Impact of a school-based pediatric obesity prevention program facilitated by health professionals.
ABSTRACT This study evaluated a school-based obesity intervention for elementary school children (N = 835) where health professionals assisted teachers with the integration of healthy messages into the school curriculum.
Schools were randomized into a professional-facilitated intervention (PFI; N = 4) or a self-help (SH; N = 3) condition. Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools (overall: N = 835 students; PFI: N = 509 students, SH: N = 326 students). Students were between ages 7 and 9 and from diverse ethnic backgrounds (Asian = 25.3%, Black = 23.3%, Hispanic = 23.1%, White = 28.3%). The sample included 321 overweight/obese (BMI ≥ 85th percentile), 477 normal-weight (BMI ≥ 5th percentile and <85th percentile), and 37 underweight (BMI < 5th percentile) students.
After 2 years, children who were overweight/obese in the PFI condition significantly reduced their standardized BMI (zBMI) compared to children in the SH condition (Wald χ(2) = 28.7, p < .001). End-of-year grades decreased for overweight/obese students in both conditions; however, students in the PFI exhibited a smaller decrease in grades compared to the SH condition (Wald χ(2) = 80.3, p < .001).
The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing zBMI compared to the SH condition.
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ABSTRACT: Background and Aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions. Methods: Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. Results are presented in narrative synthesis and meta-analysis. Results: Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference -1.82 kgs, 95% confidence interval -2.48 to -1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference -1.20 kgs, 95% confidence interval -2.23 to -0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to -0.8 kg/m2. There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status. Conclusions: Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children.International Journal of Environmental Research and Public Health 01/2015; 12(1):566-594. · 1.99 Impact Factor
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ABSTRACT: Background: The issue of childhood overweight and obesity has become a global public health crisis. School-based interventions have been developed and implemented to combat this growing concern. The purpose of this review is to compare and contrast U.S. and international school-based obesity prevention interventions and highlight efficacious strategies. Methods: A systematic literature review was conducted utilizing five relevant databases. Inclusion criteria were: (1) primary research; (2) overweight or obesity prevention interventions; (3) school-based; (4) studies published between 1 January 2002 through 31 December 2013; (5) published in the English language; (6) child-based interventions, which could include parents; and (7) studies that reported outcome data. Results: A total of 20 interventions met the inclusion criteria. Ten interventions each were implemented in the U.S. and internationally. International interventions only targeted elementary-aged students, were less likely to target low-income populations, and were less likely to be implemented for two or more years in duration. However, they were more likely to integrate an environmental component when compared to U.S. interventions. Discussion: Interventions implemented in the U.S. and internationally resulted in successful outcomes, including positive changes in student BMI. Yet, varying approaches were used to achieve success, reinforcing the fact that a one-size-fits-all approach is not necessary to impact childhood obesity. However, building on successful interventions, future school-based obesity prevention interventions should integrate culturally specific intervention strategies, aim to incorporate an environmental component, and include parents whenever possible. Consideration should be given to the potential impact of long-term, frequent dosage interventions, and subsequent follow-up should be given attention to determine long-term efficacy.International Journal of Environmental Research and Public Health 09/2014; 11(9):8940-8961. · 1.99 Impact Factor
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ABSTRACT: Background Since sugar-sweetened beverages (SSB) may contribute to the development of overweight in children, effective interventions to reduce their consumption are needed. Here we evaluated the effect of a combined school- and community-based intervention aimed at reducing children¿s SSB consumption by promoting the intake of water. Favourable intervention effects on children¿s SSB consumption were hypothesized.Methods In 2011-2012, a controlled trial was conducted among four primary schools, comprising 1288 children aged 6-12 years who lived in multi-ethnic, socially deprived neighbourhoods in Rotterdam, the Netherlands. Intervention schools adopted the `water campaign¿, an intervention developed using social marketing. Control schools continued with their regular health promotion programme. Primary outcome was children¿s SSB consumption, measured using parent and child questionnaires and through observations at school, both at baseline and after one year of intervention.ResultsSignificant positive intervention effects were found for average SSB consumption (B -0.19 litres, 95%CI -0.28;-0.10; parent report), average SSB servings (B -0.54 servings, 95%CI -0.82;-0.26; parent report) and bringing SSB to school (OR 0.51, 95%CI 0.36;0.72; observation report).Conclusions This study supports the effectiveness of the water campaign intervention in reducing children¿s SSB consumption. Further studies are needed to replicate our findings.Trial registrationCurrent Controlled Trials: NTR3400.International Journal of Behavioral Nutrition and Physical Activity 07/2014; 11(1):98. · 3.68 Impact Factor