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Table 4 Policy summaries and results

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

Study

Involvement

Policy components

Impact†

Results

Sig

Stakeholder*

Family

BMI-SDS

Ov

Ob

BF

BMIHFZ

Statistic (95% confidence interval) unless otherwise stated

Diet policies

          

Foster, et al. 2008 [55]

✓a,c,e,f,h

✓

School nutrition policy initiative

-

-

Adjusted change in BMI-SDS -0.01 (-0.08,0.06)

 

Adjust odds ratio overweight 0.65 (0.54,0.79)

Sig

Adjusted odds ratio obesity 1.09 (0.85,1.40)

 

Baxter, et al. 2009 [53]

  

Location of School Breakfast Program consumption

-

-

-

-

Δ mean BMI% breakfast in classroom compared to the cafeteria 2.64 (p=0.06)

 

Henry, 2006 [50]

  

National School Lunch Program

-

-

-

-

Hedges’ g overweight 1.39 (0.55,2.24)

Sig

Hernandez, Francis and Doyle, 2003 [41]

  

National School Lunch Program

-

-

-

-

Adjusted change in BMI Kindergarten: 0.12 (-0.33,0.57)

 

Adjusted change in BMI 1st grade: 0.20 (-0.29,0.69)

 

Adjusted change in BMI 3rd grade: 0.36 (-0.25,0.97)

 

Adjusted change in BMI 5th grade: 0.52 (-0.24,1.28)

 

Hinrichs, 2010 [47]

  

National School Lunch Program

-

-

Adjusted change in BMI ♂ -0.02 (-0.06,0.02), ♀ -0.02 (-0.07,0.03)

 

Change in prevalence of overweight ♂ <-0.01 (-0.01,<0.01), ♀ <-0.01 (-0.01, <0.01)

 

Change in prevalence of obesity ♂ <-0.01 (<-0.01, <0.01), ♀ <-0.01 (<-0.01, <0.01)

 

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

        

Bivariate Probit results assuming ρ=0.1

 

National School Lunch Program,

-

-

-

Change in probability of being overweight 0.13 (0.07, 0.20)

 

Change in probability of being obese 0.13 (0.05, 0.20)

 

School Breakfast Program

-

-

-

Change in probability of being overweight -0.07 (-0.14, <-0.01)

 

Change in probability of being obese -0.05 (-0.13, 0.03)

 

Millimet and Tchernis, 2009 [42]

       

Bias corrected minimum bias estimator assuming θ=0.25

 
  

School Breakfast Program

-

-

Change in BMI growth rate 3rd grade: -0.03 (-0.06, <-0.01)

 

Change in probability of overweight 3rd grade: -0.21 (-0.33, -0.03)

 

Change in probability of obesity 3rd grade: -0.17 (-0.26, -0.01)

 

Change in BMI growth rate 5th grade: -0.04 (-0.08, 0.01)

 

Change in probability of overweight 5th grade: -0.28 (-0.40, -0.09)

 

Change in probability of obesity 5th grade: -0.12 (-0.28, -0.04)

 

Ramirez-Lopez, et al. 2005 [54]

  

School Breakfast Program

-

Change in BMI Intervention: 0.1, Control: -0.1

 

Change in BF% Intervention: -0.2, Control: -0.5

 

Change in prevalence of overweight or obesity Intervention: 1, Control: -1

 

Change prevalence of obesity Intervention: 1, Control:-3

 

Fox, et al. 2009 [56]

  

À la carte LNED food not available

-

-

-

Adjusted change in BMI-SDS -0.15 (-0.37,0.07)

 

Adjusted odds ratio obesity 1.09 (0.57,2.08)

 

Milk not available for school lunch

-

-

-

Adjusted change in BMI-SDS -0.13 (-0.33,0.07)

 

Adjusted odds ratio obesity 1.17 (0.75,1.82)

 

Fresh fruit/ raw vegetables available

-

-

-

Adjusted change in BMI-SDS 0.19 (0.01,0.37)

 

Adjusted odds ratio obesity 1.13 (0.73,1.75)

 

Fried potato products not available

-

-

-

Adjusted change in BMI-SDS 0.20 (<0.01,0.40)

 

Adjusted odds ratio obesity 2.70 (1.58,4.62)

Sig

Desserts offered ≤once a week

-

-

-

Adjusted change in BMI-SDS 0.08 (-0.08,0.24)

 

Adjusted odds ratio obesity 1.78 (1.13,2.80)

Sig

Jones, et al. 2003 [34]

        

Adjusted odds ratio overweight and obesity:

 
  

National School Lunch Program

-

-

-

Food secure ♂1.06 (0.53,2.08), ♀0.49 (0.22,1.10),

 

Food insecure ♂0.62 (0.25,1.54), ♀0.29 (0.11,0.80)

Sig♀

School Breakfast and National School Lunch Programs

-

-

-

Food secure ♂1.33 (0.81,2.18), ♀0.66 (0.35,1.26)

 
         

Food insecure ♂0.85 (0.42,1.74), ♀0.42 (0.19,0.96)

Sig♀

Physical activity policies

        

Donnelly, et al.2009 [62]

✓h

 

Physical Activity Across the Curriculum

-

-

BMI Hedges’ g 0.01 (-0.09,0.11)

 

Heelan, et al. 2009 [61]

  

Walking school bus scheme

-

-

-

Intervention vs. Control BMI-SDS Hedges’ g: -0.21 (-0.58,0.15)

 

Frequent v. passive BMI-SDS Hedges’ g: -0.49 (-0.94,-0.03)

Sig

Infrequent v. passive BMI-SDS Hedges’ g: -0.17 (-0.61,0.28)

 

Intervention vs. Control BF% Cohen’s d: -0.25 (-0.61,0.11)

 

Frequent v. passive BF% Cohen’s d: -0.59 (-1.05,-0.13)

Sig

Infrequent v. passive BF% Cohen’s d: -0.28 (-0.72,0.17)

 

Chiodera, et al.2008 [60]

  

Professionally led PE

-

-

-

-

Change in BMI grade 1: -0.21

Sig

Change in BMI grade 2: -0.05

 

Change in BMI grade 3: -0.06

 

Change in BMI grade 4: 0.04

 

Change in BMI grade 5: 0.02

 

Datar and Sturm, 2004 [38]

  

Increased PE duration of 1 hour per week

-

-

-

-

Adjusted change in BMI, normal weight ♂ 0.04 (-0.04,0.12)

 

Adjusted change in BMI, normal weight ♀ 0.01 (-0.07,0.10)

 

Adjusted change in BMI, overweight or obese ♂ -0.07 (-0.19,0.05)

 

Adjusted change in BMI, overweight or obese ♀ -0.32 (-0.46,-0.17)

Sig

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

  

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

-

-

-

-

PE duration Adjusted change in BMI% -0.74 (-1.78,0.30), ♂ -1.56 (-3.03,-0.09), ♀ 0.05 (-1.40,1.50)

Sig♂

         

Break period duration: adjusted change in BMI% -0.74 (-1.33,-0.15), ♂ -0.81 (-1.67,0.05), ♀ -0.69 (-1.49,0.11)

Sig

Combined policies

       

Johnson, et al. 2012 [31]

✓e,f,g,h

✓

Be Active Eat Well

-

-

-

-

Adjusted change in BMI-SDS -0.085 (-0.18,0.01)

 

HE policy

-

-

-

-

Adjusted change in BMI-SDS -0.008 (-0.06,0.04)

 

PA policy

-

-

-

-

Adjusted change in BMI-SDS -0.006 (-0.06,0.05)

 

Jordan, et al. 2008 [25, 64]

✓b,c,d,e,f,h

✓

Utah’s Gold Medal Schools

-

-

-

-

Change in BMI-SDS Intervention: 0.21 (-0.71,1.13), Control: 0.53 (-0.21,1.27)

 

Chomitz, et al. 2010 [63]

✓c,e,f,h

✓

Healthy Living Cambridge Kids

-

-

Change in BMI-SDS -0.04

Sig

Change in prevalence of overweight 0.6% points

 

Change in prevalence of obesity -2.2% points

Sig

Harrison, et al. 2011 [57]

  

Cookery lessons

-

-

-

-

None of the policies were significantly associated with FMI in females, while only being able to eat any food at break times and being able to play 3-4 games during break times where association with higher FMI in males.

 

Foods permitted during break periods

-

-

-

-

 

HE policy

-

-

-

-

 

Sports allowed during break periods

-

-

-

-

 

‘Park and stride’ scheme

-

-

-

-

 

PA policy

-

-

-

-

 

PA and HE policy

-

-

-

-

 

Veugelers and Fitzgerald, 2005 [26, 58]

  

Nutrition policy

-

-

-

Adjusted odds ratio overweight: 0.91 (0.77,1.09)

 

Adjusted odds ratio obesity: 0.85 (0.63,1.55)

✓a,c,d,e,f,g,h

✓

Annapolis Valley Health Promoting Schools Project

-

-

-

Adjusted odds ratio overweight: 0.41 (0.32,0.53)

Sig

Adjusted odds ratio obesity: 0.28 (0.14,0.57)

Sig

Zhu, et al. 2010 [59]

✓a,b,d,f,g,h

 

Professionally led PE

-

-

-

-

Adjusted change in BMIHFZ achievement rate 0.62 (0.01,1.23)

Sig

Duration of PE periods

-

-

-

-

Adjusted change in BMIHFZ achievement rate 0.05 (-0.03,0.13)

 

Number of PE periods

-

-

-

-

Adjusted change in BMIHFZ achievement rate 1.06 (0.47,1.65)

Sig

Duration of Break periods

-

-

-

-

Adjusted change in BMIHFZ achievement rate 2.71 (1.75,3.67)

Sig

Number of break periods

-

-

-

-

Adjusted change in BMIHFZ achievement rate -2.25 (-3.86,-0.64)

Sig

Cancel due to weather

-

-

-

-

Adjusted change in BMIHFZ achievement rate -1.26 (-3.73,1.21)

 

PE exemptions

-

-

-

-

Adjusted change in BMIHFZ achievement rate -0.34 (-0.65,-0.03)

Sig

USDA

-

-

-

-

Adjusted change in BMIHFZ achievement rate 0.02 (-1.49,1.53)

 
   

Wellness council

-

-

-

-

Adjusted change in BMIHFZ achievement rate 0.41 (-0.04,0.86)

 
  1. Abbreviations: ♂ male, ♀ female, BF% body fat percentage, BMI body mass index, BMI% BMI percentile, BMIHFZ BMI Healthy Fitness Zone [45], BMI-SDS BMI standard deviation score, FSM free or reduced school meals, HE healthy eating, LNED low-nutrient, energy-dense, PA physical activity, PE physical education, SD standard deviation, SE standard error, Sig p < 0.05, TV television, USDA United States Department of Agriculture wellness program.
  2. *Stakeholders: school administratorsa, school boardb, sports coachesc, food servicesd, health servicese, parentsf, pupilsg, teachersh.
  3. †Impact: a symbolic representation of the statistical results. ↑: positive association, ↓: negative association, ↕: mixed association, ↔: no association. Black arrows indicate significance (p < 0.05), while grey indicates non-significance (p > 0.05) [51, 52].
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International Journal of Behavioral Nutrition and Physical Activity

ISSN: 1479-5868

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