Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review
Open accessAbstract
Background The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined. Objective We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries. Design We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool. Results From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum. Conclusions School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.
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Socioeconomic and infrastructural differences between HICs and LMICs may influence the effectiveness and feasibility of interventions, and limited access to technology, financial resources, and trained personnel in LMICs may hinder the successful implementation of tech-driven and multi-component interventions that have been promising in HICs.
“For example, the socioeconomic and infrastructural differences between HICs and LMICs may influence the effectiveness and feasibility of interventions [54–56] or limited access to technology, financial resources, and trained personnel in LMICs may hinder the successful implementation of tech-driven as well as multi-component interventions that have been promising in HICs [29, 43, 54–56].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [55]
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- Authors
- Verstraeten, R., Roberfroid, D., Lachat, C., Leroy, J. L., Holdsworth, M., Maes, L., & Kolsteren, P. W.
- Affiliations
- Ghent University (BE)
- International Food Policy Research Institute (US)
- Corresponding author
- Kolsteren, Patrick W
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 96
- Issue
- 2
- Pages
- 415-438
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2126622942
- Cited by
- 208
- References
- 10
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 17 · 2023: 12 · 2022: 19 · 2021: 8 · 2020: 13 · 2019: 18 · 2018: 13 · 2017: 12 · 2016: 23 · 2015: 19 · 2014: 18 · 2013: 12 · 2012: 5
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- IFPRI E-brary (International Food Policy Research Institute) (submittedVersion)
- CGSPace A Repository of Agricultural Research Outputs (Consultative Group for International Agricultural Research) (submittedVersion, other-oa)
- International Food Policy Research Institute (International Food Policy Research Institute) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- childhood obesity, school-based intervention, obesity prevention, dietary behavior, physical activity, body mass index, low- and middle-income countries, adolescents, school curriculum, stakeholder engagement, process evaluation
- MeSH terms
- Adolescent, Body Weights and Measures, Child, Data Collection, Developing Countries, Feeding Behavior, Female, Humans, Male, Motor Activity, Obesity, School Health Services, Schools, Randomized Controlled Trials as Topic, Treatment Outcome, Internet
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