Strategies for the prevention and control of obesity in the school setting: Systematic review and meta-analysis

Yale Prevention Research Center, Derby, CT 06418, USA.
International journal of obesity (2005) (Impact Factor: 5). 01/2009; 32(12):1780-9. DOI: 10.1038/ijo.2008.158
Source: PubMed


To determine the effectiveness of school-based strategies for obesity prevention and control using methods of systematic review and meta-analysis.
Peer-reviewed studies published between 1966 and October 2004 were considered for review. Studies meeting eligibility criteria were published in English, targeted children aged 3-18 in a school setting, reported weight-related outcomes, included a control measurement and had at least a 6-month follow-up period. Studies employed interventions related to nutrition, physical activity, reduction in television viewing or combinations thereof. Weight related data were analyzed using RevMan software.
Sixty-four studies were considered for inclusion. Fourteen did not meet inclusion criteria; 29 were excluded due to poor methodological quality. Twenty-one papers describing 19 studies were included in the systematic review and 8 of these were included in the meta-analysis. Nutrition and physical activity interventions resulted in significant reductions in body weight compared with control ((standardized mean difference, SMD=-0.29, 95% confidence interval (CI)=-0.45 to -0.14), random effects model). Parental or family involvement of nutrition and physical activity interventions also induced weight reduction ((SMD=-0.20, 95%CI=-0.41 to 0.00), random effects model).
Combination nutrition and physical activity interventions are effective at achieving weight reduction in school settings. Several promising strategies for addressing obesity in the school setting are suggested, and warrant replication and further testing.


Available from: Haq Nawaz, Jul 23, 2014
    • "Educational programs and interventions for improving health-related behaviors must be tailored to the most important determinants or mediators of these behaviors.[13] As adolescents mainly attend and gather in schools, these settings are the places that are most appropriate for nutrition-related interventions and programs among the mentioned group.[14] This study is expected to provide crucial elements for the development of a school-based fruit and vegetable programs. "
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    ABSTRACT: Background: For effectively promoting fruit and vegetable consumption among adolescents, it is necessary to identify the determinants of intake. This qualitative research was conducted to explore the determinants of fruit and vegetable consumption among Tehranian adolescents in 2012. Materials and Methods: The present qualitative study is aimed at identifying the determinants of fruit and vegetable consumption among Tehranian adolescents in 2012. Male and female students in the middle schools of Tehran, in the age range of 11-14 years, were used as the study population, which was selected by the convenience method. Semi-structured interactional interviews were used for data collection. Data was analyzed using the qualitative content analysis method. Results: The availability and accessibility of fruits and vegetables in home, availability of unhealthy options in the environment, socioeconomic status, advertising about unhealthy options, subjective norms, reinforcement, and modeling were explored as environmental factors in this study. Also, individual factors were extracted as the second category that encompassed the subcategories including; preferences, knowledge, skill in preparing fruits and vegetables, outcome expectations, outcome expectancy, perceived susceptibility, and perceived seriousness. Conclusion: It is recommended that interventions have family-based designs as well as environmental policy-based (especially schools) ones. Meanwhile, families should be educated to adapt their children's sapour with tastes of fruits and vegetables during their childhood.
    Journal of research in medical sciences 06/2014; 19(6):482-9. · 0.65 Impact Factor
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    • "Nevertheless, the main cause of obesity is a chronic energy imbalance, which occurs when energy intake exceeds energy expenditure [8,9]. Dietary intake and physical activity (PA) are important behaviours related to the energy balance [9,10] and are considered key elements in the prevention of overweight and obesity [11-13]. "
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    ABSTRACT: Background The increasing rates of obesity among children and adolescents, especially in those from lower socio-economic backgrounds, emphasise the need for interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the ‘Health Scores!’ program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents. Methods The intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted. Results No intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive intervention effects were found for self-efficacy for having a daily breakfast (p < 0.01), positive attitude towards vegetables consumption (p < 0.01) and towards lower soft drink consumption (p < 0.001). A trend towards significance (p < 0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely positive. Conclusions The ‘Health Scores!’ intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.
    BMC Public Health 05/2014; 14(1):457. DOI:10.1186/1471-2458-14-457 · 2.26 Impact Factor
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    • "E. Weichselbaum and J. L. Buttriss healthy diet and increased physical activity levels (Summerbell et al. 2005), but another systematic review (and meta-analysis) reported that a combination intervention, a single nutrition intervention and a TV reduction intervention were equally effective in achieving weight reduction compared with controls, although a physical activity intervention alone was not effective (Katz et al. 2008). A systematic review of communitybased childhood obesity prevention programmes found that out of nine studies, only four resulted in significant changes in BMI (Bleich et al. 2013). "
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    ABSTRACT: This paper updates a British Nutrition Foundation (BNF) Briefing Paper on this topic, published in 2011. Healthy eating and being physically active are particularly important for children and adolescents. This is because their nutrition and lifestyle influence their wellbeing, growth and development. There remains considerable room for improvement in the diets of British schoolchildren, according to findings of the government's National Diet and Nutrition Surveys (NDNS), but some improvements have been made in the past decade. Although intakes of saturated fatty acids and non-milk extrinsic sugars have decreased in recent years, on average, they are still above recommended upper levels. Average contribution of fat to total energy intake has dropped below the recommended upper level of 35%, but fibre intakes remain low. With regard to micronutrients, many teenage girls are consuming low amounts of iron, but there is also evidence of low intakes of vitamin A, riboflavin, calcium, magnesium, potassium, selenium, iodine and zinc. New data on micronutrient status is now available for 11–18 year-olds, and reveals low levels of vitamin D, riboflavin and iron (mainly in girls). Low vitamin D intake and status is a particular problem in some ethnic minority groups, especially South Asian children. There is also some evidence of socio-economic inequalities; for example, children from families with higher incomes tend to have higher intakes of fruits and vegetables compared with children from families with lower incomes. This paper also discusses how dietary patterns can influence the micronutrient intake and status of schoolchildren, as well as the risk of overweight and obesity. Since publication of the Briefing Paper in 2011, new physical activity guidelines have been published and, for the first time, these are UK-wide guidelines. Also for the first time, UK-wide data on physical activity levels in schoolchildren are available (for 7-year-old children). Physical activity levels vary little between the UK regions, with the exception of Northern Ireland where fewer children meet the UK recommendations than in other regions. The data highlight significant differences between boys and girls (with girls generally being less active) and significant differences between ethnic groups. In particular, children from the Bangladeshi, Indian and Pakistani ethnic groups are less likely to meet the recommended levels of physical activity compared with other children. Obesity remains a major problem among British schoolchildren and there is a stark socio-economic gradient, with levels of obesity being highest in the most socially deprived children. This paper also discusses various health issues in children, including iron deficiency anaemia, oral health, bone development, food allergy and intolerance, and cognitive function in children, updating the previous paper with the latest statistics and evidence. The findings of the NDNS serve to emphasise the importance of a whole school approach to good nutrition embracing the school curriculum as well as the food and drink available in schools (as highlighted in the recently published School Food Plan). School food provision has seen many changes over recent years, with school food standards now in place in all UK regions, most recently Wales. Various evaluations of the impact of school food standards, mainly in England, have highlighted improvements in the diets of schoolchildren, not only in the school setting but in their diets overall. However, there remains room for improvement. This paper also briefly describes a selection of initiatives and organisations of relevance to child nutrition.
    Nutrition Bulletin 02/2014; 39(1). DOI:10.1111/nbu.12071
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