Effect of school wellness policies and the Healthy, Hunger-Free Kids Act on food-consumption behaviors of students, 2006–2016: a systematic review

What should governments be doing to prevent diabetes throughout the life course?

“…Such interventions should be initiated early in pregnancy and continue throughout the pregnancy, as major short-and long-term health consequences for both the mother and the child are likely. • Develop and implement national diabetes plans as well as regional strategies promoting local partnerships with communities and stakeholders [38] • Governments should support the implementation of interdisciplinary care teams, with special regard to the involvement of pharmacists [39] • Improve the transparency of product ingredients using mandatory simple and intuitive nutrition or menu labelling [40] • Set up government food benefit programmes to incentivise the purchase of fruit and vegetables [41] • Support the certification of digital devices and apps to improve access to evidencebased health information [42] • Use narrative and visual messages to improve diabetes awareness [43] • Support interpretative nutrition labelling, like traffic lights, to decrease SSB sales [41] • Strengthen the framing of diabetes as a problem to be tackled on the societal level [44] • Raise taxes on unhealthy products (and consider the liability for adverse health effects of food and beverage products) and reinvest the money in local infrastructure (outdoor gyms and playgrounds) [45] Pregnant women and young families • Screen high-risk groups (elevated risk due to family history, increased BMI) for early detection of GDM [46] as a precondition for lifestyle change • Give advice regarding healthy eating and set activity targets during pregnancy [47,48] • Give advice regarding the benefits of breastfeeding [49] • Employ multimedia communication strategies to increase the widespread knowledge of diabetes risk during pregnancy [50,51] Children and adolescents…”

“…• Set minimum standards for break times and outdoor equipment to increase physical activity levels [52] • Include a health subject called 'health' in (pre-) schools and continuously qualify the teachers [38] • Provide drinking water and low-cost/ free-of-charge healthy food [53] • Cooperate with local sports clubs in designing break time activities, physical activity lessons and afternoon care [54] • Improve access to eHealth devices for diabetes self-management [55] • Restrict advertisement of unhealthy food choices across the media spectrum [41,56] • Publicity intervention to increase awareness to promote earlier diagnosis of type 1 diabetes [57] • Implement binding quality standards and healthy food procurement for the catering tenders in (pre-)schools [41] • Restrict the advertisement of unhealthy products [41,54,56] • Implement fat and/or sugar taxes [56] and/or set smaller prices for healthier beverages (especially at school) [41] Working-age population • Implement the structured, evidence-based curricula like the Diabetes Prevention Program (DPP) [58] and monitor their effectiveness in different settings and target groups [59] • Include community awareness campaigning in national chronic disease and/or diabetes plans [61] • Offer (tax) subvention for companies who actively support their employees' health and support companies to develop and implement measures of operational health management [58] • Improve access to eHealth devices for diabetes self-management [55] • Include workplace interventions for individuals at risk [61] • Offer subvention of healthy food procurement for companies [59] Elderly • Develop structured care programmes, and increase frequency of educational sessions [62,63] • Continuously monitor the enrolment rates in interventions and effectiveness for specific subgroups of the population [64] • Strengthen eHealth literacy to increase access to digital health information [65] • Reduce or eliminate out-of-pocket costs for diabetes medication and self-monitoring supplies [66] The Interventions should, according to the authors, include regular counselling on dietary behaviour, such as the composition of a healthy meal (not more than 75...…”

“…To date, studies involving young people in school-and community-based noncommunicable disease prevention interventions are scarce [69]. Furthermore, most analyses either report weak overall study quality [53,70] or call for more rigorously carried out studies with longer follow-up periods [38,71]. Although data on the sustainability of school policies are lacking [53], policy debates can already make use of effective policies targeting food in the school environment as these have the potential to improve childhood dietary habits and health [68].…”

“…To improve the implementation of these measures, some researchers call for partnerships between policy makers and communities, helping to overcome districtspecific barriers, and recommend the implementation of nutrition education in US school grades kindergarten to twelfth grade (i.e. from approximately 5 to 19 years of age) [38]. Implementation is also unsatisfactory for workplace interventions for individuals at risk, despite the promising evidence presented for interventions targeting populations of working age.…”

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

“…The term refers to the inappropriate termination of evidence-based programs or the inappropriate continuation of non-evidence based programs (8). An example of inappropriate termination of an evidence-based policy in the United States is notable with the rollback of Bush and Obama era healthy school lunch standards (11), which were relaxed despite evidence they increased school-aged children's consumption of healthy foods (12). Alternately, an example of inappropriate continuation of nonevidence-based programs is the continued use of health fairs for community screenings, interventions and education.…”