Interventions for preventing obesity in children

Physical activity promotion in the preschool years: a critical period to intervene

The primary aim of this paper is to provide a rationale for the necessity of intervening with a physical activity intervention in the preschool years and why the daycare environment is amenable to such intervention. We also review the prevalence of physical activity, sedentary behaviour and obesity in the preschool population and the impact that these lifestyle behaviours and conditions have on the health of preschool aged children, as secondary objectives. Moreover we discuss implications for intervention and research using a "lessons learned" model based on our research team's experience of conducting a randomized controlled trial aimed at increasing physical activity, reducing sedentary behaviour and improving motor skill development and body composition in preschoolers. Lastly, we make conclusions based on the literature and highlight issues and directions that need to be addressed in future research in order to maximize health promotion and chronic disease prevention in the pediatric population.

Children, parents, and pets exercising together (CPET) randomised controlled trial: study rationale, design, and methods

BACKGROUND

Objectively measured physical activity is low in British children, and declines as childhood progresses. Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults, but there are no published public health interventions based on dog-walking with children. The Children, Parents, and Pets Exercising Together Study aims to develop and evaluate a theory driven, generalisable, family-based, dog walking intervention for 9-11 year olds.

METHODS/DESIGN

The Children, Parents, and Pets Exercising Together Study is an exploratory, assessor-blinded, randomised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health. The trial will follow CONSORT guidance. Approximately 40 dog-owning families will be allocated randomly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a 'waiting list' control group. The primary outcome is change in objectively measured child physical activity using Actigraph accelerometry. Secondary outcomes in the child, included in part to shape a future more definitive randomised controlled trial, are: total time spent sedentary and patterning of sedentary behaviour (Actigraph accelerometry); body composition and bone health from dual energy x-ray absorptiometry; body weight, height and BMI; and finally, health-related quality of life using the PedsQL. Secondary outcomes in parents and dogs are: changes in body weight; changes in Actigraph accelerometry measured physical activity and sedentary behaviour. Process evaluation will consist of assessment of simultaneous child, parent, and dog accelerometry data and brief interviews with participating families.

DISCUSSION

The Children, Parents, and Pets Exercising Together trial should be the first randomised controlled study to establish and evaluate an intervention aimed at dog-based physical activity promotion in families. It should advance our understanding of whether and how to use pet dogs to promote physical activity and/or to reduce sedentary behaviour in children and adults. The trial is intended to lead to a subsequent more definitive randomised controlled trial, and the work should inform future dog-based public health interventions such as secondary prevention interventions in children or adults.

TRIAL REGISTRATION NUMBER

ISRCTN85939423.

Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children

The ToyBox intervention was developed using an evidence-based approach, using the findings of four reviews. These reviews included three critical and narrative reviews of educational strategies and psychological approaches explaining young children's acquisition and formation of energy-balance related behaviours, and the management of these behaviours, and also a systematic review of behavioural models underpinning school-based interventions in preschool and school settings for the prevention of obesity in children aged 4-6 years. This paper summarises and translates the findings from these reviews into practical evidence based recommendations for researchers and policy-makers to consider when developing and implementing interventions for the prevention of overweight and obesity in young (aged 4-6 years) children. The recommendations focus on two behaviours, physical activity and sedentary behaviour, and healthy eating, and include general recommendations, intervention approaches, interventions content, and simple messages. The review also briefly examines the role that the commercial sector plays in hindering or facilitating attempts to create healthy food environments for children. This paper also recognises that childhood obesity is not an issue for the education sector alone; it needs to be tackled at a multi sectoral level, recognizing the particularly important role of local governments, nongovernment organizations and the media.

Commentary on "estimation of newborn risk for child or adolescent obesity: lessons from longitudinal birth cohorts"

Childhood obesity is an increasingly prevalent problem, associated with obesity later in life, and a sequalae of health problems such as metabolic syndrome and an increased risk of coronary heart disease. Poor nutrition and a lack of physical activity are said to be causes of obesity development, with genetic factors and heritability also implicated. However, there are established, identifiable risk factors associated with the future development of obesity, both in childhood, and adolescence. These include parental weight before pregnancy, gestational weight gain, pre-pregnancy maternal smoking, as well as numerous socioeconomic factors.(1-4) Studies have also shown that once obese, children can find it very difficult to lose the excess weight,(5) with long-term management methods having shown poor efficacy.(5) Therefore, preventative strategies are becoming a high priority to battle the ever-increasing epidemic of childhood obesity. This study by Morandi et al.(6) is the first longitudinal study to analyse the predictive properties of early life risk factors for obesity, and propose a subsequent predictive algorithm to identify newborns most at risk of becoming obese in childhood and adolescence. Morandi et al.'s study aimed to develop a clinically useful formula, which could be used to identify the risk of future obesity in newborns, thereby enabling more efficient implementation of prevention strategies.(6) The lifetime Northern Finland Birth Cohort 1986 (NFBC 1986) was used to form predictive equations for both childhood and adolescent obesity, based on established risk factors: parental BMI, birth weight, maternal gestational weight gain, and socioeconomic factors. A genetic score was also created based on 39 BMI/obesity-associated polymorphisms. Validation studies were performed on both a retrospective cohort of children from Veneto, Italy, and a prospective cohort of children from Massachusetts, USA.

PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity

Vivian Welch and colleagues present consensus-based guidelines for reporting equity-focused systematic reviews, the PRISMA-Equity extension.