Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), Veysey Building, Salmon Pool Lane, EX2 4SG, Exeter, Devon, UK.
Int J Behav Nutr Phys Act. 2013 Aug 22;10:101. doi: 10.1186/1479-5868-10-101.
Obesity is a major public health concern and there are increasing calls for policy intervention. As obesity and the related health conditions develop during childhood, schools are being seen as important locations for obesity prevention, including multifaceted interventions incorporating policy elements. The objective of this systematic review was to evaluate the effects of policies related to diet and physical activity in schools, either alone, or as part of an intervention programme on the weight status of children aged 4 to 11 years. A comprehensive and systematic search of medical, education, exercise science, and social science databases identified 21 studies which met the inclusion criteria. There were no date, location or language restrictions. The identified studies evaluated a range of either, or both, diet and physical activity related policies, or intervention programmes including such policies, using a variety of observational and experimental designs. The policies were clustered into those which sought to affect diet, those which sought to affect physical activity and those which sought to affect both diet and physical activity to undertake random effects meta-analysis. Within the diet cluster, studies of the United States of America National School Lunch and School Breakfast Programs were analysed separately; however there was significant heterogeneity in the pooled results. The pooled effects of the physical activity, and other diet related policies on BMI-SDS were non-significant. The multifaceted interventions tended to include policy elements related to both diet and physical activity (combined cluster), and although these interventions were too varied to pool their results, significant reductions in weight-related outcomes were demonstrated. The evidence from this review suggests that, when implemented alone, school diet and physical activity related policies appear insufficient to prevent or treat overweight or obesity in children, however, they do appear to have an effect when developed and implemented as part of a more extensive intervention programme. Additional evidence is required before recommendations regarding the focus of policies can be made and therefore, increased effort should be made to evaluate the effect of policies and policy containing intervention programmes upon weight status.
肥胖是一个主要的公共卫生关注点，越来越多的人呼吁采取政策干预。由于肥胖和相关健康问题在儿童时期发展，学校被视为预防肥胖的重要场所，包括纳入政策要素的多方面干预措施。本系统评价的目的是评估与学校饮食和体力活动相关的政策（单独实施或作为干预计划的一部分）对 4 至 11 岁儿童体重状况的影响。全面系统地搜索医学、教育、运动科学和社会科学数据库，确定了 21 项符合纳入标准的研究。没有日期、地点或语言限制。确定的研究评估了一系列饮食和体力活动相关政策，或包括这些政策的干预计划，使用了各种观察性和实验性设计。这些政策被分为旨在影响饮食的政策、旨在影响体力活动的政策和旨在同时影响饮食和体力活动的政策，以进行随机效应荟萃分析。在饮食类群中，分别分析了美国国家学校午餐和学校早餐计划的研究；然而，汇总结果存在显著异质性。体力活动和其他饮食相关政策对 BMI-SDS 的汇总效应不显著。多方面的干预措施往往包括与饮食和体力活动相关的政策要素（综合类群），尽管这些干预措施差异很大，无法汇总其结果，但已证明体重相关结果显著降低。本综述的证据表明，单独实施时，学校与饮食和体力活动相关的政策似乎不足以预防或治疗儿童超重或肥胖，但作为更广泛的干预计划的一部分实施时，它们确实有效果。在能够提出有关政策重点的建议之前，还需要更多的证据，因此，应该加大力度评估政策和包含政策的干预计划对体重状况的影响。
