The food environment in schools and their immediate vicinities associated with excess weight in adolescence: A systematic review and meta-analysis.

Aim: The present study systematically reviewed the characteristics of the food environment in schools and their immediate vicinities associated with excess weight in adolescents.
Methods: We searched for relevant articles in seven databases. No restrictions were applied on language, publication date, and status of publication. The study selection process and data extraction were conducted by two authors independently. For meta-analyses, the random-effects model and the maximum-likelihood method were applied.
Results: A total of 9327 publications were identified from the initial search. Of these, 20 studies met the inclusion criteria and were included in the systematic review. The sale of food in school or immediate vicinity was associated with high BMI [Odds ratio (OR)= 1.14, 95% confidence interval (CI) 1.01, 2.06]. The availability of healthy food provided by school significantly decreased the odds of obesity [OR= 0.89, 95%CI 0.82, 0.96]. However, the presence of nutrition policies or programs at school was not associated with obesity (OR= 0.81, 95%CI 0.57, 1.16).
Conclusions: This study highlights the need for improvement in school food environment, including restricting students' exposure to unhealthy foods. The quality of food (healthy vs unhealthy) provided or made available to adolescents in the school food environment influences their weight status. Therefore, promotion of healthy food programs and availability of healthy food at school would limit the prevalence of excess weight in adolescents.
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