Influence of school architecture and design on healthy eating: a review of the evidence

Abstract

We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.

FIGURE 1—

Major theoretical frameworks for school physical environment influences on healthy eating, their respective levels of impact (building from individual- to community-level impacts from bottom to top), and corresponding examples of healthy eating targets.

FIGURE 2—

Source inclusion process for literature review of influence of school physical environment on healthy eating. Note. Top left box indicates the total number of records found, which were reduced through a series of exclusion processes to the 102 final sources reviewed.

FIGURE 3—

Causal loop diagram of a school’s complex system for addressing healthy eating. Note. Items and arrows in orange show design-related influences. The 3 reinforcing loops (letter “R” circled by looping arrows) represent organizational culture (green), community-modeled learning (blue), and social norms (pink). A plus sign is used to signify that a change in one variable causes the second variable to change in the same direction, a negative sign is used to signify that a change in one variable causes the second variable to change in the opposite direction. The letter “B” circled by a looping arrow indicates a balancing loop. The triangle brackets signify the variable is a “shadow variable” (a variable that is denoted twice in the diagram).