Skip to main content
Download PDF
Download ePub

School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review

International Journal of Behavioral Nutrition and Physical Activity volume 21, Article number: 117 (2024) Cite this article

Abstract

Background

The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.

Aim

This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10–19 years old).

Methods

Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation’s Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.

Results

Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents’ knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.

Conclusion

School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.

Introduction

Healthy eating is essential for adolescents’ physical and mental development, providing the calories and nutrients needed to support their growth, development, and the maintenance of an active lifestyle throughout their lives [1, 2]. Unhealthy eating contributes to obesity and associated health issues among adolescents such as growth retardation, impaired organ development, micronutrient deficiencies, and later in life can lead to non-communicable diseases (NCDs) including cardiovascular diseases, diabetes mellitus, and hypertension [3,4,5,6,7]. Adolescents (aged between 10 and 19 years old) [8] need to consume a daily intake of 2200 to 3000 calories, with a balanced distribution of macronutrients, including carbohydrates (45–65% of total energy intake), protein-rich foods, such as fish and meat (10–30%), and fats (25–35%) [9, 10]. Diets should also include at least five servings of fruits and vegetables (FV) rich in vitamins, minerals and fibre, 2.5-3 servings of dairy products and limit the intake of added sugar (less than 10% of total energy intake) and high fat foods [9, 10].

Adolescents in both low- and middle-income countries (LMICs) and high-income countries (HICs) frequently have diets that are calorie-dense yet nutrient-deficient, marked by excessive consumption of sugar-sweetened beverage (SSB), ultra-processed foods, and insufficient intake of FV [11,12,13]. Ultra-processed foods are laden with added sugars, salt and harmful fats, and are deficient in essential nutrients like dietary fibre, vitamins, and minerals [14]. These should be avoided as they pose significant health risks including increased risk of cardio-metabolic events [14]. A meta-analysis examining the Global School-based Student Health Surveys from 2008 to 2015 including Africa, Asia, Oceania, and Latin America revealed that 35% of adolescents do not meet the recommended intake of FV, 43% consume sugary sweetened beverages (SSBs) daily, and 46% eat processed foods at least weekly [12]. Furthermore, a recent UNICEF report drew attention to the low FV intake among adolescents worldwide [13]. The prevalence of meal skipping among adolescents, especially breakfast, has also been linked to increased fast food consumption [15, 16].

School can play a critical role in promoting healthy eating among adolescents. Broadly speaking, school-based healthy eating interventions use two approaches: individual-level interventions, which tailor curricula to influence adolescents’ behaviours, and system-level interventions, which embed strategic actions into daily life to modify school policies [17]. The World Health Organisation’s (WHO) Health Promoting School (HPS) framework [18] provides a comprehensive approach to promoting healthy eating in schools, encompassing three key components: health education, school environment modifications, and engagement with families and communities. However, despite there being a plethora of school-based intervention, including many reviews, there is a lack of synthesised evidence on the diverse components and contents of these interventions and their impact on adolescents’ eating behaviour. The existing literature has not adequately explored the effectiveness of specific intervention strategies within each component of HPS. One umbrella review assessed school-based healthy eating interventions focusing on behaviour changes in children aged 6 to 18 years, it did not present results separately for adolescents [19]. This is important as adolescents have unique developmental needs and challenges that require tailored intervention approaches. The lack of adolescent-specific evidence limits the ability to design and implement interventions that effectively address the unique barriers and facilitators to healthy eating in this age group. Moreover, the umbrella review’s omission of a synthesis of the interventions’ specific components and their respective contents constitutes a notable evidence gap that merits further exploration [19]. The comprehensive synthesis of intervention components and their respective contents is crucial for understanding the effectiveness, generalisability, and replicability of these interventions [20]. This umbrella review addresses these evidence gaps by synthesising evidence from reviews evaluating school-based healthy eating interventions targeting adolescents. This review will provide insights to inform the development and implementation of evidence-based, tailored interventions that promote sustainable healthy eating among adolescents in school settings.

Materials and methods

This umbrella review followed the Joanna Briggs Institute’s (JBI) methodology for umbrella reviews [21] and is reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) [22] (Supplementary file 1). The umbrella review protocol is registered with the PROSPERO database for systematic reviews (CRD42022338762).

Eligibility criteria

Our population of interest were adolescents aged 10 to 19 years. Reviews on broader age range were included if they reported data for adolescents separately. School-based interventions promoting healthy eating were included, and interventions promoting other healthy behaviours such as physical activity were included only if outcomes related to healthy eating were reported separately. Comparison groups included no intervention, or comparison to one or more other interventions. Reviews using standardised measures, such as changes in healthy eating knowledge and behaviours among adolescents, were included and those that reported non-dietary or non-nutritional outcomes such as obesity, unhealthy weight, anthropometric measurements, BMI, metabolic outcomes, and physical activity, were excluded. Reviews were selected if they reported both dietary and non-dietary outcomes separately, based on specific primary studies included in their analysis. This criterion ensured that reviews providing distinct information on outcomes regarding healthy eating knowledge and behaviour were included in our study. All types of reviews were included- systematic reviews with or without meta-analyses, narrative reviews, scoping reviews, rapid reviews, critical reviews, and integrative reviews. Peer-reviewed published reviews were considered, while protocols, conference abstracts and proceedings, commentaries, editorials, unpublished reviews, or reviews published as grey literature were excluded. We included reviews published between 1st January 2000 and 31 December 2023 and written in English.

Search strategy

Database search

Eleven electronic databases were searched: PubMed, Cumulated Index to Nursing and Allied Health Literature (CINHAL), Excerpta Medica dataBASE (EMBASE), Science Direct, Psychological Information Database (PsycINFO), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Education Resources Information Center (ERIC), and Web of Science, Cochrane Register of Systemic Review, and JBI Evidence Synthesis.

Search terms

Keywords for school-based interventions and healthy eating were discussed among the research team and further refined by consulting with a senior librarian at King’s College London. The search strategy was then piloted in PsycINFO, via Ovid, and Scopus before search terms were finalised (Supplementary file 2).

Review screening

Records identified from database search were exported to Rayyan [23]. After removing duplicates, titles and then abstracts were reviewed against the eligibility criteria by two independent reviewers (NS and FN). Full texts of eligible records were reviewed independently by NS and FN. The reasons for exclusion were recorded. Any discrepancies were resolved by consensus between the two reviewers and when required, a third reviewer (LB or DP or FA) was consulted. To assess the extent of overlap between reviews, we created a citation matrix following Cochrane guidelines [24] (Supplementary file 3). We included all relevant reviews in our study, even if they shared some primary studies. However, we found no instances where one review completely overlapped with another in terms of primary studies.

Quality appraisal

The included reviews were appraised using the standard JBI critical appraisal tool by two independent reviewers (NS and FN). Seventy per cent of these were checked by another researcher (LB or DP). The tool consisted of 11 questions (responses: “Yes”, “No”, “Unclear” or “NA”). The overall score of a review was calculated by summing the affirmative answers (range 0–11 points). This tool does not mention cut-off points for categorising the quality of systematic reviews [21], hence, we applied these cut-off points: high quality (≥ 8 “Yes”), moderate quality (5–7 “Yes”), and low quality (≤ 4 “Yes”) (Supplementary file 4).

Data extraction

We extracted the following data from the included reviews: author and date, publication year, type of review, total number of included studies, age groups of the study participants, countries of the primary studies, study designs, studied interventions (components, contents, duration), outcome, and key findings. Data were extracted independently by two researchers (NS and FN), and 70% of the extracted data was checked by a third researcher (LB or DP). We adopted the Template for Intervention Description and Replication (TIDieR) framework to identify the intervention components, i.e., distinct element of the overall intervention strategy, and intervention ‘content’, i.e., specific materials, procedures, activities, and information that are provided or used within each component of the intervention [25].

Data synthesis

We conducted a narrative synthesis of the finding [26]. We categorised the intervention components according to the World Health Organisation’s (WHO) Health Promoting School (HPS) framework and interventions with two or more components were categorised as multi-component interventions [18]. We reported findings on the effectiveness of eating knowledge and behaviour outcomes according to a framework previously employed in a Cochrane overview of reviews framework [19, 27]. This framework evaluates the effectiveness of interventions as [19, 27]: “Likely effective” if evidence supporting intervention effectiveness is based on meta-analysis or narrative synthesis of all primary studies; “Promising” if evidence of effectiveness is based on over 50% of primary studies but requires further confirmation; “Probably ineffective” if majority of the primary studies results are ineffective; “Ineffective” if findings in all primary studies are found to be ineffective; and “Inconclusive” if there is inadequate evidence on effectiveness. Additionally, we applied the Behaviour Change Technique Taxonomy (BCTT) to identify effective combinations of intervention components for promoting healthy eating behaviours among adolescents [28].

Results

A total of 19,781 records were identified through database searching (Fig. 1). After deduplication, 16,949 titles and abstracts were screened, and 151 reports were identified for full text screening. Out of 151 full text reports, four could not be retrieved because they were in conference proceedings. Remaining 144 full-text reports were assessed for eligibility, and 17 reviews were included in this umbrella review.

Fig. 1
figure 1

PRIOR flow diagram

Full size image

Characteristics of included reviews

The 17 included reviews were published between 2008 and 2023 and included studies published between 1987 and 2020 (Table 1). A total of 347 unique primary studies were captured in these 17 reviews. Fifteen of the reviews used narrative synthesis [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43] and two included both meta-analysis and narrative synthesis [44, 45]. Two reviews included primary studies with a broader age range, but synthesised results for adolescents separately [32, 34]. We incorporated these adolescent-specific findings in our synthesis. Majority of the reviews (n = 14) evaluated multi-component interventions [30,31,32, 34,35,36,37,38,39,40, 42,43,44,45] while three reviews evaluated only health education interventions [29, 33, 41]. All the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs [30, 35,36,37,38, 42, 43, 45]. Several tools were used to measure the outcomes of the interventions. According to the JBI critical appraisal tool, 14 reviews scored high [30,31,32, 34,35,36,37,38,39,40,41, 43,44,45], two reviews scored moderate [33, 42], and only one review scored low [29] in terms of methodological quality (Table 2).

Table 1 Characteristics of the included reviews (n = 17)
Full size table

Single-component interventions

Out of 17 reviews, three reviews [29, 33, 41], comprising a total of 32 unique primary studies, focused on single-component individual-level interventions (Table 2). The methodological quality of these reviews was mixed: one study was rated as high [41], one as moderate [33], and one was rated as poor methodological quality [29]. These reviews exclusively synthesised data from HICs. All the three reviews focused on promoting health eating and included some tech-driven curriculum, i.e., the integration of technological tools into educational practices. The contents included lessons on nutrition, personal diet recommendations, gamified learning experiences (such as levelling up based on healthy eating knowledge and behaviour), cooking recipes, and an app to record daily food intake. Only one review [38] reported on the theoretical frameworks that underpinned interventions - the social cognitive theory (SCT), social learning theory (SLT), and theory of reasoned action (TRA). The intervention duration, ranged from two to 10 weeks [30, 38] and the timing of follow up assessments ranged from immediately after intervention to three years after the intervention [30, 38]. Primary outcomes for these reviews were healthy eating knowledge and behaviour such as consumption of FV, dairy, meat and fibre, tendency to skip meals and intake of processed snacks and SSBs [26, 30, 38]. Two reviews [26, 38] used the food frequency questionnaire (FFQ) to measure outcomes and the third review did not report such tools [30]. Applying the effectiveness categorisation framework [25], these interventions were considered “likely effective” in improving both knowledge about healthy eating and actual eating behaviours. Two reviews [26, 38] reported on acceptability of the tech-driven curriculum and reported there was higher participation and engagement by adolescents. These reviews also found that these interventions improved accessibility overall and were equitable as they were able to engage adolescents with low resources. Flexible participation, time-saving and the ability to customise content by language were key features that improved the feasibility of these interventions [26, 38]. The combination of three BCTT hierarchical clusters was “likely effective”, as reported by only one review with high methodological quality: feedback and monitoring (SMS-based diaries); shaping knowledge (computer-tailored workshops); and associations (SMS) (Supplementary file 5).

Table 2 Evidence on single component (healthy eating education) interventions
Full size table

Multi-component interventions

Fourteen reviews, including 313 unique primary studies, assessed interventions with at least two components: healthy eating education, changes to the school environment, and family involvement (Table 3). Thirteen reviews were rated as high, and only one was rated as moderate methodological quality. These reviews mostly included studies based in HICs. Eight reviews among these 14 included primary studies based in five LMICs [30, 35,36,37,38, 42, 43, 45].

Two high-quality reviews (including 80 unique primary studies) found that interventions incorporating all three components of the HPS framework, were “likely effective” in improving healthy eating knowledge and behaviour, particularly increased consumption of FV and water, reduced consumption of SSB, total daily calories, regularly eating breakfast and other meals, willingness to try healthy foods, and improved food choice competency in HICs [31, 43]. One of these reviews included a single study from an LMIC, Ethiopia [43].

The healthy eating education components at the individual level, included lectures, tailored leaflets, handbooks, text messages, board games, drama, mobile health counselling, healthy eating club, and motivational visits from athletes and other role models. The contents involved healthy eating information, nutrition, healthy cooking lessons, club activities, such as healthy eating photography.

The school environment change components at the system level, included school-wide marketing and canteen modification with contents involving healthy food promotion and increased availability of healthy foods in schools. In the context of healthy eating interventions in our included reviews, both terms “canteen” and “cafeteria” refer to the main food service area in a school. We have used “canteen” consistently throughout.

The family involvement components at the system level, included parents’ meetings and homework with contents on healthy eating information and feeding healthy foods at home.

Only one of the reviews [43] commented on the theoretical models on which the interventions were based - trans-theoretical model (TTM), SCT, theory of planned behaviour (TPB), and attitudes social influence self-efficacy (ASE) model. Interventions in studies in these reviews ranged from one to 18 months. The outcomes were measured by surveys, focus groups, or sales transactions [31, 43]. Components related to the school environment, such as increased availability of healthy foods and parental involvement requires resources for implementation and so were found to be less feasible [31].

There were promising effects of multi-component interventions on healthy eating behaviour reported in seven high-quality [30, 32, 35,36,37,38, 45] and one moderate-quality reviews [42] (including 192 unique studies) [30, 32, 35,36,37,38, 42, 45]. The primary outcomes for these reviews were intake of FV [30, 32, 36,37,38, 42, 45], processed snacks [30, 36,37,38, 45], SSB [30, 35, 37], fat [37, 42], protein, fibre and vitamins [37], frequency of regular meals [30, 37, 38], recommended calorie intake [37, 42], healthy eating knowledge [30, 36], and staying in school for having healthy lunch [38]. These reviews mainly focused on interventions in HICs - only 11 primary studies were from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia) [30, 35,36,37,38, 42, 45]. One review (including 14 unique studies) included healthy eating education and family involvement [42], one review (including 44 unique studies) included healthy eating education and environmental changes [36], and rest six reviews (including 134 unique studies) included all the three components of the HPS framework [30, 32, 35, 37, 38, 45].

The healthy eating education components at the individual level, included lectures [30, 32, 36, 38, 42, 45], quizzes and games [30, 36, 38], media shows [37], plays, electronic messages, rewards, peer-leading activities and training for teachers [38]. The contents involved lessons on healthy eating [32, 37, 38, 42, 45], food labelling, healthy cooking [30, 36], consequences of SSB intake [35], nutrition, food safety farmers’ visits on healthy food cultivation [36], menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting [38].

The school environment change components at the system level, involved FV gardening [32, 36], school food marketing [38, 45], canteen modifications [30, 36], vending machine modifications [35], postering [45], workshops with kitchen staff [36], and loyalty programs [32]. The contents involved increased availability of milk and protein [32, 35,36,37,38, 45] and fresh fruits [30], free or subsidised FV [35], replacing SSB with healthier alternatives (milk, water, juice) in vending machines [35], chef, staff consultations on healthy culinary lessons [36], and healthy eating posters around school [45].

The family involvement components at the system level included communicating with families via newsletters [30, 32, 35, 37, 38], leaflets [30, 45], emails [35, 37], booklets [30], brochures [30] and texts [37], organising parents’ meetings [35, 45], in-school learning sessions, food coupons [37] and social support groups [35], and providing parents recipe guides [30]. The contents involved information on healthy eating knowledge [30, 32, 35, 38, 42, 45], healthy cooking, feeding healthy foods to children at home [37], nutritional guidelines [38], coupons to purchase healthy foods [37], offering FV and free healthy foods [45].

The interventions within the studies were informed by several theoretical models - SCT [30, 35, 36, 45], TPB [30, 35, 38, 45], TTM [36, 42, 45], health belief model [30, 36], TRA [30, 38], pedagogy of the oppressed by Paulo Freire [30, 45], socio-ecological model (SEM) [30, 45], self-regulation theory (SRT) [35, 45], ASE Model, the action planning literature, Bloom’s mastery of learning model, Bronfenbrenner’s ecological theory [45], cognitive behavioural theory [30], health action process approach [30], HPS [30], diffusion of innovation theory (DIT) [40], expectancy theory [40], self-determination theory [40], elaboration likelihood model [35], and theory of interpersonal behaviour [35]. The outcomes were measured by FFQ [32, 35,36,37,38, 42, 45], 24 h dietary recalls [32, 35,36,37,38, 45], food diary [38, 42], knowledge attitude practice (KAP) survey [32, 45], cognitive and attitudinal assessments [38], FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale [38], and 7-day recall [45], or 5-day food recall [42]. The intervention duration ranged from 15 min to 10 years [30, 36,37,38, 42, 45] and time of the follow up assessments ranged from immediately to four years after the intervention [30, 32, 36, 37, 42].

Four high-quality reviews (including unique 43 studies) reported “inconclusive” impacts on eating knowledge and behaviour, particularly in terms of healthy eating knowledge [44], intake of FV [34, 39, 40, 44], recommended fat [34, 39, 44], water [34, 40], processed snacks [40, 44], protein [40], fibre [44], and SSB [34]. These reviews exclusively focussed on interventions in HICs.

The healthy eating education components included lectures [34, 39, 40], group discussions [40, 44], games [39, 44], distribution of materials via compact discs (CDs), videos, emails, and text messages, blogs by a health coach [44], workshops for staff and students [39], and drama [40]. The contents involved healthy eating lessons [34, 39, 40, 44], food preparation, and taste testing [40].

The school environment components, working at the school system level, included canteen modifications [34, 39], food distributions [34], reduced price of fruits [44], social food marketing, staff trainings [39], loyalty programmes [34, 39], gardening, postering, and vending machine modifications [40]. The contents involved FV subscriptions [34, 40], increased availability of healthy food in canteen [34, 39], FV plantation [40], incentives to purchase healthy foods [34], staff training on healthy cooking healthy eating poster [39], healthy eating posters around schools [40], enhanced lunch sessions with healthy meals, and replacing SSBs with healthy foods [40].

The family involvement components included parents’ meetings and workshops [34, 39, 40], distribution of newsletters, CDs, magazines, calendars [39, 40, 44], engaging parents in school nutrition council groups [39], and loyalty programmes [39, 40]. The contents involved healthy eating lessons [34, 39, 40, 44], incentives to purchase healthy foods [34, 39], money rewards for purchasing healthy foods [40], cooking recipes [39], and healthy feeding to children [40].

The studies assessed in these four reviews employed RCTs (n = 39) [34, 39, 40, 44], non-RCTs (n = 16), cohort (n = 7), pre-post (n = 7) [34], and quasi-experimental (n = 2) designs [44]. The interventions were informed by TPB [34, 39, 40, 44], SCT [39, 40, 44], TTM [39, 44], ASE model, principles of interactive technology, SLT, health promotion model (Pender’s) [44], SEM, DIT, control theory, information-motivation-behavioural skills model [39], and community-based capacity building approach [40]. These outcomes were measured by 24-h recall [34, 39, 40, 44], FFQ [34, 40, 44], KAP [39], and 3-day food record [44]. The intervention duration ranged from 12 h to three years [34, 39, 40, 44] and only one review reported follow up assessments occurred ranged from immediately to three years after the intervention [34, 39, 40, 44].

Although none of the reviews mentioned that key stakeholders were involved in the intervention design process, only four reviews mentioned that engaging adolescents and key stakeholders in designing and implementing interventions is crucial to ensure their effectiveness [31, 33, 43, 44].

Overall, the combination of three BCTT hierarchical clusters was “likely effective”, as reported by two reviews with high methodological quality: shaping knowledge (workshops, games for students, homework for parents); associations (nutri-advice kiosks, entertainments such as drama, visits by inspiring personalities, SMS, emails, counselling via mHealth i.e., nutritional behavioural counselling); and antecedents (healthy eating club, school food marketing, canteen modification, such as increased availability of healthy foods, reduced fruit prices, parents’ meeting) (Supplementary file 5).

Table 3 Evidence on multi-component interventions
Full size table

Discussion

To our knowledge, this umbrella review represents the first comprehensive synthesis of evidence on the effectiveness of school-based healthy eating interventions targeting adolescents aged 10 to 19 years. Most (83%) of the reviews were of high methodological quality, providing confidence in the findings. The majority (71%) of high-quality reviews assessing multi-component interventions reported “promising” to “likely effectiveness”, suggesting that a combination of individual- and system-level interventions is most effective in promoting healthy eating among adolescents. This finding is consistent with recent empirical evidence [46,47,48,49], highlighting the potential of such interventions to address the complex factors influencing adolescents’ eating behaviour. Our review found that curricula driven by technology effectively encouraged healthy eating behaviours at the individual level, a finding further reinforced by recent studies [50,51,52]. However, our review also found that the broader impact and sustainability of individual-level interventions are contingent upon their integration into the system-level interventions that include changing the school environment to improve availability of healthy foods and involving families. Combining system and individual-level interventions can create supportive environments that underpin and perpetuate changes in individual behaviour [17, 19, 53, 54]. Reviews examining school-based healthy eating interventions for a wider age range, including both children and adolescents, reveal different emphases. Effective intervention components focusing on children emphasise antecedents, particularly parental involvement in shaping eating behaviour and the importance of healthy food accessibility [32, 34, 49]. However, our review found that the combination of effective components within the collaborative individual- and system-level approach for adolescents aged 10 to 19 years involved shaping knowledge through educational instructions and experiments, creating associations with stimuli that cue healthy behaviours, and establishing antecedents to facilitate healthy food choices [17, 19, 53, 54].

The evidence synthesised in this review was primarily from studies in HICs (87%) that did not differentiate between geographical contexts. As interventions are likely to be context specific, this limits its applicability to LMICs. For example, the socioeconomic and infrastructural differences between HICs and LMICs may influence the effectiveness and feasibility of interventions [54,55,56] 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, 54,55,56]. However, the evidence from HICs in this umbrella review still provides valuable insights and a foundation for future research and intervention development in resource-limited settings. The components and contents of effective interventions identified in HICs, such as the importance of multi-component approaches with the potential of technology-based strategies, are a starting point for designing and testing school-based healthy eating interventions in LMICs. However, these interventions will require adaptation and contextualisation to the constraints and opportunities in LMICs.

The limited number of reviews reporting on stakeholder involvement in intervention development underscores a critical gap in the current literature. Empirical evidence suggests that engaging key stakeholders, including adolescents, parents, teachers, and policy experts, in intervention design ensures tailoring to adolescents’ needs, feasibility, and successful implementation [57,58,59]. Adolescents offer insights into their eating habits and preferences [57,58,59], parents shape their children’s eating behaviours [59, 60], teachers ensure compatibility with school resources [59], and policymakers promote policies for long-term support [59, 61].

The scarcity of reviews reporting on the feasibility of these intervention exposes a significant gap in the current literature. Although a few reviews suggest that technology-driven interventions may be feasible [29, 41], recent studies have identified several challenges that undermine their feasibility. These challenges include teachers’ lack of understanding of the operating systems of the technology, limited internet access, and poor technology infrastructure [51, 52]. Furthermore, the feasibility of multi-component interventions that require additional resources has been questioned [52, 62], which is consistent with the reporting from one review [39]. This highlights the need for more comprehensive feasibility assessments to identify and address the logistical, contextual, and stakeholder factors that influence intervention effectiveness [62, 63].

Inconsistent reporting across reviews made it difficult to determine if effectiveness varied based on theoretical underpinnings. While psychosocial theories, such as SCT, SLT, and TPB were most commonly used to inform the interventions, these interventions did not incorporate behaviour change taxonomy technique (BCTT) [64, 65]. Literature suggests using BCTT with behaviour change theories and frameworks, such as goal setting theory, TTM, TRA, and Capability, Opportunity, Motivation-Behaviour (COM-B) framework, for more effective and sustainable behaviour change [64,65,66,67]. BCTT can improve intervention designs, enable cross-study analysis, and inform implementation feasibility [64, 68, 69].

The interventions assessed in the reviews relied on survey methods, mostly FFQs and food recalls. These outcome measures are prone to biases and inaccuracies, due to recall bias, social desirability bias (i.e., providing answers they perceive as more socially acceptable rather than accurate), short-term dietary variability, challenges in estimating portion sizes, limited food options, and seasonal variation [70]. Triangulating this data with data from wearable tech, mobile apps, and school canteen sales data, ecological momentary assessment (EMA) for real-time data collection, direct observation of adolescents’ eating behaviours, and proxy reports from family members can provide insights into behaviour changes [70,71,72,73,74,75,76]. However, the acceptability and feasibility of some of methods should be explored within the context of resource availability prior to implementation.

This umbrella review stands out for two key strengths. First, it provides a comprehensive narrative synthesis of the evidence while critically examining methodological gaps in intervention designs. Second, it goes beyond a simple narrative compilation of findings by employing the HPS framework, TIDieR framework, and an intervention effectiveness categorisation system to synthesise intervention components, contents, and their effectiveness. However, our review had some limitations. The included reviews had mixed methodological quality, and many included low-quality primary studies. Our findings may also be influenced by the heterogeneity of the intervention designs of selected reviews and inconsistent reporting of intervention characteristics. Our umbrella review included English-language peer-reviewed reviews, excluding literature in other languages and grey literature. Therefore, we might have missed reviews published in other languages or as grey literature. This may have also led to an overestimation of the interventions’ effectiveness due to publication bias [77, 78].

Conclusion

Multi-component school-based healthy eating interventions have shown promising results in improving healthy eating knowledge and behaviour among adolescents aged 10 to 19 years, particularly when combining individual- and systemic-level approaches. However, this umbrella review highlighted a significant gap in evidence from LMICs and a lack of participatory approach in designing and implementing the interventions. The limited and inconsistent reporting on intervention characteristics and strategies emphasises the need for comprehensive and high-quality systematic reviews of primary studies. Such reviews would allow for the consolidation of evidence from all types of school-based healthy eating interventions and the investigation of specific intervention components’ effectiveness. Addressing these gaps is crucial for developing effective and sustainable interventions to promote healthy eating among adolescents worldwide.

Data availability

Not applicable.

References

  1. Lassi ZS, Moin A, Das JK, Salam RA, Bhutta ZA. Systematic review on evidence-based adolescent nutrition interventions. Ann N Y Acad Sci. 2017;1393(1):34–50.

    Article  PubMed  Google Scholar 

  2. Sustainable healthy diets. guiding principles. [cited 2022 Sep 30]. https://www.who.int/publications/i/item/9789241516648

  3. UNICEF. Poor diets damaging children’s health worldwide, warns UNICEF, UNICEF. 2017 [cited 2022 Jan 24]. https://www.unicef.org/press-releases/poor-diets-damaging-childrens-health-worldwide-warns-unicef

  4. Salwa M, Atiqul Haque M, Khalequzzaman M, Al Mamun MA, Bhuiyan MR, Choudhury SR. Towards reducing behavioral risk factors of non-communicable diseases among adolescents: protocol for a school-based health education program in Bangladesh. BMC Public Health. 2019;19(1):1–9.

    Article  Google Scholar 

  5. Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS, et al. Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann N Y Acad Sci. 2017;1393(1):21–33.

    Article  PubMed  Google Scholar 

  6. Huang RC, Mori TA, Burke V, Newnham J, Stanley FJ, Landau LI, et al. Synergy between adiposity, insulin resistance, metabolic risk factors, and inflammation in adolescents. Diabetes Care. 2009;32(4):695–701.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Uauy R, Kain J, Mericq V, Rojas & Camila Corvalán J. Nutrition, child growth, and chronic disease prevention. Ann Med. 2008 [cited 2022 Sep 30];40(1):11–20. https://www.tandfonline.com/action/journalInformation?journalCode=iann20

  8. WHO. Adolescent health. WHO. 2001 [cited 2022 Jan 24]. https://www.who.int/southeastasia/health-topics/adolescent-health

  9. Wahl R. Nutrition in the adolescent. Pediatr Ann. 1999;28(2):107–11.

    Article  PubMed  CAS  Google Scholar 

  10. Diethelm K, Jankovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, et al. Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (healthy lifestyle in Europe by nutrition in adolescence) study. Public Health Nutr. 2012;15(3):386–98.

    Article  PubMed  Google Scholar 

  11. Li L, Sun N, Zhang L, Xu G, Liu J, Hu J et al. Fast food consumption among young adolescents aged 12–15 years in 54 low- and middle-income countries. Glob Health Action. 2020;13(1). https://doi.org/10.1080/16549716.2020.1795438

  12. Beal T, Morris SS, Tumilowicz A. Global patterns of adolescent fruit, vegetable, carbonated soft drink, and fast-food consumption: a meta-analysis of global school-based student health surveys. Food Nutr Bull. 2019 [cited 2022 Sep 30];40(4):444–59. https://journals.sagepub.com/doi/full/https://doi.org/10.1177/0379572119848287

  13. Fleming C, Hockey K, Schmeid V, Third A. Food and me. Unicef. 2020; https://doi.org/10.26183/26f6-ec12

  14. Petridi E, Karatzi K, Magriplis E, Charidemou E, Philippou E, Zampelas A. The impact of ultra-processed foods on obesity and cardiometabolic comorbidities in children and adolescents: a systematic review. Nutr Rev. 2023;82(7):913–28.

    Article  Google Scholar 

  15. Wang M, Zhong JM, Wang H, Zhao M, Gong WW, Pan J et al. Breakfast consumption and its associations with health-related behaviors among school-aged adolescents: a cross-sectional study in Zhejiang Province, China. Int J Environ Res Public Health. 2016;13(8).

  16. Marlatt KL, Farbakhsh K, Dengel DR, Lytle LA. Breakfast and fast food consumption are associated with selected biomarkers in adolescents. Prev Med Reports. 2016;3:49–52. https://doi.org/10.1016/j.pmedr.2015.11.014

  17. Merrell KW, Buchanan R. Intervention selection in school-based practice: using public health models to enhance systems capacity of schools. School Psych Rev. 2006;35(2):167–80.

    Article  Google Scholar 

  18. Langford R, Bonell C, Komro K, Murphy S, Magnus D, Waters E et al. The health promoting schools framework: known unknowns and an agenda for future research. Health Education and Behavior. 2017.

  19. O’brien KM, Barnes C, Yoong S, Campbell E, Wyse R, Delaney T et al. School-based nutrition interventions in children aged 6 to 18 years: an umbrella review of systematic reviews. Nutr 2021, Vol 13, Page 4113. 2021 [cited 2022 Sep 30];13(11):4113. https://www.mdpi.com/2072-6643/13/11/4113/htm

  20. Sutcliffe K, Thomas J, Stokes G, Hinds K, Bangpan M. Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions. Syst Rev. 2015;4(1):1–13.

    Article  Google Scholar 

  21. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40. https://doi.org/10.1097/XEB.0000000000000055

  22. Gates M, Gates A, Pieper D, Fernandes RM, Tricco AC, Moher D, et al. Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement. BMJ. 2022;378:e070849. https://doi.org/10.1136/bmj-2022-070849

  23. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1–10. https://doi.org/10.1186/s13643-016-0384-4

  24. Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. No Title. 6.4. Cochrane handbook for systematic reviews of interventions. Cochrane; 2023. www.training.cochrane.org/handbook

  25. Monnelly K, Marshall J, Cruice M. Intensive comprehensive aphasia programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions. Disabil Rehabil. 2022;44(21):6471–96. https://doi.org/10.1080/09638288.2021.1964626

  26. Guidance on the Conduct of. Narrative Synthesis in Systematic Reviews: A Prod from ESRC Methods Program. 2006.

  27. Cruden G, Kelleher K, Kellam S, Brown CH. Increasing the delivery of preventive health services in public education. Am J Prev Med. 2016;51(4, Supplement 2):S158–67. https://www.sciencedirect.com/science/article/pii/S0749379716302501

  28. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.

    Article  PubMed  Google Scholar 

  29. Magalhães de Alcântara CI, Newle Sousa Silva AI, Veraci Oliveira Queiroz MI, Magalhães de Alcântara C. Digital technologies for promotion of healthy eating habits in teenagers Patrícia Neyva da Costa Pinheiro II. 2019;72(2):513–20. https://doi.org/10.1590/0034-7167-2018-0352

  30. Shinde S, Wang D, Moulton GE, Fawzi WW. School-based health and nutrition interventions addressing double burden of malnutrition and educational outcomes of adolescents in low- and middle-income countries: a systematic review. Matern Child Nutr. 2023;(August):1–36.

  31. Rose K, O’Malley C, Eskandari F, Lake AA, Brown L, Ells LJ. The impact of, and views on, school food intervention and policy in young people aged 11–18 years in Europe: a mixed methods systematic review. Obes Rev. 2021;22(5):1–25.

    Article  Google Scholar 

  32. De Sa J, Lock K. Will European agricultural policy for school fruit and vegetables improve public health? A review of school fruit and vegetable programmes. [cited 2022 Sep 30]; https://academic.oup.com/eurpub/article/18/6/558/576644

  33. Tallon JM, Saavedra Dias R, Costa AM, Leitão JC, Barros A, Rodrigues V et al. Impact of technology and school-based nutrition education programs on nutrition knowledge and behavior during adolescence—a systematic review. Scand J Educ Res. 2021;65(1):169–80. https://doi.org/10.1080/00313831.2019.1659408

  34. Van Cauwenberghe E, Maes L, Spittaels H, Van Lenthe FJ, Brug J, Oppert JM, et al. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and grey literature. Br J Nutr. 2010;103(6):781–97.

    Article  PubMed  Google Scholar 

  35. Vézina-Im LA, Beaulieu D, Bélanger-Gravel A, Boucher D, Sirois C, Dugas M, et al. Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review. Public Health Nutr. 2017;20(13):2416–31.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bailey CJ, Drummond MJ, Ward PR. Food literacy programmes in secondary schools: a systematic literature review and narrative synthesis of quantitative and qualitative evidence. Public Health Nutr. 2019;(5).

  37. Calvert S, Dempsey RC, Povey R. Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: a systematic review. Obes Rev. 2019;20(4):543–53.

    Article  PubMed  Google Scholar 

  38. Hackman C, Knowlden A. Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review. Adolesc Health Med Ther. 2014;101.

  39. McHugh C, Hurst A, Bethel A, Lloyd J, Logan S, Wyatt K. The impact of the World Health Organization health promoting schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review. Public Health. 2020;182:116–24. https://doi.org/10.1016/j.puhe.2020.02.006

  40. Meiklejohn S, Ryan L, Palermo C. A systematic review of the impact of multi-strategy nutrition education programs on health and nutrition of adolescents. J Nutr Educ Behav. 2016;48(9):631–646.e1. https://www.sciencedirect.com/science/article/pii/S1499404616306716

  41. Do Amaral E, Melo GR, De Carvalho Silva Vargas F, Dos Santos Chagas CM, Toral N. Nutritional interventions for adolescents using information and communication technologies (ICTs): a systematic review. PLoS One. 2017 [cited 2022 Sep 30];12(9). https://pubmed.ncbi.nlm.nih.gov/28961248/

  42. Nakabayashi J, Melo GR, isa, Toral N. Transtheoretical model-based nutritional interventions in adolescents: a systematic review. BMC Public Health. 2020;20(1):1–14.

    Article  Google Scholar 

  43. St. Pierre C, Guan W, Barry L, Dease G, Gottlieb S, Morris A, et al. Themes in train-the-trainer nutrition education interventions targeting middle school students: a systematic review. Nutrients. 2021;13(8):1–40.

    Article  Google Scholar 

  44. Champion KE, Parmenter B, McGowan C, Spring B, Wafford QE, Gardner LA, et al. Effectiveness of school-based eHealth interventions to prevent multiple lifestyle risk behaviours among adolescents: a systematic review and meta-analysis. Lancet Digit Heal. 2019;1(5):e206–21.

    Article  Google Scholar 

  45. Medeiros GC, Azevedo KP, Garcia D, Oliveira Segundo VH, Mata ÁN, Fernandes AK, et al. Effect of school-based food and nutrition education interventions on the food consumption of adolescents: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19.

  46. Nutrition action in schools. a review of evidence related to the nutrition-friendly schools initiative. [cited 2022 Sep 30]. https://apps.who.int/iris/handle/10665/338781?show=full

  47. Charlton K, Comerford T, Deavin N, Walton K. Characteristics of successful primary school-based experiential nutrition programmes: a systematic literature review. Public Health Nutr. 2021;24(14):4642–62.

    Article  PubMed  Google Scholar 

  48. Adom T, De Villiers A, Puoane T, Kengne AP. School-based interventions targeting nutrition and physical activity, and body weight status of African children: a systematic review. Nutrients. 2020;12(1).

  49. Chaudhary A, Sudzina F, Mikkelsen BE. Promoting healthy eating among young people—a review of the evidence of the impact of school-based interventions. Nutrients. 2020;12(9):1–34.

    Article  Google Scholar 

  50. Colley P, Myer B, Seabrook J, Gilliland J. The impact of Canadian school food programs on children’s nutrition and health: a systematic review. Can J Diet Pract Res. 2019;80(2):79–86.

    Article  PubMed  Google Scholar 

  51. Benavides C, Benítez-Andrades JA, Marqués-Sánchez P, Arias N. eHealth intervention to improve health habits in the adolescent population: mixed methods study. JMIR mHealth uHealth. 2021.

  52. Hamel LM, Robbins LB. Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. J Adv Nurs. 2013;69(1):16–30.

    Article  PubMed  Google Scholar 

  53. Jenkins EL, Brennan L, McCaffrey TA. Shifting adolescents’ interest and motivation in health and healthy eating to promote a healthy and sustainable lifestyle. Proc Nutr Soc. 2023;82(OCE2):2882.

    Article  Google Scholar 

  54. Xu T, Tomokawa, Gregorio R, Mannava P, Nagai M, Sobel H. School-based interventions to promote adolescent health: a systematic review in low- and middle-income countries of WHO Western Pacific Region. PLoS One. 2020;15(3):1–15. https://doi.org/10.1371/journal.pone.0230046

  55. Verstraeten R, Roberfroid D, Lachat C, Leroy JL, Holdsworth M, Maes L et al. Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: A systematic review. Am J Clin Nutr. 2012;96(2):415–38. https://doi.org/10.3945/ajcn.112.035378

  56. Reddy P, Dukhi N, Sewpaul R, Ellahebokus MAA, Kambaran NS, Jobe W. Mobile health interventions addressing childhood and adolescent obesity in sub-Saharan Africa and Europe: current landscape and potential for future research. Front Public Heal. 2021;9(March):1–9.

    Google Scholar 

  57. McQuinn S, Belton S, Staines A, Sweeney MR. Co-design of a school-based physical activity intervention for adolescent females in a disadvantaged community: insights from the girls active project (GAP). BMC Public Health. 2022;22(1):1–18. https://doi.org/10.1186/s12889-022-12635-w

  58. Anselma M, Altenburg TM, Emke H, Van Nassau F, Jurg M, Ruiter RAC, et al. Co-designing obesity prevention interventions together with children: intervention mapping meets youth-led participatory action research. Int J Behav Nutr Phys Act. 2019;16(1):1–15.

    Article  Google Scholar 

  59. Almughamisi M, O’Keeffe M, Harding S. Adolescent obesity prevention in Saudi Arabia: co-identifying actionable priorities for interventions. Front Public Heal. 2022;10(May):1–11.

    Google Scholar 

  60. Ball R, Duncanson K, Ashton L, Bailey A, Burrows TL, Whiteford G et al. Engaging new parents in the development of a peer nutrition education model using participatory action research. Int J Environ Res Public Health. 2022;19(1).

  61. Daly-Smith A, Quarmby T, Archbold VSJ, Corrigan N, Wilson D, Resaland GK, et al. Using a multi-stakeholder experience-based design process to co-develop the creating active schools framework. Int J Behav Nutr Phys Act. 2020;17(1):1–12.

    Article  Google Scholar 

  62. Chan CMJ, Müller-Riemenschneider F, Chia MYH, Hildon ZJL, Chong MFF. Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore. Pilot Feasibility Stud. 2024;10(1):1–13. https://doi.org/10.1186/s40814-024-01479-3

  63. Gadke DL, Kratochwill TR, Gettinger M. Incorporating feasibility protocols in intervention research. J Sch Psychol. 2021;84(December 2020):1–18. https://doi.org/10.1016/j.jsp.2020.11.004

  64. Abraham C, Michie S. A taxonomy of Behavior Change techniques used in interventions. Heal Psychol. 2008;27(3):379–87.

    Article  Google Scholar 

  65. Prestwich A, Whittington C, Dombrowski SU, Rogers L, Michie S. Supplemental material for does theory influence the effectiveness of health behavior interventions? Meta-analysis. Heal Psychol. 2014;33(5):465–74.

    Article  Google Scholar 

  66. Jeong YH, Healy LC, McEwan D. The application of goal setting theory to goal setting interventions in sport: a systematic review. Int Rev Sport Exerc Psychol. 2023;16(1):474–99. https://doi.org/10.1080/1750984X.2021.1901298

  67. Willmott TJ, Pang B, Rundle-Thiele S. Capability, opportunity, and motivation: an across contexts empirical examination of the COM-B model. BMC Public Health. 2021;21(1):1014. https://doi.org/10.1186/s12889-021-11019-w

  68. Schulz R. Intervention taxonomy (ITAX): describing essential features of interventions (HMC). Heal (San Fr. 2010;34(6):811–21.

    Google Scholar 

  69. Kok G, Gottlieb NH, Peters GJY, Mullen PD, Parcel GS, Ruiter RAC, et al. A taxonomy of behaviour change methods: an intervention mapping approach. Health Psychol Rev. 2016;10(3):297–312.

    Article  PubMed  Google Scholar 

  70. Bailey RL. Overview of dietary assessment methods for measuring intakes of foods, beverages, and dietary supplements in research studies. Curr Opin Biotechnol. 2021;70:91–6. https://doi.org/10.1016/j.copbio.2021.02.007

  71. Zhao X, Xu X, Li X, He X, Yang Y, Zhu S. Emerging trends of technology-based dietary assessment: a perspective study. Eur J Clin Nutr. 2021;75(4):582–7.

    Article  PubMed  Google Scholar 

  72. Maugeri A, Barchitta M. A systematic review of ecological momentary assessment of diet: implications and perspectives for nutritional epidemiology. Nutrients. 2019;11(11):2696. https://doi.org/10.3390/nu11112696

  73. Mason TB, Do B, Wang S, Dunton GF. Ecological momentary assessment of eating and dietary intake behaviors in children and adolescents: a systematic review of the literature. Appetite. 2020;144(June 2019):104465. https://doi.org/10.1016/j.appet.2019.104465

  74. Ward S, Bélanger M, Donovan D, Carrier N. Systematic review of the relationship between childcare educators’ practices and preschoolers’ physical activity and eating behaviours. Obes Rev. 2015;16(12):1055–70.

    Article  PubMed  CAS  Google Scholar 

  75. Cecilia-Costa R, Hansmann M, McGill DE, Volkening LK, Laffel LM. Association of executive function problems and disordered eating behaviours in teens with type 1 diabetes. Diabet Med. 2021;38(11).

  76. Somerville LH, Jones RM, Casey BJ. A time of change: behavioral and neural correlates of adolescent sensitivity to appetitive and aversive environmental cues. Brain Cogn. 2010;72(1):124–33. https://doi.org/10.1016/j.bandc.2009.07.003

  77. Kharasch ED, Avram MJ, Clark JD, Davidson AJ, Houle TT, Levy JH, et al. Peer Review Matters: Research Quality and the Public Trust. Anesthesiology. 2021;134(1):1–6.

    Google Scholar 

  78. Benzies KM, Premji S, Hayden KA, Serrett K. State-of-the-evidence reviews: advantages and challenges of including grey literature. Worldviews Evidence-Based Nurs. 2006;3(2):55–61.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Nandeeta Samad is funded by a PhD scholarship from the Government of Bangladesh, the Bangabandhu Science and Technology Fellowship. Divya Parmar is funded by the GACD-MRC IMPACT Grant (MR/Y009983/1) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the funders or the UK Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. For the purpose of open access, the author(s) has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, UK

    Nandeeta Samad, Lindsay Bearne & Divya Parmar

  2. Population Health Research Institute, St George’s, University of London, London, UK

    Lindsay Bearne

  3. James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh

    Farha Musharrat Noor & Fahmida Akter

Authors
  1. Nandeeta Samad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lindsay Bearne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farha Musharrat Noor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fahmida Akter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Divya Parmar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NS was the primary reviewer and FN was the second reviewer during the review screening process. LB, FA, and DP contributed to resolving discrepancies in reviews if they occurred. NS prepared the draft with substantial input from LB, FN, FA, and DP. All authors approved the submitted version.

Corresponding author

Correspondence to Nandeeta Samad.

Ethics declarations

Ethical approval and consent to participate

Not applicable.

Consent for publication

All authors consented for the publication.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Samad, N., Bearne, L., Noor, F.M. et al. School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review. Int J Behav Nutr Phys Act 21, 117 (2024). https://doi.org/10.1186/s12966-024-01668-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12966-024-01668-6

Keywords

International Journal of Behavioral Nutrition and Physical Activity

ISSN: 1479-5868

Contact us