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Impacts of School Nutrition Interventions on the Nutritional Status of School-Aged Children in Asia: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14030589. [PMID: 35276948 PMCID: PMC8839996 DOI: 10.3390/nu14030589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 01/22/2023] Open
Abstract
This review aims to describe school nutrition interventions implemented in Asia and quantify their effects on school-aged children’s nutritional status. We searched Web of Science, Embase, Ovid MEDLINE, Global Health, Econlit, APA PsycInfo, and Social Policy and Practice for English articles published from January 2000 to January 2021. We quantified the pooled effects of the interventions on the changes in body mass index (BMI) and body mass index z score (BAZ), overall and by type of intervention. In total, 28 articles were included for this review, of which 20 articles were multi-component interventions. Twenty-seven articles were childhood obesity studies and were included for meta-analysis. Overall, school nutrition interventions reduced school-aged children’s BMI and BAZ. Multi-component interventions reduced the children’s BMI and BAZ, whereas physical activity interventions reduced only BMI and nutrition education did not change BMI or BAZ. Overweight/obesity reduction interventions provided a larger effect than prevention interventions. Parental involvement and a healthy food provision did not strengthen school nutrition interventions, which may be due to an inadequate degree of implementation. These results suggested that school nutrition interventions should employ a holistic multi-component approach and ensure adequate stakeholder engagement as well as implementation to maximise the effects.
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Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.
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Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
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Validation of the Urban Walkability Perception Questionnaire (UWPQ) in the Balearic Islands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186631. [PMID: 32932944 PMCID: PMC7557802 DOI: 10.3390/ijerph17186631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
Within the context of promoting the “healthy routes” program, the aim of this study was to validate the urban walkability perception questionnaire (UWPQ) in the Balearic Islands to determine the characteristics of the urban environment that promote walking among the population. The UWPQ measures pedestrian facilities, infrastructures of the environment, perception of safety and a participant’s general opinion. This process was performed in 12 routes predefined by a community participation program and set around the primary health centers. Degree of correlation between the items was calculated. The final internal consistency was 0.8 in all blocks according to the Cronbach’s alpha test (p < 0.01). Goodman and Kruskal–gamma correlation coefficient (γ) between the item measuring the general opinion and the rest of the items was significant. The items from the perception of safety and pedestrian facilities blocks were the ones that most affected the final assessment. Those regarding the pedestrian-only pavements, clearly marked pavements, noise, traffic density and parks condition obtained the lowest coefficients. To conclude, the results showed that the UWPQ is a suitable instrument to assess the degree of adequacy of the urban environment for walking. It could contribute to create healthy environments as well as to improve public policies.
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Lambrinou CP, Androutsos O, Karaglani E, Cardon G, Huys N, Wikström K, Kivelä J, Ko W, Karuranga E, Tsochev K, Iotova V, Dimova R, De Miguel-Etayo P, M. González-Gil E, Tamás H, JANCSÓ Z, Liatis S, Makrilakis K, Manios Y. Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component. BMC Endocr Disord 2020; 20:52. [PMID: 32370795 PMCID: PMC7201517 DOI: 10.1186/s12902-020-0526-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. METHODS Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. RESULTS From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention's acceptance in specific or vulnerable population groups. CONCLUSIONS Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives.
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Affiliation(s)
- Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele Huys
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Winne Ko
- International Diabetes Federation European Region, Brussels, Belgium
| | - Ernest Karuranga
- International Diabetes Federation European Region, Brussels, Belgium
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Roumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Pilar De Miguel-Etayo
- Growth, Exercise, NUtrition and Development (GENUD) Research Group. Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Esther M. González-Gil
- Growth, Exercise, NUtrition and Development (GENUD) Research Group. Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
- Institute of Nutrition and Food Technology. Department of Biochemistry and Molecular Biology II, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Hajnalka Tamás
- University of Debrecen, Department of Family and Occupational Medicine, Debrecen, Hungary
| | - Zoltán JANCSÓ
- University of Debrecen, Department of Family and Occupational Medicine, Debrecen, Hungary
| | - Stavros Liatis
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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 to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT, Zhang A, Segal J. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev 2015; 16:547-65. [PMID: 25893796 PMCID: PMC4561621 DOI: 10.1111/obr.12277] [Citation(s) in RCA: 362] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 01/28/2023]
Abstract
Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Environmental Health (formerly the Department of Social and Preventive Medicine), School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Cai
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Y Wu
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R F Wilson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C Weston
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - O Fawole
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - S N Bleich
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - L J Cheskin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - N N Showell
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B D Lau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D T Chiu
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Zhang
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Segal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Holub CK, Lobelo F, Mehta SM, Romero LMS, Arredondo EM, Elder JP. School-wide programs aimed at obesity among Latino youth in the United States: a review of the evidence. THE JOURNAL OF SCHOOL HEALTH 2014; 84:239-246. [PMID: 24617907 PMCID: PMC8528267 DOI: 10.1111/josh.12144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 02/11/2013] [Accepted: 03/03/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND In the past 30 years, childhood obesity rates have tripled, disproportionately affecting Latino children. From 2003 to 2006, 43.0% of Mexican-American children were classified as overweight compared with 36.9% of non-Hispanic Whites. Obesity interventions targeting children can have a significant impact in the school setting. METHODS We conducted a systematic review of evidence-based, obesity-related interventions in the school setting. Inclusion criteria included: having 50% or more Latino children in the study, and usage of obesity-related outcomes (eg, body mass index [BMI] z-score, weight, and waist circumference, and body fat). RESULTS The majority of identified studies included interventions that targeted both nutrition and physical activity. The most successful interventions were randomized, controlled trials or quasi-experimental controlled studies and had few limitations in execution in the study; however, overall results were mixed. There are promising results for interventions targeting Latino children who are already overweight or obese, but evidence of effectiveness is sparse. CONCLUSIONS This review is the first to gather evidence-based research systematically aimed at obesity-related interventions in the school setting that are specifically focused on Latino children. Results of the review are promising and timely, given the exigency of the needed evidence, and the current state of childhood obesity in the United States.
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Affiliation(s)
- Christina K. Holub
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311
| | - Felipe Lobelo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta MS K-40, GA 30341
| | - Setoo M. Mehta
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA92123-4311
| | - Luz M. Sánchez Romero
- Research Department of Nutrition Policies and Programs, Center of Nutrition and Health, National Institute of Public Health, Av. Universidad No. 655., Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, CP. 62100, Mexico
| | - Elva M. Arredondo
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311
| | - John P. Elder
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311
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Whittemore R, Chao A, Jang M, Jeon S, Liptak T, Popick R, Grey M. Implementation of a school-based internet obesity prevention program for adolescents. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:586-94. [PMID: 23850014 PMCID: PMC3797867 DOI: 10.1016/j.jneb.2013.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity. DESIGN Concurrent mixed method evaluation. SETTING Three public high schools in Connecticut. PARTICIPANTS Three hundred eighty-four adolescents, 8 teachers. INTERVENTION(S) HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training. MAIN OUTCOME MEASURE(S) Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers. ANALYSIS Mixed and logistic models, content analysis. RESULTS The sample (n = 384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m(2). Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P ≤ .001 and < .001, respectively). Girls had higher satisfaction and participation compared with boys (P = .02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P = .03). CONCLUSIONS AND IMPLICATIONS Two school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.
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Hafekost K, Lawrence D, Mitrou F, O'Sullivan TA, Zubrick SR. Tackling overweight and obesity: does the public health message match the science? BMC Med 2013; 11:41. [PMID: 23414295 PMCID: PMC3626646 DOI: 10.1186/1741-7015-11-41] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 02/18/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the increasing understanding of the mechanisms relating to weight loss and maintenance, there are currently no validated public health interventions that are able to achieve sustained long-term weight loss or to stem the increasing prevalence of obesity in the population. We aimed to examine the models of energy balance underpinning current research about weight-loss intervention from the field of public health, and to determine whether they are consistent with the model provided by basic science. EMBASE was searched for papers published in 2011 on weight-loss interventions. We extracted details of the population, nature of the intervention, and key findings for 27 articles. DISCUSSION Most public health interventions identified were based on a simple model of energy balance, and thus attempted to reduce caloric consumption and/or increase physical activity in order to create a negative energy balance. There appeared to be little consideration of homeostatic feedback mechanisms and their effect on weight-loss success. It seems that there has been a lack of translation between recent advances in understanding of the basic science behind weight loss, and the concepts underpinning the increasingly urgent efforts to reduce excess weight in the population. SUMMARY Public health weight-loss interventions seem to be based on an outdated understanding of the science. Their continued failure to achieve any meaningful, long-term results reflects the need to develop intervention science that is integrated with knowledge from basic science. Instead of asking why people persist in eating too much and exercising too little, the key questions of obesity research should address those factors (environmental, behavioral or otherwise) that lead to dysregulation of the homeostatic mechanism of energy regulation. There is a need for a multidisciplinary approach in the design of future weight-loss interventions in order to improve long-term weight-loss success.
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Affiliation(s)
- Katherine Hafekost
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA6872 Australia
| | - David Lawrence
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA6872 Australia
| | - Francis Mitrou
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA6872 Australia
| | - Therese A O'Sullivan
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA6872 Australia
- School of Exercise and Health Science, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Stephen R Zubrick
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA6872 Australia
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:429-34. [PMID: 22931856 DOI: 10.1097/med.0b013e328358c698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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