Multi-component obesity prevention interventions

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Date last updated

Multi-component obesity prevention interventions combine educational, environmental, and behavioral activities, and typically address both physical activity and nutrition. Often led by trained professionals, such interventions involve in-person meetings and offer opportunities for counseling, coaching, and support. Multi-component obesity prevention interventions frequently also include nutrition education, aerobic or strength training exercise sessions, training in behavioral techniques, and specific dietary prescriptions1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased physical activity

  • Improved weight status

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Increased self-confidence

  • Increased fruit & vegetable consumption

What does the research say about effectiveness?

There is strong evidence that multi-component obesity prevention interventions increase physical activity2345 and weight loss for children and adolescents6, 7, 8931011. Multi-component interventions also modestly improve weight status among adults12, including overweight or obese adults13 and adults with a higher risk of type 2 diabetes14. Additional evidence is needed to confirm long-term effects12.

In general, multi-component interventions are more effective than single component efforts, especially over longer durations29114, 12, 13. Longer term studies show greater weight loss among participants in multi-component interventions that address nutrition and physical activity than among participants in nutrition-only interventions; however, in the short-term, both interventions appear to have similar benefits13.

Multi-component interventions increase fruit and vegetable intake among younger children15. Such interventions have demonstrated positive effects on child and adolescent weight status1083, possibly over the long-term83. Multi-component interventions delivered in schools that include both home and community components have been shown to reduce body mass index (BMI) and improve weight status for children; interventions with only a home or community component and interventions delivered in community settings can also improve BMI and weight status7. Multi-component interventions with a specific focus on self-esteem can improve self-esteem for overweight or obese adolescents; interventions without such a focus improve weight status but not self-esteem6. Workplace-based multi-component interventions have been shown to improve weight status and self-confidence among participating employees116.

Interventions that include culturally tailored or lifestyle specific components have been shown to be most effective for minority students11. Multi-component interventions that rely primarily on providing information for behavior change may be less successful among populations with lower socio-economic status than interventions that include structural changes to the environment and community-based strategies17.

Costs for multi-component obesity prevention programs vary based on several factors, including setting, duration, meeting structure, and number of sessions. Multi-component interventions that address both nutrition and physical activity for people with an increased risk of type 2 diabetes have been shown to be cost-effective14.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

Multi-component interventions to prevent obesity are implemented throughout the country. For example, the New York State Department of Health’s Eat Well Play Hard initiative is an example of a successful multi-component obesity prevention intervention18. The 5-2-1-0 obesity prevention program is a multi-component intervention for improving diet, increasing physical activity, and reducing screen time; the program was designed for children and has been expanded to include adults. The 5-2-1-0 program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. It started in Maine19 and has expanded to cities and states across the country, including Florida20; New Hampshire21; Baton Rouge, LA22; Chesterfield County, VA23; and Palo Alto, CA24.

The B’More Fit initiative in Baltimore provides women with children who receive public assistance licensed childcare and lessons for children about fitness and eating healthy, while mothers participate in exercise classes, group meetings, and nutrition and stress management classes that are offered in English or Spanish25.

Niños Sanos, Familia Sana (Healthy Children, Healthy Family) is a five year effort that engages Mexican-origin farmworker families using culturally tailored messages, fruit and vegetable incentives, supportive environments, parenting skill classes, and nutrition and physical activity education and opportunities26.

Implementation Resources

NYS DOH-EWPH - New York State Department of Health (NYS DOH). Eat well play hard (EWPH).

ChangeLab-OPR - ChangeLab Solutions. Why adopt an obesity prevention resolution (OPR)? A fact sheet about our model resolution.

ChangeLab-Healthy communities toolkit - ChangeLab Solutions. How to create and implement healthy general plans: A toolkit for building healthy, vibrant communities.

ChangeLab-Planning guide - ChangeLab Solutions. A roadmap for healthier general plans: A guide & infographic about the planning process.

CI-WOTN - Community Initiatives (CI). The Weight of the Nation (WOTN).


* Journal subscription may be required for access.

1 CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.

2 Kriemler 2011 - Kriemler S, Meyer U, Martin E, et al. Effect of school-based interventions on physical activity and fitness in children and adolescents: A review of reviews and systematic update. British Journal of Sports Medicine. 2011;45(11):923-30.

3 Katz 2008 - Katz D, O’Connell M, Njike V, Yeh M-C, Nawaz H. Strategies for the prevention and control of obesity in the school setting: Systematic review and meta-analysis. International Journal of Obesity. 2008;32(12):1780-9.

4 Kamath 2008 - Kamath CC, Vickers KS, Ehrlich A, et al. Behavioral interventions to prevent childhood obesity: A systematic review and meta-analyses of randomized trials. Journal of Endocrinology and Metabolism. 2008;93(12):4606-15.

5 Cochrane-Waters 2011 - Waters E, de Silva-Sanigorski A, Burford BJ, et al. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2011;(12):CD001871.

6 Murray 2017 - Murray M, Dordevic AL, Bonham MP. Systematic review and meta-analysis: The impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. Journal of Pediatric Psychology. 2017;42(4):379-394.

7 Wang 2015b - Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obesity Reviews. 2015;16(7):547-565.

8 Brown 2009 - Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Reviews. 2009;10(1):110-41.

9 De Bourdeaudhuij 2011 - De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, et al. School-based interventions promoting both physical activity and healthy eating in Europe: A systematic review within the HOPE project. Obesity Reviews. 2011;12(3):205-16.

10 Kelly 2008 - Kelly SA, Melnyk BM. Systematic review of multicomponent interventions with overweight middle adolescents: Implications for clinical practice and research. Worldviews on Evidence-Based Nursing. 2008;5(3):113-35.

11 Seo 2010 - Seo D-C, Sa J. A meta-analysis of obesity interventions among U.S. minority children. Journal of Adolescent Health. 2010;46(4):309-23.

12 Stephens 2014 - Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: An overview of current evidence. Preventive Medicine. 2014;62:167-178.

13 Johns 2014 - Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P. Diet or exercise interventions vs combined behavioral weight management programs: A systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics. 2014;114(10):1557-1568.

14 CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

15 Van Cauwenberghe 2012 - Van Cauwenberghe E, Maes L, Spittaels H, et al. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: Systematic review of published and “grey” literature. British Journal of Nutrition. 2010;103(6):781-97.

16 Lombard 2009 - Lombard CB, Deeks AA, Teede HJ. A systematic review of interventions aimed at the prevention of weight gain in adults. Public Health Nutrition. 2009;12(11):2236-46.

17 Beauchamp 2014 - Beauchamp A, Backholer K, Magliano D, Peeters A. The effect of obesity prevention interventions according to socioeconomic position: A systematic review. Obesity Reviews. 2014;15(7):541-554.

18 NYS DOH-EWPH - New York State Department of Health (NYS DOH). Eat well play hard (EWPH).

19 MH-Let’s go - MaineHealth (MH). Let's go!

20 FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle.

21 FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.

22 MYAC-5210 plus 10 - Mayor's Youth Advisory Council (MYAC). Eat Right. Play Hard. Live Well. Mayor's Healthy City Initiative: 5-2-1-0+10 health and wellness campaign.

23 COACH-5210 everyday - Chesterfield County's Coalition for Active Children (COACH). 5-2-1-0 Everyday!

24 PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources.

25 BHB-B’More Fit - B’More for Healthy Babies (BHB), Baltimore Medical System. Our programs: B’More Fit.

26 Kaiser 2015 - Kaiser L, Martinez J, Horowitz M, et al. Adaptation of a culturally relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Preventing Chronic Disease. 2015;12:140591.