Table 2.

Group A: Classroom-based interventions that trained adults.

Author, Year	Intervention Name or Description	Population Characteristics: Grade Level/Age (Sample Size), Location	Group Receiving Training	Training Design	Intervention Frequency and Duration	Evaluation Indicators and Notable Results
Arlinghaus, 2017 1 [21]	Obesity prevention program with compañeros	6th and 7th grade (n = 506), Houston, TX	PE teachers	Teachers were trained in leading all aspects of the intervention, which focused on basic physical activity and nutrition education. They were provided with strategies for using positive reinforcement and constructive feedback with students. Those who worked with cross-age peers (see Group B) met with them regularly to provide feedback and guidance. Teachers met weekly with research staff to discuss any issues.	Intervention was delivered during middle school students’ regularly scheduled PE class period for 6 months; 50 min a day, 5 days a week. One day each week focused specifically on healthy eating.	Outcome: change in anthropometrics; only students with BMI percentile at or above 85% at baseline (n = 189) were included in the analysis. Process: fidelity of implementation and a random assessment of 10% of classes to record frequency of positive reinforcement and constructive feedback.
Baskin, 2009 [22]	Described design, implementation and lessons learned from a pilot obesity prevention program implemented in a low-resource school	7th and 8th grade (n = 113), Southern U.S.	PE teachers, health educator, and graduate students who served as teacher aids during lessons	Initial training provided when curriculum was finalized. Training emphasized active learning and hands-on activities. Researchers met quarterly with those implementing the intervention to address any issues that arose and discuss any program modifications.	Intervention was implemented over one school year. Students had a health education period once a week during their normally scheduled 50-min PE class. The curriculum included food demonstrations and tastings.	Outcome: changes in anthropometrics, health behaviors, dietary intake, and physical fitness. Process: meetings with school staff and research meetings were recorded and analyzed, and themes were identified. Focus groups were conducted with students and staff to determine acceptability. Results: In focus groups, students reported making changes to their diet and thought the program should continue and be expanded to 6th graders. They enjoyed interactive games but reported hesitancy to try new foods and dislike of “healthier” foods in the school cafeteria.
Bukhari, 2011 [27]	Diet for a Healthy Planet with Teen Battle Chefs curriculum	9th grade (n = 98), Brooklyn, NY	Classroom teachers	2-day training focusing on the skills necessary to teach program lesson plans. During program implementation, teachers completed an online lesson feedback survey to provide information about fidelity and feasibility.	19-week program addressing state educational standards for high school and intermediate school. Offered as an elective at the school for a semester; class was daily for 1 h.	Outcome: changes in dietary behaviors, attitudes, and frequency of eating meals with friends and family. Results: Participants reported eating vegetables as snacks significantly more often post-intervention compared with a control group. Process: reach, focus groups with students, reflective exercises for students, dose delivered, and feasibility and fidelity as reported by teachers. Results: In focus groups, students reported eating more fruits and vegetables and an increased willingness to try new foods.
Contento, 2010 [28] +4 Papers [29,30,31,32]	Choice, Control and Change	7th grade (n = 278 in pilot; n = 1136 in RCT), New York, NY	Science teachers	A 3-h intensive professional development session was held for teachers prior to the intervention start, and a follow-up 3-h training session was held in the middle of the intervention. A research staff member also attended one-third of all classroom sessions and met with each teacher weekly to provide support and feedback.	Curriculum consists of 24, 45-min, science and nutrition education lessons taught over 8–10 weeks. Some lessons were taught over multiple days for a total of 30–35 sessions. Curriculum aligns with national science standards.	Outcome: changes in food and activity choices; mediating variables measured included self-efficacy, outcome expectations, beliefs, attitudes, and perceived barriers. Results: Participants significantly decreased number of SSBs consumed and the portion size of SSBs compared to a control group. The pilot group additionally reported a significant increase in fruit and vegetable consumption, but the RCT intervention group did not. Process: teacher professional development, teacher implementation and student reception. Results: Student engagement level was evaluated by research staff during classroom sessions and the mean was 72%. Students were particularly engaged in hands-on activities. Mean student satisfaction with the program measured by survey was 2.9 on a 4-point scale.
Dubuy, 2014 2 [33]	Health Scores!	10–14 years old (n = 605), Flanders, Belgium	Teachers	Prior to the intervention, teachers at participating schools received training on a range of activities related to healthy eating and physical activity. Further details about the teacher training and in-school curriculum were not provided in the paper. The key intervention strategy was using professional football players as credible role models for healthy lifestyle behaviors (see Group D).	4 month in-school curriculum bookended at the start and end by clinics with a professional football team	Outcome: changes in dietary habits, frequency of breakfast consumption, eating attitudes and self-efficacy, and physical activity levels. Results: Those in the intervention group increased water and vegetable consumption, and this trended toward significance compared with the control group. Process: youth satisfaction with professional athlete clinics, response to videos and letters and overall satisfaction with the program. Results: Youth overall satisfaction with the intervention was 7.82 out of 10, and the two intervention topics most commonly recalled by youth when asked were breakfast and vegetables.
Duncan, 2019 [34]	Healthy Homework program	7–10 years old (n = 675), Auckland and Dunedin, New Zealand	Classroom teachers at intervention schools and a lead teacher from each control school (who were permitted to implement the program after the final follow-up of the study)	Teachers received a half-day of training. 90 min was spent on the benefits of physical activity and healthy eating for students and previous strategies to integrate these topics into the curriculum. The second 90 min was spent on the program modules, examples of implementation and an opportunity for questions about the program.	8-week in-class and applied compulsory homework teaching module (length of a school term in New Zealand) grounded in the national school curriculum. The in-class portion was delivered in 3 90-min sessions a week, and one session included a review of the previous week’s homework. An online portal allowed students to share homework-related information with other students, including those at other schools.	Outcome: changes in physical activity, dietary patterns, screen time, and anthropometrics. Results: Participants had a significant increase in fruit consumption post-intervention compared with a control group, but the change was not sustained at the 6-month follow up. Anecdotally, students seemed more engaged in the physical activity topics that nutrition ones during the intervention.
Fahlman, 2008 [36]	Michigan Model “What’s Food Got to Do With It?” curriculum	Middle school (n = 783), Large metropolitan area in Michigan	Classroom teachers	8 h of in-service training was held on the curriculum and the textbook, “What’s Food Got to Do With It?”	8-session nutrition module that is part of larger statewide health curriculum for middle school taught over the course of 1 month.	Outcome: changes in dietary intake, nutrition knowledge, and healthy eating efficacy expectations. Results: Participants significantly increased consumption of fruits and vegetables post-intervention compared with a control group. Of note, about one-third of the initial sample was lost to follow-up.
Fairclough, 2013 [37]	Children’s Health, Activity and Nutrition: Get Educated! (CHANGE!)	10–11 years old (n = 318), Wigan, England	Year 6 Teachers	A 4-h training was provided to teachers in delivering the curriculum.	20-week curriculum with weekly 60-minue classroom sessions that were aligned with the national primary school curriculum. Also included homework tasks.	Outcome: changes in anthropometrics, physical activity, sedentary time, and food intake.
Heo, 2018 3 [45]	HealthCorps	High school (n = 832), New York, NY	Program coordinator at each school teaches lessons, oversees program activities, and serves as a mentor for students Extra- curricular activities also develop youth from the target population as peer leaders (see Group F)	Coordinators receive three weeks of HealthCorps training over the summer as well as a week of professional development over the winter break. Coordinators also have weekly check-ins with program supervisors and at least one site visit from the program supervisor during the school year.	10 classroom lessons are delivered as part of the curriculum. Were delivered over the course of a semester or school year, depending on the school. For students participating in program activities outside the classroom, total exposure could be up to 45 h over 36 weeks.	Outcome: changes in anthropometrics, knowledge, and health behavior. Results: Students participating in HealthCorps significantly increased fruit and vegetable intake; there was no change in the control group. Process: site visit by program supervisor to ensure fidelity.
Irwin, 2012 2 [46] +1 paper [47]	Get Fit with the Grizzlies	4th and 5th grade (n = 888), Memphis, TN	PE teachers	Teachers attended a half-day training workshop on the 6-week curriculum and the support services that were available to them to implement the curriculum (included web support and special activities with the Memphis Grizzlies NBA team—see Group D). Teachers were also trained to administer the pre and post-tests for the intervention. Each teacher also received two one-on-one follow-up trainings at their school during the intervention.	6-week mini-unit incorporated into PE curriculum; one lesson taught per week. Players, dancers and/or the mascot for the Memphis Grizzlies visited the schools for an assembly, and there was a district-wide Get Fit with the Grizzlies Achievement Day at Grizzlies home arena at the end of the program.	Outcome: changes in knowledge, eating behaviors, and physical activity habits. Results: Daily fruit servings increased significantly from pre to post- intervention.
Kipping, 2014 [49] +1 paper [50]	Active for Life Year 5 (AFLY5) (Adapted from Planet Health and Eat Well, Keep Moving interventions in the U.S.)	9–10 years old (n = 2221), Bristol City and North Somerset, England	Year 5 classroom teachers and learning support assistants	The training was 8–9 h over the course of 1 day in a location away from school. During the training, the intervention rationale was explained, lessons and homework activities in the curriculum were discussed and taught by the trainers interactively. Teachers and assistants also had the opportunity to ask questions. At the training, teachers were given freedom to adapt materials to their style and the range of abilities for their students, but all of the knowledge and skills from the curriculum could be imparted.	The curriculum consisted of 16 in-class lessons with 10 parent-child interactive homework activities, delivered over a period of 6–7 months (two out of three school terms).	Outcome: changes in physical activity, screen time, food consumption, and anthropometrics. Results: Participants showed a significant decrease in energy drink consumption post-intervention compared with a control group.
Koch, 2019 [51]	Food, Health, & Choices	5th grade (n = 1159), New York, NY (North Manhattan and South Bronx)	Classroom teachers and graduate student “curriculum instructors”	Teachers received a stipend to attend a 6-h professional development workshop the week before school began. The workshop provided an overview of the intervention, and teachers had the opportunity to practice intervention activities. Curriculum instructors attended the professional development with the teachers, and had an additional 2-h training on the intervention, and weekly 2-h meetings with the research staff during the intervention. Classroom teachers and curriculum instructors co-taught the lessons.	23 lessons replacing 2 mandated units in the science curriculum, delivered over 10 months. September—November was 2 lessons per week, December to April was 1 lesson per month (due to standardized testing preparation), and May was 2 lessons per week.	Outcome: changes in anthropometrics, dietary intake, outcome expectations, self-efficacy, behavioral intention, habit strength, goal-setting skills, competence, and motivation. Results: A wellness component was delivered in some schools that included a policy around foods that could be served during classroom activities. Students who received only the wellness intervention showed a significant decrease in SSB intake, but those who received the curriculum only or the curriculum and wellness together did not.
Lepe, 2019 [53]	Empowering Urban School Children to Increase Fruit and Vegetable Consumption Through EFNEP-Enhanced PSE Interventions (EMPOWER)	5th grade (n = 312), Pawtucket, RI	School health teachers and EFNEP para- professional educators	Teachers were trained in the Fresh Fruit and Vegetable Program (FFVP) nutrition education curriculum by SNAP-Ed staff. EFENEP educators received 2 2-h training sessions on the Policy, Systems, and Environment (PSE) curriculum they would be delivering to students. Their training also included an in-depth orientation to process evaluation methods.	10 30-min PSE lessons to be delivered every other week by trained EFNEP staff, designed to augment the 8-week FFVP curriculum taught by classroom teachers.	Outcome: changes in knowledge and fruit and vegetable consumption. Process: fidelity, dose delivered, dose received, reach, and program perception. Results: In focus groups, students reported asking for more fruits and vegetables at home, and school staff affirmed growth in student empowerment. Mis- communication between teachers and EFNEP educators was identified as a barrier to implementation.
Li, 2010 [56] +1 paper [57]	The nutrition-based comprehensive intervention study on childhood obesity in China (NISCOC)	6–13 years old (n = 9867), Shanghai, Chongqing, Guangzhou, Jinan, Harbin, and Beijing, China	Teachers, classroom tutors, and health educators	A 2-day training was held for the school staff that would be implementing the intervention. The training covered integrating the program into the school curriculum and performing the intervention activities. Teachers practiced the lessons during the training to ensure understanding.	The intervention took place over 2 semesters and included 6 nutrition lectures that lasted a minimum of 40 min. A cartoon-style nutrition handbook was developed for the students that was to be used along with the lectures.	Outcome: changes in anthropometrics, glucose and lipid profiles, attitudes, knowledge, and nutrition practices.
Mihas, 2010 [61]	Vyronas Youth Regarding Obesity, Nutrition, and Attitudinal Styles (VYRONAS)	12–13 years old (n = 191), Athens, Greece	Home economics teachers	Teachers attended two 3-h training seminars to learn about the objectives of the program, their role in delivering the intervention, and the importance of incorporating health and nutrition into the curriculum.	12 1-h lessons were delivered in the classroom over a period of 12 weeks. Teachers were supervised by a health visitor or family doctor from the community when delivering the lessons. Two meetings were also held for parents providing information about healthy dietary habits for children.	Outcome: changes in anthropometrics and dietary intake. Results: Participants showed a significant increase in fruit consumption post-intervention compared with a control group, and this increase was sustained 12 months after the intervention.
Olivares, 2005 [64]	The program sought to design and validate appropriate nutrition education materials for Chilean primary school students and develop and validate a teacher training program that could be replicated throughout the country.	3rd—7th grade, (n = 1701), Chile (intervention was implemented in schools throughout the country)	Classroom teachers	Participants received 3 days of training on the newly developed curriculum, which included a textbook, teacher’s guide, and practical guides for students that accompanied each of the modules. Some teachers who were particularly motivated by the training spontaneously trained colleagues when they returned to their respective schools.	The lessons were implemented over a period of 5 months.	Outcome: changes in knowledge and dietary intake. Results: Fruit and vegetable intake increased significantly among 10–11-year-old girls compared to a matching control group. SSB intake increased significantly among 8–9-year-olds in both the intervention and control groups. Process: teacher feedback on program perception. Results: Students were most engaged in activities where they prepared healthy foods.
Tsai, 2009 [69]	TAKE 10!	K-6th grade (n = 840), Chicago, IL	Teachers and a full-time volunteer	The training oriented the teachers and volunteer to the curriculum, provided strategies for integrating it into their other lessons, and connected health with academic learning.	The intervention was implemented over the course of a school year. Content was adapted to be appropriate for each grade level. The program includes daily 10-min physical activity breaks in the classroom and incorporates nutrition information into these breaks.	Outcome: changes in anthropometrics and nutrition and physical activity knowledge. Process: program perception evaluated through observations of the sessions and interviews with teachers and students at the end of the intervention. Results: Teachers were generally positive about the program and implemented 3–5 of the sessions per week. Students reported better concentration after moving during the sessions and recalled nutrition information they learned in the post-intervention interviews.
Tucker, 2015 2 [70]	Let’s Go 5–2-1–0 childhood obesity prevention intervention delivered by school nurses plus 1:1 or small group coaching by nursing students	4th and 5th grade (n = 72), Location not specified; corresponding author affiliated with University of Iowa	School nurses Intervention also included nursing students as mentors (see Group D)	Training for school nurses on delivering the classroom portion of the intervention was not described in the paper.	School nurses delivered the Let’s Go 5–2-1–0 curriculum weekly during classroom instructional time in 10–15 increments. Dosage varied from 14–21 sessions. Nursing students had lunch with their assigned student/students weekly to discuss curriculum content and set health goals.	Outcome: changes in anthropometrics, physical activity levels, nutrition, family eating patterns and screen time. Results: Self-reported daily servings of fruits and vegetables increased significantly at both schools.
Zhou, 2019 2 [72] +1 paper [73]	Chinese Childhood Health, Activity and Motor Performance Study (Chinese CHAMPS) with both in-school and afterschool components	7th grade (n = 680), Beijing, Wuhu, and Weifang, China	PE teachers Intervention also included afterschool program staff (see Group D)	2-day training focusing on adolescent growth and development, designing age-appropriate physical activities, and instructional methods. Training facilitators demonstrated activities, and staff then had the opportunity to practice.	8-month intervention; the in-school portion increased PE class to 3 days/week and implemented daily recess. As part of PE, students received fitness and nutrition education and bi-weekly text messages.	Outcome: Changes in physical fitness, anthropometrics, cognitive function, food habits and preferences, knowledge, physical activity Process: fidelity and dose received through periodic monitoring of sessions by research staff.

¹ Also included in Group B. ² Also included in Group D. ³ Also included in Group F.