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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Physical Activity.

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Strategy. Multicomponent School-Based Obesity Prevention

Approach. Use a multifaceted nutrition and physical activity approach in a school-based setting to improve the overall health of students and prevent obesity

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Overview. Studies show that multicomponent school-based obesity prevention interventions, which can include a range of tailored educational, surrounding, and nutritional modifications, can positively impact physical activity and dietary outcomes for children and adolescents.[1] These strategies often include healthy living and nutrition education classes (e.g., using fictional characters to promote healthy behaviors),[2] school-wide initiatives (e.g., school meal policies), or school meals or fruit and vegetable snack interventions (e.g., School Breakfast Programs), in combination with increased physical activity opportunities (e.g., recess, active classroom breaks), large scale infrastructure changes (e.g., renovating a school playground), small scale equipment changes (e.g., jump ropes, balls), or parent and teacher/staff involvement (e.g., family engagement activities, staff training).[3,4,5]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • School cafeteria records
  • School wellness committee meeting minutes and action plans
  • Parent/guardian communication logs and engagement data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of physical education curricula updated to include electronic physical activity components. (Shows integration into school operations)
  • Number of community centers equipped with exergaming stations in areas with limited outdoor recreation spaces. (Assesses strategic resource allocation)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of obesity prevention programs that include components addressing both nutrition and physical activity. (Measures comprehensiveness of approach)
  • Percent of intervention strategies tailored to address challenges to healthy behaviors. (Assesses focused program design)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of cross-disciplinary teams formed within schools to implement obesity prevention strategies. (Shows integration into school operations)
  • Number of environmental modifications made to promote physical activity and healthy eating in schools. (Measures tangible changes to school environment)
  • Number of minutes of physical activity added to the school day as a result of the intervention. (Quantifies behavior change opportunity)
  • Number of new after-school physical activity programs initiated in areas facing significant health challenges. (Assesses access in program implementation)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of obesity prevention resources allocated to schools in areas with high childhood obesity rates. (Measures strategic deployment of resources)
  • Percent of program evaluation metrics that are disaggregated by key characteristics. (Ensures focused assessment)
  • Percent decrease in overweight and obesity prevalence among students, disaggregated by key characteristics. (Directly evaluates health impact across subgroups)
  • Percent reduction in gaps in physical activity levels between student populations from different backgrounds. (Measures improvements in health access and outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Buchanan LR, Wethington HR, Finnie RKC, Mercer SL, Merlo C, Michael S, Sliwa S, Pratt CA, Ochiai E; Community Preventive Services Task Force. A Community Guide Systematic Review: School Dietary and Physical Activity Interventions. Am J Prev Med. 2023 Mar;64(3):441-451. doi: 10.1016/j.amepre.2022.10.003. Epub 2022 Dec 8. PMID: 36496280; PMCID: PMC9974744.

2 Larson JN, Brusseau TA, Wengreen H, Fairclough SJ, Newton MM, Hannon JC. Fit "N" Cool Kids: The Effects of Character Modeling and Goal Setting on Children's Physical Activity and Fruit and Vegetable Consumption. Clinical Medicine Insights: Pediatrics. 2018;12:1-7.

3 Bartelink NHM, van Assema P, Kremers SPJ, et al. One- and two-year effects of the healthy primary School of the Future on children’s dietary and physical activity behaviours: a quasi-experimental study. Nutrients. 2019;11(3):689. https://doi.org/10.3390/nu11030689.

4 Bartelink NHM, van Assema P, Kremers SPJ, et al. Can the Healthy Primary School of the Future offer perspective in the ongoing obesity epidemic in young children? A Dutch quasi-experimental study. BMJ Open. 2019;9(10):e030676. https://doi.org/10.1136/bmjopen-2019- 030676.

5 Grydeland M, Bergh IH, Bjelland M, et al. Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2013;10:17. https://doi.org/10.1186/ 1479-5868-10-17.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.