Table 3 Summary of findings from included studies
Author, Year, Country, Name of Cohort/ study, Citation | Study design, Participant characteristicsa | Key Intervention characteristics | Main findings and results for BMI/BMI z-score outcomes b |
|---|---|---|---|
Low Risk of Bias | |||
Robbins, 2020 [66], USA GOAL | Pre test–post-test quasi-experimental design Mean age 11.6 (0.09) Intervention: n = 38 Control: n = 43 A total of 81 parent-student dyads were recruited | • Primary outcomes: feasibility and acceptability (qualitative), MVPA, diet quality, psychosocial variables (motivation, self-efficacy, and perceived social support for PA and healthy eating • Duration of intervention: 12 weeks • Follow up post intervention • Teacher training: not needed as delivered by instructors and managers with experience in nutrition programmes (for the after-school clubs) • Parental involvement: parent- student dyad combined meetings • Digital component: Facebook participation with weekly healthy eating and PA habit forming tasks for parents to help adolescents with MVPA and diet • Behaviour change theory: Self-determination theory and information-motivation-behaviour skills (IMB) model | Proportion of overweight and obese: Intervention group: Baseline and post intervention 55.9% (p = 1.00) Control group Baseline 40.5% Follow up 50.0% (p = 0.13) |
Robbins 2020 [67], USA and Pfeiffer et al. (2019) [47], USA Girls on the Move | Group RCT Mean age 12.07 (girls) Intervention: n = 593 Control: n = 601 (schools in low-income areas) | • Primary outcome: MVPA, BMI Z score, Percentage body fat and cardiorespiratory fitness • Duration of intervention: 17 weeks • Follow up: immediate post-intervention and 1–4 weeks after intervention was completed • Delivered by trained nurse and community-based instructors • Digital component: one interactive internet-based session providing motivational and feedback messages • Parental involvement: None during intervention period • Behaviour Change Theory: Health promotion model and Self-determination theory | No significant differences occurred for BMI z score post intervention (B = − 0.02, P = 0.232) Intervention Baseline 1.30 (0.74) Post intervention 1.30 (0.74) Control Baseline 1.42 (0.73) Follow up 1.44 (0.73) Unadjusted effect Size Cohen d = − 0.03 (subset analysis based on attendance (days/ week) provided but did not show any effect on BMI outcomes. 1–4 week Follow up results: Control (766): 12.05 years. Intervention (753): 12.05 years. No significant between-group differences in BMI-z existed at post intervention (B = − 0.02, .191, 95% confidence interval [CI; − 0.05-0.01]). |
Wadolawska, 2019 [60], Poland | Non-randomised study with control group Mean age: 11.9 (11.9–12.0) Intervention n = 319 Control n = 145 | • Primary outcome: Physical activity, sedentary time, diet and body composition (z-Waist to height Ratio, Z BMI for age, Waist circumference) • Duration of intervention: 3 weeks • Follow up: 9 months after baseline • Delivered by researchers • Digital component: None • Parental involvement: None • Behaviour change theory: Integrated theory | Change in z-BMI-for-age SDs (Follow up ̶ baseline): Int: − 0.01 (− 0.07 to 0.04) Con: 0.03 (− 0.01 to 0.07) Difference: − 0.04 |
Bogart, 2016d [48] USA | RCT Mean age: 12.2 (0.68) Intervention: n = 829 Control: n = 539 | • Primary outcome: BMI percentile • Duration of intervention: 5 weeks • Follow up after intervention: 2 years • Teacher training: Delivered by peer leaders and teachers (training given to peer leaders). • Parental involvement: Homework activities with parents • Behaviour change theory: Social cognitive theory and community based participatory research | BMI percentile (intervention versus control): adjusted difference = − 0.98 (SE 1.01), p = 0.33 Subset analysis (students obese at baseline) BMI percentile adjusted b = −2.33 (SE 0.83; P = 0.005) compared with control students. |
Lubans, 2016 [42] and Smith 2014 [68], Australia ATLAS | Cluster RCT Mean age: 12.7 (0.5) Intervention: n = 121 Control: n = 143 | • Primary outcome: BMI, waist circumference • Duration of intervention: 8 months • Follow up: immediately after intervention and 18 months from baseline • Teacher training: two 6-h workshops • Digital component: smartphone app and website. • Parental involvement: Parent newsletters. • Behaviour change theory: self-determination theory and social cognitive theory | BMI z-score (adjusted mean difference) at 18 months from baseline: 0.04 (95%CI: − 0.07 to 0.14) |
Melnyk, 2015 [53], USAc COPE | Cluster RCT Mean age: 14.74 (0.73) Intervention: n = 358 Control: n = 421 | • Primary outcome: BMI and depressive symptoms • Intervention duration: 15 weeks • Follow up after intervention: 12 months • Teacher training: full day training workshop • Digital component: None reported • Parental involvement: Newsletter provided and students were expected to discuss with parents • Behaviour change theory: cognitive theory | BMI at 12 months adjusted mean COPE teens (24.94, SE 0.12) Control group (25.48, SE 0.11) p-value for difference = 0.001 |
Viggiano, 2015 [45], Italyc Kaledo | RCT Mean age 13.0 (12.9–13.0) Intervention: n = 1663 Control: n = 1447 | • Primary outcomes: dietary behaviours and BMI z-scores • Duration of intervention: 20 weeks • Follow up: 6 and 18 months post baseline • Teacher training: teachers trained in playing the game • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: Not specified | BMI z-scores At 6 month follow-up: Middle schools: Intervention: 0.49 (95%CI: 0.45 to 0.53) Control: 0.58 (95%CI: 0.54 to 0.62) p-value for difference = 0.007 High schools: Intervention: 0.35 (95%CI: 0.29 to 0.40) Control: 0.57 (95%CI: 0.51 to 0.63) p-value for difference < 0.001 At 18 month FU: Middle schools: Intervention: 0.40 (95%CI: 0.28 to 0.52) Control: 0.57 (95%CI: 0.44 to 0.71) p-value for difference = 0.057 High schools: Intervention: 0.13 (95%CI: − 0.09 to 0.34) Control: 0.61 (95%CI 0.31 to 0.90) p-value for difference = 0.015 |
Dewar, 2013 [36], Australia Neat Girls | RCT Mean age 13.2 (0.5) Intervention n = 178, Control n = 179 Girls only | • Primary outcomes: BMI • Duration of intervention: one year • Follow up at 12 months and 24 months (12 months post intervention) • Teacher training: 1-day training workshop. • Digital component: SMS • Parental involvement: Parent newsletters • Behaviour change theory: Social cognitive theory | Adjusted BMI z-score change at 12 month post intervention: − 0.12 (95%CI: − 0.27, 0.04) |
Ezendam, 2012 [50], Netherlands FATaintPHAT | RCT Mean age (control group): 12.7 (0.7 Control: 340 Intervention: 395 | • Primary outcomes: Waist circumference, BMI and fitness • Duration of intervention: 10 weeks • Follow up at 4 months and 2 years • Teacher training: manual provided • Digital component: primarily an internet-based intervention • Parental involvement: None reported • Behaviour change theory: Theory of Planned Behaviour | Not reported for 4-month follow-up. BMI change at 2 years between group difference: − 0.14 (95%CI: − 0.17 to 0.45) |
Robbins, 2012 [44], USA Pilot study Girls on the Move | Quasi-experimental study Mean age: 11.4 years Intervention: n = 37 Control: n = 32 | • Primary outcomes: BMI, physical activity, and cardiovascular fitness • Duration of intervention: 6 months • Follow up after intervention: immediately post intervention • Teacher training: Motivational Interviewing training for the school nurse • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: health promotion model | BMI z-score change: Intervention: 0.06 (0.18) Control: 0.12 (0.18) Adjusted difference: − 0.04 (p = 0.24) |
Prins, 2012 [57], Netherlands | RCT Mean age: 12.7 (0.5) Intervention: 281 Control: 254 | • Primary outcomes: Compliance with MVPA guideline and minutes spent in MVPA • Duration of the intervention: Not reported • Follow up at one and six months post intervention • Teacher training: Manual provided • Digital component: Computer tailored PA promotion • Parental involvement: None reported • Behaviour change theory: Socio-ecological model | Unstandardized regression coefficient (95% CI) for prevalence of overweight and obesity at 6 month follow-up: 0.16 (95%CI: − 1.01 to 1.13). |
The HEALTHY study group, 2010 [52], USAc | RCT Mean age 11.3 (0.6) Intervention: 4603 Control: 2296 | • Primary outcomes: Risk of diabetes (BMI, waist circumference, fasting glucose and insulin levels), combined prevalence of OWO • Duration of intervention: 3 years • Follow up at 3 years from baseline • Teacher training: 4 h training with companion manual • Digital component: None • Parental involvement: newsletters matching theme of semester • Behaviour change theory: Social cognitive theory | Change in BMI z-score: Intervention: − 0.05 Control group: − 0.01 |
Peralta, 2009 [56], Australia FILA study (Fitness Improvement Lifestyle Awareness) | RCT Mean age 12.5 (0.4) Intervention: n = 16 Control: n = 17 Boys only | • Primary outcome: BMI • Follow up after intervention: 6 months • Teacher training: None (delivered by researcher) • Digital component: None reported • Parental involvement: Newsletters • Behaviour change theory: social cognitive theory | Adjusted BMI difference between intervention and control: − 0.2 (95%CI: − 0.78 to 0.39), p = 0.5 |
Singh, 2007 [59], The Netherlands DOiT (Dutch Obesity Intervention in Teenagers) | RCT Mean age (control) 12.8 (0.51) Total n = 978 | • Primary outcomes: BMI, measures of body fatness and aerobic fitness • Duration of intervention: 8 months • Follow up immediately after intervention • Teacher training: Teachers received a manual to support them in delivering the intervention • Digital component: Individual advice provided by CD rom • Parental involvement: None reported • Behaviour change theory: Not specified | BMI (difference between intervention and control in change between groups): Girls: − 0.05 (95%CI: − 0.18 to 0.08) Boys: − 0.02 (95%CI: − 0.11 to 0.16) |
Medium Risk of Bias | |||
Ermetici, 2016 [37], Italyc EAT Study | Non-randomised quasi-experimental study Mean age 12.5 (0.4) Intervention: n = 262 Control: n = 225 | • Primary outcome: BMI Z-score • Intervention duration: 2 school years • Follow up after intervention: Immediate post intervention • Teacher training: Text book to aid lessons • Digital component: Automated text messages • Parental involvement: Text messages • Behaviour change theory: not specified | After 2 years, BMI z-score (adjusted difference): - 0.18 (95%CI: − 0.27 to − 0.09), p = 0.003 |
Wilksh, 2015, Australia [62] | Four arm RCT with multiple educational modules Mean age: 13.21 (0.68) Media Smart (MS): N = 269 Life Smart (LS): N = 347 HELPP (HP): N = 225 Control (C): N = 473 | • Primary outcome: risk of eating disorders • Duration of intervention (LifeSmart): 5 weeks • Follow up after intervention: post program, 6 month and 12 months • Teacher training: None reported • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: not specified | Group by time effect showed no significant effects on BMI for boys or girls at 12 month follow up. |
Lazorick, 2015 [41], USc The MATCH Intervention | Two armed quasi-experimental study Mean age: 13.3 (0.79) Intervention: n = 189 Control: n = 173 | • Primary outcome: BMI and BMI Z-score • Intervention duration: 14 weeks • Follow up after intervention: post intervention and one year • Teacher training: One day of teacher training provided and a two-day orientation • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: Social cognitive and self-determination theory | Mean change BMI z-score immediately post intervention Intervention: − 0.06 (95%CI: − 0.08 to − 0.03) Control: 0.02 (95%CI: − 0.004 to 0.05) p-value for difference < 0.001 |
Grydeland, 2014 [40], Norwayd HEIA Intervention Study | Two armed RCT. Mean age = 11.2 (0.3) Intervention: n = 465 Control: n = 859 | • Primary outcome: BMI and BMI Z-score • Intervention duration: 20 months • Follow up after intervention: immediate post intervention • Teacher training: PE teachers were enrolled in a course • Digital component: Computer tailored individual advice • Parental involvement: Parent-based fact sheets • Behaviour change theory: socio-ecological framework | Post intervention BMI z-score (adjusted for baseline values) Girls Intervention: − 0.8 (95%CI: − 0.14, − 0.02) Control: 0.03 (95%CI: − 0.01, 0.08) p-value for difference = 0.003 Boys Intervention: − 0.01 (− 0.07, 0.05) Control: − 0.05 (95%CI: − 0.09, − 0.00) p-value for difference = 0.32 Total Intervention: − 0.04 (95%CI: − 0.09, 0.00) Control: − 0.01 (95%CI: − 0.04, 0.02) p-value for difference = 0.227 |
Bonsergent, 2013 [35], France PRALIMAP | RCT Mean age 15.6 (0.7) Intervention: 3424 Control: 2947 | • Primary outcomes: BMI and BMI Z-score • Duration of intervention: 24 months • Follow up: at 12 months and immediately post intervention • Teacher training: None reported • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: None reported | BMI z-score change at 12 months post intervention: β = 0.004 (95%CI: − 0.026, 0.034) |
Fairclough, 2013 [38], UKc The CHANGE! Intervention | RCT Mean age (control group): 10.7 (0.3) Control: 117 Intervention: 89 | • Primary outcomes: Waist circumference, BMI and BMI z-score • Duration of intervention: 20 weeks • Follow up at immediately post intervention (20 weeks) and 30 weeks • Teacher training: 4 h in how to deliver the curriculum • Digital component: CD ROM • Parental involvement: None reported • Behaviour change theory: Social cognitive theory | BMI z-score adjusted change at 20 weeks: β = − 0.04 (95% CI: − 0.22, 0.15), p = 0.68 BMI z-score adjusted change at 30 weeks: β = − 0.24 (95% CI: − 0.48, − 0.003), p = 0.04 |
Williamson, 2012 [46], USA | RCT Mean age: 12.9 (1.2) Intervention: PP = 511; PP+ SP = 516 Control: 307 | • Primary outcomes: Percentage body fat and BMI z-score • Duration of intervention: 28 months. • Follow up at 18 months and 28 months (immediately post intervention). • Teacher training: None reported • Digital component: Online platform • Parental involvement: Emails to parents. • Behaviour change theory: Not reported. | Adjusted difference between control and intervention BMI z-scores at 28 months: Boys: β = − 0.034 Girls: β = − 0.035 |
Neumark-Sztainer, 2010 [55], US New Moves | RCT Mean age: 15.8 (1.2) Intervention: 182 Control: 174 Girls only | • Primary outcomes: Physical activity levels • Duration of intervention: one school year. • Follow-up at immediately post intervention and 9 months post intervention. • Teacher training: None reported. • Digital component: None reported. • Parental involvement: Parent outreach and parent-daughter retreat days. • Behaviour change theory: Social cognitive theory. | Adjusted BMI difference between groups at 9 month post intervention follow-up: − 0.10, p = 0.446 |
Mihas, 2009 [54], Greecec VYRONAS study | RCT Mean age (control) 13.3 (0.9) Intervention: n = 98 Control: n = 93 | • Primary outcomes: dietary habits and BMI • Duration of intervention: 12 weeks • Follow ups after intervention: 15 days and 12 months • Teacher training: materials and two 3-h seminars • Digital component: none reported • Parental involvement: nutrition education and behaviour change • Behaviour change theory: social learning theory | No change in BMI at 15 days Mean BMI (adjusted) at 12 months vs baseline: Int: 23.3 (SD 2.8) vs 24.0 (SD 3.1) p < 0.001 Con: 24.8 (SD 3.8) vs 24.3 (SD 3.3) p = 0.36 |
Young, 2006 [63], USA | RCT Mean age 13.8 (0.5) Intervention: n = 111 Control: n = 99 Girls only | • Primary outcomes: physical activity and markers of cardiovascular disease risk factors • Duration of intervention: 8 months • Follow up immediately after intervention • Teacher training: not needed as intervention delivered by research staff • Digital component: none reported • Parental involvement: family workshops, monthly newsletters and parent/child homework • Behaviour change theory: social action theory | Adjusted mean BMI change: Intervention: 0.3 (SE 0.2) p = 0.2 Control: 0.2 (SE 0.2) p = 0.34 Between group p = 0.81 |
High risk of Bias | |||
Benitez-Andrades (2020),d [65] Spain | Non-randomised pre-post quasi experimental study design with control group Mean age: 12.8 for C and 12.6 for I Intervention: n = 139 Control: n = 91 | • Primary outcome: BMI age-adjusted percentile, physical activity, eating habits • Duration of intervention: 14 weeks • Follow up: immediately after intervention only • Delivered by researchers • Digital component: Facebook-based intervention • Parental involvement: None • Behaviour Change Theory: Not specified | Intervention group: BMI age-adjusted percentile (≥50 initial i.e. overweight) Mean Pre: 77.59 Mean post: 72.85 Z: − 5.394 p = 0.000 Control group: BMI age-adjusted percentile (≥50 initial) Mean pre: 78.09 Mean post: 77.49 Z = 0.241 p = 0.809 |
Froberg, 2018 [64], Sweden | Non-randomised study with control group Mean age: 12.8 (0.5) Intervention: 51 Control: 47 | • Primary outcome: physical activity, food habits, and behaviour change • Duration of intervention: 2 years • Follow up: 2 years and 4 months from after baseline • Delivered by researchers • Digital component: Facebook group for communication between researchers and students, however main intervention was delivered in class. • Parental involvement: None • Behaviour change theory: empowerment-based health promotion, shared decision making | Non-adjusted mean difference in BMI between intervention and control: 1.9 (95% CI: 0.035, 3.76). Change in prevalence for overweight: − 0.8% Change in prevalence for obesity: 1.3% |
Busch, 2015 [49], The Netherlandsd Utrecht Healthy School (UHS) | Non-randomised controlled trial Age group: high school students 1 year (N = 969) 2 years (N = 605).a | • Primary outcome: BMI, health behaviour and psychosocial health • Intervention duration: The UHS was integrated into the school curriculum for 2 years • Follow up after intervention: 1 and 2 years from baseline • Teacher training: For teachers and head teachers • Digital component: None reported • Parental involvement: participation in school projects • Behaviour change theory: not specified | Adjusted BMI change from baseline for interventions schools compared with control schools School A Year 1: β = − 0.48 (p < 0.05) Year 2: β = − 0.58 (p < 0.05) School B Year 1: β = − 0.05 (p > 0.05) Year 2: β = − 0.43 (p > 0.05) |
Millar, 2011 [43], USA c | Quasi-experimental study Mean age: 14.6 (1.42) Intervention: n = 1276 Control: 778 | • Primary outcomes: BMI, BMI z-score and body composition • Duration of intervention: Not reported • Follow up at (m; SD) 2.3 (0.68) years from baseline. • Teacher training: CPD for PE teachers. • Digital component: None reported. • Parental involvement: parent information, family and home environment • Behaviour change theory: Not reported. | Adjusted difference between intervention and control BMI z-scores at follow-up: − 0.07 (SE 0.03), p = 0.03 |
Graham, 2008 [51] Schneider, 2007 [69] USA | Non-randomised controlled trial Mean age 15.04 (0.79) Intervention: n = 63 Control: n = 59 Girls only | • Primary outcomes: Cardiovascular fitness and physical activity levels • Duration of intervention: 9 months • Follow up after immediately after intervention • Teacher training: No teacher training described, unclear who delivered the intervention • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: not specified | No significant difference (p = 0.1) between groups in change in BMI percentile |
Webber, 2008 [61], US Trial of Activity for Adolescent Girls (TAAG) | Cluster RCT Mean ages: 6th graders 12.0 8th graders 14.0 n = 1721 (6th grade 2003) n = 3504 (8th grade 2005) n = 3502 (8th grade 2006) Girls only | • Primary outcomes: physical activity levels and body composition measurements • Duration of intervention: 2–3 years • Follow-ups: 2 and 3 years post baseline • Teacher training: PE teachers and Program Champions were trained by TAAG investigators • Digital component: None reported • Parental involvement: None reported • Behaviour change theories: operant learning theory, social cognitive theory, organizational change theory, and diffusion of innovation model | BMI mean difference: 6th grade (2003): − 0.2 (95%CI: − 1.0 to 0.6) 8th grade (2005): − 0.2 (95%CI: − 0.6 to 0.2) 8th grade (2006): 0.1 (95%CI: − 0.4 to 0.7) |
Foster, 2008 [39], USc(SNIP study (School Nutrition Policy Initiative) | RCT Mean age (control) 11.2 (1.0) Intervention: n = 749 Control: n = 600 | • Primary outcomes: incidence of overweight and obesity • Duration of intervention: 2 years • Follow-up immediately after intervention • Teacher training: Teachers were offered up to 10 h of training per year • Digital component: None reported • Parental involvement: Parent outreach • Behaviour change theory: Not specified | BMI (adjusted difference): − 0.04 (95%CI: − 0.27 to 0.19), p = 0.71 BMI z-score (adjusted difference): − 0.01 (95%CI: − 0.08 to 0.06), p = 0.80 Predicted odds ratio for incidence of overweight (adjusted): 0.67 (95%CI: 0.47 to 0.96) p < 0.05 |
Rosenbaum, 2007 [58], USA c | RCT Mean age (control) 13.6 (0.2) Intervention: n = 49 Control: n = 24 | • Primary outcomes: Markers of insulin sensitivity and inflammation • Duration of intervention: 3–4 months • Follow up immediately after intervention • Teacher training: None (delivered by researchers) • Digital component: None reported • Parental involvement: None reported Behaviour change theory: Not specified | BMI at baseline and follow-up: Control: 24.3 (SD: 1.8) to 24.8 (SD: 1.9) p ≥ 0.05 Intervention: 24.7 (SD: 1.4) to 24.0 (SD:1.5) p < 0.05 |
Amaro, 2006 [34], Italy, Kaledo pilot (See Viggiano, 2015 [45]) | RCT Mean age (control) 12.5 (0.7) Intervention: n = 153 Control: n = 88 | • Primary outcomes: dietary behaviours and BMI Z-score • Duration of intervention: 24 weeks • Follow up: immediately after intervention • Teacher training: teachers trained in playing the game. • Digital component: None reported • Parental involvement: None reported • Behaviour change theory: Not specified | BMI z-score (adjusted mean controlling for baseline values): Intervention: 0.35 (95CI%: 0.30 to 0.39) Control: 0.41 (95%CI: 0.35 to 0.47) |