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Key Elements in Elementary School-Based Nutrition Interventions to Reduce Obesity in Mexico and the United States: A Systematic Review

      Objective

      To identify and compare elements in school-based nutrition intervention programs that improved dietary habits and anthropometrics in populations of Hispanic children in the United States and Mexico.

      Design, Setting, Participants, and Intervention

      Articles, between 01-2005 and 12-2015, were extracted from PubMed, PsycINFO, and Web of Science using key words: school-based interventions, diet/nutrition, overweight/obesity, 6-12 year old children, Hispanic, Latino/a, and United States/Mexico. A 9- and 7–point inclusion and exclusion criteria, respectively, were established. Two researchers independently extracted articles, applied exclusion/inclusion criteria to titles and abstracts, and assessed the quality of included articles using the Academy of Nutrition and Dietetics Evidence Analysis Manual.

      Outcome, Measures, Analysis

      Diet quality improvement included increased consumption of whole grains and fruits/vegetables, and reduction of total fats, added sugars, and salt. Anthropometric measurements included BMI, waist circumference and skin fold.

      Results

      A total of 149 articles were found, of which 40 articles were examined after exclusion/inclusion criteria. Ten articles (Mexico= 6; US=4) were included in the study based on quality assessment. Seven studies reported improvements in children’s anthropometric measurements. All studies reported improvement in at least one of the dietary behaviors. Elements associated with larger improvements in outcomes across countries and programs were: using a behavior change framework, using multiple frameworks, active community participation during design and implementation of intervention, and uniform messaging from school members and parents.

      Conclusions and Implications

      The evidence supports that efficacious elementary school-based interventions to reduce obesity included several behavior change frameworks and the active participation of stakeholders. Further research needs to examine the optimal combination of frameworks and specific elements that result in improved outcomes.

      Funding

      None

      Supplementary data