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Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Background: Encouraging healthy lifestyles in children is a challenge. This project aimed to improve lifestyles of younger peers by engaging adolescent creators (ACs) to design and implement peer-led and social marketing (SM) health-promoting activities., Methods: A 10-month parallel-cluster randomised controlled school-based pilot study was performed in disadvantaged neighbourhoods in Reus (Spain) spanning two academic years (2015-2016/2016-2017). Eight primary schools (n=375 children) and four high schools (n=94ACs) were randomly placed in the intervention group. The 94 ACs (12-14 years) designed and implemented four SM activities for their younger peers (9-11 years). Eight primary schools (n=327 children) and three high schools (n=98 adolescents) served as the control group and received no intervention. Primary (physical activity and fruit consumption) and secondary outcomes (screen time, vegetables, soft drinks, sweets and fast food consumptions) were assessed with validated questionnaires at baseline and at the end of the study., Results: After 10 months, fruit consumption and physical activity were maintained in the children who consumed ≥1 fruit/day and spent ≥6 hours/week physical activity. However, compared with the controls, the intervention significantly increased the physical activity of girls to 15.6 min/week, whereas the percentage of girls who consumed sweets, soft drinks and fast food decreased significantly by 8.4%, 14.5% and 5.9%, respectively. Additionally, the percentage of ≥2 hour/weekday of screen time by boys decreased significantly by 8.2%., Conclusion: The European Youth Tackling Obesity-Kids, SM and peer-led intervention, effectively increased physical activity hours/week in girls, but was not effective in improving the percentage of children who consumed the recommended fruit. Moreover, the percentages of girls who consumed sweets, soft drinks and fast food and boys screen time decreased., Trial Registration Number: NCT02702336; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A wide range of chronic diseases could be prevented through healthy lifestyle choices, such as consuming five portions of fruits and vegetables daily, although the majority of the adult population does not meet this recommendation. The use of mobile phone applications for health purposes has greatly increased; these applications guide users in real time through various phases of behavioural change. This review aimed to assess the potential of self-monitoring mobile phone health (mHealth) applications to increase fruit and vegetable intake. PubMed and Web of Science were used to conduct this systematized review, and the inclusion criteria were: randomized controlled trials evaluating mobile phone applications focused on increasing fruit and/or vegetable intake as a primary or secondary outcome performed from 2008 to 2018. Eight studies were included in the final assessment. The interventions described in six of these studies were effective in increasing fruit and/or vegetable intake. Targeting stratified populations and using long-lasting interventions were identified as key aspects that could influence the effectiveness of these interventions. In conclusion, evidence shows the effectiveness of mHealth application interventions to increase fruit and vegetable consumption. Further research is needed to design effective interventions and to determine their efficacy over the long term.

Sustainability capacity, always considered a challenge, is the ability to maintain effective long-term intervention in a community. The aim of the study was to improve the sustainability capacity of effective "Som la Pera," a school-based, peer-led, social-marketing intervention that encourages healthy diet and physical activity, in low socioeconomic adolescents from Spain. The sustainability capacity was analyzed by a "programme sustainability assessment tool (PSAT)" comprising eight domains: political support, funding stability, partnerships, organizational capacity, programme evaluation, programme adaptation, communications, and strategic planning. Each domain was evaluated from 1 (no or to a small extent) to 7 points (to a great extent). The final score for sustainability capacity was the mean of the eight domain scores. The PSAT was assessed by nine professionals (researchers, staff members, and stakeholders) at two periods during intervention implementation: end of the first year (January 2015) and end of the second year (September 2015). At the end of the first year, strategic planning (4.43 ± 1.98) and funding stability (4.38 ± 1) were considered deficient domains, and at the end of the second year, these domains had improved by 1.67 points (p =.043) and 0.59 points (p = .159), respectively. The funding stability increase was not significant because only one of the five specific items, "policies implemented to ensure sustained funding," improved by 1.08 points (p = .036). The sustainability capacity final score was 5.93 ± 1.13. The sustainability capacity assessment during the intervention allows its improvement before the programme expires, ensuring the long-term implementation of the "Som la Pera" intervention programme to encourage healthy lifestyles in adolescents.

Context: The use of social marketing to modify lifestyle choices could be helpful in reducing youth obesity. Some or all of the 8 domains of the National Social Marketing Centre's social marketing benchmark criteria (SMBC) are often used but not always defined in intervention studies., Objective: The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention., Data Sources: The PubMed, Cochrane, and ERIC databases were used., Study Selection: Nonrandomized and randomized controlled trials conducted from 1990 to April 2014 in participants aged 5 to 17 years were included., Data Extraction: After the study selection, the 8 domains of the SMBC were assessed in each included study., Results: Thirty-eight publications were included in the systematic review. For the meta-analysis, randomized controlled trials (RCTs) reporting body mass index or prevalence of overweight and obesity were considered. Eighteen RCTs with a total of 8681 participants included at least 5 SMBC. The meta-analysis showed a small standardized mean difference in body mass index of -0.25 (95%CI, -0.45 to -0.04) and a prevalence of overweight and obesity odds ratio of 0.72 (95%CI, 0.5-0.97)., Conclusion: Current evidence indicates that the inclusion of at least 5 SMBC domains in school-based interventions could benefit efforts to prevent obesity in young people. PROSPERO registration number: CRD42014007297., (© The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Background: The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical activity practice, and to prevent obesity in socioeconomically disadvantaged and vulnerable adolescents. The EYTO project works through a peer-led social marketing intervention that is designed and implemented by the adolescents of each participating country. Each country involved in the project acts independently. This paper describes the "Som la Pera" intervention Spanish study that is part of the EYTO project., Methods/design: In Spain, the research team performed a cluster randomised controlled intervention over 2 academic years (2013-2015) in which 2 high-schools were designated as the control group and 2 high-schools were designated as the intervention group, with a minimum of 121 schoolchildren per group. From the intervention group, 5 adolescents with leadership characteristics, called "Adolescent Challenge Creators" (ACCs), were recruited. These 5 ACCs received an initial 4 h training session about social marketing principles and healthy lifestyle theory, followed by 24 sessions (1.30 h/session) divided in two academic years to design and implement activities presented as challenges to encourage healthy lifestyles among their peers, the approximately 180-200 high-school students in the intervention group. During the design of the intervention, it was essential that the ACCs used the 8 social marketing criteria (customer orientation, behaviour, theory, insight, exchange, competition, segmentation and methods mix). The expected primary outcomes from the Spanish intervention will be as follows: increases in the consumption of fruits and vegetables and physical activity practice along with reductions in TV/computer/game console use. The secondary outcomes will be as follows: increased breakfast consumption, engagement with local recreation and reduced obesity prevalence. The outcomes will be measured by the Health Behaviour in School-aged Children Study (HBSC) survey at baseline and at the end of the intervention. In the control group, no intervention was implemented, but the outcome measurements were collected in parallel with the intervention group., Discussion: This study described a new methodology to improve lifestyles and to address adolescent obesity., Trial Registration: ClinicalTrials.gov: NCT02157402. Registered 03 June 2014.

Purpose: The Educació en Alimentació (EdAl) program conducted over 28 months in primary school children reduced obesity (OB) prevalence in boys and increased voluntary physical activity (PA). The continued benefit after cessation of EdAl is unknown. We assessed the changes in OB prevalence and healthy lifestyle in 11- to 13-year-old adolescents, the age group that had complete inclusion data available 2 years after the EdAl program's conclusion., Methods: Adolescents (n = 421 intervention; n = 198 control) with data at baseline and 2-year follow-up were recruited. Analyses included body mass index (BMI), BMI z-score, and lifestyle data (from questionnaires)., Results: Between baseline and 2-year follow-up, OB prevalence was reduced (-5.5%; p < .01) and BMI z-score (-.29; p < .001) in intervention compared with control group. BMI z-score was effectively reduced in intervention in both genders: -.26 units in boys and -.32 units in girls, compared with control group. The ≥4 hours/week after-school PA was increased significantly by 13.1% in adolescents of intervention group compared with control group (p = .023); a tendency toward increased PA in intervention girls was observed (p = .062). At 2-year follow-up, participating in ≥4 hours/week after-school PA (odds ratio, .240; p = .002) and daily fruit consumption (odds ratio, .447; p = .025) were protective factors against OB, whereas ≤2 hours/week after-school PA was a risk factor for OB., Conclusions: At 2-year follow-up, the EdAl program induced a lowering of BMI z-score and OB prevalence, compared with control group. After-school PA practice can be stimulated in primary school as part of a healthy lifestyle and maintained subsequently despite cessation of the intervention program., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is one of the main determinants of avoidable disease burden.To implement a program by university students acting as "health promoting agents" (HPAs) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle, including dietary and physical activity recommendations over 28 months., Methods: Two school clusters were randomly assigned to intervention (24 schools, 1,222 pupils) or control (14 schools, 717 pupils); 78% of pupils were Western European. Mean age (±SD) was 8.4±0.6 years (49.9% females) at baseline. Generalized linear mixed models were used to analyze differences in primary outcome between both groups. Data collected included body mass index (BMI) every year. Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study. The interventions focused on eight lifestyle topics covered in 12 activities (1 hour/activity/session) implemented by HPAs over 3 school academic years., Results: At 28 months, obesity prevalence in boys was decreased -2.36% in the intervention group (from 9.59% to 7.23%) and increased 2.03% (from 7.40% to 9.43%) in the control group; the difference was 4.39% (95% CI 3.48 to 5.30; P=0.01). The boys in the intervention group had an effective reduction of -0.24 units in the change of BMI z-score (from 0.01 to -0.04), compared to control (from -0.10 to 0.09); 5.1% more intervention pupils undertook physical activity>5 hours/week than control pupils (P=0.02).Fish consumption was a protector (odds ratio 0.39; 95% CI 0.23 to 0.67) while "fast-food" consumption was a risk factor for childhood obesity (odds ratio: 2.27; 95% CI 1.08 to 4.77)., Conclusions: Our school-based program, conducted by HPA students, successfully reduced childhood obesity prevalence in boys., Trial Registration: International Standard Randomized Controlled Trial Number: ISRCTN29247645.

Background: The EdAL (Educació en Alimentació) study is a long-term, nutrition educational, primary-school-based program designed to prevent obesity by promoting a healthy lifestyle that includes dietary recommendations and physical activity.The aims are: 1) to evaluate the effects of a 3-year school-based life-style improvement program on the prevalence of obesity in an area of north-west Mediterranean 2) To design a health-promotion program to be implemented by health-promoter agents (university students) in primary schools., Methods/design: 1) The intervention study is a randomised, controlled, school-based program performed by university-student health-promoter agents. Initial pupil enrolment was in 2006 and continued for 3 years. We considered two clusters (designated as cluster A and cluster B) as the units for randomisation. The first cluster involved 24 schools from Reus and the second involved 14 schools from surrounding towns Cambrils, Salou and Vilaseca combined in order to obtain comparable groups. There are very good communications between schools in each town, and to avoid cross influence of the programs resulting from inter-school dialogue, the towns themselves were the unit for randomisation. Data collected included name, gender, date and place of birth at the start of the program and, subsequently, weight, height, body mass index (BMI) and waist circumference every year for 3 years. Questionnaires on eating and physical activity habits are filled-in by the parents at the start and end of the study and, providing that informed consent is given, the data are analysed on the intention-to-treat basis.The interventions are based on 8 nutritional and physical activity objectives. They are implemented by university students as part of the university curriculum in training health-promoter agents. These 8 objectives are developed in 4 educational activities/year for 3 years (a total of 12 activities; 1 h/activity) performed by the health-promoter agents in primary schools. Control pupils follow their usual activities.2) Courses on education and promotion of health, within in the curriculum of medicine and health sciences for university students, are designed to train health-promoter agents to administer these activities in primary schools., Discussion: This controlled school-based intervention will test the possibility of preventing childhood obesity., Trial Registration Number: ISRCTN: ISRCTN29247645.

Background: Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience. Objectives: To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies. Design: The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries. Setting and Participants: Eighteen peer leaders (aged 13–15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers. Measures: The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study. Results: The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries. Conclusion: The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size. Patient or Public Contribution: The peer leaders contributed to the design and implementation of the training and intervention. [ABSTRACT FROM AUTHOR]

Background: Restaurant-based interventions can be an enjoyable way to encourage healthier eating choices by all members of a family. Thus, the principal aims of this study were a) to promote healthy diets by increasing healthy food offerings and b) to increase the number of foods offered specifically as gluten-free and lactose-free and to inform patrons by including nutritional and allergen information that complies with Regulation 1169/2011 regarding the food served in restaurants, takeaways and snack bars.Methods: A restaurant-based intervention was implemented at 16 food establishments at 2 resorts (the Cambrils Park Resort and Camping Sangulí, Spain, from 2014 to 2015) based on the following 4 components: 1) providing nutritional and allergen analyses of the offered dishes, 2) increasing the number of healthy food choices, 3) identifying menu items associated with allergies and intolerance, and 4) training staff on healthy eating and allergens. Customer satisfaction regarding food aspects was assessed using surveys (10-point scale).Results: Both resorts significantly increased their offerings of healthy dishes (28.6% to 44.7%; P = 0.003) and desserts with fruit (20% to 51.3%; P = 0.013), thus obtaining the Spanish Government's Mediterranean Diet certification. Additionally, both resorts obtained Catalan Celiac Association certification. Moreover, both resorts significantly increased their percentages of gluten-free dishes (2.1% to 50.5%; P < 0.001) and lactose-free dishes (5.5% to 37.5%; P < 0.001) after the intervention. Customer satisfaction increased (mean ± standard deviation) from 6.9 ± 1.6 to 8.5 ± 1.5 (P < 0.001).Conclusion: This restaurant-based intervention expanded the number of healthy and allergen-free foods offered in a family-oriented holiday resort environment to encourage healthy food choices, resulting in increased customer satisfaction. [ABSTRACT FROM AUTHOR]