Systematic review of health policy interventions for overweight-obesity in adolescents and their impact

Introduction: Childhood obesity is a public health concern in the United States, affecting nearly one-third of adolescents. While many school-based programs have implemented nutritional and physical activity (PA) programs to address this, there have been varying degrees of success. Given the rates of childhood obesity and its impact on long-term health, examining programmatic outcomes from these health policy initiatives targeting childhood obesity is warranted.

Methods: We conducted a systematic review of Pubmed (MEDLINE), Embase, and the Cochrane database to examine nutrition and PA programs targeting childhood obesity and prevention. We included studies that stemmed from policy initiatives that were implemented in elementary and secondary (middle/high schools) in the United States. Article screening and data extraction were conducted in a masked, duplicative fashion to identify the article’s intervention type, duration, and outcome measures.

Results: The searches produced 205 articles, from which 189 were excluded due to duplicates, not including PA or nutrition intervention, not having obesity outcome measures, or being older than the date range. Of the included articles, 11 (68.75%) were PA-related, 11 (68.75%) involved nutrition, and 6 (37.5%) contained both. Eight (50%) articles also included wellness education in their primary interventions. Outcome measures of all studies used BMI criteria for obesity. Notable secondary outcomes included nutrient intake (4/16, 25%). A study by Matsuzaki et al. in 2021 showed the most benefit—with a nutrition access intervention between the years 2002 and 2016 revealing evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends.

Conclusion: Our systematic review showed that the majority of interventions published in the literature were either PA or nutrition based and related to State/Local policy guidelines. Between intervention types, more publications of nutrition interventions showed positive effects than PA studies. As the concerns for addressing pediatric obesity are critical, school-based programs targeting both PA and nutrition are necessary, but may not be sufficient alone. We encourage not only physician organizations to help lead policy changes at the national and state levels, but also with every pediatric patient and parent they treat.