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Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear.<\/jats:p>\n                  <jats:p>\n                    We undertook a systematic review, a meta\u2010analysis, and meta\u2010regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random\u2010effects meta\u2010analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI]\n                    <jats:italic>z<\/jats:italic>\n                    score, standard mean difference: \u22120.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that\n                    <jats:italic>n<\/jats:italic>\n                    = 43 (81%) of non\u2010randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (\n                    <jats:italic>n<\/jats:italic>\n                    = 34, 79%) and low protection of potential contamination (\n                    <jats:italic>n<\/jats:italic>\n                    = 41, 95%) presented the highest risk of bias for randomized controlled trials.\n                  <\/jats:p>\n                  <jats:p>Changes in the school food environment could improve children's dietary behavior and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.<\/jats:p>","DOI":"10.1111\/obr.13176","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T03:07:46Z","timestamp":1611025666000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":98,"title":["Improving the school food environment for the prevention of childhood obesity: What works and what doesn't"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5210-1538","authenticated-orcid":false,"given":"Elisa","family":"Pineda","sequence":"first","affiliation":[{"name":"Centre for Health Economics &amp; Policy Innovation (CHEPI) Imperial College Business School  London UK"},{"name":"School of Public Health Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0833-3523","authenticated-orcid":false,"given":"Josefina","family":"Bascunan","sequence":"additional","affiliation":[{"name":"Centre for Health Economics &amp; Policy Innovation (CHEPI) Imperial College Business School  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9773-2117","authenticated-orcid":false,"given":"Franco","family":"Sassi","sequence":"additional","affiliation":[{"name":"Centre for Health Economics &amp; Policy Innovation (CHEPI) Imperial College Business School  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","unstructured":"Osei\u2010AssibeyG.The influence of the food environment on overweight and obesity in young children: a systematic review.https:\/\/doi.org\/10.1136\/bmjopen-2012-001538","DOI":"10.1136\/bmjopen-2012-001538"},{"key":"e_1_2_10_3_1","unstructured":"PenneyTL Almiron\u2010RoigE ShearerC McIsaacJ KirkSFL.Modifying the food environment for childhood obesity prevention: challenges and opportunities"},{"issue":"2","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"S192","DOI":"10.4103\/2230-8210.104037","article-title":"Childhood obesity: determinants, evaluation, and prevention","volume":"16","author":"Raychaudhuri M","year":"2012","journal-title":"Indian J Endocrinol Metab"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.404"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12040922"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0029665108008616"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-19.5.330"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13679-016-0204-0"},{"key":"e_1_2_10_10_1","unstructured":"WilliamsJ ScarboroughP MatthewsA et al.A systematic review of the influence of the retail food environment around schools on obesity\u2010related outcomes"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000402"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2010.07.003"},{"issue":"1","key":"e_1_2_10_13_1","first-page":"AMP89","article-title":"Effectiveness of school procurement policies for improving dietary behaviors: a systematic review and meta\u2010analysis","volume":"133","author":"Micha R","year":"2016","journal-title":"Circulation"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194555"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-019-0798-1"},{"key":"e_1_2_10_16_1","unstructured":"BourdeaudhuijId CauwenbergheEv SpittaelsH et al.School\u2010based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194555"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu7064426"},{"key":"e_1_2_10_19_1","unstructured":"WHO.Definition of key terms. 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