# Assessing the association between health promotion initiatives and student nutritional status and lifestyle: a regional observational study from Italy

## TL;DR

This study examines how health promotion in Italian schools affects students' nutrition and activity levels, finding limited impact.

## Contribution

The study evaluates the real-world effectiveness of school health initiatives in a specific Italian region.

## Key findings

- Overweight prevalence was 25.1% in primary and 16.7% in secondary students.
- Schools with parent-involved nutrition programs had better mid-morning snack habits.
- Fruit consumption improved in secondary schools with nutrition policies.

## Abstract

Schools are widely recognized as key settings for health promotion interventions to address excessive weight among children and adolescents. This cross-sectional observational study evaluated the association between the presence or absence of health promotion practices in a representative sample of primary and secondary school classes in the Friuli-Venezia Giulia (FVG) region and students’ weight status and dietary and physical activity (PA) habits.

Data on nutritional status, dietary and PA habits, and on school health promotion initiatives, with or without family or local health unit (LHU) involvement, were derived from questionnaires completed by school principals, students and families as part of the 2023 OKkio alla Salute (children aged 8–9) and the 2022 Health Behaviour in School-aged Children (adolescents aged 11–17) surveys.

The prevalence of overweight or obesity was 25.1% among primary school children and 16.7% among adolescents. Most primary schools implemented nutrition (86.5%) and PA (97%) education, but with limited family and LHU involvement. The only significant difference was observed in eating habits, with higher consumption of adequate mid-morning snacks in children attending primary schools that implemented healthy eating initiatives involving parents (p < 0.001). In secondary schools, most of which reported implementing policies on nutrition (92.8%) and PA (97.3%), the only significant difference was fruit consumption ≥ once/day in adolescents attending schools with nutrition-related policies.

While school-based health promotion practices and policies are widely implemented in the FVG region, their association with students’ nutritional status, dietary habits and PA was limited. These findings highlight the limited benefits yielded by existing school practices and policies and underline the potential importance of stronger parental involvement, multi-sectoral collaboration and more structured school health policies.