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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Jarnig G, Kerbl R, Jaunig J, van Poppel MNM. Effects of a daily physical activity intervention on the health-related fitness status of primary school children: A cluster randomized controlled trial. J Sports Sci 2023; 41:1073-1082. [PMID: 37733413 DOI: 10.1080/02640414.2023.2259210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/20/2023] [Indexed: 09/22/2023]
Abstract
An important barrier for a nationwide implementation of a daily physical activity (PA) at primary schools is the lack of spatial and human resources. Therefore, we developed a PA intervention that can be implemented without additional spatial resources or changes in school curricula. In the intervention group, children received a daily PA unit consisting of physical education lessons and simultaneous academic content over a 9-month period. The control group received conventional (physical education) classes. Body weight, height, waist circumference and health-related fitness parameters were measured. Of 412 children (9.7 ± 0.5 years) included, 228 participated in the intervention group. In regression analysis adjusted for baseline, gender, school location, sports club membership (total only) with standardized outcome variables, the intervention group showed a reduction in waist-to-height ratio (B = 0.30, p < 0.001) and an increase in several fitness parameters (cardiorespiratory endurance: B = 0.20, p = 0.037; lower body muscle strength: B = 0.11, p = 0.041; lower body muscle endurance: B = 0.12, p = 0.027; flexibility: B = 0.19, p = 0.019) compared to the control group. Intervention effects for cardiorespiratory endurance and flexibility were more pronounced in the group of children without sports club membership. Thus, especially children with no sport club membership seem to benefit from daily PA in school (Trial registration: DRKS00025515).
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Affiliation(s)
- Gerald Jarnig
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Reinhold Kerbl
- Department of Pediatrics and Adolescent Medicine, LKH Hochsteiermark, Leoben, Austria
| | - Johannes Jaunig
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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The Helping Everyone Achieve Long Term Health Passport: exploring potential use of the HEALTH Passport in primary and secondary schools. J Public Health (Oxf) 2022:6565630. [DOI: 10.1093/pubmed/fdac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chronic disease is a significant burden on the global population. The Helping Everyone Achieve Long Term Health (HEALTH) Passport is a paper-based approach previously utilized to help adults modify clinical risk factors through lifestyle, which may be effective in improving the long-term health of school-age children. This study investigates the feasibility of in-school use by engaging trainee teachers in primary and secondary education.
Methods
Two hundred and fifty six unique responses were collated to evaluate current teaching of the main health risk factors and HEALTH Passports specifically adapted for schools. Trainees attended workshops with pre- and post-questionnaires used to measure training efficacy and evaluate the Passports’ suitability for in-school use. Narrative analysis of feedback was performed.
Results
Feedback received for both Passports was positive overall. Trainees highlighted the need for the Passports to be further age differentiated. Significantly increased confidence (P < 0.01) in knowledge of exercise, type 2 diabetes, weight and blood pressure was shown. Confidence in smoking, drugs and alcohol knowledge was reduced highlighting the requirement for further teacher training.
Conclusions
The HEALTH Passport has potential as an intervention to improve health literacy in school-age children. Age adaptation is needed with references to weight measures removed. Emotional well-being should be focused on, and data management stringently assessed for child protection.
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Smit MS, Raat H, Mölenberg F, Wolfers MEG, Bannink R, Jansen W. Study protocol for the evaluation of long-term effects of the school-based obesity prevention program Lekker Fit! ('enjoy being fit'): a retrospective, controlled design. BMJ Open 2021; 11:e046940. [PMID: 34389567 PMCID: PMC8365823 DOI: 10.1136/bmjopen-2020-046940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Preventive interventions to reduce overweight and obesity in childhood and adolescence are studied on their effectiveness worldwide. A number with positive results. However, long-term effects of these interventions and their potentially wider influence on well-being and health have been less studied. This study aims to evaluate the long-term effects of a multicomponent intervention in elementary school children targeting individual behaviour as well as environment (Lekker Fit!). The primary outcomeis body mass index and the secondary outcomes are waist circumference, weight status, physical fitness, lifestyle, psychosocial health and academic performance. METHODS AND ANALYSIS In a naturalistic effect evaluation with a retrospective, controlled design adolescents in secondary schools, from intervention and non-intervention elementary schools, will be compared on a wide set of outcome variables. Data will be collected by questionnaires and through anthropometric and fitness measurements by trained physical education teachers and research assistants. Baseline data consist of measurements from the adolescents at the age of 5 years old and are gathered from preventive youth healthcare records, from before the intervention took place. Multilevel regression models will be used and adjusted for baseline measurements and potential confounding variables on the individual and environmental level. Furthermore, propensity scores will be applied. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the Erasmus Medical Centre, Rotterdam, The Netherlands (permission ID: MEC-2020-0644). Study findings will be disseminated in peer-reviewed journals and by conference presentations. TRIAL REGISTRATION NUMBER NL8799. Pre-results.
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Affiliation(s)
| | - Hein Raat
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Rienke Bannink
- Policy and Research, CJG Rijnmond, Rotterdam, The Netherlands
| | - Wilma Jansen
- Public Health, Erasmus MC, Rotterdam, The Netherlands
- Social Development, Gemeente Rotterdam, Rotterdam, The Netherlands
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Fang Y, Ma Y, Mo D, Zhang S, Xiang M, Zhang Z. Methodology of an exercise intervention program using social incentives and gamification for obese children. BMC Public Health 2019; 19:686. [PMID: 31159776 PMCID: PMC6547593 DOI: 10.1186/s12889-019-6992-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traditional exercise [supervised exercise (SE)] intervention has been proved to be one of the most effective ways to improve metabolic health. However, most exercise interventions were on a high-cost and small scale, moreover lacking of the long-term effect due to low engagement. On the other hand, it was noteworthy that gamification and social incentives were promising strategies to increase engagement and sustain exercise interventions effects; as well as mobile technologies such as WeChat also can provide an appropriate platform to deploy interventions on a broader, low-cost scale. Thus, we aim to develop a novel exercise intervention ('S&G exercise intervention') that combines SE intervention with gamification and social incentives design through WeChat, with the aim of improving metabolic health and poor behaviors among overweight and obesity children. METHODS We propose a randomized controlled trial of a 'S&G exercise intervention' among 420 overweight and obese children who have at least one marker of metabolic syndrome. Children will be randomized to control or intervention group in a 1:1 ratio. The exercise intervention package includes intervention designs based on integrated social incentives and gamification theory, involving targeted essential volume and intensity of activity (skipping rope) as well as monitoring daily information and providing health advice by WeChat. Participants will undertake assessments at baseline, at end of intervention period, in the follow-up time at months 3,6,12. The primary outcome is outcome of metabolic health. Secondary outcomes include behavioral (e.g., diary physical activity, diet) and anthropometric measures (e.g., body fat rate and muscle mass). DISCUSSIONS This will be the first study to design an exercise intervention model that combines traditional supervised exercise (SE) intervention with gamification and social incentives theory through WeChat. We believed that this study could explore a low-cost, easy-to-popularize, and effective exercise intervention model for improving metabolic health and promote healthy among obese children. Furthermore, it will also provide important evidence for guidelines to prevent and improve metabolic health and health behaviors. TRIAL REGISTRATION 10-04-2019;Registration number: ChiCTR1900022396 .
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Affiliation(s)
- Yue Fang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Yunsheng Ma
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Dandan Mo
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | | | - Mi Xiang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Wang L, van de Gaar VM, Jansen W, Mieloo CL, van Grieken A, Raat H. Feeding styles, parenting styles and snacking behaviour in children attending primary schools in multiethnic neighbourhoods: a cross-sectional study. BMJ Open 2017; 7:e015495. [PMID: 28710213 PMCID: PMC5734265 DOI: 10.1136/bmjopen-2016-015495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate whether feeding styles and parenting styles are associated with children's unhealthy snacking behaviour and whether the associations differ according to children's ethnic background. METHOD Cross-sectional data from the population-based 'Water Campaign' study were used. Parents (n=644) of primary school children (6-13 years) completed a questionnaire covering sociodemographic characteristics, feeding style dimensions ('control over eating', 'emotional feeding', 'encouragement to eat' and 'instrumental feeding'), parenting style dimensions ('involvement' and 'strictness') and children's unhealthy snacking behaviour. Logistic regression analyses were performed to determine whether feeding styles and parenting styles were associated with children's unhealthy snacking behaviour. RESULT Overall, children whose parents had a higher extent of 'control over eating' had a lower odds of eating unhealthy snacks more than once per day (OR, 0.57; 95% CI 0.42 to 0.76). Further stratified analysis showed that 'control over eating' was associated with less unhealthy snacking behaviour only in children with a Dutch (OR, 0.37; 95% CI 0.20 to 0.68) or a Moroccan/Turkish (OR, 0.44; 95% CI 0.25 to 0.77) ethnic background. 'Encouragement to eat' was associated with a lower odds of eating unhealthy snacks every day in children with a Dutch ethnic background only (OR, 0.48; 95% CI 0.25 to 0.90). 'Instrumental feeding' was associated with a higher odds of eating unhealthy snacks more than once a day in children with a Moroccan/Turkish ethnic background only (OR, 1.43; 95% CI 1.01 to 2.04). CONCLUSION Our results suggest that 'control over eating' may be associated with less unhealthy snack consumption in children. The associations of feeding styles and parenting styles with children's unhealthy snacking behaviour differed between children with different ethnic backgrounds.
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Affiliation(s)
- Lu Wang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vivian M van de Gaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Social Development, Rotterdam, The Netherlands
| | - Cathelijne L Mieloo
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Minatto G, Barbosa Filho VC, Berria J, Petroski EL. School-Based Interventions to Improve Cardiorespiratory Fitness in Adolescents: Systematic Review with Meta-analysis. Sports Med 2017; 46:1273-92. [PMID: 26846429 DOI: 10.1007/s40279-016-0480-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND School-based intervention can contribute to the promotion of cardiorespiratory fitness (CRF) in adolescents. However, it is neces sary to systematize how intervention strategies and the methodological characteristics of studies influence the effects of CRF interventions. OBJECTIVE A meta-analysis review of school-based intervention studies aimed at increasing CRF in adolescents (10-19 years of age) was conducted. METHODS A search for studies was conducted using the Medline, Web of Science, LILACS, PsycINFO, Embase, Scopus, SPORTDiscus and Cochrane databases and the reference lists of the selected studies. The peer selection process included consideration of school-based randomized or non-randomized controlled trials with a duration ≥12 weeks published in English, Portuguese or Spanish, and with some CRF measures. The methodological quality of the studies was also assessed. The standardized mean differences (SMDs) and 95 % confidence intervals (95 % CIs) were calculated as an effect measure. RESULTS Forty publications of 30 interventions were included in the review, and 25 of these were meta-analysed. The effects of CRF interventions were moderate and significant (SMD = 0.68, 95 % CI 0.45-0.90), with high heterogeneity (I (2) = 97 %). The effect size varied significantly according to the age group, sample size, intervention environment, strategies in experimental groups, CRF priority in the study, CRF test and indicator, session length, weekly frequency, intervention duration and presentation of results by sex. CONCLUSION Interventions in the school environment seem to have a positive effect on CRF among adolescents, but there is high heterogeneity between studies. Some intervention characteristics can explain better effects on CRF (e.g. exercise sessions in addition to physical education classes; primary focus on this outcome; combination of aerobic and resistance exercises; classes lasting ≥60 min; frequency of three times weekly; and intensity control).
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Affiliation(s)
- Giseli Minatto
- Research Centre for Kinanthropometry and Human Performance, Sports Centre, Campus Universitário, Federal University of Santa Catarina, Trindade, Caixa Postal 476, Florianópolis, SC, CEP 88040-900, Brazil.
| | - Valter Cordeiro Barbosa Filho
- Research Centre for Physical Activity and Health, Sports Centre, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Juliane Berria
- Research Centre for Kinanthropometry and Human Performance, Sports Centre, Campus Universitário, Federal University of Santa Catarina, Trindade, Caixa Postal 476, Florianópolis, SC, CEP 88040-900, Brazil
| | - Edio Luiz Petroski
- Research Centre for Kinanthropometry and Human Performance, Sports Centre, Campus Universitário, Federal University of Santa Catarina, Trindade, Caixa Postal 476, Florianópolis, SC, CEP 88040-900, Brazil
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A Systematised Review of Primary School Whole Class Child Obesity Interventions: Effectiveness, Characteristics, and Strategies. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4902714. [PMID: 27668254 PMCID: PMC5030395 DOI: 10.1155/2016/4902714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/26/2016] [Indexed: 01/30/2023]
Abstract
Background. A systematised review was conducted to examine the effectiveness of school-based interventions that focus on changing dietary intake and physical activity levels to reduce childhood obesity. Methods. Multiple databases were searched for randomised and nonrandomised interventions from 2007 to 2016 in full-time elementary schools, which were delivered to the whole class, included dietary and physical activity components, involved both sexes, were written in English, and used body mass index (BMI) as an outcome. Results. The database search produced 8,866 titles from which 78 were deemed relevant and assessed for inclusion resulting in 15 studies meeting all inclusion criteria. From these 15 studies, 9 yielded a reduction or stabilisation in BMI or BMI z-score in the entire intervention group and/or subgroups. Programmes lasting between 6 and 12 months that involve multiple environmental, educational, and physical strategies appear to be most likely to result in BMI or BMI z-score improvement. Moderators most likely influencing an improvement in BMI included increased physical activity, decreased sugar sweetened beverages intake, and increased fruit intake. Conclusions. School-based interventions may be an effective means for child obesity prevention. The identification of consistent elements used in school-based interventions that have demonstrated effectiveness may aid in preventing child obesity.
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The desired learning outcomes of school-based nutrition/physical activity health education. HEALTH EDUCATION 2016. [DOI: 10.1108/he-12-2014-0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to utilise the collective opinion of a group of Finnish experts to identify the most important learning outcomes of secondary-level school-based health education, in the specific domains of physical activity and nutrition.
Design/methodology/approach
– The study uses a Delphi survey technique to collect the opinions of a group (panel) of Finnish experts. A list of learning outcomes was compiled via an extensive literature review of documents from all levels of health education (physical activity and nutrition) policy development and implementation. A general inductive analysis method was conducted, resulting in education themes which were then compiled into health literacy-constructed learning outcomes to present to the panel in the two Delphi rounds.
Findings
– The study question is answered in the form of a ranked list of the 24 most important learning outcomes of physical activity and nutrition education in Finnish schools. The analysis of variance pair-wise comparisons with Bonferroni indicated that six items were statistically possibly more important than the 18 others. The three most important items being: first, understand the importance of a varied and balanced diet; second, the ability to analyse their own lifestyle; third, understand the link between physical activity and health. The study also identified topics/themes which could be either under-represented or over-represented in the current literature and teaching.
Originality/value
– This study is the only one of its type, and researches an as yet unknown area of health education. The value of this study lies in its role in the further development of school health education, in terms of identifying the “most important” contemporary issues to teach in the classroom, and may also be used as a topic prioritisation and curriculum planning tool.
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de Villiers A, Steyn NP, Draper CE, Hill J, Gwebushe N, Lambert EV, Lombard C. Primary School Children's Nutrition Knowledge, Self-Efficacy, and Behavior, after a Three-Year Healthy Lifestyle Intervention (HealthKick). Ethn Dis 2016; 26:171-80. [PMID: 27103767 DOI: 10.18865/ed.26.2.171] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effects of HealthKick(HK), a healthy lifestyle intervention, on nutrition knowledge, behavior, and dietary self-efficacy of school children in the Western Cape Province of South Africa. DESIGN A three-year cluster randomized control trial at primary schools in low socioeconomic settings with a baseline study in 2009 and follow-up in 2010 and 2011. PARTICIPANTS Participants were Grade four children (n=500) at eight schools in the intervention group and at eight schools in the control group (n=498). METHODS An action planning process was followed with educators whereby they identified their own school health priorities and ways to address them. Schools were provided with nutrition resources, including curriculum guidelines and the South African food-based dietary guidelines. Children completed a questionnaire comprising nutrition knowledge, self-efficacy and behavioral items. RESULTS The intervention significantly improved the knowledge of the intervention group at the first (mean difference =1.88, 95%CI: .32 to 3.43, P=.021) and second follow-up (mean difference=1.92, 95%CI: .24 to 3.60, P=.031) compared with the control group. The intervention effect for self-efficacy was not significant at the first follow-up (mean difference=.32, 95%CI: -.029 to .94, P=.281) whereas a significant effect was observed at the second follow-up (mean difference=.71, 95%CI: .04 to 1.38, P=.039). There were no significant differences between the intervention and control groups for nutritional behavior scores at any of the follow-up time points. CONCLUSIONS The HK intervention improved nutrition knowledge and self-efficacy significantly in primary schoolchildren; however, it did not improve their eating behavior.
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Affiliation(s)
- Anniza de Villiers
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town
| | - Nelia P Steyn
- Division of Nutrition, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Catherine E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town
| | - Nomonde Gwebushe
- Biostatistics Unit, South African Medical Research Council, Cape Town
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town
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Petralias A, Papadimitriou E, Riza E, Karagas MR, Zagouras ABA, Linos A. The impact of a school food aid program on household food insecurity. Eur J Public Health 2016; 26:290-6. [PMID: 26873860 PMCID: PMC4804736 DOI: 10.1093/eurpub/ckv223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: We had a unique opportunity to establish the extent of food insecurity and the potential impact of a large-scale school-based nutritional program, in low-socioeconomic status districts of Greece, during the current economic crisis. Methods: Around 162 schools with 25 349 students participated during the 2012–2013 school year. Each student received a daily healthy meal designed by nutrition specialists. Food insecurity levels, measured using the Food Security Survey Module were assessed at baseline and after a 1–8-month intervention period. Pre–post intervention responses were matched at an individual level. Results: Around 64.2% of children’s households experienced food insecurity at baseline. This percentage decreased to 59.1% post-intervention, P < 0.001. On an individual level, food insecurity score diminished by 6.5%, P < 0.001. After adjustment for various socioeconomic factors, for each additional month of participation, the odds of reducing the food insecurity score increased by 6.3% (OR = 1.06, 95% CI: 1.02–1.11). Those experiencing food insecurity with hunger at baseline were more likely to improve food insecurity score than those who did not (OR = 3.51, 95%CI: 2.92–4.21). Conclusion: Children and families residing in low socioeconomic areas of Greece, experience high levels of food insecurity. Our findings suggest that participation in a school-based food aid program may reduce food insecurity for children and their families in a developed country in times of economic hardship.
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Affiliation(s)
- Athanassios Petralias
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Eleni Papadimitriou
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Margaret R Karagas
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alexia B A Zagouras
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Athena Linos
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E, Komro K, Gibbs L, Magnus D, Campbell R. The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta-analysis. BMC Public Health 2015; 15:130. [PMID: 25886385 PMCID: PMC4339015 DOI: 10.1186/s12889-015-1360-y] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization's Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. METHODS We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school's ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. RESULTS We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. CONCLUSION This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.
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Affiliation(s)
- Rebecca Langford
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Christopher Bonell
- Social Science Research Unit, Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Hayley Jones
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Theodora Pouliou
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Simon Murphy
- Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Elizabeth Waters
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Kelli Komro
- Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th Street, Gainesville, FL, 32610-0177, USA.
| | - Lisa Gibbs
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Daniel Magnus
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Rona Campbell
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
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van de Gaar VM, Jansen W, van Grieken A, Borsboom GJJM, Kremers S, Raat H. Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial. Int J Behav Nutr Phys Act 2014; 11:98. [PMID: 25060113 PMCID: PMC4222660 DOI: 10.1186/s12966-014-0098-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since sugar-sweetened beverages (SSB) may contribute to the development of overweight in children, effective interventions to reduce their consumption are needed. Here we evaluated the effect of a combined school- and community-based intervention aimed at reducing children's SSB consumption by promoting the intake of water. Favourable intervention effects on children's SSB consumption were hypothesized. METHODS In 2011-2012, a controlled trial was conducted among four primary schools, comprising 1288 children aged 6-12 years who lived in multi-ethnic, socially deprived neighbourhoods in Rotterdam, the Netherlands. Intervention schools adopted the 'water campaign', an intervention developed using social marketing. Control schools continued with their regular health promotion programme. Primary outcome was children's SSB consumption, measured using parent and child questionnaires and through observations at school, both at baseline and after one year of intervention. RESULTS Significant positive intervention effects were found for average SSB consumption (B -0.19 litres, 95% CI -0.28;-0.10; parent report), average SSB servings (B -0.54 servings, 95% CI -0.82;-0.26; parent report) and bringing SSB to school (OR 0.51, 95% CI 0.36;0.72; observation report). CONCLUSIONS This study supports the effectiveness of the water campaign intervention in reducing children's SSB consumption. Further studies are needed to replicate our findings. TRIAL REGISTRATION Current Controlled Trials: NTR3400.
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014; 2014:CD008958. [PMID: 24737131 PMCID: PMC11214127 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Christopher P Bonell
- Institute of Education, University of LondonSocial Science Research Unit18 Woburn SquareLondonLondonUKWC1H 0NR
| | - Hayley E Jones
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Theodora Pouliou
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Simon M Murphy
- Cardiff UniversityCardiff School of Social Sciences1‐3 Museum PlaceCardiffSouth GlamorganUKCF10 3BD
| | - Elizabeth Waters
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Kelli A Komro
- University of FloridaHealth Outcomes and Policy and Institute for Child Health PolicyPO Box 100177GainesvilleFloridaUSA32610‐0177
| | - Lisa F Gibbs
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Daniel Magnus
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Xu F, Wang X, Ware RS, Tse LA, Wang Z, Hong X, Chan EYY, Li J, Wang Y. A school-based comprehensive lifestyle intervention among Chinese kids against Obesity (CLICK-Obesity) in Nanjing City, China: the baseline data. Asia Pac J Clin Nutr 2014; 23:48-54. [PMID: 24561972 DOI: 10.6133/apjcn.2014.23.1.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND urgent development of effective interventions to prevent rapidly rising childhood obesity in China is needed. METHODS Between May 2010 and December 2013, a cluster randomized controlled trial was conducted among 4th graders in eight urban primary schools randomly assigned to intervention or control groups in Nanjing, China. A multi-component intervention program was implemented within the treatment group, while students in the control group followed their usual health education curriculum without additional intervention. RESULTS At baseline, 638 and 544 students were enrolled in the intervention and control group, respectively. The prevalence of excess body weight was 26.8%, with 27.4% in the intervention group and 26.1% in the control group (p=0.61). The mean (SD) BMI and WC was 18.7 (3.0) and 63.0 (9.2) for participants in intervention schools, and 18.5 (2.9) and 63.6 (8.7) for students in control group, separately (p=0.24 and 0.41, respectively). Compared to those who were not aware of what lifestyle/behavior factors were unhealthy, students who were aware of the unhealthy lifestyle/ behavior factors consumed fewer fried snacks (0.46±0.76 serves/week vs 0.65±0.91 serves/week; p<0.01), soft drinks (160±194 ml/week vs 199±227 ml/week; p<0.01), but larger amount of meat (502±429 g/week vs 449±344 g/week; p=0.03), and reported less screen time (214±232 minutes/week vs 252±264 minutes/week; p<0.01). Moreover, there was no difference within physical activity time between these two groups (257±341 minutes/week vs 218±324 minutes/week; p=0.13). CONCLUSIONS Main characteristics of participants were balanced at baseline within intervention and control schools, but a gap existed between healthy lifestyle knowledge and actual healthy behavior in students. TRIAL REGISTRATION NUMBER ChiCTR-ERC-11001819.
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Affiliation(s)
- Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, 2, Zizhulin, Nanjing 210003, China.
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Kothandan SK. School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review. Arch Public Health 2014; 72:3. [PMID: 24472187 PMCID: PMC3974185 DOI: 10.1186/2049-3258-72-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity, which has seen a rapid increase over the last decade, is now considered a major public health problem. Current treatment options are based on the two important frameworks of school- and family-based interventions; however, most research has yet to compare the two frameworks in the treatment of childhood obesity.The objective of this review is to compare the effectiveness of school-based intervention with family-based intervention in the treatment of childhood obesity. METHODS Databases such as Medline, Pub med, CINAHL, and Science Direct were used to execute the search for primary research papers according to inclusion criteria. The review included a randomised controlled trial and quasi-randomised controlled trials based on family- and school-based intervention frameworks on the treatment of childhood obesity. RESULTS The review identified 1231 articles of which 13 met the criteria. Out of the thirteen studies, eight were family-based interventions (n = 8) and five were school-based interventions (n = 5) with total participants (n = 2067). The participants were aged between 6 and 17 with the study duration ranging between one month and three years. Family-based interventions demonstrated effectiveness for children under the age of twelve and school-based intervention was most effective for those aged between 12 and 17 with differences for both long-term and short-term results. CONCLUSIONS The evidence shows that family- and school-based interventions have a considerable effect on treating childhood obesity. However, the effectiveness of the interventional frameworks depends on factors such as age, short- or long-term outcome, and methodological quality of the trials. Further research studies are required to determine the effectiveness of family- and school-based interventions using primary outcomes such as weight, BMI, percentage overweight and waist circumference in addition to the aforementioned factors.
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Leenaars K, Jacobs-van der Bruggen M, Renders C. Determinants of successful public-private partnerships in the context of overweight prevention in Dutch youth. Prev Chronic Dis 2013; 10:E117. [PMID: 23845178 PMCID: PMC3711500 DOI: 10.5888/pcd10.120317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A public-private partnership (PPP) is an essential component of the Dutch community-based approach toward overweight prevention, Youth on Healthy Weight (JOGG). Beginning in 2010, 25 Dutch municipalities have implemented JOGG, but little is known about determinants of successful partnerships. This study aims to identify these determinants to guide other municipalities or communities in creating successful partnerships. METHODS Semistructured interviews were held in Veghel, a town in the southeast of the Netherlands, with private (n=7) and public (n=5) partners from the PPP involved in JOGG. We developed a themes and topics list that fit the purpose of our study. The interviews focused on the formation, functioning, and output of the partnership. RESULTS Recruitment of partners was facilitated by using preexisting networks. Corporate social responsibility, belief in the JOGG approach, importance of the health issue, and strengthened contacts with other partners were important motivations for partners to participate. In addition to partnership functioning and output, enthusiastic and decisive management, shared commitment, joint responsibility, and effective internal communication were important to the partners, as were clear goals and concrete actions to achieve these goals. CONCLUSION To create successful partnerships, the program and its goals should appeal to the motivations of the partners. Involving partners in defining local program objectives can help to create shared commitment and joint responsibility. Further evaluation of partnerships' impact on achieving program goals is a subsequent step to be taken to identify long-term determinants of successful PPPs.
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Affiliation(s)
- Karlijn Leenaars
- Regional Public Health Service, GGD Hart voor Brabant, 's-Hertogenbosch, the Netherlands
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Magnée T, Burdorf A, Brug J, Kremers SPM, Oenema A, van Assema P, Ezendam NPM, van Genugten L, Hendriksen IJ, Hopman-Rock M, Jansen W, de Jong J, Kocken PL, Kroeze W, Kwak L, Lechner L, de Nooijer J, van Poppel MN, Robroek SJW, Schreurs H, van Sluijs EM, Steenhuis IJM, van Stralen MM, Tak NI, te Velde SJ, Vermeer WM, Wammes B, van Wier MF, van Lenthe FJ. Equity-specific effects of 26 Dutch obesity-related lifestyle interventions. Am J Prev Med 2013; 44:e57-66. [PMID: 23683991 DOI: 10.1016/j.amepre.2012.11.041] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/24/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022]
Abstract
CONTEXT Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES. EVIDENCE ACQUISITION Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up. EVIDENCE SYNTHESIS Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups. CONCLUSIONS Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.
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Affiliation(s)
- Tessa Magnée
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, the Netherlands
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Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2013; 2013:CD007651. [PMID: 23450577 PMCID: PMC7197501 DOI: 10.1002/14651858.cd007651.pub2] [Citation(s) in RCA: 424] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades. OBJECTIVES The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. SEARCH METHODS The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate. DATA COLLECTION AND ANALYSIS Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured. MAIN RESULTS In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. AUTHORS' CONCLUSIONS The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.
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Brug J, van Stralen MM, Chinapaw MJM, De Bourdeaudhuij I, Lien N, Bere E, Singh AS, Maes L, Moreno L, Jan N, Kovacs E, Lobstein T, Manios Y, Te Velde SJ. Differences in weight status and energy-balance related behaviours according to ethnic background among adolescents in seven countries in Europe: the ENERGY-project. Pediatr Obes 2012; 7:399-411. [PMID: 22730265 DOI: 10.1111/j.2047-6310.2012.00067.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/26/2012] [Accepted: 04/09/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to explore differences in weight status and energy balance behaviours according to ethnic background among adolescents across Europe. METHODS A school-based survey among 10-12-year-old adolescents was conducted in seven European countries. Weight, height and waist circumference were measured; engagement in physical activity, sedentary and dietary behaviour, and sleep duration was assessed by child and parent-report. A distinction between native and non-native ethnic background was based on language spoken at home, and the parents' country of birth. Analyses were conducted with and without adjustment for parental education. RESULTS With valid data on both indicators of ethnic background for 5149 adolescents, 7307 adolescents (52% girls; 11.6 ± 0.7 years) participated. Significantly higher prevalence of overweight, obesity, body mass index and waist circumference were observed among non-native compared with native adolescents. Non-native adolescents had less favourable behavioural patterns (sugary drinks, breakfast skipping, sport, TV and computer time, hours of sleep) with the exception of active transport to school. Similar patterns were observed for both indicators of ethnicity, and in most of the separate countries; however, in Greece, weight status indicators were better among non-native adolescents. After adjustment for parental education, most differences remained significant according to country of origin of the parents, but not according to language spoken at home. CONCLUSION Adolescents of native ethnicity of the country of residence have, in general, more favourable weight status indicators and energy balance-related behaviours than adolescents of non-native ethnicity across Europe.
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Affiliation(s)
- J Brug
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Xu F, Ware RS, Tse LA, Wang Z, Hong X, Song A, Li J, Wang Y. A school-based comprehensive lifestyle intervention among chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China. BMC Public Health 2012; 12:316. [PMID: 22545755 PMCID: PMC3376033 DOI: 10.1186/1471-2458-12-316] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/30/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity among adolescents has been rapidly rising in Mainland China in recent decades, especially in urban and rich areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited data regarding adolescent overweight prevention in China are available. Thus, we developed a school-based intervention with the aim of reducing excess body weight in children. This report described the study design. METHODS/DESIGN We designed a cluster randomized controlled trial in 8 randomly selected urban primary schools between May 2010 and December 2013. Each school was randomly assigned to either the intervention or control group (four schools in each group). Participants were the 4th graders in each participating school. The multi-component program was implemented within the intervention group, while students in the control group followed their usual health and physical education curriculum with no additional intervention program. The intervention consisted of four components: a) classroom curriculum, (including physical education and healthy diet education), b) school environment support, c) family involvement, and d) fun programs/events. The primary study outcome was body composition, and secondary outcomes were behaviour and behavioural determinants. DISCUSSION The intervention was designed with due consideration of Chinese cultural and familial tradition, social convention, and current primary education and exam system in Mainland China. We did our best to gain good support from educational authorities, school administrators, teachers and parents, and to integrate intervention components into schools' regular academic programs. The results of and lesson learned from this study will help guide future school-based childhood obesity prevention programs in Mainland China. TRIAL REGISTRATION REGISTRATION NUMBER ChiCTR-ERC-11001819.
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Affiliation(s)
- Fei Xu
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, 2, Zizhulin, Nanjing, 210003, Peoples Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Lap Ah Tse
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhiyong Wang
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, 2, Zizhulin, Nanjing, 210003, Peoples Republic of China
| | - Xin Hong
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, 2, Zizhulin, Nanjing, 210003, Peoples Republic of China
| | - Aiju Song
- Nanjing Jianye District Center for Disease Control and Prevention, Nanjing, China
| | - Jiequan Li
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, 2, Zizhulin, Nanjing, 210003, Peoples Republic of China
| | - Youfa Wang
- Johns Hopkins Global Center for Childhood Obesity, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Room E2546, 615 North Wolfe Street, Baltimore, MD, 21205, USA
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Mouratidou T, Mesana MI, Manios Y, Koletzko B, Chinapaw MJM, De Bourdeaudhuij I, Socha P, Iotova V, Moreno LA. Assessment tools of energy balance-related behaviours used in European obesity prevention strategies: review of studies during preschool. Obes Rev 2012; 13 Suppl 1:42-55. [PMID: 22309064 DOI: 10.1111/j.1467-789x.2011.00958.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Valid and reliable measures of energy balance-related behaviours are required when evaluating the effectiveness of public health interventions aiming at prevention of childhood obesity. A structured descriptive review was performed to appraise food intake, physical activity and sedentary behaviour assessment tools used in obesity intervention strategies targeting mainly preschool children across Europe. In total, 25 papers are described, addressing energy balance-related behaviours as study outcomes and targeting individuals or clusters of individuals at school- or home-based environment. Parentally reported food records and 24-h recalls were commonly used to assess food intake. Subjective levels of physical activity and sedentary behaviour were commonly accessed via parentally reported questionnaires. Accelerometry was used to obtain objective measures of physical activity. Insufficient evidence of tool evaluation was provided. When feasible, food records and accelerometry are recommended as the most appropriate methods to assess food intake in young children. Sedentary behaviour could be assessed via questionnaires that include key indicators of sedentarism and are able to differentiate individual practices. The choice of methodology for the assessment of specific intervention effects should be equally balanced between required accuracy levels and feasibility, and be guided by the intervention targets.
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Affiliation(s)
- T Mouratidou
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, C/Corona de Aragon, Zaragoza, Spain.
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Brug J, van Stralen MM, Te Velde SJ, Chinapaw MJM, De Bourdeaudhuij I, Lien N, Bere E, Maskini V, Singh AS, Maes L, Moreno L, Jan N, Kovacs E, Lobstein T, Manios Y. Differences in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-project. PLoS One 2012; 7:e34742. [PMID: 22558098 PMCID: PMC3338827 DOI: 10.1371/journal.pone.0034742] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/05/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current data on the prevalence of overweight and energy-balance behaviors among European children is necessary to inform overweight prevention interventions. METHODOLOGY/PRINCIPAL FINDINGS A school-based survey among 10-12 year old children was conducted in seven European countries using a standardized protocol. Weight, height, and waist circumference were measured; Engagement in physical activity, sedentary and dietary behaviors, and sleep duration were self-reported. Descriptive analyses were conducted, looking at differences according to country, gender, and parental education. 7234 children (52%girls; 11.6 ± 0.7 years) participated. 25.8% and 5.4% of boys, and 21.8% and 4.1% of girls were overweight (including obese) and obese (according to International Obesity Task Force criteria), respectively. Higher prevalence of overweight/obesity was observed in Greece, Hungary, Slovenia and Spain than in Belgium, Netherlands and Norway. Large differences between countries were found in intakes of sugar-sweetened beverages, breakfast, active transport, TV and computer time. More favorable overweight status and behavior patterns were found in girls than boys and in children of higher educated parents than in children of lower educated parents. CONCLUSIONS/SIGNIFICANCE High levels and striking differences in overweight status and potential risk behaviors were found among schoolchildren across Europe.
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Affiliation(s)
- Johannes Brug
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
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Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011:CD001871. [PMID: 22161367 DOI: 10.1002/14651858.cd001871.pub3] [Citation(s) in RCA: 754] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. OBJECTIVES This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" SEARCH METHODS The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. SELECTION CRITERIA The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). MAIN RESULTS This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. AUTHORS' CONCLUSIONS We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:· school curriculum that includes healthy eating, physical activity and body image· increased sessions for physical activity and the development of fundamental movement skills throughout the school week· improvements in nutritional quality of the food supply in schools· environments and cultural practices that support children eating healthier foods and being active throughout each day· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.
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Affiliation(s)
- Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, The University of Melbourne, Level 5/207 Bouverie St, Carlton, VIC, Australia, 3010
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Jansen W, Borsboom G, Meima A, Zwanenburg EJV, Mackenbach JP, Raat H, Brug J. Effectiveness of a primary school-based intervention to reduce overweight. ACTA ACUST UNITED AC 2011; 6:e70-7. [DOI: 10.3109/17477166.2011.575151] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND With the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future research. OBJECTIVE To conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next decade. METHODS A literature review was conducted between December 2009-April 2010. Studies published between the years 2000-2009 that used family-based interventions to treat childhood obesity were included. A total of 20 studies met inclusionary criteria. RESULTS Although results varied by study design, the majority of studies had a moderate to large effect size for change in the target child's BMI (BMI percentile, zBMI, percent overweight) after participating in a family-based intervention. Long-term change varied by study, but the majority of studies produced sustainable change in child BMI, although smaller effect sizes. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as trends. CONCLUSION To date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Including families in weight loss treatment of obese children warrants further implementation and study. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are discussed.
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Affiliation(s)
- Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Jessie C. Everts
- Department of Family Social Science, University of Minnesota, Minneapolis, MN
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Burguera B, Colom A, Piñero E, Yanez A, Caimari M, Tur J, Frontera M, Couce M, Cardo E, Aguiló A, Burguera A, Cabeza E. ACTYBOSS: activity, behavioral therapy in young subjects--after-school intervention pilot project on obesity prevention. Obes Facts 2011; 4:400-6. [PMID: 22166761 PMCID: PMC6444671 DOI: 10.1159/000333436] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS To test the feasibility of a school-based intervention, which combines an incentive-driven physical activity program with lifestyle lectures, and its potential beneficial outcome on children's metabolic parameters. METHODS We conducted a 6-month pilot intervention in two high schools in Mallorca, Spain, consisting of a program which involved free supervised exercise sessions and nutritional lectures, where children received credit points as a reward for the hours spent exercising and attendance to the lectures. The credit-earned points obtained were exchanged for gifts. We developed personalized cards and a web application for the participants to check the gifts they were eligible for (www.actyboss.com). Percentage body fat, percentage of fat-free mass and BMI were measured. Secondary measures included fitness parameters, blood pressure and blood lipids levels. 90 children signed up the consent form and 56 completed the program until the endpoint. RESULTS We found a beneficial effect on body composition, fitness parameters, and systolic blood pressure in children who participated in ACTYBOSS compared to children who did not start the intervention. CONCLUSIONS We describe the incentive-driven, after-school intervention pilot program to promote physical activity and a healthy lifestyle. The program had a positive effect on anthropometric measurements. A larger incentive-driven healthy lifestyle program is now ongoing.
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Affiliation(s)
- Bartolome Burguera
- Research Unit/CAIBER, IUNICS, 1er piso Edificio S, Hospital Universitario Son Espases, Ctra. Valldemossa 79, C.P 07010 Palma, Spain.
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Nichols MS, Swinburn BA. Selection of priority groups for obesity prevention: current approaches and development of an evidence-informed framework. Obes Rev 2010; 11:731-9. [PMID: 20059705 DOI: 10.1111/j.1467-789x.2009.00705.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Resources for obesity prevention interventions are inevitably limited, necessitating the selection of priority groups to ensure effective and equitable use of funds. This paper aims to review published approaches to selection of priority groups ('target populations') for obesity prevention, and to present the development of a new systematic framework for organizing and assessing evidence for selecting priority groups. A review was conducted of the process and justification described for selecting priority groups in a sample of obesity prevention publications. Using the results of this review and adaptation of theory and frameworks in both the obesity prevention and health promotion priority-setting literature, a framework was developed for assessment of potential priority groups for obesity prevention. The published literature lacks discussion of and explicit processes for selection of priority groups for obesity prevention intervention. The new framework describes specific types of evidence that should be considered in the assessment of a potential priority group for obesity prevention and has applications for funding and implementing community-based or settings-level obesity prevention interventions and research. Application of this framework has the potential to enhance the effective use of limited obesity prevention resources and to identify areas in need of additional research evidence.
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Affiliation(s)
- M S Nichols
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia.
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Impact of group-based dietary education on the dietary habits of female adolescents: a cluster randomized trial. Public Health Nutr 2010; 14:702-8. [PMID: 20843402 DOI: 10.1017/s1368980010002405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The number of extremely thin young women has increased and education at school on maintaining an optimal weight has become important. The aim of the present study was to assess the effectiveness of a group-based home-collaborative dietary education (HCDE) programme to maintain appropriate dietary intake compared to conventional school classroom education. DESIGN Two-arm cluster randomized controlled trial. Twelve classes were randomly assigned as clusters to either the HCDE group or the control group. Each participant in the HCDE group received twelve sessions of group counselling aimed at increasing energy intake at breakfast by modifying dietary intake and adopting appropriate habits. The hypothesis underlying the study was that after 6 months of HCDE the total energy intake would be increased by 627 kJ from baseline (primary endpoint). Secondary outcomes were differences in intake of various nutrients from baseline. Outcome measures after log transformation were examined by t tests and linear mixed models (crude and baseline-adjusted). SETTING Young women among Japanese female adolescents in Tokyo. SUBJECTS Four hundred and seventy-four participants aged 13-15 years. RESULTS Students in twelve classes were used for analysis (n 459). Energy intake was decreased in many of the classes during the 6-month period, especially for those in the control group. After adjustment for the baseline value, significant increases in energy intake and protein, calcium, magnesium and iron intakes at breakfast were observed (P<0.05) CONCLUSIONS Although energy intake was increased in the HCDE group compared to the control group, further study of the HCDE is warranted.
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Hasanbegović S, Mesihović-Dinarević S, Cuplov M, Hadzimuratović A, Boskailo H, Ilić N, Njuhović A, Cengić N, Bajramović E, Brković S. Epidemiology and etiology of obesity in children and youth of Sarajevo Canton. Bosn J Basic Med Sci 2010; 10:140-6. [PMID: 20507295 PMCID: PMC5509400 DOI: 10.17305/bjbms.2010.2713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aims of the study were to estimate the prevalence of excessive weight in infants and school-age children in Sarajevo Canton, to isolate the main causative agents and to propose a strategy for its efficient prevention. The methods included anthropometry and originally designed questionnaire. Calculated body mass index was classified according to the criteria proposed by Centre for Disease Control and Prevention (CDC). The research included 3608 students from elementary and secondary schools from Sarajevo Canton. Nearly 1/5 of subjects had excessive body weight while 12.49% of students were malnourished. Elementary school lower graders had the highest grade of excessive weight, while the secondary school students exhibited the lowest grade of excessive weight. During school hours, about 42.47% of students were fed on bakery produces and snacks. Non-sparkling, thickened juices are frequently consumed beverages (20.65%), second only to water (51.82%). 58.15% of children consume sweets on daily basis. This is even more prominent among secondary school students (80.85%). Only 1/3 of students practice sports on daily basis, while 8.51% of them rarely engage in sports. Elementary school lower grade students had the lowest level of activity while the secondary school students were the most active. As many as 27.56% students spend two hours or more sitting by the computer or TV set. The most significant mediators of excessive weight gain are sedentary life-style, frequent consumption of sweets and thickened juices and unsuitable nutrition during school hours. Continuous preventive and therapeutically activities must be undertaken among as wide population as possible.
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Affiliation(s)
- Snijezana Hasanbegović
- Paediatric Clinic, University of Sarajevo Clinics Centre, Patriotske lige 81, Sarajevo, Bosnia and Herzegovina
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Laure P, Binsinger C, Ambard MF. « La santé à grands pas » : intérêt d’un conseil personnalisé pour la promotion de l’activité physique en lycée professionnel. Sci Sports 2010. [DOI: 10.1016/j.scispo.2009.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jansen W, Mackenbach JP, Joosten-van Zwanenburg E, Brug J. Weight status, energy-balance behaviours and intentions in 9â12-year-old inner-city children. J Hum Nutr Diet 2010; 23:85-96. [PMID: 20078731 DOI: 10.1111/j.1365-277x.2009.01027.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- W Jansen
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Patriarca A, Di Giuseppe G, Albano L, Marinelli P, Angelillo IF. Use of television, videogames, and computer among children and adolescents in Italy. BMC Public Health 2009; 9:139. [PMID: 19439070 PMCID: PMC2696431 DOI: 10.1186/1471-2458-9-139] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 05/13/2009] [Indexed: 11/26/2022] Open
Abstract
Background This survey determined the practices about television (video inclusive), videogames, and computer use in children and adolescents in Italy. Methods A self-administered anonymous questionnaire covered socio-demographics; behaviour about television, videogames, computer, and sports; parental control over television, videogames, and computer. Results Overall, 54.1% and 61% always ate lunch or dinner in front of the television, 89.5% had a television in the bedroom while 52.5% of them always watched television there, and 49% indicated that parents controlled the content of what was watched on television. The overall mean length of time daily spent on television viewing (2.8 hours) and the frequency of watching for at least two hours per day (74.9%) were significantly associated with older age, always ate lunch or dinner while watching television, spent more time playing videogames and using computer. Those with parents from a lower socio-economic level were also more likely to spend more minutes viewing television. Two-thirds played videogames for 1.6 daily hours and more time was spent by those younger, males, with parents that do not control them, who watched more television, and who spent more time at the computer. The computer was used by 85% of the sample for 1.6 daily hours and those older, with a computer in the bedroom, with a higher number of computers in home, who view more television and play videogames were more likely to use the computer. Conclusion Immediate and comprehensive actions are needed in order to diminish time spent at the television, videogames, and computer.
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Affiliation(s)
- Alessandro Patriarca
- Department of Public, Clinical and Preventive Medicine, Second University of Naples, Naples, Italy.
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