BeE-school: promoting health literacy and reducing obesity risk in vulnerable school communities

Abstract Background Noncommunicable diseases (NCDs) risks often begin in childhood and are shaped by modifiable determinants such as unhealthy diet and imbalanced 24-hour movement patterns. These risks are especially pronounced in socially vulnerable groups. Despite increasing recognition of NCDs as a public health priority, prevention efforts remain inconsistent. In this context, strengthening health literacy and promoting healthy lifestyles through school-based approaches is crucial. The aim of this study is to evaluate the effectiveness of the BeE-school health literacy intervention. Methods BeE-school is a cluster-RTC conducted in 10 primary schools in socioeconomically disadvantaged areas of Northern Portugal. N = 735 children (6-12 y.) participated in the intervention, which is grounded in health promotion theory and the Fogg behavior model. It involved a 16-week programme comprising accredited teacher training (48 hours), classroom activities, and biweekly family challenges focusing on nutrition, movement, emotional well-being, and misinformation resilience. Data on anthropometrics, lifestyles, and health literacy were collected at baseline, post-intervention (4 months), and at long-term follow-up (12 months). Results Children in the intervention group exhibited significant reductions in BMI Z-scores, waist-to-height, and waist-to-weight ratios after the intervention, with BMI improvements sustained at 12-month follow-up. Higher parental health literacy was associated with greater adherence to the Mediterranean diet and lower odds of childhood overweight/obesity. Among families with lower education levels, more quality time together was also protective. Conclusions BeE-school is a promising, sustainable program to foster health literacy and reduce obesity risk among vulnerable children. Its success highlights the value of integrating health promotion, co-creation, and family engagement within school settings to tackle early determinants of NCDs.