[Show abstract][Hide abstract] ABSTRACT: To evaluate the 4-year outcome of a school-based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS).
Within a cluster-sampled quasi-randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20-minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures.
The 4-year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4-year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal-weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4-year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal-weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle.
A school-based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal-weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the feasibility and 4-year outcome of school-based health promotion on overweight among 6-10-year-old children.
Four-year follow-up data of 344 children participating in health promotion (I) as part of the Kiel Obesity Prevention Study (KOPS) at age 6 years, compared with 4-year changes in 1420 non-intervention children (NI). Nutritional knowledge was assessed before and 3 months after intervention in 1996 and 2004. Outcome was characterized compared to reference values for (i) BMI, (ii) triceps skinfold (TSF) and (iii) waist circumference (WC).
Process evaluation showed an increase in knowledge after intervention. However, the prevalence of children with good nutritional knowledge before intervention doubled from 1996 to 2004 but similar intervention-induced increases in knowledge (+50%) were observed. When compared with NI I increased remission of overweight with no significant effect on incidence. The effect was most pronounced in girls. The effect was affected by definition of overweight: when compared with parameters of fat mass (TSF and WC), BMI was showing a stronger effect (remission in girls (Delta I - NI): BMI: +13.4%, TSF: +18.7%, WC: +20.7%).
School-based health promotion has sustainable effects on nutritional knowledge and remission of overweight being most pronounced in girls. The effect of intervention was most pronounced using TSF and WC as criteria of overweight.
No preview · Article · May 2007 · Acta paediatrica (Oslo, Norway: 1992). Supplement
[Show abstract][Hide abstract] ABSTRACT: There are only few controlled studies on prevention of overweight in children and adolescence. These studies differ with respect to strategy, setting, duration, focus, variables of outcome and statistical power. Universal and school-based interventions show some improvement of health knowledge and health-related behaviours but they have only minor or no effects on nutritional status. However they reduce the incidence of overweight. The effects seem to be more pronounced in girls than in boys. Children of middle and high class as well as children with intact families benefit better from intervention than children with low socioeconomic status. Selected prevention in overweight children was most successful when children were treated together with their parents. However there are social barriers limiting the success. Simple interventions in a single area are unlikely to work on their own. The development of effective preventive interventions likely require strategies that affect multiple settings simultaneously. At present there is no concerted action but many strategies are followed in isolation. There is need for national campaigns and action plans on childhood overweight and obesity. It is tempting to speculate that this will also increase the effects of isolated approaches.
No preview · Article · Aug 2006 · International Journal for Vitamin and Nutrition Research
[Show abstract][Hide abstract] ABSTRACT: In Germany overweight and obesity in children, adolescents and adults are endemic. In our society, overweight is not equally distributed. There is an inverse socioeconomic gradient in childhood overweight: children of low socioeconomic status have the highest prevalence of overweight. These differences are only partly explained by socially determined behaviours. Social factors also serve as a barrier to interventions of health promotion at school and treatment of overweight. Since overweight is a social, familial and gender problem it is not solved by intervention addressing the individual behaviour only. Effective intervention strategies should comprise multiple settings.
No preview · Article · Jun 2006 · Ernährungs Umschau
[Show abstract][Hide abstract] ABSTRACT: Prevention of obesity is a public health agenda. There are only few longitudinal studies on prevention of overweight in children. The Kiel Obesity Prevention Study (KOPS) intends to characterise the determinants of childhood overweight and the effect of preventive measures within schools as well as within families.
Between 1996 and 2005, KOPS investigated 4997 German 5-7 and 4487 9-11-y-old children or 41 and 37% of the total population of all first and fourth graders in 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. Main outcome measures were nutritional status, health habits and risk factors of disease. In addition, health promotion was performed each year in three schools for all first graders and their teachers (nutrition education and active school breaks) together with a family-oriented approach in families with obese and preobese children. Up to now, the children were followed for 4y and were reinvestigated at age 10 y.
The KOPS population was representative for all 5-7 and 9-11-y-old children in Kiel. The prevalence of overweight/ obesity (> or = 90th/97th BMI reference percentile) was 7.0/5.8 and 11.3/6.3% in 5-7 and 9-11-y-old children, respectively. Parental overweight, a low socio-economic status and a high birth weight were identified as main risk factors for overweight in prepubertal children. The first results of the interventions show that obesity prevention was possible, but there were limited success rates in boys and children from low social class.
Faced with the environmental contributors to the obesity problem societal rather than individual responsibilities are evident. This idea suggests that dissecting and tackling the obesogenic environment is necessary to complement school- and family-based interventions.
Full-text · Article · Sep 2005 · International Journal of Obesity
[Show abstract][Hide abstract] ABSTRACT: There have been only a few controlled studies on the prevention of overweight and obesity in children and adolescents. These studies differ in relation to strategy, setting, duration, focus, variables of outcome and statistical power, and therefore do not allow general conclusions to be made about the value of preventive measures. All school-based interventions aimed at the prevention of overweight and obesity show some improvement of health knowledge and health-related behaviours. Short-term effects on nutritional state seem to be more pronounced in girls than in boys. School-based interventions can reduce the incidence of overweight. There is evidence that families of intermediate and high socio-economic status as well as intact families benefit more from treatment than families sharing other characteristics. Selected prevention in obese children is most successful when children are treated together with their parents. However, there are social barriers limiting the success of family-based interventions. Although some positive effects have been reported, simple interventions in a single area (e.g. a school health education programme) are unlikely to work on their own. The development of effective preventive interventions probably requires strategies that affect multiple settings simultaneously. At present there is no concerted action, rather many strategies in health promotion that are followed in isolation. Faced with the epidemic of overweight there is a need for national campaigns and action plans on childhood overweight and obesity. It is tempting to speculate that this strategy will also increase the value of isolated approaches (e.g. in schools and families).
Full-text · Article · Jun 2005 · Proceedings of The Nutrition Society
[Show abstract][Hide abstract] ABSTRACT: We have analysed dietary intake of 173 patients of the university hospital Kiel using 3-day dietary records. In addition 2 standard diets ("Vollkost" and "Leichte Vollkost") were analysed over a period of 7 weeks. The patients interest in dietary counselling were evaluated using a questionaire. Dietary records showed significant deviations from reference values. The intake of carbohydrates, fiber, Vitamin D, Vitamin E, folate, iron, iodine and polyunsaturated fatty acids were too low, ranging between - 26 to -59% (reference values = 100%). Concomitantly the intake of fat, retinol-equivalentes, Vitamin B6, Vitamin B12 and saturated fatty acids were higher than the DACH-reference values (+ 35 to + 106%). The healthy eating index was low. We observed a high consumption of meat and sausages but fruit and fish intake was low. When compared with the DACH-reference values "Vollkost" and "Leichte Vollkost" showed considerable deviations for some nutrients (≥ 25% in opposite to the DACH-reference values = 100%). The intake of retinol-equivalente (+ 102% "Vollkost"/+ 184% "Leichte Vollkost"), Vitamin B 1 (+ 45%/+ 38%), Vitamin B6 (+ 78%/+ 69%), Vitamin B 12 (+ 144/+ 139%), Vitamin C (+ 55%/+ 37%) and saturated fatty acids(+ 37%/+ 28%) were higher than the reference values. The intake for folate (- 38%/- 37%), poly-unsaturated fatty acids (- 41%/-39%), carbohydrates (- 26% "Vollkost") and Vitamin D (- 64% "Leichte Vollkost") were low. Meat intake was high in "Vollkost" as well as in "Leichte Vollkost". Concomitantly fruit, uncooked vegetarian food and fish was seldom offered. "Healthy" eating had a great significance for male and female patients. They interested in "healthy" eating. 79% of men and 87% of women felt that they eat "healthy". Accordingly only 23% (males) and 33% (females) felt that they should improve their nutrition. The interest in nutritional counselling after the hospitalization was very small, and only 32% or 31% of male or female patients respectively were interested in nutrition counselling. Taken together dietary intake of male and female patients of the university hospital Kiel showed significant deviations from reference values for "healthy" eating. Two standard diets ("Vollkost" and "Leichte Vollkost") contributed to these deviations and should be optimised. It is easy to improve the two diets. The kitchen of the hospital ought to change the choice of food and the arrangement of meals. Since there is not much interest in counselling this measure does not seem to have a major impact.
No preview · Article · Feb 2004 · Aktuelle Ernährungsmedizin