Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis

Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.

Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Development and Pilot Testing of a Food Literacy Curriculum for High School-Aged Adolescents

Adolescent obesity and poor diet quality are increasingly prevalent and could be mitigated with attainment of food literacy. However, as these programs for adolescents are lacking, the purpose of this project was to develop a food literacy curriculum for high school-aged adolescents. The curriculum was designed in accordance with food literacy attributes and components utilizing Backward Design, Social Cognitive Theory, and Constructivism. After expert committee review, pilot testing was completed in two low-income communities by a trained facilitator and observer. Detailed observations were collected during pilot testing to assess achievement of learning objectives. Modifications were made to lesson procedures as required. The resulting curriculum, Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition, contains 12 modules of experiential lessons and application activities within three topics. Agriculture lessons concentrate on the food supply chain and food environments; nutrition lessons include food groups while focusing on nutrients of concern for underconsumption; and cooking lessons include food safety, budgeting, and preparation. Teens CAN provides a comprehensive and necessary approach to advancing food literacy in adolescents. Future directions include assessing dietary implications after participating in Teens CAN lessons and employment of an innovative two-tiered cross-age teaching model.

Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools

Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.

Nutrition Curriculum Training and Implementation Improves Teachers' Self-Efficacy, Knowledge, and Outcome Expectations

OBJECTIVE

To examine the effects of training and implementation of Forecasting Your Future: Nutrition Matters on teachers' self-efficacy to teach nutrition and teachers' nutrition knowledge and explore outcome expectations for students.

METHODS

A mixed-methods study, with Indiana Family and Consumer Sciences high school teachers randomized to control and intervention, was conducted using baseline surveys, implementation of new or usual curriculum, follow-up survey(s), and semistructured interviews. Self-efficacy and knowledge were analyzed by hierarchical linear modeling. Interviews were thematically analyzed using a 5-phase process to identify outcome expectations.

RESULTS

Intervention teachers (n = 17) had greater increases in nutrition knowledge (P = 0.028) and self-efficacy (P = 0.010) compared with controls (n = 18). Interviews revealed that teachers sought to affect students' long-term health by providing knowledge and skills to make healthy choices.

CONCLUSIONS AND IMPLICATIONS

This training with updated curricula and implementation improved theoretical determinants of effective nutrition instruction. Teachers expected student learning will contribute to future eating behaviors.

Minimizing Health-Compromising Behaviors via School-Based Programs: An Optimization Approach

School health programs are united by their desire to promote health and health-related outcomes among youth. They are also united by the fact that their expected effects are contingent on successful program implementation, which is often impeded by a multitude of real-world barriers. Techniques used in management science may help optimize school-based programs by accounting for implementation barriers. In this exploratory study, we present a detailed example of the first known application of linear programming (LP), which is an optimization technique, to Positive Action (PA). PA is a social emotional and character development program that includes a six-unit, teacher-delivered, classroom curriculum. We specify how we used LP to calculate the optimal levels of program implementation needed to minimize substance use, subject to known levels of implementation barriers (e.g., disruptive behavior, teacher education, teacher attitudes towards character development, school resources, and school safety). We found that LP is a technique that can be applied to data from a school health program. Specifically, we were able to develop a model that calculated the number of lessons that should be taught to minimize a specific health-compromising behavior, given expected levels of predetermined implementation barriers. Our findings from this exploratory study support the utility of applying LP during the program planning and implementation processes of school health programs.

Food, Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

OBJECTIVE

To evaluate Food, Health, & Choices, two 10-month interventions.

DESIGN

Cluster-randomized, controlled study with 4 groups: curriculum, wellness, curriculum plus wellness, and control.

SETTING

Twenty elementary schools (5/group) in New York City.

PARTICIPANTS

Fifth-grade students (n = 1,159). At baseline, 44.6% were at the ≥85th body mass index (BMI) percentile for age and 86% qualified for free or reduced-price lunch.

INTERVENTION

Curriculum was 23 science lessons based on social cognitive and self-determination theories, replacing 2 mandated units. Wellness was classroom food policy and physical activity bouts of Dance Breaks.

MAIN OUTCOME MEASURES

For obesity, age- and sex-specific BMI percentiles were used (anthropometric measures). The researchers also employed 6 energy balance-related behaviors and 8 theory-based determinants of behavior change (by questionnaire).

ANALYSIS

Pairwise adjusted odds in hierarchical logistic regression models were determined for >85th BMI percentile. Behaviors and theory-based determinants were examined in a 2-level hierarchical linear model with a 2 × 2 design for intervention effects and interactions.

RESULTS

Obesity showed no change. For behaviors, there was a negative curriculum intervention change in physical activity (P = .04). The wellness intervention resulted in positive changes for sweetened beverages frequency (P = .05) and size (P = .006); processed packaged snacks size (P = .01); candy frequency (P = .04); baked good frequency (P = .05); and fast food frequency (P = .003), size (P = .01), and combo meals (P = .002). Theory-based determinants demonstrated no change.

CONCLUSIONS AND IMPLICATIONS

The findings of the lack of a decrease in obesity, behavior changes only for the wellness intervention, and no changes in theory-based determinants warrant further research.