Collection of Evidence-Based Strategies for School Nutrition and Physical Activity
CDC has published a collection of peer-reviewed articles that present a decade of school-based physical activity (PA) and nutrition intervention research conducted across multiple Whole School, Whole Community, Whole Child (WSCC) components. This research is presented in a special issue of the Journal of School Health titled, “Collection of Evidence-Based Strategies for School Nutrition and Physical Activity.”
In this special issue, CDC identifies evidence-based strategies that district and school leaders can use to improve the nutrition and PA environments. These strategies affect student and school staff PA and nutrition knowledge, attitudes, perceptions, and behaviors. Several school health practices highlighted in the issue include low and no-cost PA and nutrition strategies to advance health equity. Below is an overview of the research and strategies presented in eight separate articles:
Implement Policies and Practices That Promote Healthy Eating Among K-12 Students
Using multiple approaches to improve the school nutrition environment and services can provide students with opportunities to learn about and adopt food and beverage choices that support health.
- Implement nutrition standards for school meals and other foods outside of school meals, like 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.
The strategies improve access to healthier options that help students select and consume healthier items. Promising strategies that merit more exploration include consistently implementing smart snacks standards for competitive foods, ensuring that foods offered at classroom celebrations support student health, and addressing food and beverage marketing in school settings.
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 PA policies, physical education (PE), and recess all offer opportunities for increasing PA during the school day.
- Provide classroom PA breaks
- Integrate PA into lesson plans
- Use active commuting options (such as Safe Routes to School and walking school buses).
- Implement a school-wide PA strategies, such as:
- a district-mandated 20-minute PA policy
- a school-wide structured walking program
- a district-level fitness assessment policy
- an Active School Day policy
- Use a pre-packaged PE curriculum
- Implementing a PE policy or requirement
- Increasing PA opportunities during recess, such as:
- creating activity zones
- redesigning the playground
- adding greenspace
- using teacher activity prompts
A CSPAP can be used to guide and encourage schools to implement these intervention strategies.
Access the full article, “Physical Activity Interventions During the School Day: Reviewing Policies, Practices, and Benefits.”
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 PA is important for preparing students to make healthy decisions now and as adults.
- Require health education from pre-kindergarten through grade 12.
- Provide health education that includes units on nutrition and PA 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; enable dissemination of evidence-based, culturally appropriate and tailored PA and nutrition health education to communities.
More extensive research may help us can understand which PA- and nutrition-focused health education strategies best address and reduce inequities. Such research can include evaluations to understand what works for different cultures and ages or grade-levels.
Establish healthy school environments to support student and employee PA, dietary behaviors, and mental health.
The school environment, consisting of the physical environment and social-emotional climate, plays a crucial role in both student and employee health. Establishing healthy school environments can support student and employee PA, dietary behaviors, and mental health.
- Transform or modify physical environments to increase students’ healthy eating behaviors.
- Use marketing (such as banners throughout the school, communications through school loudspeakers, color-coded items on school lunch menus) to influence healthy food choices.
- Place emoticons next to healthy food options or display photographs of model trays with vegetables.
- Alter plating, portion sizes, or presentation, such as serving pre-sliced apples or vegetables.
- Transform the physical environment to increase students’ PA and other prosocial play behaviors.
- Purchase PA equipment, such as slides, swings, ladders, and various climbing structures for students to interact with.
- 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 PA environment for school employees.
- Install teaching kitchens and school gardens.
- Share nutrition information throughout the worksite (such as displaying banners and advertising walking routes).
- Enhance infrastructure supports, such as sit-to-stand desks, elliptical machines, treadmills, stairwells, and walking paths.
- Introduce yoga/mindfulness programming for students and school employees
- Include evidence-based yoga/mindfulness curricula for students and school employees.
- Introduce mindfulness opportunities into the school day.
These interventions, among others, had positive influences on student PA and dietary behaviors, and those with a social-emotional climate component (such as yoga/mindfulness and prosocial play) had promising impacts on both student and employee mental health and emotional well-being.
Promote Physical Activity and Healthy Eating During Out-of-School Time
Out of School Time (OST) programs can complement school-day efforts to address PA and nutrition and increase opportunities for students to be active and eat healthful foods.
Multiple interventions, including organizational-level policy changes and physical activity programming, can enhance the OST program environment, staff practices, and student behaviors.
- Adopt organizational policy changes to make nutritious foods and physical activity routinely available.
- Train staff on how to use “ready-made”, evidence-based, programs and afterschool curricula to increase physical activity.
- Design professional development to be responsive and flexible to staff turnover, including peer-learning communities and train-the-trainer approaches.
- Partner with nonprofits or community organizations to deliver OST programs or program support.
- Strengthen relationships between after-school program staff and school nutrition professionals to increase access to food storage and support the adoption of nutrition standards.
Most of the studies in this review focused on after-school programs. Additional research evaluating 1) the impacts of school-based summer or before-school programming on youth PA or dietary intake and 2) potential additional benefits, such as impacts on learning, could address a gap in knowledge. 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.
Engage Families and Community Members in School Health Efforts
Most of the current evidence on family and community engagement exists within multi-component school and OST interventions on PA and nutrition. Although it would be useful to understand how specific family and community engagement strategies affect student health behaviors, there is value in implementing these multicomponent approaches, including using a variety of family and community engagement strategies, within school and OST interventions.
- Use various methods to communicate with families about school health policies, practices, and programs, such as newsletters, emails or websites, parent listservs, telephone calls, parent information nights, and other informational materials like parent handbooks, booklets, and postcards.
- Provide educational classes and support for families. Family nights or family wellness events can attract families to the school to engage them in health education and promotion activities.
- Engage families and community members in volunteer opportunities to support school health initiatives, such as preparing and serving meals to students, providing social support for PA 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 PA.
- 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, as well as assess the resources needed to incorporate these approaches to improve student health behaviors and outcomes.
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 PA.
- Increase PA 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 strategies for incorporating more PA) to prevent or delay chronic health conditions, such as type 2 diabetes and cardiovascular disease, or to support obesity or weight management.
- Provide teachers and staff with opportunities for PA, role modeling, participation 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 are important to the organization. These programs can create a positive work climate and environment by improving working conditions, addressing safety concerns, and promoting supportive and collegial relationships.
Access the full article, “Supporting School Staff: Insights from Employee Health and Well-Being Programs.”
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 with engagement from all school staff. Bringing together multiple components of the whole school can impact environmental outcomes and health behaviors.
Coordinated school health approaches involve the following:
- Establishing 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 school health strategies and activities across multiple components of the WSCC framework.
- Use assessment tools (such as the School Health Index and the Wellness Policy in Action Tool) to identify school health needs and improve the implementation of wellness policies.
- Consider revising wording of policies for nutrition and PA, since policies written with exact, clear language are more easily understood and implemented.
- Coordinate school health approaches that use two or more components of the WSCC framework to improve PA and dietary behaviors.
- Communicate with families about school health policies, practices, and programs, such as newsletters, emails or websites, parent listservs, telephone calls, parent information nights, and other informational materials like parent handbooks, booklets, and postcards.
Access the full article, “Coordinated Approach: Comprehensive Policy and Action Planning.”
Health education, physical education, and classroom teachers can apply the evidence-based strategies in various ways, such as:
- Integrate PA and nutrition opportunities into classroom time.
- Provide classroom PA breaks that include activities to help students move.
- Integrate PA into course lesson plans.
- Practice yoga and mindfulness activities with students to help improve their focus and reduce anxiety and stress.
- Try hands-on, experiential learning, such as food taste tests.
- Engage students, families, and communities.
- Engage parents in school health activities to draw their support for instilling healthy behaviors at home.
- Gather input from students and families for the development of physical activity and nutrition programming.
- Engage community organizations and resources to support programming opportunities.
Resources that provide school staff, parents, and school groups (such as parent-teacher associations and organizations) ideas and strategies for working together to create a healthier school.
2020–2025 Dietary Guidelines for Americans
Science-based recommendations to instill good dietary habits among people aged 2 years or older that can promote health and reduce the risk for major chronic diseases.
Physical Activity Guidelines for Americans, 2nd ed.
Science-based recommendations to help people aged 6 years or older improve their health through physical activity.
Healthy People 2030 Topics and Objectives
Science-based, 10-year objectives for improving the health of Americans.