A Policy-Based School Intervention to Prevent Overweight and Obesity

Center for Obesity Research and Education, Temple University, 3223 N Broad St, Suite 175, Philadelphia, PA 19140, USA.
PEDIATRICS (Impact Factor: 5.47). 05/2008; 121(4):e794-802. DOI: 10.1542/peds.2007-1365
Source: PubMed


The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity.
The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (> 95.0th percentile) among children in grades 4 through 6 over a 2-year period.
Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with > or = 50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach.
The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years.
A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.

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    • "At 6 months differences were observed in BMI and after 24 months, BMI z-score and WC enhanced and abdominal obesity declined Foster et al., 2008, USA [47] Randomized controlled cluster trial 4-6 th grade school children 2 years Meal supply, nutrition education, nutrition policy, social marketing, parent outreach Weight, BMI z scores, dietary intake, PA 50% decline in overweight incidence but not obesity Plachta-Danielzik et al., 2007, Germany [32] Randomized, controlled trial 6 years old children 1 year Nutrition education, increase in PA and decrease in TV consumption BMI percentiles, healthy eating index Cumulative incidence of overweight after 4 years was less only in children's of high socioeconomic status families Johnston, 2010 et al., Texas [48] Participants were randomized to either the ILI or SH 10-14 years old adolescents 1 year Increasing healthy eating and PA using behavioral strategies to individualize the plans which was parent-guided in SH and trainer guide in ILI group Weight, TSF, zBMI zBMI and TSF declined more in ILI children after 1 and 2 years Jiang et al., 2007, China [49] "
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    • " multidisciplinary [9]. Schools are commonplace in promoting healthy eating and physical activity policies [1] but are also ideal environments for such interventions [10]. "
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