Table 4

Policy summaries and results
Study Involvement Policy components Impact† Results Sig
Stakeholder* Family BMI-SDS Ov Ob BF BMIHFZ Statistic (95% confidence interval) unless otherwise stated
Diet policies
Foster, et al. 2008 [55] a,c,e,f,h School nutrition policy initiative
- - Adjusted change in BMI-SDS -0.01 (-0.08,0.06)
Adjust odds ratio overweight 0.65 (0.54,0.79) Sig
Adjusted odds ratio obesity 1.09 (0.85,1.40)
Baxter, et al. 2009 [53] Location of School Breakfast Program consumption
- - - - Δ mean BMI% breakfast in classroom compared to the cafeteria 2.64 (p=0.06)
Henry, 2006 [50] National School Lunch Program -
- - - Hedges’ g overweight 1.39 (0.55,2.24) Sig
Hernandez, Francis and Doyle, 2003 [41] National School Lunch Program
- - - - Adjusted change in BMI Kindergarten: 0.12 (-0.33,0.57)
Adjusted change in BMI 1st grade: 0.20 (-0.29,0.69)
Adjusted change in BMI 3rd grade: 0.36 (-0.25,0.97)
Adjusted change in BMI 5th grade: 0.52 (-0.24,1.28)
Hinrichs, 2010 [47] National School Lunch Program
- - Adjusted change in BMI ♂ -0.02 (-0.06,0.02), ♀ -0.02 (-0.07,0.03)
Change in prevalence of overweight ♂ <-0.01 (-0.01,<0.01), ♀ <-0.01 (-0.01, <0.01)
Change in prevalence of obesity ♂ <-0.01 (<-0.01, <0.01), ♀ <-0.01 (<-0.01, <0.01)
Millimet, Tchernis and Husain, 2008 [43] and 2010 [44] Bivariate Probit results assuming ρ=0.1
National School Lunch Program, -
- - Change in probability of being overweight 0.13 (0.07, 0.20)
Change in probability of being obese 0.13 (0.05, 0.20)
School Breakfast Program -
- - Change in probability of being overweight -0.07 (-0.14, <-0.01)
Change in probability of being obese -0.05 (-0.13, 0.03)
Millimet and Tchernis, 2009 [42] Bias corrected minimum bias estimator assuming θ=0.25
School Breakfast Program
- - Change in BMI growth rate 3rd grade: -0.03 (-0.06, <-0.01)
Change in probability of overweight 3rd grade: -0.21 (-0.33, -0.03)
Change in probability of obesity 3rd grade: -0.17 (-0.26, -0.01)
Change in BMI growth rate 5th grade: -0.04 (-0.08, 0.01)
Change in probability of overweight 5th grade: -0.28 (-0.40, -0.09)
Change in probability of obesity 5th grade: -0.12 (-0.28, -0.04)
Ramirez-Lopez, et al. 2005 [54] School Breakfast Program
- Change in BMI Intervention: 0.1, Control: -0.1
Change in BF% Intervention: -0.2, Control: -0.5
Change in prevalence of overweight or obesity Intervention: 1, Control: -1
Change prevalence of obesity Intervention: 1, Control:-3
Fox, et al. 2009 [56] À la carte LNED food not available
-
- - Adjusted change in BMI-SDS -0.15 (-0.37,0.07)
Adjusted odds ratio obesity 1.09 (0.57,2.08)
Milk not available for school lunch
-
- - Adjusted change in BMI-SDS -0.13 (-0.33,0.07)
Adjusted odds ratio obesity 1.17 (0.75,1.82)
Fresh fruit/ raw vegetables available
-
- - Adjusted change in BMI-SDS 0.19 (0.01,0.37)
Adjusted odds ratio obesity 1.13 (0.73,1.75)
Fried potato products not available
-
- - Adjusted change in BMI-SDS 0.20 (<0.01,0.40)
Adjusted odds ratio obesity 2.70 (1.58,4.62) Sig
Desserts offered ≤once a week
-
- - Adjusted change in BMI-SDS 0.08 (-0.08,0.24)
Adjusted odds ratio obesity 1.78 (1.13,2.80) Sig
Jones, et al. 2003 [34] Adjusted odds ratio overweight and obesity:
National School Lunch Program -
- - Food secure ♂1.06 (0.53,2.08), ♀0.49 (0.22,1.10),
Food insecure ♂0.62 (0.25,1.54), ♀0.29 (0.11,0.80) Sig♀
School Breakfast and National School Lunch Programs -
- - Food secure ♂1.33 (0.81,2.18), ♀0.66 (0.35,1.26)
Food insecure ♂0.85 (0.42,1.74), ♀0.42 (0.19,0.96) Sig♀
Physical activity policies
Donnelly, et al.2009 [62] h Physical Activity Across the Curriculum
- - BMI Hedges’ g 0.01 (-0.09,0.11)
Heelan, et al. 2009 [61] Walking school bus scheme
- -
- Intervention vs. Control BMI-SDS Hedges’ g: -0.21 (-0.58,0.15)
Frequent v. passive BMI-SDS Hedges’ g: -0.49 (-0.94,-0.03) Sig
Infrequent v. passive BMI-SDS Hedges’ g: -0.17 (-0.61,0.28)
Intervention vs. Control BF% Cohen’s d: -0.25 (-0.61,0.11)
Frequent v. passive BF% Cohen’s d: -0.59 (-1.05,-0.13) Sig
Infrequent v. passive BF% Cohen’s d: -0.28 (-0.72,0.17)
Chiodera, et al.2008 [60] Professionally led PE
- - - - Change in BMI grade 1: -0.21 Sig
Change in BMI grade 2: -0.05
Change in BMI grade 3: -0.06
Change in BMI grade 4: 0.04
Change in BMI grade 5: 0.02
Datar and Sturm, 2004 [38] Increased PE duration of 1 hour per week
- - - - Adjusted change in BMI, normal weight ♂ 0.04 (-0.04,0.12)
Adjusted change in BMI, normal weight ♀ 0.01 (-0.07,0.10)
Adjusted change in BMI, overweight or obese ♂ -0.07 (-0.19,0.05)
Adjusted change in BMI, overweight or obese ♀ -0.32 (-0.46,-0.17) Sig
Fernandes, 2010 [39] and Fernandes and Sturm, 2011 [40] Meeting the National Association for Sport and Physical Education (NASPE) guidelines
- - - - PE duration Adjusted change in BMI% -0.74 (-1.78,0.30), ♂ -1.56 (-3.03,-0.09), ♀ 0.05 (-1.40,1.50) Sig♂
Break period duration: adjusted change in BMI% -0.74 (-1.33,-0.15), ♂ -0.81 (-1.67,0.05), ♀ -0.69 (-1.49,0.11) Sig
Combined policies
Johnson, et al. 2012 [31] e,f,g,h Be Active Eat Well
- - - - Adjusted change in BMI-SDS -0.085 (-0.18,0.01)
HE policy
- - - - Adjusted change in BMI-SDS -0.008 (-0.06,0.04)
PA policy
- - - - Adjusted change in BMI-SDS -0.006 (-0.06,0.05)
Jordan, et al. 2008 [25,64] b,c,d,e,f,h Utah’s Gold Medal Schools
- - - - Change in BMI-SDS Intervention: 0.21 (-0.71,1.13), Control: 0.53 (-0.21,1.27)
Chomitz, et al. 2010 [63] c,e,f,h Healthy Living Cambridge Kids
- - Change in BMI-SDS -0.04 Sig
Change in prevalence of overweight 0.6% points
Change in prevalence of obesity -2.2% points Sig
Harrison, et al. 2011 [57] Cookery lessons - - -
- None of the policies were significantly associated with FMI in females, while only being able to eat any food at break times and being able to play 3-4 games during break times where association with higher FMI in males.
Foods permitted during break periods - - -
-
HE policy - - -
-
Sports allowed during break periods - - -
-
‘Park and stride’ scheme - - -
-
PA policy - - -
-
PA and HE policy - - -
-
Veugelers and Fitzgerald, 2005 [26,58] Nutrition policy -
- - Adjusted odds ratio overweight: 0.91 (0.77,1.09)
Adjusted odds ratio obesity: 0.85 (0.63,1.55)
a,c,d,e,f,g,h Annapolis Valley Health Promoting Schools Project -
- - Adjusted odds ratio overweight: 0.41 (0.32,0.53) Sig
Adjusted odds ratio obesity: 0.28 (0.14,0.57) Sig
Zhu, et al. 2010 [59] a,b,d,f,g,h Professionally led PE - - - -
Adjusted change in BMIHFZ achievement rate 0.62 (0.01,1.23) Sig
Duration of PE periods - - - -
Adjusted change in BMIHFZ achievement rate 0.05 (-0.03,0.13)
Number of PE periods - - - -
Adjusted change in BMIHFZ achievement rate 1.06 (0.47,1.65) Sig
Duration of Break periods - - - -
Adjusted change in BMIHFZ achievement rate 2.71 (1.75,3.67) Sig
Number of break periods - - - -
Adjusted change in BMIHFZ achievement rate -2.25 (-3.86,-0.64) Sig
Cancel due to weather - - - -
Adjusted change in BMIHFZ achievement rate -1.26 (-3.73,1.21)
PE exemptions - - - -
Adjusted change in BMIHFZ achievement rate -0.34 (-0.65,-0.03) Sig
USDA - - - -
Adjusted change in BMIHFZ achievement rate 0.02 (-1.49,1.53)
Wellness council - - - -
Adjusted change in BMIHFZ achievement rate 0.41 (-0.04,0.86)

Abbreviations: male, female, BF% body fat percentage, BMI body mass index, BMI% BMI percentile, BMIHFZ BMI Healthy Fitness Zone [45], BMI-SDS BMI standard deviation score, FSM free or reduced school meals, HE healthy eating, LNED low-nutrient, energy-dense, PA physical activity, PE physical education, SD standard deviation, SE standard error, Sig p < 0.05, TV television, USDA United States Department of Agriculture wellness program.

*Stakeholders: school administratorsa, school boardb, sports coachesc, food servicesd, health servicese, parentsf, pupilsg, teachersh.

†Impact: a symbolic representation of the statistical results. : positive association, : negative association, : mixed association, : no association. Black arrows indicate significance (p < 0.05), while grey indicates non-significance (p > 0.05) [51,52].

Williams et al.

Williams et al. International Journal of Behavioral Nutrition and Physical Activity 2013 10:101   doi:10.1186/1479-5868-10-101

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