Which school-based interventions work better to combat obesity in children? A network meta-analysis.

Background: Adolescent obesity is linked to a higher risk of becoming obese adults and developing chronic diseases. School-based interventions, focusing on nutritional education and physical activity (PA), are crucial for preventing childhood obesity. This study aimed to evaluate the effectiveness of such interventions using network meta-analysis.

Methods: We searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies on school-based obesity interventions. Interventions included behavioral, nutritional, and physical activity components. Network meta-analysis (NMA) employed random-effects models, generating network plots. Surface under the cumulative ranking curve (SUCRA) ranked intervention efficacy.

Results: Sixty-one studies were included. School-based interventions significantly reduced body mass index z-score (z-BMI; mean difference [MD]: - 0.06; 95% CI: - 0.1, - 0.03) and BMI (MD: - 0.351; 95% CI: - 0.566, - 0.135). NMA indicated that combined interventions, PA + health education (HE) + school policy (SP), were more effective in reducing BMI than HE alone (MD: - 0.61; 95% CI: - 1.2, - 0.02). SUCRA rankings highlighted PA + HE + SP and PA alone as the most effective interventions in reducing BMI and z-BMI, respectively.

Conclusions: School-based interventions are effective long-term strategies for managing childhood obesity. Combining PA, HE, and SP showed the highest efficacy in reducing BMI. Meanwhile, intervention duration and parental involvement did not show any significant additional effect, necessitating further prospective studies.