Relationship between primary school healthy eating and physical activity promoting environments and children’s dietary intake, physical activity and weight status: a longitudinal study in the West Midlands, United Kingdom

Research output: Contribution to journalArticlepeer-review


External organisations

  • Health Education Service, Birmingham


Objectives: We aimed to examine the association between food and physical activity environments in primary schools and child anthropometric, healthy eating and physical activity measures.

Design: Observational longitudinal study using data from a childhood obesity prevention trial.

Setting: State-primary schools in the West Midlands region, UK.

Participants: 1,392 pupils who participated in the West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) childhood obesity prevention trial (2011-2015).

Primary and secondary outcome measures: School environment (exposure) was categorised according to questionnaire responses indicating their support for healthy eating and/or physical activity. Child outcome measures, undertaken at three time-points (age 5-to-6, 7-to-8 and 8-to-9 years), included: body mass index z-scores, dietary intake (using a 24-hour food-tick-list) and physical activity (using an Actiheart monitor over five days). Associations between school food and physical activity environment categories and outcomes were explored through multilevel models.

Results: Data were available for 1,304 children (94% of the study sample). At age 8-to-9 years, children in ten schools with healthy eating and physical activity-supportive environments had a higher physical activity energy expenditure than those in 22 schools with less supportive healthy eating/physical activity environments (mean difference=5.3kJ/kg body weight/24 hours, p=0.05). Children in schools with supportive physical activity environments (n=8) had a lower body mass index z-score than those in schools with less supportive healthy eating/physical activity environments (n=22; mean difference=-0.17, p=0.02). School food and physical activity promoting environments were not significantly associated with dietary outcomes.

Conclusions: School environments that support healthy food and physical activity behaviours may positively influence physical activity and childhood obesity.

Trial registration: The WAVES trial was registered on 19/05/2010, registration number: ISRCTN97000586.


Original languageEnglish
Article number040833
JournalBMJ open
Issue number12
Publication statusPublished - 22 Dec 2020


  • Obesity, Child, Primary school, Environment, Diet, Healthy eating, Physical activity