Combinations of obesity prevention strategies in US elementary schools: a critical review.

The prevalence of obesity among children has roughly tripled in the past 30 years. Given the numerous health risks associated with obesity, elementary schools have implemented a variety of prevention programs targeting this problem. This review examines recent studies of combinations of obesity prevention programs in US elementary schools and offers recommendations about effective strategies. We found 12 studies that met selection criteria and reviewed their findings related to obesity-related outcomes. Among the single intervention strategies, neither physical activity nor education alone demonstrated efficacy in reducing objective measures of obesity. Most studies of programs with two or three components (i.e., physical activity plus nutrition, physical activity plus both education and nutrition) reported statistically significant improvements in objective obesity-related outcomes. Studies evaluating programs with community and parental involvement suggest that these components may increase effectiveness. However, studies assessing outcomes following the cessation of the program showed a reversal of positive effects, suggesting that long-term implementation of programs is important for sustained gains. Results suggest that combinations of obesity prevention programs sustained over time are most likely to be effective.