School Obesity Prevention Recommendations: Complete List

Healthy Schools, Healthy Weight

The foundation for lifelong good health is laid in childhood. And outside of home life, nothing provides more of an immersive experience for children than the time they spend in school. This means schools have a rich opportunity to improve youth health and tackle obesity at the ideal point in time—before problems take hold.

One of the main avenues that schools can use to positively affect health is also one most directly in line with every school’s mission: educating students. Nutrition and physical activity lessons can be woven throughout the curriculum—in core classroom subjects, physical education, and after-school programs—to teach skills that help students choose and maintain healthy lifestyles. In addition to teaching evidence-based nutrition and activity messages, school physical education should focus on getting students engaged in high-quality and regular activity.

Schools can also promote health outside of the classroom, by surrounding students with opportunities to eat healthy and stay active. To improve nutrition, schools can include healthier food offerings in the cafeteria and eliminate marketing for unhealthy foods. To improve activity, schools can develop safe walking and biking routes to school, and can promote active recess time.

Wellness programs for faculty and staff can also be integral to improving the school environment, not only serving to boost faculty and staff health but also building school-wide enthusiasm for student-focused programs.

Additionally, schools can serve as important data sources on student health. Anonymous, school-level information on markers like students’ body mass index (BMI), can help educators and policy makers assess success of current programs and decide the direction of future programs.

With good evidence that school-based prevention programs can successfully—and without many added resources—help students to eat better, be more active, and achieve healthier weights, schools are poised to become an integral part of the fight against the obesity epidemic. As with education in general, the sooner we act, the better.

This section of The Obesity Prevention Source summarizes obesity prevention recommendations for the school setting, based on a review of expert guidance from the Centers for Disease Control and Prevention, the Institute of Medicine, the Alliance for a Healthier Generation, the World Health Organization, and others.

Healthy Schools, Healthy Weight

The foundation for lifelong good health is laid in childhood. And outside of home life, nothing provides more of an immersive experience for children than the time they spend in school. This means schools have a rich opportunity to improve youth health and tackle obesity at the ideal point in time—before problems take hold.

Tools and Resources (tools_and_resrouces.jpg)

Related Articles (related-articles.jpg)

One of the main avenues that schools can use to positively affect health is also one most directly in line with every school’s mission: educating students. Nutrition and physical activity lessons can be woven into the curriculum—in core classroom subjects, physical education, and after-school programs—to teach skills that help students choose and maintain healthy lifestyles. In addition to teaching evidence-based nutrition and activity messages, school physical education should focus on getting students engaged in high-quality and regular activity.

Schools can also promote health outside of the classroom, by surrounding students with opportunities to eat healthy and stay active. To improve nutrition, schools can include healthier food offerings in the cafeteria and eliminate marketing of unhealthy foods. To improve activity, schools can develop safe walking and biking routes to school, and can promote active recess time.

Wellness programs for faculty and staff can also be integral to improving the school environment, not only serving to boost faculty and staff health but also building school-wide enthusiasm for student-focused programs.

Additionally, schools can serve as important data sources on student health. Anonymous, school-level information on markers like students’ body mass index (BMI) can help educators and policy-makers assess success of current programs and decide the direction of future programs.

With good evidence that school-based prevention programs can successfully—and without many added resources—help students to eat better, be more active, and achieve healthier weights, schools are poised to become an integral part of the fight against the obesity epidemic. As with education in general, the sooner we act, the better.

This section of The Obesity Prevention Source summarizes obesity prevention recommendations for the school setting, based on a review of expert guidance from the Centers for Disease Control and Prevention, the Institute of Medicine, the Alliance for a Healthier Generation, the World Health Organization, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list on each page, as well as the links to useful toolkits and other resources.

School Meals, Competitive Foods, and the School Food Environment

school lunch tray (healthy_lunch_plate.jpg)

Serving healthy choices in the lunch room, limiting availability and marketing of unhealthful foods and sugary drinks, and making water available to students throughout the day are some of the ways that schools can help prevent obesity. Making these types of changes in the school food environment will be no easy task, however. In the U.S., for example, the Department of Agriculture recently finalized comprehensive new school meal guidelines that will increase vegetables, fruit, and whole grains and curb sodium, saturated fat, and trans fat. (1) But due to political pressures, the agency was not able to fully implement the meal guidelines recommended by an expert panel at the Institute of Medicine. (2) (Read more about the political battles over school lunch, on The Nutrition Source website.)

Now that the new nutrition standards are on the books, will schools actually be able to meet them? It may be difficult to answer that question, since compliance is not strictly monitored week to week. And schools and face many other challenges to creating a food environment where the healthy choice is the default choice. Among the obstacles: budgeting for the higher costs of purchasing and preparing more healthful foods; coaxing children to accept the more healthful options; and addressing the multitude of ways that unhealthful foods and drinks are sold or served outside of school meals, from classroom birthday parties to school-wide bake sales and sporting events.

Here is a summary of obesity prevention recommendations for school meals and the school food environment, based on a review of expert guidance from the Centers for Disease Control and Prevention, the Institute of Medicine, the World Health Organization, the School Nutrition Association, the American Heart Association, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

School Meal Programs

Tools for healthy school food (tools_for_healthy_school_food.jpg)

Related Topics (related-topics.jpg)

Read and print the complete list of school obesity prevention recommendations.

Encourage students to participate in breakfast, lunch, and after-school snack programs (1,2,3,4,5,6,7)
Offer meals that meet national nutritional standards, such as the U.S. Dietary Guidelines (1,2,3,4,6,7,8,9)
Set minimum and maximum calorie levels for school breakfast and lunch, for each age group (9)
Invest in cafeteria facilities to store, prepare, and display healthy foods, such as salad bars (7,10)
Avoid stigmatizing children who participate in free/reduced price school meal programs (3,7)
Give students adequate time to eat (1,2,10)
Train food service staff in healthy food preparation techniques and food safety (3,7,9)
Incorporate nutrition education into school meal programs (1,3,10)
Increase financial support for school meal programs from federal, state, and local governments (7,10)

Foods Sold or Served Outside of School Meals (Competitive Foods )

Soda Ban (soda-ban-bottles-2.jpg)

School Soda Bans
Promising Policy

Boston banned sugary drink sales in public schools in 2004, and a new study from Harvard School of Public Health finds that after the ban, city students cut back on sugary drink consumption.

Ensure competitive foods meet healthy nutrition standards that are consistent with those of the school meal program (1,2,3,4,6,7,8,11)
Eliminate sugar-sweetened beverages in the school environment or limit access to them (2,3,4,10,12)
Ensure that food served at classroom parties and school functions, including fundraisers, meets competitive food standards (3,4,10)
Never use food as a reward or punishment (3,10,12)

School Food Environment

Water Fountain (water-fountain-2.jpg)

Water Access in Schools
Hot Topic

A study in a large California school district finds that students may not have adequate access to water during the school day.

Make drinking water freely available to students in dining areas and throughout the day (1,3,8,10,12)
Offer pleasant, clean, and safe cafeterias (1,2,7)
Market healthy food choices (7,8,10)
Limit marketing of unhealthy foods (10)

  • Bar commercial food marketing outside of dining areas; (3)
  • Bar marketing of foods that do not meet competitive food guidelines or other nutrition standards; (2,3) or
  • Bar all food advertising in schools (6)
Create and support school gardens (2,7)
Encourage staff to model healthy eating (1)

School Meals, Competitive Foods, and the School Food Environment—Source List

1. Pekruhn C. Preventing Childhood Obesity: A School Health Policy Guide. Arlington, VA: Center for Safe and Healthy Schools, National Association of State Boards of Education; 2009.

2. Lagarde F, LeBlanc CMA, McKenna M, et al. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Geneva, Switzerland: World Health Organization; 2008.

3. Alliance for a Healthier Generation. Healthy Schools Program Framework. 2009. Accessed July 11, 2011.

4. School Nutrition Association. National Nutrition Standards Recommendations. Alexandria, VA: School Nutrition Association; 2008.

5. Wechsler H, McKenna ML, Lee SM, Dietz WH. The Role of Schools in Preventing Childhood Obesity. The State Education Standard. 2004.

6. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: Institute of Medicine; 2005.

7. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation: White House Task Force on Childhood Obesity Report to the President. 2010. Accessed July 11, 2011.

8. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. 2010. Accessed May 1, 2012.

9. Institute of Medicine. School Meals: Building Blocks for Healthy Children. Washington, D.C.: Institute of Medicine; 2010.

10. American Heart Association. Policy Position Statement on School Nutrition. 2008. Accessed July 11, 2011.

11. American Heart Association. Policy Position Statement on Body Mass Index (BMI) Surveillance and Assessment in Schools. 2008. Accessed July 11, 2011.

12. Institute of Medicine. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington, D.C.: National Academies Press; 2007.

Staying Active throughout the School Day

physical education (physical_education.jpg)Children require at least 60 minutes of moderate to vigorous physical activity each day. Schools can help prevent obesity by offering higher quality and more active physical education—for all grades, every day—and by promoting physical activity throughout the school day. But according to the U.S. Government Accounting Office, which reviewed the most recent national data, physical education instruction time has decreased in the U.S., and only 4 percent of elementary schools, 8 percent of middle schools, and 2 percent of high schools in the U.S. offered daily physical education (or its equivalent) in 2006. (1) Though more and more schools have instituted physical education requirements, many schools still do not require students to take physical education, especially at the high school level: In 2006, only 1 in 5 schools nationwide had a physical education requirement for students in grades 11 and 12.

Here is a summary of school physical activity and physical education obesity prevention recommendations, based on a review of expert guidance from the Centers for Disease Control and Prevention, the Institute of Medicine, the World Health Organization, the American Heart Association, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

Physical Education

Provide daily physical education (PE) to children in grades K-12 (1,2,3,4,5)
Provide a total of 150 minutes of PE per week in elementary school and 225 minutes per week in middle and high school (2,3,5)
Ensure that children spend most of their PE time being physically active (3,4,5,7)
Base PE on national standards (3,5)
Adapt PE curricula for children with disabilities or special needs (1,3,4,7)
Hire licensed PE teachers and offer them ongoing training (3,4,5)
Limit PE class sizes so that they are similar to academic class sizes (3,4)
Promote enjoyable activities and lifelong physical activity in PE (4,7)
Assess student learning in PE and include in school report cards (3,5)
Make sure that PE requirements are not waived for other physical or academic activities (3,5,7)

Physical Activity During School and Out-of-School Time

recess at school (recess_at_school.jpg)

Joint Use Agreements
Obesity Prevention Resource

Public Health Law and Policy, a California-based non-profit, offers a toolkit for Opening School Grounds to the Community After Hours and Model Joint-Use Agreements.

Provide all students an opportunity for daily physical activity (3,8)
Give elementary school students daily recess, and schedule recess before lunch (1,2,3,6,7)
Avoid withholding or mandating physical activity for disciplinary or academic reasons (1,7)
Develop active transit plans (bike, walk to school), working with local government and community groups (1,2,3,7,8)
Offer children physical activity opportunities before and after school, including competitive sports and noncompetitive activities (1,2,3,7,8,9)
Collaborate with communities to maximize use of school and community spaces for physical activity during and outside school hours (2,3,7,8)
Monitor physical activity space and equipment for safety (3,7)
Offer staff opportunities for physical activity (1)

Staying Active throughout the School Day—Source List

1. Pekruhn C. Preventing Childhood Obesity: A School Health Policy Guide Arlington, VA: Center for Safe and Healthy Schools, National Association of State Boards of Education; 2009.

2. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. 2010. Accessed May 1, 2012.

3. Alliance for a Healthier Generation. Healthy Schools Program Framework 2009. Accessed July 11, 2011.

4. Wechsler H, McKenna ML, Lee SM, Dietz WH. The Role of Schools in Preventing Childhood Obesity The State Education Standard. 2004.

5. American Heart Association. Policy Position Statement on Physical Education in Schools. 2008. Accessed May 1, 2012.

6. American Heart Association. Policy Position Statement on School Nutrition. 2008. Accessed May 1, 2012.

7. Lagarde F, LeBlanc CMA, McKenna M, et al. School policy framework : implementation of the WHO global strategy on diet, physical activity and health Geneva, Switzerland: World Health Organization; 2008.

8. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance Washington, D.C.: Institue of Medicine; 2005.

9. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation: White House Task Force on Childhood Obesity Report to the President. 2010. Accessed July 11, 2011.

Health Education and School Wellness

school health education (school_health_education.jpg)It’s essential to incorporate nutrition and physical activity into a school’s health education curriculum. Nutrition and physical activity themes can be also woven into other areas of the curriculum—in core classroom subjects, physical education, and after-school programming. School district wellness policies should also address nutrition and physical activity and encompass staff wellness, not just student wellness.

Here is a summary of health education and school wellness obesity prevention recommendations, based on a review of expert guidance from the Centers for Disease Control and Prevention, the Institute of Medicine, the Alliance for a Healthier Generation, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

Health Education

Tools for school health education (tools_for__health_education.jpg)

Address nutrition and physical activity in health education programs (1,2,3,4,5,6,7,8)
Align health education with national standards (1,4)
Incorporate healthy eating and physical activity themes into other subject areas (1)
Offer teachers ongoing health education training (1,2,5)
Assess student learning in health education classes and report on school report cards (1)

School Wellness

Related Topics (related-topics.jpg)

Read the complete list of school obesity prevention recommendations.

Implement, fund, and monitor a comprehensive school wellness policy that addresses nutrition, physical activity, and school food, among other topics (1,2,3,4)
Provide wellness programming for school staff (1,3,5)

Health Education and School Wellness—Source List

1. Alliance for a Healthier Generation. Healthy Schools Program Framework. 2009. Accessed July 11, 2011.

2. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. 2010. Accessed July 11, 2011.

3. Wechsler H, McKenna ML, Lee SM, Dietz WH. The Role of Schools in Preventing Childhood Obesity. The State Education Standard. 2004.

4. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation: White House Task Force on Childhood Obesity Report to the President. 2010. Accessed July 11, 2011.

5. American Heart Association. School Nutrition Policy Recommendations. 2008. Accessed July 11, 2011.

6. Lagarde F, LeBlanc CMA, McKenna M, et al. School policy framework : implementation of the WHO global strategy on diet, physical activity and health. Geneva, Switzerland: World Health Organization; 2008.

7. Pekruhn C. Preventing Childhood Obesity: A School Health Policy Guide. Arlington, VA: Center for Safe and Healthy Schools, National Association of State Boards of Education; 2009.

8. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: Institute of Medicine; 2005.

Body Mass Index (BMI) Assessment at School

weight scale (weight-scale.jpg)Gathering students’ BMIs, in the aggregate, can help schools monitor the success of obesity prevention efforts; screening students’ BMIs for individual health assessment purposes is more controversial and requires schools to address privacy and parent communication, among other issues.

Here is a summary of BMI assessment recommendations for schools, based on a review of expert guidance from the the Institute of Medicine, the World Health Organization, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

tools for school BMI assessment (tools_for_school_bmi_assessment.jpg)

Related Topics (related-topics.jpg)

Read and print the complete list of school obesity prevention recommendations.

Assess students’ BMIs, confidentially and in aggregate, to track the prevalence of obesity and evaluate the success of obesity prevention programs (1,2)
If students’ BMI’s are screened for individual health assessment purposes, ensure that schools address the following: (2,3,4,5)

  • student privacy
  • student safety and support
  • staff training
  • accuracy of data collection
  • sensitive and informative parent/guardian communication
  • referral to community resources for follow-up, as needed
  • healthy eating and physical activity promotion, using science-based strategies

BMI Assessment at SchoolSource List

1. Alliance for a Healthier Generation. Healthy Schools Program Framework. 2009. Accessed July 11, 2011.

2. American Heart Association. Policy Position Statement on Body Mass Index (BMI) Surveillance and Assessment in Schools. 2008. Accessed July 11, 2011.

3. Pekruhn C. Preventing Childhood Obesity: A School Health Policy Guide. Arlington, VA: Center for Safe and Healthy Schools, National Association of State Boards of Education; 2009.

4. Lagarde F, LeBlanc CMA, McKenna M, et al. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Geneva, Switzerland: World Health Organization; 2008.

5. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: Institute of Medicine; 2005.

Terms of Use

The aim of the Harvard School of Public Health Obesity Prevention Source Web site is to provide timely information about obesity’s global causes, consequences, prevention, and control, for the public, health and public health practitioners, business and community leaders, and policymakers. The contents of this Web site are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site. The Web site’s obesity prevention policy recommendations are based primarily on a review of U.S. expert guidance, unless otherwise indicated; in other countries, different policy approaches may be needed to achieve improvements in food and physical activity environments, so that healthy choices are easy choices, for all.