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Meta-Analysis
. 2021 Jan 4;18(1):1.
doi: 10.1186/s12966-020-01065-9.

A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

Chandni Maria Jacob  1   2   3 , Polly Louise Hardy-Johnson  4   5 , Hazel M Inskip  6   7 , Taylor Morris  7 , Camille M Parsons  7 , Millie Barrett  7 , Mark Hanson  8   6   9 , Kathryn Woods-Townsend  6   10 , Janis Baird  6   7
Affiliations
Meta-Analysis

A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

Chandni Maria Jacob et al. Int J Behav Nutr Phys Act. .

Abstract

Background: Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.

Methods: A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score.

Results: Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated.

Conclusions: Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.

Keywords: Adolescent health; Body mass index; Diet; Health education; Intervention; Nutrition; Obesity; Physical activity; School.

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Conflict of interest statement

KWT, MH and HI are directors of LifeLab, a non-profit intervention at the University of Southampton and Southampton University Hospital, both registered charitable organizations. All other authors declare no conflicts of interest. The proposal for this review was registered with PROSPERO (ID: CRD42016053477).

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram of study selection
Fig. 2
Fig. 2
Meta-analysis of 14 studies showing the effect of educational interventions on BMI z-score. The pooled estimate shows significant difference between intervention and control in change in BMI z-score
Fig. 3
Fig. 3
Funnel plot for risk of publication bias
See this image and copyright information in PMC

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