Food Environment and Childhood Overweight/Obesity: A Systematic Review.

Childhood overweight/obesity has emerged as a pressing public health concern globally, and the impact of the food environment on children's diets and health outcomes has gained heightened attention. Comprehensive and child-specific monitoring systems are critical for guiding targeted interventions and policies. This review aimed to synthesize recent literature on food environment indicators associated with children with overweight/obesity using the 4A framework, including food availability, accessibility, affordability, and appeal. We conducted a systematic search of peer-reviewed literature (2020-2025). This systematic review is guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses and involved narrative synthesis and framework-based classification (CRD420251116187). A total of 75 observational and 6 intervention studies are included. Indicators related to availability (e.g., home food supply and fast food outlet density) and accessibility (e.g., proximity to healthy food stores) are most commonly studied, whereas affordability and appeal indicators (e.g., food pricing and marketing exposure) are less frequently addressed. Current evidence underscores deficiencies in the measurement and monitoring of the food environment for children, which is important to prevent and manage childhood overweight/obesity using integrated indicators at home, schools, communities, and society. Moreover, there is a necessity to develop a standardized, child-centered food environment monitoring system, facilitating prompt, equity-sensitive policy action to address children with overweight/obesity on a worldwide scale, which also supports global sustainable development. This systematic review paper will be useful for selecting indicators to construct a food environment monitoring system.