School-based programs aimed at the prevention and treatment of obesity: evidence-based interventions for youth in Latin America

Effects of physical activity interventions on anthropometric indicators and health indices in Chilean children and adolescents: A protocol for systematic review and/or meta-analysis

INTRODUCTION

Physical activity interventions have been a proven effective means of preventing or treating overweight and obesity in children and adolescents. The results of these interventions in many cases are based on the determination of the effect they produce on anthropometric evaluations, which allow the calculation of health indices. However, the effects of physical activity interventions on anthropometric assessments in Chilean children and adolescents have not been systematized. The objective of this study is to provide a detailed protocol for a systematic review with meta-analysis that synthesizes the available evidence on the effect of physical activity interventions on anthropometric indicators and health indices in Chilean children and adolescents and identifies the field-based methods and health indices most used for body composition estimation.

METHODS

This protocol was performed according to the PRISMA declaration. MEDLINE (PubMed), Web of Science, Scopus, and Scielo databases will be systematically searched. Eligible studies will include randomized controlled trials (RCTs), non-RCTs and pre-post studies.

CONCLUSION

This systematic review and meta-analysis protocol is designed to provide up-to-date evidence that could significantly assist public health policy makers and implementers of physical activity interventions through evidence-based guidance and recommendations.

The influence of Chile's food labeling and advertising law and other factors on dietary and physical activity behavior of elementary students in a peripheral region: a qualitative study

BACKGROUND

In 2016, Chile implemented the Food Labeling and Advertising Law to fight childhood obesity through front-of-package food labelling, marketing restrictions and school activities and programs. Nevertheless, little is known on its influence on key stakeholders in vulnerable peripheral regions of the country. This study aimed at identifying important influencing factors including the Food Labeling and Advertising Law on dietary habits and physical activity patterns of second graders in Chile, as perceived by school representatives and the children themselves.

METHODS

Semi-structured interviews with four school directors and 17 groups of three second graders, informal interviews with 9 key teachers and 4 food services staff complemented with documented observations were carried out in four primary schools of the Chilean city of Punta Arenas, in the Magallanes Punta Arenas region. The different sources allowed for triangulation of results.

RESULTS

FLAL seems to have a negligible influence on young children's diet and physical activity in the study region. Barriers are children's deeply rooted dietary habits, excessive screen-time, the parents' lacking problem awareness, limited time for parenting practices and bad role modeling. Environmental barriers are overloaded schools due to insufficient coordination between governmental entities, lacking funds for sound teacher training and unsafe neighborhoods limiting children's play.

CONCLUSIONS

Policy interventions aimed at reducing childhood obesity need to include and empower schools, families and local communities as active partners and consider their framework conditions for greater influence on dietary habits and physical activity.

School environments and obesity: a systematic review of interventions and policies among school-age students in Latin America and the Caribbean

BACKGROUND

The rapid rise in obesity rates among school children in Latin America and the Caribbean (LAC) could have a direct impact on the region's physical and mental health, disability, and mortality. This review presents the available interventions likely to reduce, mitigate and/or prevent obesity among school children in LAC by modifying the food and built environments within and around schools.

METHODS

Two independent reviewers searched five databases: MEDLINE, Web of Science, Cochrane Library, Scopus and Latin American and Caribbean Health Sciences Literature for peer-reviewed literature published from 1 January 2000 to September 2021; searching and screening prospective studies published in English, Spanish and Portuguese. This was followed by data extraction and quality assessment using the Cochrane risk-of-bias tool (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), adopting also the PRISMA 2020 guidelines. Due to the heterogeneity of the intervention's characteristics and obesity-related measurements across studies, a narrative synthesis was conducted.

RESULTS

A total of 1342 research papers were screened, and 9 studies were included; 4 in Mexico, and 1 each in Argentina, Brazil, Chile, Colombia, and Ecuador. Four studies reported strategies for modifying food provision; four other targeted the built environment, (modifying school premises and providing materials for physical activity); a final study included both food and built environment intervention components. Overall, two studies reported that the intervention was significantly associated with a lower increase over time in BMI/obesity in the intervention against the control group. The remaining studies were non-significant.

CONCLUSIONS

Data suggest that school environmental interventions, complementing nutritional and physical education can contribute to reduce incremental childhood obesity trends. However, evidence of the extent to which food and built environment components factor into obesogenic environments, within and around school grounds is inconclusive. Insufficient data hindered any urban/rural comparisons. Further school environmental intervention studies to inform policies for preventing/reducing childhood obesity in LAC are needed.

Effectiveness of health promoting schools: A comparative health profile assessment of higher as compared to low accredited schools in Chandigarh, Union Territory of North India

Objectives

To assess and classify all private and government schools located in a northern city of India for accreditation as health promoting schools and comparative health profile assessment of selected higher accredited schools with lower accredited and non-accredited schools

Design

Quasi experimental study with pre and post assessment with comparison of higher with lower accredited schools.

Settings

The current study was conducted in 206 schools of Chandigarh City of Northern India. Comparative health profile assessment was undertaken in 8 schools with 754 children from higher accredited (platinum, gold, silver) and 8 schools with 700 children from lower accredited (bronze) and non-accredited (below bronze) schools.

Interventions

Multicomponent and multilevel intervention was undertaken with self-quality improvement by schools with help of a manual of accreditation of school as health promoting schools. Key intervention included capacity building, technical visits, supportive supervision, sensitization of policymakers and key stakeholders, implementation of policy initiatives, use of social media, technical support and monitoring of activities.

Outcomes

Accreditation levels (bronze, silver, gold and platinum levels) as health promoting schools after pre and post intervention.

Results

Out of 206 schools, 203 participated in the baseline assessment and 204 in the endline assessment. The response rate was 99%. Two schools which refused participation were excluded and not assessed. Schools (N = 17) which participated in the 2011–2013 study were excluded from analysis. There was a statistically difference (p = 0.01) in the improvement of accreditation level of the baseline and endline assessment after intervention(p<0.05). Overall, the proportion of schools at the gold level increased from 1(0.5%) in 2016 to 71(38%). Silver level from 9(5%) to 57 (31%) of schools after intervention. The response rate in health profile assessment in higher(8) and lower(8) accredited schools was 95.9% and 92.7% respectively. The health profile of children higher accreditation level schools (N = 754) were found better in hygiene practices protective factors (peer support at school, parental or guardian supervision), handling stress and less prone to injury as compared to lower accreditation level schools (N = 700),(p<0.05).

Conclusions

The health promoting school programme was found to be feasible and effective and lead to significant improvement in accreditation level as compared to baseline assessment after continuous self-quality improvement by schools(p<0.05). The health profile of children studying in higher accredited schools was better as compared to lower accredited schools.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies

School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Nutrition education improves knowledge and BMI-for-age in Ghanaian school-aged children

BACKGROUND

Adequate nutrition is required for growth and development in children. This study tested the effectiveness of nutrition education on knowledge and BMI-for-age (BFA) of school-aged children in the Kumasi Metropolis.

METHODS

Children, aged 9-13 years old were recruited from ten randomly selected primary schools in the Metropolis. The schools were randomly allocated into 3 groups: nutrition education (3 schools), physical activity (PA) education (3 schools), both interventions (2 schools), or control (2 schools). Following a baseline nutrition and PA knowledge and status assessment in 433 children, twice-monthly nutrition and PA education and demonstrations were carried out for 6 months, followed by a post-intervention assessment.

RESULTS

PA and nutrition knowledge improved in all groups (P<0.001); the highest improvement was among those who received both interventions (31.0%), followed by the nutrition education group (29.8%), and the least, the control group (19.1%). Overall, BFA improved by +0.36, from baseline (-0.26) to end of the intervention (+0.10, P<0.001). Within the groups, the nutrition group (+0.65, P<.001) had the highest improvement, then, both the intervention group (+0.27, P<0.001), the PA group (+0.23, P<0.001) and lastly, the control group (+0.18, P=0.001).

CONCLUSION

Nutrition education could improve knowledge and BMI-for-age in school-aged children in Ghana.

Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients

The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.

Effectiveness of school-based interventions to prevent obesity among children aged 4 to 12 years old in middle-income countries: A systematic review and meta-analysis

Economic and accompanying nutrition transition in middle-income countries is resulting in rapidly increasing childhood obesity prevalence, exceeding acceleration rates in the West. Previous school-based obesity prevention reviews have mainly included studies from high-income countries. This review aimed to summarize the evidence from randomized controlled trials evaluating the effectiveness of school-based interventions in preventing childhood obesity in middle-income countries. Six electronic databases were searched: MEDLINE, EMBASE, CINAHL Plus, LILACS, IBECS and WPRIM. Eligibility criteria included middle-income country setting, randomized/cluster-randomized controlled trials, children aged 4-12 years and school-based interventions targeting dietary intake and/or physical activity. Twenty-one cluster-randomized controlled trials, conducted in Asia (n = 10), South America (n = 4), North America (n = 4) and the Middle East (n = 3), were included. Fifteen studies reported a significant intervention effect on at least one adiposity-related outcome. Characteristics of effective interventions included combined diet and PA interventions, school teacher-delivery, duration of >8 months, parental involvement, education sessions and school food modifications. The risk of bias in these trials was mixed. The pooled estimate of the odds ratio for obesity in intervention versus control schools (nine studies) was 0.77; 95% CI, 0.63 to 0.94; p = 0.009. In conclusion, there is some evidence to support school-based interventions in preventing childhood obesity in middle-income countries.

Effects of participation level and physical activity on eating behavior and disordered eating symptoms in the Brazilian version of the New Moves intervention: data from a cluster randomized controlled trial

BACKGROUND

Childhood and adolescent obesity is a worldwide public health concern. The New Moves program aims to change eating behavior (EB) and physical activity (PA).

OBJECTIVE

To evaluate the effectiveness of an intervention and predictors of better outcomes relating to EB and PA levels.

DESIGN AND SETTING

Secondary data from a cluster randomized controlled trial in 10 public schools in São Paulo, Brazil.

METHODS

270 female adolescents, aged 12 to 14 years, were analyzed. Participation levels were categorized as presence in 1 to 9 sessions or 10 to 17 sessions, or control. Effectiveness was evaluated through improvement in disordered EB (DEB) and EB. Predictors of better outcomes relating to PA levels were evaluated through clustering of individual characteristics that affected changes in PA scores.

RESULTS

Participation level was not significantly associated with changes in DEB or EB. Girls with higher body mass index percentile (BMI-P) percentile tended to have increases in sedentary lifestyles through the program. Girls with less body image dissatisfaction presented higher increases in daily PA. Girls with higher BMI-P percentile and higher self-esteem showed reductions in sedentary lifestyles. The program seemed to have more effect on daily PA among older girls than among younger girls.

CONCLUSIONS

This program could be used as a structured action plan in schools, with the aims of improving eating behaviors and physical activity, in addition to promoting self-acceptance. The results indicate the importance of evaluating determinants of adherence, as these metrics might influence the effectiveness and future design of lifestyle programs.

School-based obesity prevention interventions in Latin America: A systematic review

OBJECTIVE

To evaluate the implementation and effectiveness of school-based interventions to prevent obesity conducted in Latin America and provide suggestions for future prevention efforts in countries of the region.

METHODS

Articles published in English, Spanish, and Portuguese between 2000 and 2017 were searched in four online databases (Google Scholar, PubMed, LILACS, and REDALYC). Inclusion criteria were: studies targeting school-aged children and adolescents (6-18 years old), focusing on preventing obesity in a Latin American country using at least one school-based component, reporting at least one obesity-related outcome, comprising controlled or before-and-after design, and including information on intervention components and/or process.

RESULTS

Sixteen studies met the inclusion criteria. Most effective interventions (n = 3) had moderate quality and included multi-component school-based programs to promote health education and parental involvement focused on healthy eating and physical activity behaviors. These studies also presented a better study designs, few limitations for execution, and a minimum duration of six months.

CONCLUSIONS

Evidence-based prevention experiences are important guides for future strategies implemented in the region. Alongside gender differences, an adequate duration, and the combined use of quantitative and qualitative evaluation methods, evidence-based prevention should be considered to provide a clearer and deeper understanding of the true effects of school-based interventions.

The Effects of Physical Activity and Diet Interventions on Body Mass Index in Latin American Children and Adolescents: A Systematic Review and Meta-Analysis

The objective of this systematic review and meta-analysis is to compare the effect of physical activity only with that of physical activity plus diet interventions on body mass index (BMI) in Latin American children and adolescents. We searched the Medline, Embase, Scopus, Web of Science, and Scielo databases from their inception until March 2020, including studies examining the effect of physical activity or physical activity plus diet interventions on BMI in children and adolescents and based on data from intervention studies. The DerSimonian and Laird method was used to compute a pooled standardized mean difference for BMI in terms of effect size (ES) and respective 95% confidence intervals (CIs). Eighteen studies were included. Analyses were performed based on intervention (four studies were included for physical activity only and four studies were included for physical activity plus diet). In the analysis of physical activity only versus control, there was no effect on BMI (ES = 0.00; 95% CI −0.17–0.17, I² = 0.0%; p = 0.443). In the analysis of physical activity plus diet versus control, there was a decrease in BMI in favour of the intervention group (ES = −0.28; 95% CI −0.42–−0.14, I² = 74.5%; p = 0.001). When ES was estimated considering only the effect in intervention groups, there was no evidence of a decrease in BMI (ES = −0.17; 95% CI −0.44–0.11, I² = 84.5%; p < 0.001) for physical activity only (eight studies). However, there was a statistically significant decrease in BMI (ES = −0.30; 95% CI −0.50–0.11, I² = 95.8%; p < 0.001) for physical activity plus diet (ten studies). Some limitations of this review could compromise our results, but the main limitation that should be stated is the quality of the studies (mainly medium/moderate), especially as physical activity and diet interventions cannot be blinded, compromising the quality of these studies. In summary, this meta-analysis offers evidence that physical activity plus diet interventions produced a reduction in BMI in Latin American children and adolescents, but physical activity only interventions did not.

Characterizing Obesity Interventions and Treatment for Children and Youths During 1991-2018

Overweight and obesity have become a serious health problem globally due to its significant role in increased morbidity and mortality. The treatments for this health issue are various such as lifestyle modifications, pharmacological therapies, and surgery. However, little is known about the productivity, workflow, topics, and landscape research of all the papers mentioning the intervention and treatment for children with obesity. A total of 20,925 publications from the Web of Science database mentioning interventions and treatment in reducing the burden of childhood overweight and obesity on physical health, mental health, and society published in the period from 1991 to 2018 were in the analysis. We used Latent Dirichlet Allocation (LDA) for identifying the topics and a dendrogram for research disciplines. We found that the number of papers related to multilevel interventions such as family-based, school-based, and community-based is increasing. The number of papers mentioning interventions aimed at children and adolescents with overweight or obesity is not high in poor-resource settings or countries compared to the growth in the prevalence of overweight and obesity among youth due to cultural concepts or nutrition transition. Therefore, there is a need for support from developed countries to control the rising rates of overweight and obesity.

Partnering with Panama: Exploring Anthropometrics, Dietary Patterns, and the Built Food Environment of School-aged Children

Childhood obesity is a global public health concern in developed and developing countries. Approximately 3 in 10 Panamanian children suffer from obesity, and overweight/obesity is responsible for the highest number of premature or avoidable deaths in this country. A formative community assessment and exploration of the built food environment was conducted. Analysis suggests that almost one-third of the children measured were overweight or obese, and the availability of foods recommended for optimal health is limited in this community. Actionable recommendations for intervention and future collaboration were provided, and stakeholders from all groups will continue to explore opportunities.

School Food Environment, Food Consumption, and Indicators of Adiposity Among Students 7-14 Years in Bogotá, Colombia

BACKGROUND

In Colombia, the prevalence of overweight/obesity in children has increased by 26% in the past 5 years. School food environment may be an important contributor and offers opportunities for effective intervention.

METHODS

We conducted a cross-sectional study among 7- to 14-year-old schoolchildren from 10 schools in Bogotá, Colombia. We examined the school food environment and the relationship of individual-level consumption, and physical activity with overweight/obesity, measured by body mass index and percentage body fat.

RESULTS

Schools with a restaurant/store were characterized as having excessive unhealthy foods. In the sample of 714 schoolchildren, 17.5% were overweight and 10.5% were obese. In multivariate models, boys had significantly increased odds of being overweight/obese (odds ratio [OR]: 1.53; p = .01) as compared to girls. Schoolchildren who consumed a greater number of energy drinks (OR = 1.82; p = .04), and those who spent more than 3 hours per schoolday watching TV (OR = 1.53; p < .01) had increased odds of being overweight/obese.

CONCLUSIONS

Approximately 1 in 4 schoolchildren were overweight/obese, with boys, energy drink consumers, and those with low physical activity having increased risk. School-based interventions focused on improving food options and providing health behavior education may be effective to reduce overweight among children in Bogotá and similar settings.

Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America

Background and objectives

Latin American (LA) countries have begun to adopt a variety of regulations targeting sugar-sweetened beverages (SSBs) for public health reasons. Our objective was to characterize the regulatory strategies designed to reduce SSB consumption over the last decade, and assess the available evidence on their enforcement and impact.

Methods

We searched legal and public health databases for public and private SSBs regulations in 14 LA countries and then conducted a systematic review of the available literature. We tracked comparative variations in the type of body issuing the regulations, their scope, and binding status. We present data following a 5-category framework we named NUTRE that classifies SSBs regulations as: (1) restrictions to SSB availability in schools (N), (2) taxes and other economic incentives to discourage consumption (U), (3) restrictions on advertising and marketing (T), (4) regulations on government procurement and subsidies (R), and (5) product labeling rules (E).

Results

Since 2006, 14 LA countries have adopted at least 39 public and private SSB regulatory initiatives across the NUTRE framework. Comprehensive efforts have only been approved by Chile, México and Ecuador, while the rest have comparatively few initiatives. 28 out of the 39 regulatory initiatives were passed by legislative and executive bodies; 11 initiatives represent self-regulatory undertakings by the beverage industries. An 86% (24/28) of public sector regulations are binding; 56% (22/39) contain explicit monitoring or evaluation methods; and 62% (24/39) provide for sanctions. Moreover, 23 regulations specify the body in charge of monitoring the new rules and standards.

Conclusions

LA countries are targeting SSB consumption through a variety of mechanisms, particularly via restrictions to availability in schools and through taxes. Interdisciplinary evidence comparing alternative regulatory strategies is scarce, and few studies offer data on impact and implementation challenges. More evidence and further comparative assessments are needed to support future decision-making.

Development of an investment case for obesity prevention and control: perspectives on methodological advancement and evidence

This paper opens a discussion on the main features of an investment case for obesity prevention and control, by scanning available evidence on existing approaches and by highlighting contextual considerations and evidence for Latin America and the Caribbean. We call on researchers and analysts in the field to update and broaden existing methods of economic analyses to better reflect the multisectoral nature of an investment case for obesity prevention and control. We also identify research gaps and further work required to advance methods and evidence towards investment cases throughout the Americas.

Obesity Prevention: Strategies and Challenges in Latin America

PURPOSE OF REVIEW

The purpose of this study is to present changes of policies and norms aimed to reduce obesity levels that have been adopted in some Latin American countries.

RECENT FINDINGS

The global increase of the excess weight within the population has been demanding governmental actions aimed at preventing health impacts generated by obesity. Over recent years, many Latin American countries have established a number of regulations aimed at reducing weight in the population using interventions that could effectively prevent childhood obesity, including the taxation of sugar-sweetened beverages (SSBs), increasing physical activity in open spaces, and, especially, front-of-package labeling. Some strategies are part of the Action Plan for Prevention of Child and Adolescence Obesity signed by all countries in Latin America, which currently have among the highest prevalence of childhood obesity in the world. Among them are the implementation of fiscal policies on energy-dense and nutrient-poor foods and taxes on SSBs; improvements in nutrition labeling, highlighting the front-of-package (FOP) labeling to promote the choice of healthier products at the time of purchase; and promotion of an active lifestyle, such as encouraging the use of bicycle paths or physical activity programs at school. The real impact of these prevention strategies implemented in Latin America on the prevalence of obesity is still unknown.

Exploring the perspectives of 10-, 11-, and 12-year-old primary school students on physical activity engagement-"'Cause you can't just be sitting at a desk all the time!"

BACKGROUND

Research indicates that 91% of Canadian children are not engaging in enough physical activity (PA) to achieve health benefits. Physical education (PE) classes have been identified as a way to improve child health by facilitating engagement in movement-based activities. The daily physical activity (DPA) initiative was created with similar intentions and requires that students participate in at least 20 min of PA daily via PE classes and/or during instructional time for other subjects. Despite recommendations that 150 min of exercise/play be incurred weekly through either avenue, nearly half of Canadian schools fail to achieve this goal. The disconnect between PA-related school policies and low reported participation rates suggests that additional research is warranted. The purpose of this study was to explore the perspectives of primary students regarding the facilitators, barriers, and recommendations for PA engagement at their schools.

METHODS

Researchers conducted nine group interviews with 53 children aged 10-12, representing six primary schools in Northwestern Ontario using a semi-structured interview format. Sessions were analysed using inductive content analysis.

RESULTS

Participants discussed several facilitators of PA including enjoying activities (alleviating boredom and participating with others), accomplishment (skill building and enhanced self-image), and benefits in the classroom (thinking clearly and enhanced readiness to learn). Barriers to PA participation included school rules and culture (PA/PE restrictions, heavy workload, and "no work, no PA"), personal struggles (physical challenges and varied skill levels), and technology (being addictive and a replacement for being active). Recommendations for enhancing engagement that were outlined by the children centred around PE and daily physical activity (increase opportunities and involve students in planning/delivery) and recess-based themes (decrease focus on safety and make equipment more available).

CONCLUSION

These student perspectives and related recommendations may be beneficial for administrators and teachers in similar contexts who are seeking to enhance PA engagement among students with the goal of improving child health.

From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America

The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.

School-based primary NCD risk reduction: education and public health perspectives

The rising global burden of noncommunicable diseases (NCDs) has heightened awareness of the necessity for primary risk prevention programmes. These aim to facilitate long-term behaviour changes in children and adolescents that can reduce NCD risk factors and disease onset in later-life. School-based programmes designed to improve childhood and adolescent health behaviours and wellbeing contribute to this; however, design and impact assessment of these is complex. These programmes should be multidisciplinary, utilizing both educational and health expertise. Health outcomes may not be evident in the short term, but may occur with learning-related behaviour modifications, highly effective when sustained over a lifetime. Thus assessment must analyse short-term learning and behaviour impacts as well as long-term capability, behaviour and health outcomes.The focus of assessment measures in the health and education sectors differs and often lacks depth in one or other area. Educators generally focus on identifying evidence of learning related to capability, attitude and/or behaviour changes, while public health practitioners typically focus on health measures (e.g. body mass index (BMI), mental health, or risk behaviours).We argue that multidisciplinary approaches incorporating education and health viewpoints clarify issues relating to the potential value of schools as a setting to facilitate primary NCD risk reduction. To demonstrate this, we need to: 1) build stronger understandings of the features of effective learning for behavioural change and the best way to evaluate these, and 2) convincingly correlate these measures with long-term metabolic health indicators by tracking learner behaviour and health over time.

Preventing weight-related problems among adolescent girls: A cluster randomized trial comparing the Brazilian 'New Moves' program versus observation

PURPOSE

To conduct a cluster randomized controlled trial comparing the Brazilian version of the New Moves program (NMP) versus observation among Brazilian adolescent girls.

METHODS

Ten schools were randomly allocated to the Brazilian NMP or the observation arm. Study participants included 12-14-year-old girls. Recruitment occurred between February 2014 and March 2015. The NMP included sports, nutritional support, motivational interviews, collective lunch, and parental information materials. Our main outcome was the Body Shape Questionnaire (BSQ). Secondary outcomes included the Rosenberg Self-Esteem Scale and the Unhealthy Weight-Control Behaviors Index, as well as body mass index. Study results were evaluated through generalized estimating equations.

RESULTS

A total of 270 adolescents participated in the study. At baseline, mean age was 13.4 years, and average BMI was 21.4. The intervention did not result in any statistically significant differences between the NMP and the observation arm, including BSQ (predicted means of 64.33 - IC 95% 59.2-69.47 vs. 62.02 - IC 95% 56.63-67.4), respectively) and our secondary outcomes. Adherence was low during the intervention (32.9%) and maintenance (19.1%) phases of the program.

CONCLUSION

The New Moves program did not lead to significant changes in our measured outcomes. Future studies should investigate whether changes might occur when comprehensive behavioral programs are sustained over longer periods while also being customized to local population characteristics.

School Context Matters: The Impacts of Concentrated Poverty and Racial Segregation on Childhood Obesity

BACKGROUND

Schools are important sites for interventions to prevent childhood obesity. This study examines how variables measuring the socioeconomic and racial composition of schools and counties affect the likelihood of obesity among third to fifth grade children.

METHODS

Body mass index data were collected from third to fifth grade public school students by teachers from 317 urban and rural North Carolina schools in 38 counties. Multilevel models are used to examine county-, school-, and individual-level effects.

RESULTS

Low concentrations of poverty at the school level are associated with lower odds of obesity. Schools in rural counties had significantly higher rates of obesity, net the other variables in the model. Students in minority-segregated schools had higher rates of obesity than those in more racially diverse schools, but the effect was not statistically significant once school-level poverty was controlled.

CONCLUSIONS

Place-based inequalities are important determinants of health inequalities. The results of this study show that school-level variables related to poverty are important for understanding and confronting childhood obesity.

Environmental components of childhood obesity prevention interventions: an overview of systematic reviews

Childhood obesity has a complex multi-factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems-based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population-level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population-level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5-18 years). Sixty-three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy-relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision-making.

Early nutrition transition in Haiti: linking food purchasing and availability to overweight status in school-aged children

Objective

The primary aim was to examine the association of socio-economic factors and diet with overweight (including obesity) among school-aged children in Haiti. The secondary aim was to describe food availability and the physical activity built environment in participating schools.

Design

This cross-sectional study examined baseline data from the intervention Mamba study assessing the effectiveness of a fortified peanut butter paste in school-aged children. Logistic regression modelling was used to test hypothesized factors in association with overweight status.

Setting

Six primary schools in Cap-Haitien, the second largest city in Haiti.

Subjects

Children (n 968) aged 3–13 years, in good health and enrolled in a participating school for the 2012/13 school year.

Results

Child age (adjusted OR (AOR); 95 % CI=0·25; 0·12, 0·56), child age squared (1·08; 1·03, 1·13), always purchasing food at school (3·52; 1·12, 11·08), mother’s BMI (1·10; 1·04, 1·16) and household ownership of a bicycle (0·28; 0·11, 0·71) were significantly associated with overweight (likelihood ratio=36, P<0·0001). Consumption of fish was significantly lower in overweight children in the binary analysis (P=0·033) and improved the fit of the model. Schools had limited time and space for physical activity and foods sold by vendors were predominantly high in sugar or fat.

Conclusions

To our knowledge the present study is the first to examine the covariates of childhood overweight or describe school food availability and physical activity built environments in Haiti. Further research is necessary to identify intervention targets and feasible, cost-effective approaches for prevention of obesity in Haiti children.

Obesity-promoting factors in Mexican children and adolescents: challenges and opportunities

BACKGROUND

Mexico is a developing country with one of the highest youth obesity rates worldwide; >34% of children and adolescents between 5 and 19 years of age are overweight or obese.

OBJECTIVES

The current review seeks to compile, describe, and analyze dietary conditions, physical activity, socioeconomic status, and cultural factors that create and exacerbate an obesogenic environment among Mexican youth.

DESIGN

A narrative review was performed using PubMed and the Cochrane Library databases, as well as grey literature data from the Mexican government, academics, and statistical reports from nongovernmental organizations, included in electronic formats.

RESULTS

The recent socioeconomic and nutritional transition has resulted in reduced healthy meal options at public schools, high rates of sedentary lifestyles among adolescents, lack of open spaces and playgrounds, socioeconomic deprivation, false or misunderstood sociocultural traditional beliefs, misconceptions about health, a high percentage of overweight or obese adults, and low rates of maternal breastfeeding. Some of the factors identified are exacerbating the obesity problem in this population. Current evidence also shows that more policies and health programs are needed for prevention of childhood and adolescent obesity. Mexico presents alarming obesity levels, which need to be curtailed and urgently reversed.

CONCLUSIONS

The present narrative review presents an overview of dietary, physical activity, societal and cultural preconceptions that are potentially modifiable obesity-promoting factors in Mexican youth. Measures to control these factors need to be implemented in all similar developing countries by governments, policy makers, stakeholders, and health care professionals to tackle obesity in children and young people.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

OBJECTIVE

To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents.

DATA SOURCE

Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed.

SUMMARY OF THE FINDINGS

Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation.

CONCLUSIONS

Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

Characteristics of physical activity programs in the Brazilian primary health care system

The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

Geographical variation in health-related physical fitness and body composition among Chilean 8th graders: a nationally representative cross-sectional study

PURPOSE

In addition to excess adiposity, low cardiorespiratory fitness (CRF) and low musculoskeletal fitness (MSF) are important independent risk factors for future cardio-metabolic disease in adolescents, yet global fitness surveillance in adolescents is poor. The objective of this study was to describe and investigate geographical variation in levels of health-related physical fitness, including CRF, MSF, body mass index (BMI), and waist circumference (WC) in Chilean 8th graders.

METHODS

This cross-sectional study was based on a population-based, representative sample of 19,929 8th graders (median age = 14 years) in the 2011 National Physical Education Survey from Chile. CRF was assessed with the 20-meter shuttle run test, MSF with standing broad jump, and body composition with BMI and WC. Data were classified according to health-related standards. Prevalence of levels of health-related physical fitness was mapped for each of the four variables, and geographical variation was explored at the country level by region and in the Santiago Metropolitan Area by municipality.

RESULTS

Girls had significantly higher prevalence of unhealthy CRF, MSF, and BMI than boys (p<0.05). Overall, 26% of boys and 55% of girls had unhealthy CRF, 29% of boys and 35% of girls had unhealthy MSF, 29% of boys and 44% of girls had unhealthy BMI, and 31% of adolescents had unhealthy WC. High prevalence of unhealthy fitness levels concentrates in the northern and middle regions of the country and in the North and Southwest sectors for the Santiago Metropolitan Area.

CONCLUSION

Prevalence of unhealthy CRF, MSF, and BMI is relatively high among Chilean 8th graders, especially in girls, when compared with global estimates. Identification of geographical regions and municipalities with high prevalence of unhealthy physical fitness presents opportunity for targeted intervention.