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

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Background 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. Methods 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. Results 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. Conclusion 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.