Healthier Choices in School Cafeterias: A Systematic Review of Cafeteria Interventions

Gordon, Katelyn; Dynan, Linda; Siegel, Robert

doi:10.1016/j.jpeds.2018.07.031

Cited by 14 publications

(7 citation statements)

References 62 publications

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“…One review 27 was of high quality according to AMSTAR 2, whereas all the others were of low (seven reviews) to moderate quality (five reviews). Thirteen reviews that were of critically low quality were excluded, 41–53 with the main reasons being lack of information provided in the reviews, particularly regarding quality assessment of the included studies. The main reasons for judging seven reviews to be of low quality according to the AMSTAR 2 was that risk of bias of individual studies was not accounted for when interpreting the results of the review and in some cases that review authors did not report separate summaries for RCTs and NRCTS when including both study designs.…”

Section: Resultsmentioning

confidence: 99%

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews

et al. 2020

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The aim of this overview of systematic reviews was to summarize evidence from up-to-date reviews of the effectiveness of interventions aimed at preventing overweight and obesity in adolescents aged 10 to 19 years. We searched nine databases for systematic reviews published between January 2008 and November 2019. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 to assess the quality of reviews, excluding those of critically low quality, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to grade the certainty of included evidence. We included 13 reviews. Three reviews focused on dietary behaviour, six on physical activity, and four on both types of behaviours. Individual-oriented and school-based interventions dominated. Results across reviews showed little or no effect on body mass index, or physical activity levels of adolescents, whereas results from a couple of reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e., consumption of sugar-sweetened beverages). The certainty of evidence was low to very low for all outcomes. Overall, the evidence base for the effect of primary interventions to prevent overweight and obesity in adolescents is weak. In particular, there is a lack of reviews assessing the impact of environmental interventions targeting adolescents, and reviews addressing social inequality are virtually absent from this body of literature.

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Section: Resultsmentioning

confidence: 99%

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews

et al. 2020

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“…Importantly, the more traditional techniques (e.g., attractive bowls, verbal prompts, creative names, etc.) have generally been found to be effective at improving the selection of certain meal components, especially fruits and vegetables, in prior systematic reviews [29][30][31][32]. Therefore, schools should not abandon these practices, but also not rely only on these approaches to improve students' school meal intakes.…”

Section: Discussionmentioning

confidence: 99%

“…However, a scoping review of research examining factors that impact school meal consumption has not been conducted. Several systematic reviews have examined techniques to nudge students towards healthier options (i.e., choice architecture), but many of the included studies only measured selection [28][29][30][31][32][33][34]. Other recent school-based reviews have been limited in scope, such as examining only fruits and vegetables [23,35,36].…”

Section: Introductionmentioning

confidence: 99%

Strategies to Improve School Meal Consumption: A Systematic Review

et al. 2021

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School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

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“…(2) government policy for public health; and (3) patient, provider and health care systems in medical care decisions. We then discuss the application of BE to sustainable development goals [3].…”

Section: Materials and Methods Reviewmentioning

confidence: 99%

“…Increasing the availability, variety and portion sizes of fruits and vegetables in relation to less healthy choices have also been shown to increase the selection of healthy items [24,25]. In a systematic review of behavioral economic interventions targeting child decision making in school cafeterias, Gordon et al showed that interventions that relied on Kahneman's System 1 thinking (e.g., visual clues) were much more likely to be successful than those that relied on System 2 thinking (e.g., information comparison) [3].…”

Section: Survey Of the Application Of Be To Individual Choice-evidenc...mentioning

confidence: 99%

Behavioral Economics: A Primer and Applications to the UN Sustainable Development Goal of Good Health and Well-Being

Siegel

Gordon

Dynan

2021

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Behavioral economics (BE) is a relatively new field within economics that incorporates insights from psychology that can be harnessed to improve economic decision making with the potential to enhance good health and well-being of individuals and societies, the third of the United Nations Sustainable Development Goals. While some of the psychological principles of economic decision making were described as far back as the 1700s by Adam Smith, BE emerged as a discipline in the 1970s with the groundbreaking work of psychologists Daniel Kahneman and Amos Tversky. We describe the basic concepts of BE, heuristics (decision-making shortcuts) and their associated biases, and the BE strategies framing, incentives, and economic nudging to overcome these biases. We survey the literature to identify how BE techniques have been employed to improve individual choice (focusing on childhood obesity), health policy, and patient and healthcare provider decision making. Additionally, we discuss how these BE-based efforts to improve health-related decision making can lead to sustaining good health and well-being and identify additional health-related areas that may benefit from including principles of BE in decision making.

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Healthier Choices in School Cafeterias: A Systematic Review of Cafeteria Interventions

Cited by 14 publications

References 62 publications

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews

Strategies to Improve School Meal Consumption: A Systematic Review

Behavioral Economics: A Primer and Applications to the UN Sustainable Development Goal of Good Health and Well-Being

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