Evidence-Based Strategies for School Nutrition and Physical Activity

About the research

• In this issue, CDC identifies evidence-based strategies that district and school leaders can use to improve the nutrition and physical activity environments.
• These strategies affect student and school staff physical activity and nutrition knowledge, attitudes, perceptions, and behaviors.
• Several school health practices highlighted in the issue include low- and no-cost physical activity and nutrition efforts to advance health equity.
• Below is an overview of the research and strategies from eight articles.

School nutrition

Implement policies and practices that promote healthy eating among K–12 students

It's helpful to use multiple approaches to improve the school nutrition environment and services. These approaches can help students learn about and adopt healthy food and beverage choices.

• Set nutrition standards for school meals and foods served outside of school meals, like in after-school programs.
• Provide school nutrition professionals with ongoing professional development.
• Improve the taste of school meals.
• Offer taste tests of menu items.
• Pre-slice fruit.
• Provide recess before (instead of after) lunch.
• Offer incentives or rewards for trying healthier options.

Physical education and physical activity

Adopt policies and practices to increase student physical activity during the school day

Schools can use a Comprehensive School Physical Activity Program (CSPAP) to increase student physical activity before, during, and after school.

School-level physical activity policies, physical education, and recess all help increase physical activity during the school day.

• Provide classroom physical activity breaks.
• Integrate physical activity into lesson plans.
• Use active commuting options (such as Safe Routes to School and walking school buses).
• Implement school-wide physical activity strategies, such as:
  • A district-mandated 20-minute physical activity policy.
  • A school-wide structured walking program.
  • A district-level fitness assessment policy.
  • An Active School Day policy.
• Use a pre-packaged physical education curriculum.
• Implement a physical education policy or requirement.
• Increase physical activity opportunities during recess, such as:
  • Creating activity zones.
  • Redesigning the playground.
  • Adding greenspace.
  • Using teacher activity prompts.

A CSPAP can guide and encourage schools to implement these intervention strategies.

Health education

Provide health education that gives students the knowledge, attitudes, skills, and experiences needed for lifelong healthy eating and physical activity

Standards-based K–12 health education that includes nutrition and physical activity helps prepare students to make healthy decisions now and as adults.

• Require pre-K–12 health education.
• Offer health education that includes units on nutrition and physical activity, with a focus on strategies such as:
  • Taste testing.
  • School gardening.
  • Physically active lessons.
  • Peer mentoring.
• Integrate health education content with other subject areas.
• Make health education accessible to all; help disseminate evidence-based, culturally appropriate, and tailored physical activity and nutrition health education to communities.

More research may help us understand which physical activity- and nutrition-focused health education strategies best address and reduce inequities. Such research can include evaluations to understand what works for different cultures, ages, and grade levels.

School environment and physical and social-emotional well-being

Establish healthy school environments to support student and employee physical activity, dietary behaviors, and mental health

The school environment consists of the physical environment and social-emotional climate. The entire school environment plays a key role in both student and employee health. Creating healthy school environments can support student and employee physical activity, dietary behaviors, and mental health.

• Transform or modify physical environments to increase students' healthy eating behaviors.
  • Influence healthy food choice with marketing (such as banners throughout school, announcements over loudspeakers, color-coded items on school lunch menus).
  • Place emoticons next to healthy food options, or display photos of model trays with vegetables.
  • Alter plating, portion sizes, or presentation, such as serving pre-sliced apples or vegetables.
• Change the physical environment to increase students' physical activity and other prosocial play.
  • Purchase physical activity equipment, such as slides, swings, ladders, and various climbing structures.
  • Add painted play spaces or markings to the playground.
  • Play music during physical education class.
  • Enhance green spaces and nature within the playgrounds.
• Enhance the nutrition and physical activity environment for school employees.
  • Install teaching kitchens and school gardens.
  • Share nutrition information (such as displaying banners and advertising walking routes).
  • Support infrastructure options, such as sit-to-stand desks, elliptical machines, treadmills, stairwells, and walking paths.
• Introduce yoga/mindfulness programming:
  • Include evidence-based yoga/mindfulness curricula for students and school employees.
  • Include mindfulness in the school day.

These interventions, among others, had positive influences on student physical activity and dietary behaviors. Interventions promoting a social-emotional climate (like yoga/mindfulness, prosocial play) had promising effects on students' and employees' mental health and emotional well-being.

Out-of-school time

Promote physical activity and healthy eating during out-of-school time

Out-of-school time (OST) programs can complement school-day efforts to address physical activity and nutrition. These programs can also increase options for students to be active and eat healthful foods.

Multiple interventions can enhance the OST program environment, staff practices, and student behaviors. Interventions may include organizational-level policy changes and physical activity programming.

• Adopt policy changes to support nutritious foods and routine physical activity.
• Train staff how to use "ready-made," evidence-based programs and after-school curricula to increase physical activity.
• Design professional development to be responsive and flexible to staff turnover. Options may include peer-learning communities and train-the-trainer approaches.
  • Work with nonprofits or community organizations to deliver OST programs or program support.
  • Strengthen relationships between after-school program staff and school nutrition professionals. This can increase encourage following nutrition standards.

Most of the studies in this review focused on after-school programs. Additional research could address a gap in knowledge, such as looking at:

• Effects of school-based summer or before-school programming on youth physical activity or dietary intake.
• Other potential benefits, such as effects on learning.

To maximize their potential impact, OST programs need to be accessible to families. Providing transportation and increasing family awareness of available childcare subsidies for school-aged children may help address some barriers to participation.

Family and community engagement

Engage families and community members in school health efforts

Most current evidence on family and community engagement focuses on school and OST interventions for physical activity and nutrition. There is value in these multicomponent approaches, including family and community engagement strategies, in school and OST interventions.

• Use various ways to communicate with families about school health policies, practices, and programs. Examples include: newsletters; emails or websites; parent listservs; telephone calls; parent information nights; and parent handbooks, booklets, and postcards.
• Provide classes and support for families. Family nights or family wellness events can bring families to the school, to interest them in health education and promotion activities.
• Engage families and community members in volunteer activities to support school health initiatives. Options include preparing and serving student meals, providing social support for physical activity programs, and leading a district-wide fitness challenge.
• Involve families and community members in decision making for school health policies and practices.
• Provide students and their families with activities that could be done at home to reinforce messages and practices learned about nutrition and physical activity.
• Link students and their families to resources, programs, and services provided by the community.

As a big step forward, future research could better identify and explain the family and community engagement strategies used. Research could also assess the resources needed to use these approaches—to improve student health behaviors and outcomes.

School employee health and well-being

Support school staff with employee health and well-being programs

Multi-component employee health and well-being programs can improve the health of staff and organizations. These programs can address many physical and emotional concerns of school staff and may be effective at supporting nutrition and physical activity.

• Increase physical activity and reduce sedentary time by using alerts and prompts to disrupt sedentary behavior and foster activity breaks.
• Promote lifestyle changes, such as offering lessons on types of nutritious foods, and ways to incorporate more physical activity. Lifestyle changes can prevent or delay chronic health conditions (such as type 2 diabetes and cardiovascular disease) and support weight management.
• Provide teachers and staff with opportunities for physical activity. Also offer opportunities for role modeling, participating in behavior change campaigns, and training and education on health and well-being.

When schools offer employee health and well-being programs, it shows faculty and staff that they are valued and important to the organization. These programs can create a positive work environment by improving working conditions, addressing safety concerns, and promoting collegial relationships.

Coordinated school health approach

Coordinate healthy eating and physical activity policies and practices

School health coordination can occur at different levels, including within and across classrooms, in school departments, and among all school staff. Bringing together various people and parts of the school can affect environmental outcomes and health behaviors.

Coordinated school health approaches involve the following:

• Setting up infrastructure (school health councils and coordinators) within school district and school levels.
• Conducting needs assessments of health policies, practices, and programs.
• Revising policies, practices, and programs, as needed.
• Coordinating health strategies and activities across multiple parts of the Whole School Whole Community, Whole Child (WSCC) framework.

Strategies:

• Use assessment tools, such as the School Health Index and the Wellness Policy in Action Tool. These tools can identify school health needs and improve the implementation of wellness policies.
• Consider revising nutrition and physical activity policies using precise, clear language—so that the policies are more easily understood and implemented.
• Coordinate school health strategies using two or more components of the WSCC framework—to improve physical activity and dietary behaviors.
• Communicate with families about school health policies, practices, and programs. You can use: newsletters; emails or websites; parent listservs; telephone calls; parent information nights; and parent handbooks, booklets, and postcards.