Impact of multi-component school food environment interventions on adiposity and food consumption in children and adolescents: systematic review and meta-analysis.

Childhood overweight and obesity are growing public health concerns, leading to metabolic consequences such as increased body mass index, larger waist circumference, and excess body fat. Multi-component school interventions that address both the obesogenic environment and individual behaviors have been recommended, but their effectiveness remains uncertain. This review and meta-analysis, conducted following PRISMA guidelines, examined the impact of multi-component interventions - including modifications to the school food environment - on adiposity and food consumption among children and adolescents. A search on MEDLINE, SciELO, CENTRAL, Clinical Trials, Scopus, Embase, and Web of Science identified 51 eligible studies. The meta-analysis showed a small but significant reduction in waist circumference (MD: -0.70cm; 95%CI: -1.22, -0.19; I2 = 40%). Interventions were also linked to lower intake of unhealthy foods, total energy, total fat, saturated fat, and increased vegetable consumption. However, no consistent effects were observed for body mass index or body fat percentage. Study quality varied, and intervention designs and implementation strategies were heterogeneous; thus, results should be interpreted cautiously. These findings suggest that while school food environment interventions can improve some dietary behaviors and adiposity indicators, their effectiveness in preventing obesity remains inconclusive. Strengthening policies and ensuring long-term, structured interventions are crucial for meaningful and sustained health improvements in school settings.