Obesity among school-age students is a form of malnutrition resulting from excessive body fat relative to a child’s growth. Nutrition literacy plays an important role in shaping healthy eating behaviors and promoting long-term health. Although interest in this area has increased, evidence on the effectiveness and design of school-based programs to improve nutrition literacy remains limited. Therefore, this study aimed to (1) assess the effectiveness of interventions to promote nutrition literacy among school-age students for obesity prevention, and (2) identify the strategies, activity components, and implementation methods used in these interventions. A systematic review and meta-analysis were conducted of randomized and non-randomized controlled trials conducted in school settings. Nine databases—CINAHL Complete, ProQuest, PubMed, Scopus, Web of Science, ThaiJo, ThaiLIS, TCI, and Google Scholar (English and Thai leaguages)—were searched for studies published in English or Thai up to 14 February 2025. Studies were included if they evaluated school-based interventions designed to improve nutrition literacy among school-age students aged 6 to 12 years old for obesity prevention and reported at least one nutrition literacy, behavioral, or anthropometric outcome. Two reviewers independently screened the studies, extracted the data, and assessed methodological quality using the Effective Public Health Practice Project tool. Meta-analysis was performed when the data were sufficiently comparable. A total of 21 studies were included in the review, of which 18 were included in the meta-analysis. Overall, the findings showed that school-based interventions improved food and nutrition literacy among school-age students, particularly in cognitive domains such as knowledge and related competencies. Interventions were commonly delivered through classroom-based, teacher-led approaches and were often supplemented with practical activities such as cooking, tasting, gardening, label-reading tasks, and family or school support. The pooled analysis showed a significant improvement in food and nutrition literacy outcomes, whereas the effect on healthy eating behavior was small and not statistically significant. Across studies, behavioral and anthropometric outcomes were less consistent than literacy outcomes, and substantial heterogeneity was observed. School-based interventions can improve food and nutrition literacy among school-age students, but their effects on healthy eating behavior and anthropometric outcomes remain limited and inconsistent. Interventions that combine classroom teaching with practical skill-based activities and support from the family or school environment may be more promising than information-based approaches alone. Further studies with longer follow-up, clearer reporting of intervention content and implementation, and more consistent outcome measures are needed to clarify which intervention components are most effective for obesity prevention.
Posri et al. (Thu,) studied this question.