ce nt s ag ed 11 –1 9 ye ar s S ch oo l- ba se d In te rv en ti on s ai m ed a t in fl ue nc in g ve ge ta bl e in ta ke w hi ch a pp lie d ch oi ce a rc hi te ct ur e nu dg in g (e .g . d is tr ib ut io n of f re e ve ge ta bl es , m od ifi ca ti on s to s er vi ng st yl e, c ha ng es to th e ph ys ic al e nv ir on m en t) N ot s pe ci fi ed P ri m ar y: V eg et ab le in ta ke ; m ea su re s o f at ti tu de s or le ve l o f pu bl ic a pp ro va l t ow ar ds nu dg e in te rv en ti on s or fo od c on su m pt io n S ec on da ry : N ot s pe ci fi ed In te rv en ti on o r ex pe ri m en ta l st ud ie s, in cl ud in g cl us te r R C Ts , q ua si ex pe ri m en ta l de si gn s an d pr e- an d po st -t es t ex pe ri m en ts 59 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s O hl y 20 16 (6 4) A s ys te m at ic re vi ew o f t he he al th a nd w el l- be in g im pa ct s of s ch oo l ga rd en in g: sy nt he si s of qu an ti ta ti ve an d qu al it at iv e ev id en ce To u nd er st an d th e he al th a nd w el l- be in g im pa ct s of s ch oo l ga rd en s an d th e fa ct or s th at h el p or h in de r th ei r su cc es sf ul d ev el op m en t E nt ir e sc ho ol co m m un it y, in cl ud in g pu pi ls , st aff , f am ily an d co m m un it y m em be rs o f a ll ag es O E C D c ou nt ri es S ch oo l- ba se d ga rd en in g ac ti vi ti es , i nc lu di ng pr ep ar in g th e so il, pl an ti ng , w ee di ng , w at er in g, h ar ve st in g an d ga rd en -r el at ed c oo ki ng an d ta st in g ac ti vi ti es , in te gr at ed in to th e cu rr ic ul um o r co nd uc te d ou ts id e of le ss on ti m e (e .g . a ft er s ch oo l c lu bs , sc ho ol -o rg an iz ed tr ip s to co m m un it y al lo tm en ts ) C on tr ol g ro up w it h no in te rv en ti on o r gr ou ps p ar ti ci pa ti ng in al te rn at iv e ac ti vi ti es (e .g . n ut ri ti on e du ca ti on w it ho ut g ar de ni ng ac ti vi ti es ) ( qu an ti ta ti ve st ud ie s) P ri m ar y: D ie ta ry in ta ke ; fo od -r el at ed k no w le dg e, at ti tu de s an d pr ef er en ce s; p hy si ca l, m en ta l o r em ot io na l he al th ; a nd q ua lit y of li fe in di ca to rs (q ua nt it at iv e st ud ie s) ; t he m es , co nc ep ts a nd m et ap ho rs re la ti ng to th e ex pe ri en ce a nd m ea ni ng of s ch oo l g ar de ns , a nd an y pe rc ei ve d fa ct or s th at h el p or h in de r th ei r su cc es s (q ua lit at iv e st ud ie s) S ec on da ry : A dd it io na l ou tc om es in cl ud in g ad ve rs e or u ni nt en de d ou tc om es (o nl y w he n re po rt ed a lo ng si de he al th a nd w el l- be in g ou tc om es ) S ui ta bl e qu an ti ta ti ve st ud ie s, in cl ud in g R C Ts , n on - R C Ts a nd o th er co nt ro ll ed b ef or e- an d- a ft er s tu di es , an d qu al it at iv e st ud ie s O os te rh off 20 16 (6 5) Th e eff ec ts of s ch oo l- ba se d lif es ty le in te rv en ti on s on b od y m as s in de x an d bl oo d pr es su re : a m ul ti va ri at e m ul ti le ve l m et a- an al ys is of r an do m iz ed co nt ro ll ed tr ia ls To r ev is e, sy st em at ic al ly , t he cu rr en t e vi de nc e on th e im pa ct o f s ch oo l- ba se d lif es ty le in te rv en ti on s on c hi ld re n’ s B M I a nd bl oo d pr es su re w it h th e us e of m ul ti le ve l m et a- an al ys is te ch ni qu es C hi ld re n ag ed 4 –1 2 ye ar s S ch oo l- ba se d lif es ty le in te rv en ti on s pr om ot in g a ch an ge to w ar ds he al th ie r ea ti ng (e .g . b y ch an ge s in f oo ds p ro vi de d by s ch oo l c an te en s/ ca fe te ri as ), or a c ha ng e in p hy si ca l ( in )a ct iv it y le ve ls (e .g in cr ea si ng ph ys ic al e du ca ti on lo ad ) an d/ or e du ca ti on f or he al th ie r be ha vi ou rs (e .g . pa m ph le ts , l ec tu re s) C on tr ol g ro up w it h no in te rv en ti on b ey on d th e us ua l c ur ri cu la r ac ti vi ti es P ri m ar y: B M I; ca rd io va sc ul ar r is k fa ct or s (e .g . sy st ol ic bl oo d pr es su re , d ia st ol ic bl oo d pr es su re ) S ec on da ry : N ot s pe ci fi ed R C Ts r ep or ti ng a t le as t o ne f ol lo w - up m om en t p os t in te rv en ti on s ta rt 60 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s P an te r 20 18 (6 6) O be si ty pr ev en ti on : A s ys te m at ic re vi ew o f se tt in g- ba se d in te rv en ti on s fr om N or di c co un tr ie s an d th e N et he rl an ds To id en ti fy , s yn th es iz e, an d ev al ua te th e qu al it y of in te rv en ti on s in cl ud in g en vi ro nm en ta l co m po ne nt s ba se d in th e in s et ti ng s fr om N or di c co un tr ie s an d th e N et he rl an ds , a im ed at p re ve nt in g ob es it y A ll ag e gr ou ps N or di c co un tr ie s (D en m ar k, F in la nd , Ic el an d, N or w ay an d S w ed en ) a nd th e N et he rl an ds S ch oo l- , c om m un it y- an d w or kp la ce -b as ed In te rv en ti on s ta rg et in g th e w ei gh t s ta tu s of th e po pu la ti on w hi ch in cl ud e at le as t o ne en vi ro nm en ta l c om po ne nt (e .g . s ch oo l c ur ri cu lu m ch an ge s, in fr as tr uc tu re an d bu ilt e nv ir on m en t, po lic ie s) N ot s pe ci fi ed P ri m ar y: B M I a nd ob es it y or c hr on ic di se as e pr ev en ti on m ea su re s (e .g . c ha ng es in p hy si ca l a ct iv it y, sm ok in g, b lo od pr es su re , l ip id s) S ec on da ry : N ot s pe ci fi ed A ny in te rv en ti on al st ud y de si gn s ot he r th an p ur el y qu al it at iv e st ud ie s R ah m an 20 18 (6 7) E ff ec ti ve ne ss of b eh av io ur al in te rv en ti on s to r ed uc e th e in ta ke o f s ug ar - sw ee te ne d be ve ra ge s in ch ild re n an d ad ol es ce nt s: a sy st em at ic re vi ew a nd m et a- an al ys is To e xp lo re th e eff ec ti ve ne ss of e du ca ti on al an d be ha vi ou ra l in te rv en ti on s to r ed uc e su ga r- sw ee te ne d be ve ra ge in ta ke a nd to in fl ue nc e he al th ou tc om es a m on g ch ild re n ag ed 4 to 1 6 ye ar s C hi ld re n an d ad ol es ce nt s ag ed 4 –1 6 ye ar s S ch oo l- , h om e an d co m m un it y- ba se d ed uc at io na l o r be ha vi ou ra l i nt er ve nt io ns ta rg et in g th e re du ct io n of s ug ar -s w ee te ne d be ve ra ge c on su m pt io n C on tr ol g ro up w it ho ut in te rv en ti on P ri m ar y: S ug ar - sw ee te ne d be ve ra ge co ns um pt io n S ec on da ry : o be si ty pr ev al en ce (s ta tu s) ; ag e an d ge nd er s pe ci fi c B M I z -s co re s; d en ta l ca ri es m ea su re d by th e di ff er en ce in d ec ay ed , m is si ng , a nd fi ll ed te et h; ca rd io va sc ul ar d is ea se ri sk f ac to rs ; r is k of an y ch ro ni c di se as e, in cl ud in g ty pe II d ia be te s m el lit us , h yp er te ns io n, dy sl ip id ae m ia , a nd or th op ae di c ai lm en ts R C Ts o nl y S ac co 2 01 6 (6 8) Th e in fl ue nc e of m en u la be ll in g on f oo d ch oi ce s am on g ch ild re n an d ad ol es ce nt s: a sy st em at ic re vi ew o f t he lit er at ur e To a ss es s w he th er m en u la be ll in g in fl ue nc es th e am ou nt of c al or ie s or de re d by c hi ld re n an d ad ol es ce nt s (o r pa re nt s on b eh al f o f y ou th ) i n fo od o ut le ts in cl ud in g re st au ra nt s an d ca fe te ri as C hi ld re n an d ad ol es ce nt s ag ed un de r 18 y ea rs M en u- la be ll in g in te rv en ti on s w it h di sc lo su re o f c al or ie s an d ot he r nu tr ie nt s on m en us o r m en u bo ar ds in f oo d ou tl et s, in cl ud in g re st au ra nt s an d sc ho ol ca fe te ri as C on tr ol g ro up w it ho ut in te rv en ti on or p re - in te rv en ti on co m pa ri so n gr ou p P ri m ar y: M ea n ca lo ri es se le ct ed p er p ar ti ci pa nt S ec on da ry : T ot al fa t c on te nt o f f oo d; pu rc ha se d or c on su m ed ; aw ar en es s of n ut ri ti on in fo rm at io n on m en us an d m en u bo ar ds ; s el f- re po rt ed u se o f l ab el s w he n pu rc ha si ng f oo d; m en u- la be ll in g fo rm at pr ef er en ce s R C Ts ; b ef or e- an d- af te r st ud ie s (d es cr ib ed in re su lt s) 61 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s S ar af 2 01 2 (6 9) A s ys te m at ic re vi ew o f s ch oo l- ba se d in te rv en - ti on s to p re ve nt ri sk f ac to rs as so ci at ed w it h no nc om m un ic a- bl e di se as es To a ss es s th e eff ec ti ve ne ss o f s ch oo l- ba se d in te rv en ti on s in br in gi ng a bo ut a c ha ng e in th e kn ow le dg e, at ti tu de a nd p ra ct ic es of s ch oo lc hi ld re n at sc ho ol , f am ily a nd co m m un it y le ve ls f or th e pr ev en ti on o f N C D ri sk f ac to rs (p hy si ca l in ac ti vi ty , d ie t a nd to ba cc o co ns um pt io n) an d to id en ti fy pr oc es se s th at a ff ec t th e m ai n ou tc om e S ch oo l- ag ed ch ild re n S ch oo l- ba se d in te rv en ti on s w it h or w it ho ut a f am ily o r co m m un it y co m po ne nt fo cu se d on m od if yi ng ph ys ic al a ct iv it y, nu tr it io n, o be si ty -r el at ed ri sk f ac to rs , s ed en ta ry ha bi ts a nd /o r to ba cc o co ns um pt io n A p ar al le l c om pa ri so n co nt ro l g ro up o r a pr e- in te rv en ti on co m pa ri so n gr ou p P ri m ar y: C ha ng e in k no w le dg e, at ti tu de , p ra ct ic es ; an th ro po m et ri c m ea su re s (e .g . B M I, w ei gh t, s ki n fo ld th ic kn es s) S ec on da ry : N ot s pe ci fi ed N ot p re -s pe ci fi ed S av oi e- R os ko s 20 17 (7 0) In cr ea si ng f ru it an d ve ge ta bl e in ta ke a m on g ch ild re n an d yo ut h th ro ug h ga rd en in g- ba se d in te rv en ti on s: a sy st em at ic re vi ew To id en ti fy th e eff ec ti ve ne ss o f ga rd en in g in te rv en ti on s th at h av e be en im pl em en te d to im pr ov e fr ui t a nd v eg et ab le co ns um pt io n am on g ch ild re n ag ed 2 to 15 y ea rs in s ch oo l, co m m un it y an d af te rs ch oo l s et ti ng s C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs in d ev el op ed co un tr ie s A ny s ch oo l- ba se d, ga rd en in g- ba se d in te rv en ti on s an d pr og ra m m es d el iv er ed as p ar t o f t he s ch oo l cu rr ic ul a or a s pa rt o f ou t- of -s ch oo l c lu bs o r co m m un it y pr oj ec ts w hi ch a ll ow ed c hi ld re n to r ec ei ve h an ds -o n ex pe ri en ce w it h pl an ti ng , gr ow in g, a nd h ar ve st in g fr ui t a nd v eg et ab le s N ot s pe ci fi ed P ri m ar y: F ru it a nd ve ge ta bl e co ns um pt io n S ec on da ry : N ot s pe ci fi ed A ny s tu dy d es ig n S ch ro ed er 20 16 (7 1) A re s ch oo l nu rs es a n ov er lo ok ed re so ur ce in r ed uc in g ch ild ho od ob es it y? A sy st em at ic re vi ew a nd m et a- an al ys is To e xa m in e th e effi ca cy of s ch oo l- ba se d ob es it y in te rv en ti on s th at in vo lv e nu rs es S ch oo l- ag ed ch ild re n S ch oo l- ba se d in te rv en ti on s to p re ve nt or tr ea t c hi ld ho od ob es it y th at in vo lv e nu rs es in a r ol e be yo nd an th ro po m et ri c m ea su re m en t N ot s pe ci fi ed P ri m ar y: b od y w ei gh t or B M I ( e. g. B M I, B M I z- sc or e, B M I p er ce nt ile ) S ec on da ry : N ot s pe ci fi ed Q ua si - ex pe ri m en ta l o r ex pe ri m en ta l de si gn s (e .g R C Ts ) 62 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s S ob ol - G ol db er g 20 13 (7 2) S ch oo l- ba se d ob es it y pr ev en ti on pr og ra m m es : a m et a- an al ys is of r an do m iz ed co nt ro ll ed tr ia ls To a ss es s th e effi ca cy of s ch oo l- ba se d ob es it y pr ev en ti on p ro gr am m es (u si ng th e m et ho do lo gy em pl oy ed b y a pr ev io us re vi ew b y K am at h et a l., 2 00 8b a nd b as ed on s tu di es p ub lis he d be tw ee n 20 06 a nd 2 01 2) C hi ld re n an d ad ol es ce nt s ag ed 5 –1 8 ye ar s S ch oo l- ba se d in te rv en ti on p ro gr am m es ai m ed a t p re ve nt in g ch ild ho od o be si ty C on tr ol g ro up w it h no in te rv en ti on P ri m ar y: B M I S ec on da ry : N ot s pe ci fi ed R C Ts Tu rb ut t 20 19 (7 3) Th e im pa ct of h ot f oo d ta ke aw ay s ne ar sc ho ol s in th e U K o n ch ild ho od ob es it y: A sy st em at ic re vi ew o f t he ev id en ce To id en ti fy a ll pa pe rs pu bl is he d si nc e th e id en ti fi ca ti on of th e ob es og en ic en vi ro nm en t i n 19 98 fo cu se d on th e im pa ct of h ot f oo d ta ke aw ay s in th e fo od e nv ir on m en t su rr ou nd in g sc ho ol s in th e U K o n ch ild ho od ob es it y S ch oo l- ag ed ch ild re n an d th ei r pa re nt s in th e U K P ol ic ie s an d pr og ra m m es (in cl ud in g fo od en vi ro nm en t d es ig n) w hi ch in fl ue nc e th e fo od en vi ro nm en t s ur ro un di ng sc ho ol s N ot s pe ci fi ed P ri m ar y: M ea su re s of c hi ld ho od o be si ty m ea su re s (e .g . B M I, w ei gh t, o be si ty pr ev al en ce ) S ec on da ry : F oo d- re la te d be ha vi ou rs am on g pu pi ls o r ad ul ts in th e en vi ro nm en t su rr ou nd in g sc ho ol s N ot p re -s pe ci fi ed Tu rn er 2 02 0 (7 4) Fo od en vi ro nm en t re se ar ch in lo w - an d m id dl e- in co m e co un tr ie s: a sy st em at ic sc op in g re vi ew To a dd re ss th e fo ll ow in g fi ve q ue st io ns : 1) W he re h as f oo d en vi ro nm en t r es ea rc h be en u nd er ta ke n? 2) H ow h av e fo od en vi ro nm en ts b ee n co nc ep tu al iz ed ? 3) W hi ch k ey d om ai ns an d di m en si on s of f oo d en vi ro nm en ts h av e be en s tu di ed ? 4) W hi ch s tu dy de si gn s, m et ho ds a nd m ea su re s ha ve b ee n im pl em en te d? Lo w - an d m id dl e- in co m e co un tr ie s In te rv en ti on s ai m ed a t im pr ov in g th e sc ho ol f oo d en vi ro nm en t b y re du ci ng th e av ai la bi lit y of e ne rg y- de ns e fo od s an d su ga r- sw ee te ne d be ve ra ge s; in cr ea si ng th e av ai la bi lit y of h ea lt hi er f oo d op ti on s; pr ov id in g nu tr it io n ed uc at io n; a do pt in g sc ho ol p ol ic ie s; a nd lim it in g ac ce ss to v en do rs se ll in g un he al th y fo od s in an d ar ou nd s ch oo ls N ot s pe ci fi ed P ri m ar y: D ie ta ry , nu tr it io na l s ta tu s or he al th m ea su re s S ec on da ry : N ot s pe ci fi ed A ny o ri gi na l pe er -r ev ie w ed pu bl is he d ar ti cl es (q ua nt it at iv e an d qu al it at iv e st ud ie s) 63 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s 5) W ha t a re th e ke y fi nd in gs r eg ar di ng as so ci at io ns b et w ee n fo od e nv ir on m en t ex po su re a nd d ie ta ry , nu tr it io n, a nd h ea lt h ou tc om es ? Va n Li pp ev el de 20 12 (7 5) D oe s pa re nt al in vo lv em en t m ak e a di ff er en ce in sc ho ol -b as ed nu tr it io n an d ph ys ic al a ct iv it y in te rv en ti on s? A s ys te m at ic re vi ew o f ra nd om iz ed co nt ro ll ed tr ia ls To d et er m in e th e im pa ct of p ar en ta l i nv ol ve m en t in s ch oo l- ba se d ob es it y pr ev en ti on in te rv en ti on s, to id en ti fy th e ch ar ac te ri st ic s of p ar en ts w ho d o pa rt ic ip at e in s ch oo l- ba se d in te rv en ti on s, an d to e xp lo re th e ki nd o f p ar en ta l in vo lv em en t i n sc ho ol - ba se d in te rv en ti on s th at m ay c on tr ib ut e to eff ec ti ve ne ss H ea lt hy c hi ld re n an d ad ol es ce nt s ag ed 6 –1 8 ye ar s, a nd th ei r pa re nt s S ch oo l- ba se d in te rv en ti on s fo cu se d on ob es it y- , n ut ri ti on - an d ph ys ic al a ct iv it y- re la te d be ha vi ou rs (e .g . h ea lt h ed uc at io n, in cr ea se d op po rt un it ie s fo r ph ys ic al ac ti vi ty , s ch oo l f oo d se rv ic e m od ifi ca ti on s, ac ti ve tr av el p ro m ot io n) S ch oo l- on ly in te rv en ti on g ro up P ri m ar y: a nt hr op om et ri c ou tc om es (e .g . B M I, ov er w ei gh t) ; n ut ri ti on be ha vi ou rs , k no w le dg e an d at ti tu de s (f ru it co ns um pt io n, s na ck in g) ; ph ys ic al a ct iv it y- re la te d be ha vi ou rs (e .g . ex er ci se , s cr ee n ti m e) S ec on da ry : N ot s pe ci fi ed C on tr ol le d tr ia ls in w hi ch a sc ho ol -o nl y in te rv en ti on g ro up w as c om pa re d w it h a sc ho ol - pl us -f am ily - in te rv en ti on - gr ou p Va rg as - G ar ci a 20 17 (7 6) In te rv en ti on s to r ed uc e co ns um pt io n of s ug ar - sw ee te ne d be ve ra ge s or in cr ea se w at er in ta ke : ev id en ce f ro m a sy st em at ic re vi ew a nd m et a- an al ys is To e va lu at e th e eff ec ti ve ne ss o f p ub lic he al th in te rv en ti on s to r ed uc e su ga r- sw ee te ne d be ve ra ge in ta ke o r in cr ea se w at er in ta ke in c hi ld re n, ad ol es ce nt s an d ad ul ts C hi ld re n an d ad ul ts no y ou ng er th an 3 ye ar s C om m un it y- ba se d in te rv en ti on s w hi ch in cl ud e a sp ec ifi c sc ho ol co m po ne nt th at a re ai m ed a t r ed uc in g su ga r- sw ee te ne d be ve ra ge co ns um pt io n (s ch oo l– sp ec ifi c in te rv en ti on s in cl ud e e du ca ti on al m at er ia ls (e .g . s tu de nt bo ok le ts , p os te rs a nd fa ct s he et s fo r pa re nt s) as w el l a s ed uc at io na l ac ti vi ti es (e .g . t he at re sk et ch es , m ov ie s, p up pe t sh ow s, w ri ti ng a nd dr aw in g co nt es ts ) A ny c on tr ol g ro up P ri m ar y: In ta ke s of su ga r- sw ee te ne d be ve ra ge o r w at er (d ai ly ch an ge , i n m ill ili tr es ) S ec on da ry : N ot s pe ci fi ed R C Ts ; c lu st er R C Ts ; n on -R C Ts 64 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s Ve rj an s- Ja ns se n 20 18 (7 7) E ff ec ti ve ne ss o f sc ho ol -b as ed ph ys ic al a ct iv it y an d nu tr it io n in te rv en ti on s w it h di re ct pa re nt al in vo lv em en t on c hi ld re n’ s B M I a nd e ne rg y ba la nc e- re la te d be ha vi or s – A sy st em at ic re vi ew To s tu dy th e eff ec ti ve ne ss o f pr im ar y sc ho ol -b as ed ph ys ic al a ct iv it y an d nu tr it io n in te rv en ti on s w it h di re ct p ar en ta l in vo lv em en t r eg ar di ng ch ild re n’ s w ei gh t s ta tu s an d en er gy b al an ce - re la te d be ha vi ou rs C hi ld re n ag ed 4 –1 2 ye ar s P ri m ar y sc ho ol -b as ed in te rv en ti on s w it h di re ct pa re nt al in vo lv em en t ta rg et in g ph ys ic al a ct iv it y be ha vi ou r, s ed en ta ry be ha vi ou r an d/ or nu tr it io n be ha vi ou r N ot s pe ci fi ed P ri m ar y: B M I; B M I z- sc or e (a dj us te d fo r ag e an d ge nd er ) ; p hy si ca l ac ti vi ty ; s ed en ta ry be ha vi ou r an d/ or nu tr it io na l b eh av io ur S ec on da ry : N ot s pe ci fi ed A ny m at ch in g se ar ch te rm s: Ev al ua ti on (s ) (s tu dy ), eff ec t( s) , eff ec ti ve (n es s) , eff ec ti vi ty , p re - po st -t es t( s) Ve rs tr ae te n 20 12 (7 8) E ff ec ti ve ne ss of p re ve nt iv e sc ho ol -b as ed ob es it y in te rv en ti on s in lo w - an d m id dl e- in co m e co un tr ie s: A sy st em at ic re vi ew To id en ti fy e ff ec ti ve pa th w ay s th at a lt er be ha vi ou r an d/ or B M I in s ch oo lc hi ld re n in lo w - an d m id dl e- in co m e co un tr ie s C hi ld re n an d ad ol es ce nt s ag ed 6 –1 8 ye ar s in lo w - an d m id dl e- in co m e co un tr ie s S ch oo l- ba se d pr og ra m m es f oc us ed on p ri m ar y pr ev en ti on of o ve rw ei gh t o r ob es it y in c hi ld re n th ro ug h in te rv en ti on s w hi ch ta rg et d ie ta ry a nd / or p hy si ca l a ct iv it y be ha vi ou rs A ny c on tr ol g ro up P ri m ar y: D ie ta ry an d ph ys ic al a ct iv it y be ha vi ou r ou tc om es an d/ or a nt hr op om et ri c ou tc om es S ec on da ry : N ot s pe ci fi ed A ny c on tr ol le d tr ia l s tu dy d es ig n (w it h or w it ho ut ra nd om iz at io n) Vé zi na -I m 20 17 (7 9) E ffi ca cy o f sc ho ol -b as ed in te rv en ti on s ai m ed a t de cr ea si ng su ga r- sw ee te ne d be ve ra ge co ns um pt io n am on g ad ol es ce nt s: a sy st em at ic re vi ew To p er fo rm a s ys te m at ic re vi ew o f s ch oo l- ba se d in te rv en ti on s ai m ed at r ed uc in g su ga r- sw ee te ne d be ve ra ge co ns um pt io n am on g ad ol es ce nt s ag ed 1 2– 17 ye ar s A do le sc en ts a ge d 12 –1 7 ye ar s S ec on da ry s ch oo l- ba se d in te rv en ti on s an d nu tr it io n po lic ie s ai m ed at r ed uc in g su ga r- sw ee te ne d be ve ra ge co ns um pt io n N ot s pe ci fi ed P ri m ar y: S ug ar - sw ee te ne d be ve ra ge co ns um pt io n S ec on da ry : N ot s pe ci fi ed R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; o ne gr ou p pr e– an d- po st s tu di es 65 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s vo n P hi lip sb or n 20 19 (8 0) E nv ir on m en ta l in te rv en ti on s to r ed uc e th e co ns um pt io n of su ga r- sw ee te ne d be ve ra ge s an d th ei r eff ec ts o n he al th To a ss es s th e eff ec ts of e nv ir on m en ta l in te rv en ti on s (e xc lu di ng ta xa ti on ) o n th e co ns um pt io n of s ug ar - sw ee te ne d be ve ra ge s an d su ga r- sw ee te ne d m ilk , d ie t- re la te d an th ro po m et ri c m ea su re s an d he al th ou tc om es , a nd o n an y re po rt ed u ni nt en de d co ns eq ue nc es o r ad ve rs e ou tc om es ’ C hi ld re n an d ad ul ts S ch oo l- , h om e- a nd co ns um er -b as ed in te rv en ti on s (i. e. in cl ud in g in te rv en ti on s in s up er m ar ke ts a nd re st au ra nt s/ ca fe s) in te nd in g to r ed uc e, o r ha ve p ot en ti al e ff ec ts o n, th e co ns um pt io n of s ug ar - sw ee te ne d be ve ra ge s an d su ga r- sw ee te ne d m ilk , or m it ig at e th ei r ad ve rs e eff ec ts o n he al th C on tr ol g ro up w it h no in te rv en ti on o r m in im al o r al te rn at iv e in te rv en ti on s (e .g . be ha vi ou ra l i nt er ve nt io n) P ri m ar y: D ir ec t a nd in di re ct m ea su re s of s ug ar -s w ee te ne d be ve ra ge in ta ke ; d ie t- re la te d an th ro po m et ri c m ea su re s an d he al th ou tc om es ; a ny r ep or te d ad ve rs e ou tc om es o r un in te nd ed c on se qu en ce s S ec on da ry : M ea su re s of fi na nc ia l a nd e co no m ic vi ab ili ty ; d ie t- re la te d ps yc ho so ci al v ar ia bl es ; ta rg et g ro up p er ce pt io ns of th e in te rv en ti on ; co ns um pt io n of be ve ra ge s ot he r th an su ga r- sw ee te ne d be ve ra ge s R C Ts (i nc lu di ng cl us te r R C Ts ); no n - R C Ts (i nc lu di ng cl us te r no n -R C Ts ); co nt ro ll ed b ef or e- an d- af te r st ud ie s; in te rr up te d ti m e- se ri es st ud ie s; r ep ea te d m ea su re s st ud ie s W an g 20 13 (8 1) Th e im pl em en ta ti on an d eff ec ti ve ne ss of s ch oo l- ba se d nu tr it io n pr om ot io n pr og ra m m es us in g a he al th - pr om ot in g sc ho ol s ap pr oa ch : a sy st em at ic re vi ew To e va lu at e th e im pl em en ta ti on a nd eff ec ti ve ne ss o f sc ho ol -b as ed n ut ri ti on pr om ot io n pr og ra m m es us in g th e he al th pr om ot in g sc ho ol s (H P S ) a pp ro ac h, to in di ca te a re as w he re fu rt he r re se ar ch is ne ed ed a nd to m ak e re co m m en da ti on s fo r pr ac ti ce in th is fi el d S ch oo lc hi ld re n, th ei r pa re nt s an d te ac he rs S ch oo l- ba se d in te rv en ti on s on n ut ri ti on w hi ch in vo lv e he al th - pr om ot in g ac ti vi ti es in o ne or m or e of th e fo ll ow in g th re e ar ea s: (a ) t he s ch oo l e th os a nd /o r en vi ro nm en t ( e. g. s ch oo l po lic y) ; (b ) t he c ur ri cu lu m , sp ec ifi ca lly th e nu tr it io n cu rr ic ul um ; ( c) th e fa m ily an d/ or c om m un it y S ch oo l s et ti ng N o re st ri ct io ns ap pl ie d on g ro un ds o f co m pa ra to r gr ou ps P ri m ar y: P ar ti ci pa nt s’ kn ow le dg e; p ar ti ci pa nt s’ at ti tu de s an d sk ill s; pa rt ic ip an ts ’ b eh av io ur s re la ti ng to d ie t a nd nu tr it io n S ec on da ry : N ot s pe ci fi ed C on tr ol le d st ud ie s; be fo re -a nd -a ft er st ud ie s 66 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s in te r v en ti o n s W an g 20 15 (8 2) W ha t c hi ld ho od ob es it y pr ev en ti on pr og ra m m es w or k? A sy st em at ic re vi ew a nd m et a- an al ys is To s ys te m at ic al ly ev al ua te th e eff ec ti ve ne ss o f a ll ch ild ho od o be si ty pr ev en ti on p ro gr am m es im pl em en te d in v ar io us se tt in gs C hi ld re n an d ad ol es ce nt s ag ed 2– 18 y ea rs i n hi gh - in co m e co un tr ie s In te rv en ti on s co nd uc te d in m ul ti pl e se tt in gs (i .e . sc ho ol , h om e, p ri m ar y ca re , c hi ld ca re a nd o th er co m m un it y se tt in gs ) to p re ve nt o be si ty (o r “e xc es si ve w ei gh t g ai n” ) i n ch ild re n ag ed 2 –1 8 ye ar s N ot s pe ci fi ed P ri m ar y: A di po si ty - re la te d ou tc om es (e .g . B M I, B M I z -s co re , B M I p er ce nt ile , w ai st ci rc um fe re nc e , p er ce nt bo dy f at , s ki n -f ol d th ic kn es s, p re va le nc e of ov er w ei gh t o r ob es it y) S ec on da ry : B eh av io ur al ou tc om es (e .g . d ie ta ry in ta ke s, p hy si ca l ac ti vi ty a nd s ed en ta ry be ha vi ou rs ); ob es it y- re la te d cl in ic al o ut co m es (e .g . b lo od p re ss ur e an d bl oo d lip id le ve ls ) R C Ts ; q ua si - ex pe ri m en ta l st ud ie s; n at ur al ex pe ri m en ts th at r ep or te d in te rv en ti on eff ec ts o n ad ip os it y- re la te d ou tc om es W hi tt em or e 20 13 (8 3) S ch oo l- ba se d In te rn et o be si ty pr ev en ti on pr og ra m m es fo r ad ol es ce nt s: A s ys te m at ic lit er at ur e re vi ew To d es cr ib e, s yn th es iz e an d ev al ua te th e re se ar ch o n sc ho ol - ba se d In te rn et o be si ty pr ev en ti on p ro gr am m es fo r ad ol es ce nt s A do le sc en ts S ch oo l- ba se d ob es it y pr ev en ti on p ro gr am m es ta rg et in g ad ol es ce nt s A ny c on tr ol g ro up P ri m ar y: B M I; nu tr it io n be ha vi ou rs ; p hy si ca l ac ti vi ty b eh av io ur S ec on da ry : N ot s pe ci fi ed E m pi ri ca l s tu di es W ill m ot t 20 15 (8 4) E ff ec ti ve ne ss of h an d hy gi en e in te rv en ti on s in r ed uc in g ill ne ss a bs en ce am on g ch ild re n in e du ca ti on al se tt in gs : a sy st em at ic re vi ew a nd m et a- an al ys is To e st ab lis h th e eff ec ti ve ne ss o f ha nd w as hi ng in re du ci ng a bs en ce an d/ or th e sp re ad o f re sp ir at or y tr ac t an d/ or g as tr oi nt es ti na l in fe ct io n am on g sc ho ol - ag ed c hi ld re n an d/ or s ta ff in e du ca ti on al se tt in gs C hi ld re n ag ed 3 –1 1 ye ar s, a nd th ei r ca re rs /t ea ch er s S ch oo l- b as ed (p ri m ar y or e le m en ta ry ) h an d hy gi en e in te rv en ti on s P la ce bo o r ac ti ve co m pa ra to r gr ou ps P ri m ar y: In ci de nc e of r es pi ra to ry tr ac t an d ga st ro in te st in al in fe ct io ns o r sy m pt om s; ab se nt ee is m r at e; la bo ra to ry -c on fi rm ed re sp ir at or y tr ac t an d ga st ro in te st in al in fe ct io ns R C Ts 67 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s S ec on da ry : H os pi ta l ad m is si on s du e re sp ir at or y tr ac t a nd / or g as tr oi nt es ti na l in fe ct io ns ; kn ow le dg e, at ti tu de s, b el ie fs o r be ha vi ou rs a bo ut h an d hy gi en e am on g ch ild re n an d/ or s ta ff w or ki ng w it h th em iM P le M en tA ti o n r e v ie W s Fr er ic hs 20 16 (8 5) C hi ld a nd y ou th pa rt ic ip at or y in te rv en ti on s fo r ad dr es si ng lif es ty le -r el at ed ch ild ho od ob es it y: a sy st em at ic re vi ew To id en ti fy to id en ti fy c hi ld a nd yo ut h pa rt ic ip at or y in te rv en ti on s in th e pe er -r ev ie w ed lit er at ur e in o rd er to c ha ra ct er iz e th e ap pr oa ch es a nd ex am in e th ei r im pa ct on o be si ty a nd o be si ty - re la te d lif es ty le be ha vi ou rs C hi ld re n an d ad ol es ce nt s ag ed 5 –1 8 or a bo ve (u p to c ol le ge -a ge ) S ch oo l- a nd c om m un it y- ba se d he al th y- lif es ty le in te rv en ti on s w hi ch in vo lv ed c hi ld re n an d yo ut h in p ar ti ci pa to ry ro le s in th ei r im pl em en ta ti on P re -i nt er ve nt io n co nt ro l gr ou p P ri m ar y: W ei gh t; ph ys ic al a ct iv it y; d ie ta ry ch an ge S ec on da ry : N ot s pe ci fi ed In di vi du al R C Ts ; cl us te r R C Ts ; co nt ro ll ed b ef or e- an d- af te r st ud ie s S ch aa p 20 18 (8 6) M ea su ri ng im pl em en ta ti on fi de lit y of s ch oo l- ba se d ob es it y pr ev en ti on pr og ra m m es : a sy st em at ic re vi ew To : 1) id en ti fy w hi ch fi de lit y co m po ne nt s ha ve b ee n m ea su re d in s ch oo l- ba se d ob es it y pr ev en ti on pr og ra m m es ; 2) id en ti fy h ow fi de lit y co m po ne nt s ha ve b ee n m ea su re d; a nd 3 ) s co re th e qu al it y of th es e m et ho ds C hi ld re n an d ad ol es ce nt s ag ed 4 –1 8 ye ar s S ch oo l- ba se d pr og ra m m es th at t ar ge t ob es it y (t hr ou gh n ut ri ti on an d/ or p hy si ca l a ct iv it y in te rv en ti on s) f or w hi ch at le as t o ne c om po ne nt of fi de lit y im pl em en ta ti on w as m ea su re d N ot s pe ci fi ed P ri m ar y: Im pl em en ta ti on fi de lit y m ea su re s (e .g . do se , r es po ns iv en es s, ad he re nc e, q ua lit y of de liv er y) c S ec on da ry : N ot s pe ci fi ed S tu di es e va lu at in g im pl em en ta ti on fi de lit y us in g qu an ti ta ti ve m et ho ds (i .e . qu es ti on na ir es , ob se rv at io ns , st ru ct ur ed in te rv ie w s or lo gb oo ks ) 68 Assessing the existing evidence bAse on school Food And nutrition Policies s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s iM P le M en tA ti o n r e v ie W s W ol fe nd en 20 17 (8 7) S tr at eg ie s fo r en ha nc in g th e im pl em en ta ti on of s ch oo l- ba se d po lic ie s or p ra ct ic es ta rg et in g ri sk fa ct or s fo r ch ro ni c di se as e (R ev ie w ) To e xa m in e th e eff ec ti ve ne ss o f st ra te gi es a im in g to im pr ov e th e im pl em en ta ti on o f sc ho ol -b as ed p ol ic ie s, pr og ra m m es o r pr ac ti ce s to a dd re ss ch ild d ie t, p hy si ca l ac ti vi ty , o be si ty , t ob ac co or a lc oh ol u se C hi ld re na a nd ad ol es ce nt s ag ed 5 –1 8 ye ar s S ch oo l- ba se d in te rv en ti on s ai m ed at i m pr ov in g th e im pl em en ta ti on o f po lic ie s, p ro gr am m es or p ra ct ic es in a sc ho ol s et ti ng w hi ch ta rg et h ea lt hy e at in g, ph ys ic al a ct iv it y, o be si ty pr ev en ti on , t ob ac co o r al co ho l p re ve nt io n (o r co m bi na ti on o f) P ar al le l g ro up w it ho ut in te rv en ti on P ri m ar y: O bj ec ti ve ly or s ub je ct iv el y (s el f- re po rt ed ) a ss es se d m ea su re o f s ch oo l po lic y, p ro gr am m e or pr ac ti ce im pl em en ta ti on (e .g . pa rt ia l/ co m pl et e up ta ke c on si st en t w it h pr ot oc ol /d es ig n) S ec on da ry : M ea su re s of h ea lt h be ha vi ou rs o r ri sk f ac to rs r el ev an t t o po lic ie s, p ro gr am m es , or p ra ct ic es b ei ng im pl em en te d; a ny m ea su re o f s ch oo l st aff k no w le dg e, s ki ll s or a tt it ud es r el at ed to th e im pl em en ta ti on o f po lic ie s, p ro gr am m es or p ra ct ic es s up po rt iv e of d ie t, p hy si ca l a ct iv it y, or h ea lt hy w ei gh t, o r to ba cc o or a lc oh ol u se pr ev en ti on ; e st im at es of a bs ol ut e co st s or an y as se ss m en t o f t he co st - eff ec ti ve ne ss o f st ra te gi es to im pr ov e im pl em en ta ti on o f po lic ie s, p ro gr am m es or p ra ct ic es in s ch oo ls ; an y re po rt ed u ni nt en de d ad ve rs e co ns eq ue nc es R C Ts ; c lu st er R C Ts ; q ua si -R C Ts ; cl us te r qu as i- R C Ts ; c on tr ol le d be fo re -a nd -a ft er st ud ie s; c lu st er co nt ro ll ed b ef or e- an d- af te r st ud ie s 69 A scoping review s tu dy id ti tl e A im P op ul at io n in te rv en ti on s c om pa ra to r gr ou ps o ut co m es (p ri m ar y & se co nd ar y) el ig ib le s tu dy de si gn s of a s tr at eg y to im pr ov e im pl em en ta ti on o f po lic ie s, p ro gr am m es o r pr ac ti ce s in s ch oo ls B M I, bo dy m as s in de x; H P S , h ea lt h pr om ot in g sc ho ol s; IC T, in fo rm at io n an d co m m un ic at io n te ch no lo gi es ; N C D , n on co m m un ic ab le d is ea se ; n on -R C Ts ,n on -r an do m is ed c on tr ol le d tr ia ls ; R C Ts , ra nd om iz ed c on tr ol le d tr ia ls ; a W at er s E , d e S ilv a- S an ig or sk i A , B ur fo rd B J, B ro w n T, C am pb el l K J, G ao Y e t a l. In te rv en ti on s fo r pr ev en ti ng o be si ty in c hi ld re n. C oc hr an e D at ab as e of S ys t R ev . 2 01 1: C D 00 18 71 . b K am at h C C , V ic ke rs K S , E hr lic h A , M cG ov er n L , J oh ns on J , S in gh al V e t a l. C lin ic al r ev ie w : b eh av io ra l i nt er ve nt io ns to p re ve nt c hi ld ho od o be si ty : a s ys te m at ic r ev ie w a nd m et aa na ly se s of ra nd om iz ed tr ia ls . J C lin E nd oc ri no l M et ab . 2 00 8; 93 (1 2) :4 60 6 –1 5. d oi : 1 0. 12 10 /j c. 20 06 -2 41 1. c U se d fi de lit y m ea su re s pr ev io us ly d efi ne d by D us en bu ry L , B ra nn ig an R , F al co M , H an se n W B . A r ev ie w o f r es ea rc h on fi de lit y of im pl em en ta ti on : i m pl ic at io ns f or d ru g ab us e pr ev en ti on in sc ho ol s et ti ng s. H ea lt h E du c R es . 2 00 3; 18 (2 ):2 37 –5 6. 70 Annex 3. characteristics of excluded studies study id (author & year) title reason for exclusion Aaron 2015 Multiple-micronutrient fortified non-dairy beverage interventions reduce the risk of anemia and iron deficiency in school-aged children in low-middle income countries: a systematic review and meta-analysis Review did not include any school-based interventions (wrong intervention) Adolphus 2013 The effects of breakfast on behaviour and academic performance in children and adolescents Review did not complete risk of bias/quality assessment (wrong study design) Adolphus 2016 The effects of breakfast and breakfast composition on cognition in children and adolescents: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Alan 2013 Elementary school personnel’s perceptions of and recommendations for managing child obesity: a naturalistic study Review did not include school- based interventions (wrong intervention) Aliyar 2015 A review of nutritional guidelines and menu compositions for school feeding programmes in 12 countries Review did not complete risk of bias/quality assessment (wrong study design) Aloia 2016 Pertinence of the recent school-based nutrition interventions targeting fruit and vegetable consumption in the United States: a systematic review Review only used one database for search (wrong study design) An 2012 Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments Review did not complete risk of bias/quality assessment (wrong study design) Ashton 2019 Effectiveness of interventions and behaviour change techniques for improving dietary intake in young adults: a systematic review and meta-analysis of RCTs Review included participants 17 to 35 years old (wrong participants) Barco Leme 2019 Brazilian children’s dietary intake in relation to Brazil’s new nutrition guidelines: a systematic review Review did not include any school-based studies (wrong intervention) Berezowitz 2015 School gardens enhance academic performance and dietary outcomes in children Review did not complete risk of bias/quality assessment (wrong study design) Bhatnagar 2014 Food marketing to children in India: comparative review of regulatory strategies across the world Study is an editorial/literature review article (wrong study design) Bonell 2013 The effects on student health of interventions modifying the school environment: systematic review Review did not complete risk of bias/quality assessment (wrong study design) Bonell 2013 Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis Study is a mapping review (wrong study design) Bonell 2013 The effects of the school environment on student health: A systematic review of multi- level studies Review included studies with only psycho-social outcomes (wrong intervention) Bourke 2014 Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review Review did not include any school-based interventions (wrong intervention) Boyl 2016 Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and non- alcoholic beverage advertising on intake in children and adults Review did not include school- based interventions (wrong intervention) 71 A scoping review study id (author & year) title reason for exclusion Brackney 2014 Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse Review only used one database for search (wrong study design) Brand 2014 What works in community-based interventions promoting physical activity and healthy eating? A review of reviews Review assessed the effectiveness of community- based interventions and it was not possible to separate out data on school-based interventions (wrong intervention) Brannon 2014 A systematic review: Is there an app for that? Translational science of paediatric behaviour change for physical activity and dietary interventions Review did not include school- based interventions (wrong intervention) Branscum 2012 After-school based obesity prevention interventions: A comprehensive review of the literature Review did not complete risk of bias/quality assessment (wrong study design) Brennan 2014 Childhood obesity policy research and practice evidence for policy and environmental strategies Review did not complete risk of bias/quality assessment and includes systematic reviews as well as primary studies (wrong study design) Brooks 2014 Adolescent food literacy programmes: A review of the literature Review did not complete risk of bias/quality assessment (wrong study design) Busch 2013 Changing multiple adolescent health behaviour’s through school-based interventions: a review of the literature Study is an editorial/literature review article (wrong study design) Casemiro 2014 Promoting health in school: reflections based on a review of school health in Latin America Study is an editorial/literature review article (wrong study design) Cesar 2016 School Food in Brazil and the United States: an integrative review Non-English publication Chae 2017 TEACH Kitchen: A chronological review of accomplishments Study is not a systematic review (wrong study design) Chambers 2015 Reducing the volume, exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: A systematic review of the evidence from statutory and self- regulatory actions and educational measures Review did not include any school-based interventions (wrong intervention) Chau 2018 The use of social media in nutrition interventions for adolescents and young adults — A systematic review Review did not include any school-based interventions (wrong intervention) Chriqui 2013 Obesity prevention policies in U.S. states and localities: Lessons from the field Study is an editorial/literature review article (wrong study design) Chriqui 2014 Influence of school competitive food and beverage policies on obesity, consumption, and availability: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Chung 2017 The influence of peers on diet and exercise among adolescents: a systematic review Review assessed the association of peer behaviour with adolescent diet and exercise interventions (wrong intervention) Clarke 2013 The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review Study is a qualitative systematic review (wrong study design) 72 Assessing the existing evidence bAse on school Food And nutrition Policies study id (author & year) title reason for exclusion Clasen 2015 Interventions to improve water quality for preventing diarrhoea (Review) Review did not include any school-based interventions (wrong intervention) Collins 2013 Effectiveness of parent-centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Review did not include any school-based interventions (wrong intervention) Colquitt 2016 Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years Review included participants ≥ 6 years old (wrong participants) Coufopoulous 2013 Interventions to improve nutrition and nutrition related health amongst homeless mothers and their children: a systematic review Review included mothers as participants (wrong participants) Coughlin 2017 Community-based participatory research to promote healthy diet and nutrition and prevent and control obesity among African Americans: A literature review Study is an editorial/literature review article (wrong study design) Curran 2016 School-based positive youth development: a systematic review of the literature Review included positive youth development interventions with psychosocial-social outcomes (wrong intervention) Dangour 2013 Can nutrition be promoted through agriculture-led food price policies? A systematic review Review did not include school-based policies (wrong intervention) Darfour-Oduro 2018 Review of policies to increase fruit and vegetable consumption and physical activity in 49 low- and middle-income countries Review did not complete risk of bias/quality assessment (wrong study design) de Alcântara 2019 Digital technologies for promotion of healthy eating habits in teenagers Review did not include school- based interventions (wrong intervention) De Buck 2017 Approaches to promote handwashing and sanitation behaviour change in low- and middle-income countries: a mixed method systematic review Review did not include school- based interventions (wrong intervention) de Melo Boff 2016 Weight loss interventions for overweight and obese adolescents: a systematic review Review did not include school- based interventions (wrong intervention) DeCosta 2017 Changing children’s eating behaviour– a review of experimental research Review did not complete risk of bias/quality assessment (wrong study design) Dixon 2012 Elementary school personnel’s perceptions of and recommendations for managing child obesity: A naturalistic study Study is editorial/literature review article (wrong study design) Dunn 2019 A systematic review and content analysis of classroom teacher professional development in nutrition education programmes Review included teachers as participants (wrong participants) Dwyer 2015 Promoting family meals: a review of existing interventions and opportunities for future research Review did not include school- based interventions (wrong intervention) Eid 2018 Child nutrition programmes in kindergarten schools implemented by the governmental sector and global nutrition consulting companies: A systematic review Study is not a systematic review (wrong study design) Everson-Hock 2013 Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: A mixed methods systematic review Review did not include school- based interventions (wrong intervention) 73 A scoping review study id (author & year) title reason for exclusion Ewart-Pierce 2016 Using mobile apps to promote a healthy lifestyle among adolescents and students: a review of the theoretical basis and lessons learned Review did not complete risk of bias/quality assessment (wrong study design) Friedrich 2012 Effect of interventions on the body mass index of school-age students Review did not complete risk of bias/quality assessment (wrong study design) Ganann 2012 Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review Study is a scoping review (wrong study design) Garcia 2016 Urban gardens and build of environments promoters of healthy eating Study is an editorial/literature review article (wrong study design) Girum 2018 The effect of deworming school children on anemia prevalence: a systematic review and meta-analysis Review did not complete risk of bias/quality assessment (wrong study design) Godin Examining guidelines for school-based breakfast programmes in canada: a systematic review of the grey literature Review did not complete risk of bias/quality assessment (wrong study design) Gordon 2018 Healthier choices in school cafeterias: a systematic review of cafeteria interventions Review did not complete risk of bias/quality assessment (wrong study design) Gorga 2016 School and family-based interventions for promoting a healthy lifestyle among children and adolescents in Italy: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Graziose 2018 Factors related to fruit and vegetable consumption at lunch among elementary students: a scoping review Study is a scoping review (wrong study design) Griebler 2017 Effects of student participation in school health promotion: a systematic review Review assessed the effects of student participation in designing, planning, implementing and/or evaluating school health promotion measures (wrong intervention) Guerra 2013 The effect of school-based physical activity interven- tions on body mass index: a meta- analysis of randomized trials Review assessed school-based physical activity interventions that did not contain nutrition components (wrong intervention) Guerra 2014 School-based physical activity and nutritional education interventions on body mass index: A meta-analysis of randomised community trials — Project PANE Review did not complete risk of bias/quality assessment (wrong study design) Hackman 2014 Theory of reasoned action and theory of planned behaviour-based dietary interventions in adolescents and young adults: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Haddad 2018 Food consumption pattern and physical activity level among adolescents from families in diverse social strata: Systematic literature review and analysis of data of the National School Health Survey Review did not include school- based interventions (wrong intervention) 74 Assessing the existing evidence bAse on school Food And nutrition Policies study id (author & year) title reason for exclusion Hale 2014 A systematic review of effective interventions for reducing multiple health risk behaviour’s in adolescence Review included interventions that prevented health risk behaviours (i.e. tobacco use, alcohol use, illicit drug use, risky sexual behaviour, aggressive acts) (wrong intervention) Harriger 2014 Assessment of school wellness policies implementation by benchmarking against diffusion of innovation framework Review did not complete risk of bias/quality assessment (wrong study design) Hernandez- Garbanzo 2013 Psychosocial measures used to assess the effectiveness of school-based nutrition education programmes: review and analysis of self-report instruments for children 8 to 12 years old Review assessed psychometric properties of evaluation instruments that measure mediators of dietary behaviours in school-aged children (wrong intervention) Hillier-Brown 2014 A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children Review did not complete risk of bias/quality assessment (wrong study design) Hollands 2019 Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption (Review) Review included participants ≥ 18 years old (wrong participants) Hopkins 2015 A historical review of changes in nutrition standards of usda child meal programmes relative to research findings on the nutritional adequacy of programme meals and the diet and nutritional health of participants: implications for future research and the Summer Food Service Programme Study is an editorial/literature review article (wrong study design) Huelskamp 2018 Enhancing the health of school garden programmes and youth: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Hung 2014 Understanding of factors that enable health promoters in implementing health-promoting schools: A systematic review and narrative synthesis of qualitative evidence Review assessed the efficacy of strategies used by health promoters to implement school- based interventions (wrong intervention) Hung 2015 A meta-analysis of school-based obesity prevention programmes demonstrates limited efficacy of decreasing childhood obesity Review did not complete risk of bias/quality assessment (wrong study design) Hyseni 2017 Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? Review assessed the evidence on the effectiveness of possible salt reduction interventions (wrong study design) Jamal 2013 The school environment and student health: a systematic review and meta-ethnography of qualitative research Review included only qualitative studies (wrong study design) Jamal 2014 Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health Study is an editorial/literature review article (wrong study design) Jasper 2012 Water and sanitation in schools: a systematic review of the health and educational outcomes Review did not complete risk of bias/quality assessment (wrong study design) Joshi 2013 Impact of water, sanitation, and hygiene interventions on improving health outcomes among school children Review did not complete risk of bias/quality assessment (wrong study design) 75 A scoping review study id (author & year) title reason for exclusion Jourdan 2016 The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes Study is a scoping review (wrong study design) Kagie 2019 A pragmatic review to assist planning and practice in delivering nutrition education to indigenous youth Review did not complete risk of bias/quality assessment (wrong study design) Kase 2017 Educational outcomes associated with school behavioural health interventions: a review of the literature Study is an editorial/literature review article (wrong study design) Ke 2015 Food insecurity and hunger: A review of the effects on children’s health and behaviour Study is an editorial/literature review article (wrong study design) Kelishadi 2014 Controlling childhood obesity: A systematic review on strategies and challenges Review did not complete risk of bias/quality assessment (wrong study design) Kessler 2016 Simple interventions to improve healthy eating behaviours in the school cafeteria Review did not complete risk of bias/quality assessment (wrong study design) Khambalia 2011 A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity Review did not complete risk of bias/quality assessment (wrong study design) Kirkland 2018 School-based nutrition and garden programmes and parental dietary changes in low-income settings: a review Review did not complete risk of bias/quality assessment (wrong study design) Kirkpatrick 2018 Gaps in the evidence on population interventions to reduce consumption of sugars: A review of reviews Review did not complete risk of bias/quality assessment and included systematic reviews as well as primary studies (wrong study design) Knowlden 2013 Systematic review of school-based obesity interventions targeting African american and Hispanic children Review did not complete risk of bias/quality assessment (wrong study design) Kraak 2012 Government and school progress to promote a healthful diet to American children and adolescents: a comprehensive review of the available evidence Review did not complete risk of bias/quality assessment (wrong study design) Kraak 2013 Addressing barriers to improve children’s fruit and vegetable intake Study is an editorial/literature review article (wrong study design) Krishnaswami 2012 Community-engaged interventions on diet, activity, and weight outcomes in US schools: A systematic review Review did not complete risk of bias/quality assessment (wrong study design) Kula 2016 Effectiveness of combined interventions for the prevention of overweight for children and youths : A systematic review Non-English publication Lane 2016 A systematic review to assess sugar- sweetened beverage interventions for children and adolescents across the socioecological model Review did not complete risk of bias/quality assessment (wrong study design) Langellotto 2012 Gardening increases vegetable consumption in school-aged children: a meta-analytical synthesis Review did not complete risk of bias/quality assessment (wrong study design) Langford 2015 Obesity prevention and the Health Promoting Schools framework: Essential components and barriers to success Review did not complete risk of bias/quality assessment (wrong study design) 76 Assessing the existing evidence bAse on school Food And nutrition Policies study id (author & year) title reason for exclusion Larson Policies with the potential to impact disparities in US child-care settings? A narrative review and call for surveillance and evaluation efforts Review included participants ≥ 6 years old (wrong participants) Lavelle 2012 Systematic review and meta-analysis of school-based interventions to reduce body mass index Review did not complete risk of bias/quality assessment (wrong study design) Lawson 2012 Impact of school feeding programmes on educational, nutritional, and agricultural development goals: a systematic review of literature Review did not complete risk of bias/quality assessment (wrong study design) Lee 2016 A systematic review and meta-analysis of intervention for paediatric obesity using mobile technology Review did not include school- based interventions (wrong intervention) Leroy 2012 The impact of daycare programmes on child health, nutrition and development in developing countries: a systematic review Review included participants ≥ 6 years old (wrong participants) Levine 2019 Prevention of eating disorders: 2018 in review Study is an editorial/literature review article (wrong study design) Lineberry 2014 The role and impact of nurses in American elementary schools: a systematic review of the research Review assessed the efficacy of school nursing activities in elementary schools (wrong intervention) Luecking 2017 Social marketing approaches to nutrition and physical activity interventions in early care and education centres: a systematic review Review included participants 2 to 5 years old (wrong participants) Mancipe Navarrete 2015 Effectiveness of educational interventions conducted in Latin America for the prevention of overweight and obesity in scholar children from 6–17 years old: a systematic review Non-English publication Martin 2014 Lifestyle intervention for improving school achievement in overweight or obese children and adolescents Review did not include school- based interventions (wrong intervention) Mazarello Paes 2015 Determinants of sugar-sweetened beverage consumption in young children: a systematic review Review included participants ≥ 6 years old (wrong participants) McGinnis 2017 A systematic review: Costing and financing of Water, Sanitation, and Hygiene (WASH) in Schools Review described the current knowledge around the costs of WASH components as well as financing models for schools (wrong intervention) McIsaac 2016 Interventions to support system-level implementation of health promoting schools: a scoping review Study is a scoping review (wrong study design) McIsaac 2019 Factors influencing the implementation of nutrition policies in schools: a scoping review Study is a scoping review (wrong study design) McKinnon 2016 Obesity-related policy/environmental interventions: a systematic review of economic analyses Review did not complete risk of bias/quality assessment (wrong study design) McMichael 2019 Water, Sanitation and Hygiene (WASH) in schools in low-income countries: a review of evidence of impact Review did not complete risk of bias/quality assessment (wrong study design) Medeiros 2018 Studies evaluating of health interventions at schools: an integrative literature review Review did not complete risk of bias/quality assessment (wrong study design) 77 A scoping review study id (author & year) title reason for exclusion Mukamana 2016 What is known about school-based interventions for health promotion and their impact in developing countries? A scoping review of the literature Study is a scoping review (wrong study design) Murimi 2018 Factors that contribute to effective nutrition education interventions in children: a systematic review Review did carry out risk of bias assessment (wrong study design) Mutschler 2018 Realist-informed review of motivational interviewing for adolescent health behaviours Review sought to understand how, for whom, and under what circumstances motivational interviewing works for adolescent health behaviour change (wrong intervention) Newton 2019 A systematic review of tools measuring nutrition knowledge of pre-adolescents and adolescents in a school-based setting Review did not include school- based interventions (wrong intervention) Niebylski 2014 Healthy food procurement policies and their impact Review did not complete risk of bias/quality assessment (wrong study design) Nigg 2016 A review of promising multicomponent environmental child obesity prevention intervention strategies by the Children’s Healthy Living Programme Review did not include school- based interventions (wrong intervention) Oddo 2018 Potential interventions targeting adolescent nutrition in Indonesia: a literature review Review did not complete risk of bias/quality assessment (wrong study design) Oeralta 2015 Teaching healthy eating to elementary school students: a scoping review of nutrition education resources Review did not complete risk of bias/quality assessment (wrong study design) Oosterhoff 2018 A systematic review on economic evaluations of school-based lifestyle T interventions targeting weight-related behaviours among 4–12 year olds: Issues and ways forward Review examined and discussed the key aspects in the design of economic evaluations on school- based interventions (wrong intervention) Peralta 2016 Teaching healthy eating to elementary school students: a scoping review of nutrition education resources Study did not perform risk of bias assessment (wrong study design) Pedraza 2018 Evaluation of the National School Food Programme: review of the literature Review did not complete risk of bias/quality assessment (wrong study design) Perez Cueto 2011 Assessment of evaluations made to healthy eating policies in Europe: A review within the EATWELL Project Published before 2012 Pérez-López 2015 Effects of school-based physical activity and nutrition programmes in spanish adolescents: systematic review Review did not complete risk of bias/quality assessment (wrong study design) Pollick 2013 Salt fluoridation: a review Study is an editorial/literature review article (wrong study design) Pratt 2017 A Systematic Review of Obesity Disparities Research Review did not complete risk of bias/quality assessment (wrong study design) Price 2017 Nutrition education and body mass index in grades k-12: a systematic review Review did not complete risk of bias/quality assessment (wrong study design) Prowse 2017 Food marketing to children in Canada: a settings-based scoping review on exposure, power and impact Study is a scoping review (wrong study design) 78 Assessing the existing evidence bAse on school Food And nutrition Policies study id (author & year) title reason for exclusion Pucher 2012 School health promotion interventions targeting physical activity and nutrition can improve academic performance in primary- and middle school children Review did not complete risk of bias/quality assessment (wrong study design) Qutteina 2019 Media food marketing and eating outcomes among pre-adolescents and adolescents: a systematic review and meta-analysis Review did not include school- based interventions (wrong intervention) Racey 2016 Systematic review of school-based interventions to modify dietary behaviour: does intervention intensity impact effectiveness? Review did not complete risk of bias/quality assessment (wrong study design) Ran 2016 Economic evaluation of school-based health centres: a community guide systematic review Review did not complete risk of bias/quality assessment (wrong study design) Ramos 2013 Food and nutrition education in school: a literature review Non-English publication Randev 2018 Vitamin D supplementation in childhood – A review of guidelines Review did not include school- based interventions (wrong intervention) Reeves 2012 School toilets: facilitating hand hygiene? A review of primary school hygiene facilities in a developed country Study is an editorial/literature review article (wrong study design) Ribeiro de Vasconcelos 2018 Educational interventions in the promotion of health eating in schools Study is an editorial/literature review article (wrong study design) Robinson 2014 Effectiveness of pre-school- and school- based interventions to impact weight-related behaviours in African American children and youth: a literature review Review did not complete risk of bias/quality assessment (wrong study design) Ruggieri 2014 A comprehensive review of school-based body mass index screening programmes and their implications for school health: do the controversies accurately reflect the research? Review did not complete risk of bias/quality assessment (wrong study design) Santillana Marín 2013 Programmes aimed to increase the nutritional content of lunch packs; systematic review Non-English publication Schober 2013 The reporting of fidelity measures in primary prevention programmes for eating disorders in schools Review assessed the effectiveness of interventions for primary prevention for eating disorders (wrong intervention) Seward 2017 Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: a systematic review Review included participants ≥ 18 years old (wrong participants) Shirley 2015 Combinations of obesity prevention strategies in US elementary schools: a critical review Study is an editorial/literature review article (wrong study design) Silden 2018 Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review Review did not complete risk of bias/quality assessment (wrong study design) Sisson 2016 Obesity prevention and obesogenic behaviour interventions in child care: a systematic review Review included participants 3 to 5 years old (wrong participants) Stephens 2015 K-12 school food service staff training interventions: a review of the literature Review did not complete risk of bias/quality assessment (wrong study design) 79 A scoping review study id (author & year) title reason for exclusion Tanskey 2018 The State of the Summer: a review of child summer weight gain and efforts to prevent it Review did not include school- based interventions (wrong intervention) Tremblay 2012 Major initiatives related to childhood obesity and physical inactivity in canada: the year in review Study is an editorial/literature review article (wrong study design) Tugault-Lafleur 2017 A systematic review of methods to assess children’s diets in the school context Review assessed the accuracy and reliability of dietary assessment methods used in the school context (wrong intervention) Ty 2012 Impact of school feeding programmes on educational, nutritional, and agricultural development goals: a systematic review of literature Study is an editorial/literature review article (wrong study design) Valentine 2019 Families and Schools Together (FAST) for improving outcomes for children and their families (Review) Review assessed the effectiveness of the Families and Schools Together (FAST) programme in improving outcomes among children and their families (wrong intervention) Vasques 2014 Effects of intervention programmes on child and adolescent BMI: a meta-analysis study Review did not complete risk of bias/quality assessment (wrong study design) Velazquez 2017 Food and beverage marketing in schools: a review of the evidence Review examined current approaches for measuring school food and beverage marketing practices (wrong intervention) Verloigne 2012 Family- and school-based correlates of energy balance-related behaviours in 10–12-year- old children: a systematic review within the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project Review did not complete risk of bias/quality assessment (wrong study design) Verrotti 2014 Childhood obesity: prevention and strategies of intervention. A systematic review of school- based interventions in primary schools Review did not complete risk of bias/quality assessment (wrong study design) Ward 2016 Strength of obesity prevention interventions in early care and education settings: a systematic review Review included studies conducted in preschool or childcare settings with all participants ≥ 6 years old (wrong participants) Watson 2017 Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries Review did not include school- based interventions (wrong intervention) Weaver 2011 A conceptual model for training after-school programme staffers to promote physical activity and nutrition Review included after-school personnel as participants (wrong participants) Weihrauch-Blüher 2018 Current guidelines for obesity prevention in childhood and adolescence Review did not complete risk of bias/quality assessment (wrong study design) 80 Assessing the existing evidence bAse on school Food And nutrition Policies study id (author & year) title reason for exclusion Welch 2017 Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis Review assessed the effects of mass deworming for soil-transmitted helminths on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas (wrong intervention) Wheaton 2016 School start times, sleep, behavioural, health, and academic outcomes: a review of the literature Review assessed the association between school start times, sleep, and other outcomes among adolescent students (wrong intervention) Wolf 2018 Effectiveness of obesity intervention programmes based on guidelines for adolescent students: systematic review Review did not complete risk of bias/quality assessment (wrong study design) Wolfenden 2016 Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services Review included participants ≥ 6 years old (wrong participants) Wu 2013 Future research needs for childhood obesity prevention programmes Study is an editorial/literature review article (wrong study design) Wu 2015 Is the balanced school day truly balanced? A review of the impacts on children, families, and school food environments Study is an editorial/literature review article (wrong study design) Wu 2019 The influence of diet quality and dietary behaviour on health-related quality of life in the general population of children and adolescents: a systematic review and meta- analysis Review did not include school- based interventions (wrong intervention) Yager 2013 What works in secondary schools? A systematic review of classroom-based body image programmes Review did not complete risk of bias/quality assessment (wrong study design) Yakoob 2017 Nutrition (micronutrients) in child growth and development: a systematic review on current evidence, recommendations and opportunities for further research Review did not complete risk of bias/quality assessment (wrong study design) Yip 2016 Peer-led nutrition education programmes for school-aged youth: a systematic review of the literature Review did not complete risk of bias/quality assessment (wrong study design) Zheng 2015 Substitution of sugar-sweetened beverages with other beverage alternatives: a review of long-term health outcomes Review did not include school- based interventions (wrong intervention) Zhou 2014 Childhood obesity prevention interventions in childcare settings: systematic review of randomized and nonrandomized controlled trials Review included participants ≤ 6 years old (wrong participants) 81 Annex 4. systematic reviews awaiting assessment Systematic reviews deemed potentially eligible for inclusion, but for which the full-texts could not be accessed at the time of writing are listed below. no. citation 1 Ajie WN, Chapman-Novakofki KM. Impact of computer-mediated nutrition education interventions in adolescents: A systematic review. J Adolesc Health. 2014;54(6):631–45.  doi: 10.1016/j.jadohealth.2013.12.019. 2 Canella D, Q., J.; oni, D. Scientific production of the national school food programme in Brazil: a systematic review. Ann Nutr Metabol. 2017;315. 3 Cardoso C, F., Matheus Pintanel; Rombaldi, Airton J. School-based interventions to promote a healthy life style among elementary school students: a systematic review. Rev. Bras. Ciênc. Saúde. 2016; 20(3):247–252. 4 Colley P, Myer B, Seabrook J, Gilliland J. The Impact of Canadian school food programmes on children’s nutrition and health: a systematic review. Can J Diet Pract Res. 2019; 80(2):79–86. doi: 10.3148/cjdpr-2018-037.  5 Dute DJ, Bemelmans WJE, Breda J. Using mobile apps to promote a healthy lifestyle among adolescents and students: a review of the theoretical basis and lessons learned. JMIR Mhealth Uhealth. 2016;4(2):e39. doi: 10.2196/mhealth.3559. 6 Godin K, Leatherdale ST, Elton-Marshall T. A systematic review of the effectiveness of school-based obesity prevention programmes for First Nations, Inuit and Metis youth in Canada. Clin Obes. 2015;5(3):103–115. doi.org/10.1111/cob.12099. 7 Markova AI. [Health promoting schools and health of schoolchildren (analytical review)]. Gig Sanit. 2013;May-Jun(3):60–66. In Russian. 8 Micha R, Bakogianni I, Karageorgou D, Trichia E, Shulkin ML, Shangguan S et al. Effectiveness of school procurement policies for improving dietary behaviours: A systematic review and meta-analysis. Circulation. 2016;133(Suppl. 1): Abstract MP89. 9 Park JJ, Bakhet R, Karl D, Yuan F, Lonn E. Effects of school-based interventions on body mass index in children and adolescents: A systematic overview and meta-analysis. Circulation. 2014;130(Suppl. 2):Abstract 17944. 10 Rausch Herscovici C, Kovalskys I. Childhood obesity. A review of school-based preventive interventions. Rev Mex Trastor Aliment {Mex J Eating Dosorders]. 2015;6(2):143–151. DOI: 10.1016/j.rmta.2015.10.006 11 Thury C, Melo de Matos CV. Prevention of childhood obesity: a review of the current guidelines and supporting evidence. S D Med. 2015;Spec No.:18–23. 12 Welch VA, Ghogomu E, Hossain A, Awasthi S, Bhutta Z, Cumberbatch C et al. Deworming and adjuvant interventions for improving the developmental health and well-being of children in low- and middle-income countries. Campbell Systematic Reviews. 2016;12(1):1–376. doi.org/10.4073/csr.2016.7 13 Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C et al. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (US); 2013 (Report No.: 13-EHC081-EF. PMID: 23865092). 14 Williams J, Scarborough P, Matthews A, Cowburn G, Foster C, Roberts N et al. A systematic review of the influence of the retail food environment around schools on obesity-related outcomes. Obes Rev, 2014;15(5): 359–74. doi: 10.1111/obr.12142. 82 Assessing the existing evidence bAse on school Food And nutrition Policies no. citation 15 Wu Y, Brandyn LD, Bleich S, Cheskin L, Boult C, Segal JB et al. Future research needs for childhood obesity prevention programs. Future Research Needs Papers, Number 31. Rockville, MD: Agency for Healthcare Research and Quality (US); 2013 (AHRQ Publication No. 13-EHC036-EF; https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/child- obesity-future_research.pdf, accessed 26 February 2021). 16 Community-based programs to improve early childhood health outcomes. Guidelines and Recommendations Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2013 (CADTH Rapid Response Reports; https://www.cadth.ca/community- based-programs-improve-early-childhood-health-outcomes-guidelines-and- recommendations, accessed 24 February 2021).

For More inForMAtion, PleAse contAct: Department of Nutrition and Food Safety World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland Fax: +41 22 791 4156 Email: nutrition@who.int www.who.int/nutrition