Obesity prevention - is school an effective place? A systematic review

Background

Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation.

Methods

The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively.

Results

48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition.

Conclusions

The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses.

Funded by DIMDI

Key messages

School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.

[Costs of a guideline-based treatment of patients with chronic hepatitis C in the era of interferon-free treatment]

The treatment of chronic hepatitis C has considerably changed with the introduction of recent direct acting antivirals. These antivirals have sustained virologic response (SVR) rates above 90 % as well as reduced toxicity and treatment duration. Therefore, current German guidelines recommend these interferon-free regimens as first-choice treatment. Nevertheless, recent developments were accompanied by a significant increase in treatment costs, which led to extensive discussions on reasonable pharmaceutical prices. The aim of the current study was to analyze the average treatment costs and costs per patient cured for guideline treatment recommendations. Analyses were stratified according to genotype, treatment status (naive/experienced), and presence/absence of cirrhosis. Costs were separated in (1.) basic diagnostic procedures, (2.) monitoring, and (3.) pharmaceuticals. The calculation is based on a remuneration scheme in the statutory health insurance system. In treatment-naïve non-cirrhotic patients, the average cost is 41 766 €/SVR for the treatment with SOF/LDV calculated (PTV/r/OMV+DSV: 53 129 €/SVR). In treatment-naive cirrhotic patients, costs were 60 323 €/SVR (SOF/LDV+RBV) and 80 604 €/SVR (PTV/r/OMV+DSV+RBV). Treatment-experienced genotype 1 patients had average costs of 60 366 €/SVR for SOF/LDV treatment as well as 53 134 €/SVR for PTV/r/OMV+DSV±RBV treatment (cirrhotic patients: 62 208 €/SVR for SOF/LDV+RBV; 80 824 €/SVR for PTV/r/OMV+DSV+RBV). The average treatment costs per SVR in treatment-naive genotype 1 patients are comparable to previous standard of care treatments and lower in treatment-experienced patients. In other genotypes, treatment costs and costs per cure are significantly higher compared to previous standard of care. However, long-term modelling studies show that new regimens are cost-effective.

[Effectiveness and Cost-Effectiveness of Daily School Sport in the Primary School--Project: "fit for pisa"]

The "fit for pisa" intervention implemented daily physical education at five primary schools in Göttingen. The results of the evaluation show an increase in physical activity among the students participating in the programme. At the same time sedentary behaviour, like watching television, decreased remarkably. In the long run the promotion of an active lifestyle had improved the body mass index. The study emphasises the need for government funding to implement the programme across the country.

[Health economic evaluation of health promotion - the example "fit for pisa"]

The increasing prevalence of risk factors associated with physical inactivity lead to an economic burden on society. The article uses the example of the prevention measure "fit for pisa" to investigate to what extent a full economic evaluation can provide a basis for decision-makers. The intervention integrated the daily physical education at 5 primary schools in Göttingen for the entire school term. The study is intended to provide information on short- and long-term potential savings. A process analysis identified the prevention performance from a societal perspective. Resource consumption was recorded in (partly) standardisedform and evaluated and also revealed the need for investment in sports halls with capacity to expand the programme to all primary schools in Göttingen. In the routine the implementation costs of half-day schools are 619 € per student year; for all-day schools 236 € per student year. The consideration of the short-term outcomes shows that TV viewing has decreased and physical activity has been strongly encouraged. The active life style promotion has shown an improvement on BMI in the medium-term. On the basis of a decision analytical model, a cost-benefit analysis of the program over the life course will be undertaken.

Integrating water resources management in eco-hydrological modelling

In this paper the integration of water resources management with regard to reservoir management in an eco-hydrological model is described. The model was designed to simulate different reservoir management options, such as optimized hydropower production, irrigation intake from the reservoir or optimized provisioning downstream. The integrated model can be used to investigate the impacts of climate variability/change on discharge or to study possible adaptation strategies in terms of reservoir management. The study area, the Upper Niger Basin located in the West African Sahel, is characterized by a monsoon-type climate. Rainfall and discharge regime are subject to strong seasonality. Measured data from a reservoir are used to show that the reservoir model and the integrated management options can be used to simulate the regulation of this reservoir. The inflow into the reservoir and the discharge downstream of the reservoir are quite distinctive, which points out the importance of the inclusion of water resources management.

Integrating local and technical knowledge to support soil salinity monitoring in the Amudarya river basin

The role of monitoring is changing due to the increasing awareness of complexity and uncertainty in environmental resources management. Monitoring systems are required to support critical reflection about the effectiveness of actions toward the achievement of management objectives. To this aim, monitoring should be based on a strong integrated and multi-scale approach. Monitoring costs could be prohibitive if the monitoring is only based on traditional scientific methods of measurements. To deal with these issues, the design of an innovative monitoring system should be based on the integration between different sources of knowledge and information. In this work the usability of local knowledge to support environmental monitoring is investigated. A multi-step participatory monitoring design process has been implemented aiming to design a program for soil salinity monitoring in the lower Amudarya river basin in Uzbekistan. Although there is an increasing awareness of the importance of stakeholders being involved in decision processes, the current socio-cultural and institutional context is not favourable to the participatory approach. The choice of method to be implemented in this work was influenced by such conditions. The analysis of the lessons learned from the experiences gained in this project revealed some important clues concerning the development of a locally-based monitoring program. These lessons can be subdivided according to three fundamental issues: the long term involvement of local community members in monitoring activities, the acceptance of locally-based monitoring systems by decision makers, and the reliability of monitoring information.