<p>Risk of bias assessment.</p>

Risk of bias was generally low to some concerns. Overall, the evidence suggests that combined physical activity and nutrition education interventions may improve anthropometric indicators, dietary behaviors, physical activity levels and sedentary behaviors among overweight and obese early adolescents. However, the overall certainty of evidence was very low primarily because of substantial heterogeneity and the limited number of available studies.Given the very low certainty of evidence, the effectiveness of combined nutrition and physical activity education interventions among overweight and obese early adolescents living in resource-constrained settings remains uncertain.

While positive trends were noted, the highly inconsistent data across a limited number of studies indicate the data should be interpreted with caution. Furthermore, a substantial gap exists regarding underweight early adolescents. To address this, further high-quality trials, are needed particularly in low-income settings.

Protocol registration: PROSPERO (CRD42024569008).</p></div>