Preventing childhood obesity and diabetes: is it time to move out of the school?

Childhood obesity interventions in the USA and Europe have predominantly focused on the school environment for over two decades with mixed or modest success. The focus on school--while intuitive, apparently efficient, and convenient--does not address larger upstream environmental factors, which affect obesity among youth. In this article, we examine potential drawbacks and limitations of previous school-based obesity and diabetes prevention programs. The future of school-based obesity and diabetes interventions and potential strategies for improvement is explored. Increased use and reporting of diversified theoretical frameworks, formative research to inform the interventions, and process evaluations to improve programs are recommended. More importantly, addressing the broader issue of the overall food environment and its impact on children's diet with intensified involvement of key stakeholders, including families, supermarkets, and corner stores is essential. We discuss the development of healthy eating zones around schools as a potential tool in the fight to reduce childhood obesity.