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Table 2 Summary study characteristics

From: Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies

Study/ Location

Study design/ Sample size

Policy

Gender

Age/ Follow-up or exposure duration

Ethnicity

Socioeconomic status

Baseline weight status

Outcome measure(s)/ Growth reference

Diet policies

       

Foster, et al. 2008 [55]/ USA

Randomised controlled trial/ n = 844, I:n = 479, C: n = 365

School nutrition policy initiative

I: 45.0% males, 55.0% females, C: 47.8% males, 52.2% females

I: mean ± SD 11.1 ± 1.0 years, C: mean ± SD 11.2 ± 1.0 years/ 2 years

I: 44.3% black, 22.4% Hispanic, 17.1% Asian, 10.7% white, 5.5% other, C: 46.8% black, 27.7% Asian, 14.2% white, 5.8% Hispanic, 5.5% other

Not described

I: 17.2% overweight, 25.34% obese, C: 16.5% overweight, 21.8% obese

BMI-SDS, overweight, obese/ CDC 2000

Baxter, et al. 2009 [53]/ USA

Cohort study/ n = 1,557

Location of School Breakfast Program consumption

Males and females

9–10 year olds/ 4 years

90% black

Not described

Not provided

BMI%

Henry, 2006 [50]/ USA

Cohort study/ n = 7,446

National School Lunch Program

Males and females

4–10 year olds/ 3 years

66% white, 26% African American, 5% Hispanic, 4% American Indian, 3% Asian

26% eligible for FSM

Kindergarten: 4% overweight, 4% obese, 3rd grade: 4% overweight, 6% obese

Overweight from BMI/ CDC2000

Hernandez, Francis and Doyle, 2003 [41]/ USA

Cohort study/ n = 1,140

National School Lunch Program

50% males, 50% females

Mean ± SD 6.2 ± 0.4 years/ 9 years

54% white, 24% Hispanic, 12% black, 10% other

37% household income < $20,000

Mean BMI% ± SD, Kindergarten: 63.3 ± 28.0, 1st grade: 62.1 ± 29.8, 3rd grade: 66.6 ± 28.8, 5th grade: 69.4 ± 28.7

BMI/ CDC 2000

Hinrichs, 2010 [47]/ USA

Cohort study/ n = 130,353

National School Lunch Program

47.4% males, 52.6% females

Not provided (studied adults who had participated in policy during childhood)

88.0% white, 10.3% black, 1.6% other

Not described

Males: 42.5% overweight, 8.0% obese, Females: 22.4% overweight, 7.4% obese

BMI, overweight, obese

Millimet, Tchernis and Husain, 2008 [43] and 2010 [44]/ USA

Cohort study/ n = 13.531

National School Lunch Program and School Breakfast Program

50.7% males, 49.3% females

Mean ± SD 9.2 ± 0.4 years/ 3 years

57.9% white, 17.4% Hispanic, 13.8% black, 4.5% Asian

Mothers education: 19.8% high school, 28.1% some college, 14.4% bachelor’s degree, 8.4% advanced college degree

Kindergarten: 25.8% overweight, 11.4% obese, 3rd grade: 32.5% overweight, 17.1% obese

BMI%, BMI growth rate/ CDC 2000

Millimet and Tchernis, 2009 [42]/ USA

Cohort study/ n = 7,824

School Breakfast Program

51.3% males, 48.7% females

Mean ± SD 9.1 ± 0.3 years/ 5 years

55.4% white, 19.1% Hispanic, 13.7% black

Mean socioeconomic status index 0.06 ± 0.77

3rd grade: 36.5% overweight or obese, 5th grade: 41.4% overweight or obese

BMI growth rate/ CDC 2000

Ramirez-Lopez, et al. 2005 [54]/ Mexico

Cohort study/ n = 360, I: n = 254, C: n = 106

School Breakfast Program

Males and females

I: mean ± SD 8.6 ± 1.3 years, C: mean ± SD 8.4 ± 1.3 years/ 9 months

Not described

Not described

I: 10.6% overweight, 10.6% obese, C: 8.5% overweight, 11.3% obese

BMI, body fat%, overweight, obese/ CDC 2000

Fox, et al. 2009 [56]/ USA

Cross-sectional study/ n = 706

Nutrition guidelines

51% males, 49% females

Mean 8.8 years/ > 1 year

52% white, 24% Hispanic, 17% black, 7% other

48.49% eligible for FSM

Not described

BMI-SDS, obese/ CDC 2000

Jones, et al. 2003 [34]/ USA

Cross-sectional study/ n = 772

National School Lunch Program and School Breakfast Program

50% males, 50% females

50% aged 5–8 years, 50% aged 9–12 years/ up to 7 years

58.2% Black, 25,8% white, 10.4% Hispanic, 0.1% other

Head of household has <12 years education 33.9%, household food insecure 24.0%

34.2% overweight or obese

Overweight and obese from BMI%/ CDC 2000

Physical activity policies

       

Donnelly, et al.2009 [62]/ USA

Randomised controlled trial/ n = 1,527, I: n = 814, C: n = 713

Physical activity across the curriculum

48.8% males, 51.2% females

7–9 year olds/ 3 years

77.4% Caucasian, 10.1% Hispanic, 6.2% African American, 3.6% multi-ethnic, 1.6% Native American, 1.2% Asian

43% eligible for FSM

Mean BMI ± SD I: 17.9 ± 3.1, C:18.0 ± 3.7

BMI/ CDC 2000

Heelan, et al. 2009 [61]/ USA

Controlled before and after study/ n = 324, I: n = 201, C: n = 123

Walking school bus scheme

44.8% males, 55.2% females

Mean ± SD I: 8.1 ± 1.7 years, C: 8.4 ± 1.6 years/ 2 years

90% white, 7% Hispanic, 3% other

~30% eligible for FSM

Mean BMI% ± SD I:67.6 ± 22.3, C:61.6 ± 29.1

BMI-SDS,% body fat/ CDC 2000

Chiodera, et al.2008 [60]/ Italy

Cohort study/ n = 4,500

Professionally led PE

51.1% males, 48.9% females

6–10 year olds/ 8 months

Not described

Not described

Mean BMI ± SD: grade 1 16.3 ± 2.3, grade 2 16.9 ± 2.5, grade 3 17.2 ± 2.6, grade 4 17.9 ± 3.1, grade 5 18.6 ± 3.1

BMI

Datar and Sturm, 2004 [38]/ USA

Cohort study/ n = 9,751, I: n = 8,917, C: n = 834

Increased PE duration of 1 hour per week

50% males, 50% females

4–6 year olds/ 1 year

I: 61% white, 16% Hispanic, 12% black, 11% other, C: 58% white, 20% black, 15% Hispanic, 8% other

I: 13% family income < $15,000, C: 16% family income < $15,000

I: 15% overweight, 11% obese, C: 15% overweight, 12% obese

BMI/ CDC 2000

Fernandes, 2010 [39] and Fernandes and Sturm, 2011 [40]/ USA

Cohort study/ n = 8,246

Meeting the National Association for Sport and Physical Education (NASPE) guidelines

50.4% males, 49.6% females

6–11 year olds/ 5 years

61.2% white, 18.7% Hispanic, 13.1% black, 7.0% other

11.3% below the poverty threshold

Mean BMI% ± CD 60.8 ± 28.3, 13.3% obese

BMI%/ CDC 2000

Combined policies

      

Johnson, et al. 2012 [31]/ Australia

Controlled before and after study/ n = 1318

Be Active Eat Well

I: 46.3% males, 53.7% females, C: 50.8% males, 49.2% females

Baseline mean ± SD – I: 8.16 ± 2.25, C: 8.19 ± 2.15. Follow-up mean ± SD – I: 11.1 ± 2.26 C:10.3 ± 2.14

Parents born overseas [27]* I: 6% C: 12%

Mothers didn’t complete high school education I: 47.1% C: 40.6%

Baseline mean BMI-SDS ± SD – I: 0.59 ± 0.92, C: 0.60 ± 0.87. Follow-up mean BMI-SDS ± SD – I: 0.54 ± 0.94 C:0.59 ± 0.88

BMI-SDS/ CDC 2000

Jordan, et al. 2008 [64]/ USA

Controlled before and after study/ n = 577

Utah’s Gold Medal Schools

I: 51% males, 49% females, C:52% males, 48% females

Mean ± SD I: 9.0 ± 1.6 years, C: 9.0 ± 1.6 years/ 1 year

I: 85.8% white, 7.6% Hispanic, 2.8% Hawaiian, 0.7% Asian, 0.4% American Indian, 0.0% African American, 2.8% other C: 86.7% white, 7.0% Hispanic, 2.1% African American, 0.7% American Indian, 0.7% Asian, 0.4% Hawaiian, 2.5% other

Maternal education: <high school I: 1.7%, C: 4.9%, high school graduate I: 19.9%, C: 25.9%, some college I: 41.9%, C: 41.6%, college graduate I: 32.0%, C: 25.5%, graduate degree I: 4.5%, C: 2.1%

Not described

BMI-SDS/ CDC 2000

Chomitz, et al. 2010 [63]/ USA

Cohort study/ n = 1,858

Healthy living Cambridge kids

51.8% males, 48.2% females

Mean ± SD 7.7 ± 1.8 years/ 3 years

37.3% white, 36.9% black, 14.0% Hispanic, 10.2% Asian, 1.7% other

43.3% from low income families

Mean BMI-SDS ± SD 0.7 ± 1.1. 16.8% overweight, 20.2% obese

BMI-SDS, overweight, obese/ CDC 2000

Harrison, et al. 2011 [57]/ UK

Cross-sectional study/ n = 1,724

Variety of diet and physical activity related policies

44.4% males, 55.6% females

Mean ± SD 10.3 ± 3.1 years/ 5 years

Not described

Age parent left full time education: <16 years 46.5%, 16–18 years 33.4%, >18 years 20.1%

16.8% overweight, 5.2% obese

Fat mass index (FMI)/ IOTF

Veugelers and Fitzgerald, 2005 [58]/ Canada

Cross-sectional study/ 279 schools

Nutrition policy and Annapolis valley health promoting schools project

Males and females

10–11 year olds/ 5 years

Not described

Not described

32.8% overweight, 9.9% obese

Overweight, obese from BMI-SDS/ IOTF

Zhu, et al. 2010 [59]/ USA

Cross-sectional study/ 738 schools

Variety of diet and physical activity related policies

Males and females

Not described/ up to 6 years

Not described

53% eligible for FSM

Mean ± SD 71.7% ± 12.6 within BMIHFZ

BMIHFZ