School-based behaviour change intervention to reduce ultra-processed food consumption among adolescents: evidence from a cluster-randomized controlled trial in India
File(s)
Accepted version
Supporting information
Author(s)
Kaur, Sandeep
Kumar, Rajesh
Kaur, Manmeet
Type
Journal Article
Abstract
Background:
The global surge in ultra-processed food (UPF) consumption is a major public health challenge, particularly among adolescents. UPFs, characterized by high energy density, added sugars, fats, and sodium, and low essential nutrients, are linked to poor diet quality and heightened risks of obesity, diabetes, and all-cause mortality. Despite growing concerns, there is limited evidence on school-based interventions targeting UPF reduction in low- and middle-income countries like India.
Methods:
A cluster-randomized controlled trial was conducted across 12 public schools in Chandigarh, India, targeting Grade 8 adolescents and their parents. The intervention was structured around the PRECEDE–PROCEED Model and comprised eleven sessions for adolescents delivered over six months. Additionally, a single educational session was conducted for parents to enhance their awareness of reducing UPF consumption and encouraging healthier dietary behaviours. Dietary
intake data were collected at baseline and end-line using two non-consecutive 24-hour dietary recalls. Foods were categorized based on NOVA food processing levels. Energy levels were estimated using PURE study data. The intervention's effectiveness was evaluated using a difference-in-differences analytical approach.
Findings:
The intervention significantly reduced UPF energy intake among adolescents by 1062 Kcal/d (95% CI: -2100, -67) and processed food by 274 Kcal/d (95% CI: -526, -23). However, no significant changes were observed in minimally processed food consumption. Among parents, the intervention had no significant impact on energy intake for any of the NOVA classified food categories. Process evaluation highlighted high participant engagement and feasibility of the intervention in school settings.
Conclusion:
This study demonstrates the potential of school-based behavioural interventions to reduce UPF consumption among Indian adolescents, addressing a critical gap in public health research and practice in LMICs.
The global surge in ultra-processed food (UPF) consumption is a major public health challenge, particularly among adolescents. UPFs, characterized by high energy density, added sugars, fats, and sodium, and low essential nutrients, are linked to poor diet quality and heightened risks of obesity, diabetes, and all-cause mortality. Despite growing concerns, there is limited evidence on school-based interventions targeting UPF reduction in low- and middle-income countries like India.
Methods:
A cluster-randomized controlled trial was conducted across 12 public schools in Chandigarh, India, targeting Grade 8 adolescents and their parents. The intervention was structured around the PRECEDE–PROCEED Model and comprised eleven sessions for adolescents delivered over six months. Additionally, a single educational session was conducted for parents to enhance their awareness of reducing UPF consumption and encouraging healthier dietary behaviours. Dietary
intake data were collected at baseline and end-line using two non-consecutive 24-hour dietary recalls. Foods were categorized based on NOVA food processing levels. Energy levels were estimated using PURE study data. The intervention's effectiveness was evaluated using a difference-in-differences analytical approach.
Findings:
The intervention significantly reduced UPF energy intake among adolescents by 1062 Kcal/d (95% CI: -2100, -67) and processed food by 274 Kcal/d (95% CI: -526, -23). However, no significant changes were observed in minimally processed food consumption. Among parents, the intervention had no significant impact on energy intake for any of the NOVA classified food categories. Process evaluation highlighted high participant engagement and feasibility of the intervention in school settings.
Conclusion:
This study demonstrates the potential of school-based behavioural interventions to reduce UPF consumption among Indian adolescents, addressing a critical gap in public health research and practice in LMICs.
Date Acceptance
2025-12-21
Citation
BMJ Global Health
ISSN
2059-7908
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Global Health
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted
Date Publish Online
2026-01-09