Global school-based childhood obesity interventions: a review

Assessing the impact of obesity interventions in the early years: a systematic review of UK-based studies

OBJECTIVES

Childhood obesity rates in the UK are high. The early years of childhood are critical for establishing healthy behaviours and offer interventional opportunities. We aimed to identify studies evaluating the impact of UK-based obesity interventions in early childhood.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Nine databases were searched in March 2023.

ELIGIBILITY CRITERIA

We included UK-based obesity intervention studies delivered to children aged 6 months to 5 years that had diet and/or physical activity components and reported anthropometric outcomes. The primary outcome of interest was z-score Body Mass Index (zBMI) change (within and between subjects). Studies evaluating the effects of breastfeeding interventions were not included as obesity prevention interventions, given that best-practice formula feeding is also likely to encourage healthy growth. The publication date for studies was limited to the previous 12 years (2011-23), as earlier reviews found few evaluations of interventions in the UK.

DATA EXTRACTION AND SYNTHESIS

The reviewers worked independently using standardised approach to search, screen and code the included studies. Risk of bias was assessed using Cochrane tools (ROB 2 or ROBINS-I).

RESULTS

Six trials (five studies) were identified, including two randomised controlled trials (RCT), one cluster randomised trial (CRT), two feasibility CRTs and one impact assessment. The total number of participants was 566. Three trials focused on disadvantaged families and two included high-risk children categorised as having overweight or obesity. Compared with baseline, five interventions reported reductions in zBMI, three of which were statistically significant (p<0.05). Compared with control, five interventions showed zBMI reductions, one of which was significant. Only two trials were followed up beyond 12 months. All studies were found to have a high risk of bias. Meta-analysis was not possible due to the heterogeneity of studies.

CONCLUSION

UK evidence was limited but some interventions showed promising results in promoting healthy growth. As part of a programme of policies, interventions in the early years may have an important role in reducing the risk of childhood obesity.

PROSPERO REGISTRATION NUMBER

CRD42021290676.

A systematic review of school-based weight-related interventions in the Gulf Cooperation Council countries

BACKGROUND

The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes.

METHODS

Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors.

RESULTS

Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour.

CONCLUSIONS

This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020156535.

The impact of a health promotion program on toddlers' socio-emotional development: a cluster randomized study

BACKGROUND

The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic.

METHODS

A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) at baseline and post-intervention.

RESULTS

After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels.

CONCLUSION

These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations.

TRIAL REGISTRATION

This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).

Affect, Body, and Eating Habits in Children: A Systematic Review

The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.

"We Eat Without Thinking: We Just Eat, Eat, Eat" - A Thematic Exploration of Cultural Practices of Ethnically Diverse Youth and Their Parents Who Are at Risk for Prediabetes and Type 2 Diabetes

PURPOSE

Cultural beliefs and practices influence management of type 2 diabetes (T2D) in youth and their parents, and have been minimally explored, limiting our understanding and implementation of preventative healthcare. An enhanced evidence base may inform comprehensive, effective community health nursing (CHN). Thus, the purpose of this research was to explore the influence of youths' and their parents' understandings of cultural practices on risk for prediabetes and T2D.

DESIGN

A secondary thematic analysis was conducted. Qualitative data were obtained from semi-structured interviews with 24 participants who were purposefully recruited from two mid-western Canadian high schools.

FINDINGS

Three themes and one subtheme were developed including: 1) Food Culture and related subtheme, Acculturation to New Food Choices; 2) Exercise Culture: Adapting Physical Activity in a New Country; and, 3) Risk Perception of the Effects of T2D on Loved Ones: Behavior Modifications and Motivation. Cultural practices and acculturation to food such as dietary choices, preparation, large portions, different dietary staples, food availability, and food gathering patterns influenced health behaviors. Similarly, changes in exercise patterns including adapting to Western video game culture, weather in Canada, and the new way of life emerged as important factors that impacted health. Participants who perceived a familial risk of diabetes identified behavior modifications such as regular diabetes screening, nutrition counseling, healthier food choices, smaller food portions, and an increase in physical activity as strategies to reduce risk of prediabetes and diabetes.

CONCLUSIONS

There is a critical need for research aimed at prediabetes and T2D prevention, and intervention programs targeting ethnically diverse groups where prediabetes and T2D is most prevalent.

CLINICAL EVIDENCE

Community health nurses are at the core of implementing and supporting disease prevention and, therefore, may consider the findings from this research to develop family-focused, intergenerational, and culturally-based interventions.

Associations between dietary intake, physical activity, and obesity among public school teachers in Jeddah, Saudi Arabia

Objective

We aimed to assess the dietary intake of certain food groups in a representative sample of public-school teachers living in Jeddah city. We also, examined the association of dietary intake with physical activity and obesity among schoolteachers.

Methods

The study was a cross-sectional online survey, conducted among 640 (177 male, 463 female) schoolteachers aged between 20 and 62 years old and working in public primary, intermediate, and high schools in Jeddah. Measurements included gender, weight, height, body mass index (BMI), health problems, and lifestyle behaviours, including physical activity levels, smoking status, and dietary intake.

Results

Based on gender, number of non-smoking women (94%) was higher than number of non-smoking men (57.1%) (P < 0.001). However, men were more active than women (P = 0.03). Regarding BMI, there were more overweight men than women, while obese women numbered more than men (P = 0.003). There was no significant difference in dietary intake between men and women except that men consumed more soft drinks than women (P = 0.002). Lower physically active schoolteachers were less likely to consume salad (OR = 0.6, 95% CI 0.4-0.9; P = 0.02), vegetables (OR = 0.6, 95% CI 0.3-0.9; P = 0.01), beans and legumes (OR = 0.4, 95% CI 0.2-0.7; P = 0.005), wholegrain bread (OR = 0.6, 95% CI 0.4-0.9; P = 0.03), dairy products (OR = 0.6, 95% CI 0.4-0.9; P = 0.01), snacks (OR = 0.5, 95% CI 0.2-0.8; P = 0.01), and fish (OR = 0.4, 95% CI 0.2-0.9; P = 0.04) compared to those with high levels of physical activity. Only fruit intake was considered statistically significant (OR = 0.4, 95% CI 0.3-0.7; P = 0.003). The study found a relationship between the BMI of schoolteachers and food intake. Obese schoolteachers had lower consumption of fruits (OR = 0.3, 95% CI 0.2-0.7; P = 0.007) and white meat (OR = 0.5, 95%CI 0.3-0.9; P = 0.03) than schoolteachers in the normal weight group.

Conclusion

The high prevalence of physical activity, dietary intake and body weight among Saudi teachers is a major public health concern. The present study identified several lifestyle factors associated with body weight that may represent valid targets for the prevention and management of obesity among Saudi school teachers. Promoting active lifestyles and healthy diets would be primary targets for obesity prevention.

Bikes for Life: Measuring the effects of a bicycle distribution program on 6 to 12-year-old children's BMI and health behaviors

Treating pediatric obesity is challenging. The objective was to evaluate effect of receiving a bicycle on (a) physical activity, (b) sedentary activity, (c) Body Mass Index (BMI), and (d) eating habits. A stepped-wedge randomized controlled trial of 6- to 12-year-old patients with overweight/obesity was conducted April 2012-2018. Participants were randomized to wait 0, 2, 4, or 6 months for a bicycle. Outcomes on activity, BMI and eating were collected at 3, 6, 9- and 12-months after children received a bicycle. A total of 525 participants with 387 (74%) completed 3-month follow-up questionnaire, and 346 (66%) completed 12-month follow-up visit. Participants were mostly Latino/a (71%) and low income (58%), and 31% had never ridden a bicycle. Median baseline BMI was 98th percentile. At 3 months, 62% reported bicycle use last week, on average 3.6 days. Time spent on sedentary activities decreased by 48 min/day (p = 0.04), and time spent playing sports increased by 1.7 h/week (p < 0.01). No reduction in BMI was seen. Consumption of sugary drinks decreased (by 0.59 servings/week, p < 0.01), and consumption of vegetables increased (0.71 servings/week, p = 0.04). At 12 months, sedentary time, sugary drink and vegetable consumption remained significantly more favorable than at enrollment (p < 0.01, p < 0.01, p = 0.04 respectively), but not significantly different (p = 0.47 for sedentary, p = 0.73 for sugary drink) and significantly less favorable (p < 0.01 for vegetables) than at the time of intervention. Participants reported riding bicycle, improved activity and dietary habits, though reversion towards baseline behavior was seen by one year and no change in BMI from enrollment.

Snacks, nudges and asymmetric peer influence: Evidence from food choice experiments with children in Indonesia

Many children in low- and middle-income countries are growing up during a rapid nutrition transition. Experimental evidence on food choice in developing countries is scarce, while it is unclear to what extent evidence from high-income countries can be generalized. Children participated in a snack choice experiment. We expose some children to emoji labels encouraging healthy snacks, while others observe healthy or unhealthy snacking by peers. While emoji labels moderately promote healthy snacking, the adverse effect of observing a peer eating the unhealthy snack is very large. The effect associated with observing a healthy peer is insignificant. Additionally, cross-randomized blocks of children watched a nutrition video to study the interaction of information provision and nudging. The video independently improves healthy choices but does not aid the emoji nudge and cannot counter the strong negative peer effect. We compare our findings to studies conducted in developed countries and discuss policy implications.

Associations between elementary and middle school teachers' physical activity promoting practices and teacher- and school-level factors

BACKGROUND

Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers' PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors.

METHODS

This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7-35; Cronbach's alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district.

RESULTS

Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = - 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = - 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = - 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices.

CONCLUSIONS

Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students' PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors.

TRIAL REGISTRATION

Clinical Trials, NCT03432715 ; Registered on 02/2/2018.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

School as a Protective Setting for Excess Weight Gain and Child Obesity: A Meta-Analysis

BACKGROUND

The structure provided by school settings even with no specific obesity-intervention may prevent weight gain. This meta-analytic study considered this premise by examining weight outcomes from control groups in published randomized controlled trials of school-year obesity-related interventions conducted in-school and out-of-school.

METHODS

A systematic review and random-effects meta-analysis were conducted in accordance with Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were systematically searched and resulted in 1976 unique citations, with 14 retained for analysis. Analyses examined the change in weight outcomes among control group participants.

RESULTS

For studies (N = 6) reporting body mass index (BMI) (kg/m² ) the overall standardized mean difference (SMD) from pre- to post-intervention was 0.085 (raw units 0.278 kg/m² ); for studies (N = 9) reporting zBMI, the SMD was 0.022 (0.020 z-scores), for studies (N = 2) reporting waist circumference (cm), the SMD was 0.149 (1.609 cm); for studies (N = 2) reporting BMI percentile, the SMD was 0.064 (0.985 percentiles); and for studies (N = 1) reporting percent body fat, the SMD was 0.031 (0.30 percentage).

CONCLUSIONS

Children assigned to control conditions (as part of school-based obesity-related interventions) experience, on average, minimal changes in weight outcomes during the school year. Therefore, routine practices of schools may protect against unhealthy weight gains.

Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program

Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8–12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.

Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices

Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25 kg/m2 = overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha = 0.65; higher score = more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI = 30.5 ± 7.1; aged 41.1 ± 11.8 years). Means and standard deviations were calculated for HEI (52.2 ± 12.2) and nutrition-related classroom practices sum score (25.4 ± 5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE = 0.05; p < 0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.

Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities

Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.

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

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.

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

Model of goal directed behavior for limiting Latino preschoolers' television viewing: validity and reliability

Background

Accurately measuring parents’ attitudes and beliefs regarding limiting their children’s TV viewing is important to inform the design and evaluation of effective interventions. This manuscript assesses the internal consistency reliability, test-retest reliability, convergent validity, and construct validity of the Model of Goal Directed Behavior (MGDB) scales among parents of Latino preschoolers to characterize Latino parents’ attitudes and beliefs toward limiting their preschoolers’ TV viewing.

Method

Participants included parents of Latino preschoolers in the United States, 3–5 years old (n = 186). Parents completed a socio-demographic survey and the 105-item MGDB questionnaire (Attitudes, Perceived Positive/Negative Behavioral Control, Subjective Norms, Positive and Negative Anticipated Emotions, Habits, Self-Efficacy, Desires, and Intentions surrounding their child’s TV viewing) which was used to measure internal consistency reliability and construct validity. A subsample of participants completed the questionnaire twice to measure test-retest reliability. Further, parents completed a 7-day TV viewing diary for their preschooler, and a TV parenting practices questionnaire as measures of convergent validity.

Results

Internal consistency reliability was generally acceptable for the MGDB scales (Cronbach’s alphas> 0.7), except for the Desires scale, which was revealed to have two factors and the Attitudes and Perceived Behavioral Control scales. Test-retest reliability over 2 months had negligible to moderate correlations (r’s = 0.28 to 0.61). Two structural equation models were conducted. One yielded acceptable model fit (x² (97) = 113.65, p = .119) and the other had questionable model fit (x² (97) = 125.39; p = .028). Testing convergent validity, only two MGDB scales (Habits and Self-Efficacy) were positively correlated with the TV parenting practices questionnaire (r’s = 0.33 to 0.51), and none were meaningfully correlated with preschoolers’ mean daily TV viewing.

Conclusions

Initial reliability and validity for some of the MGDB scales appear acceptable among parents of Latino preschoolers. Refinement of the instrument and testing among larger samples is necessary to fully evaluate psychometric properties. This instrument may be useful for characterizing Latino parents’ attitudes and beliefs toward limiting their preschoolers’ TV viewing and informing future TV reduction interventions.

Trial registration

Clinical Trials NCT01216306 Registered October 6, 2010.

Physical Activity in the Prevention of Childhood Obesity: The Position of the European Childhood Obesity Group and the European Academy of Pediatrics

Obesity affects an increasing number of children and adolescents. Physical activity (PA) is a significant factor in the prevention of excessive body mass in the pediatric population. A significant percentage of pediatric population do not attain the public health recommendation for PA, and typically, those with higher levels of PA have lower content of body fat than less active peers. Although the development of childhood obesity is multifactorial, the decline in energy expenditure is considered as one of the most important determinants of excessive body weight. The lack of intervention causes that excess body weight to remain stable from birth through childhood and adolescence to adulthood. Accordingly, public health interventions are needed to increase the level of PA in the pediatric population. The task force from the European Childhood Obesity Group and the European Academy of Pediatrics reviewed English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from 2018 to August 2020, and developed a consensus statement. This statement presents the role of PA in the prevention of excessive body weight and gives age-appropriate recommendations for PA and recommendations for school-based interventions, parents, and guardians.

Global Implementation of Obesity Prevention Policies: a Review of Progress, Politics, and the Path Forward

PURPOSE OF REVIEW

This review describes policy and regulatory strategies to prevent obesity and summarizes worldwide progress and impediments to scaling up strategies globally.

RECENT FINDINGS

While there is considerable variation in the breadth and depth of uptake of recommended strategies, the adoption of effective obesity prevention policies has been slow and inconsistent. There is broad consensus that strong government, corporate, and consumer actions, including regulatory measures, are needed to advance obesity prevention policies. Governments have lacked sufficient will to take necessary action, the food industry has actively worked to thwart policies to protect its commercial interests, and consumers have not exerted sufficient influence or demand to produce change. Advancing obesity prevention will require the use of effective strategies to shape and influence the information environments and political environments towards messages and actions to support public health. Greater emphasis is needed on reducing the influence of commercial interests, mobilizing civil society, and targeting vulnerable populations through equity-focused frameworks.

Frequency of school-based intervention needed to improve weight outcomes of Mexican-American adolescents with overweight or obesity: a randomized controlled trial

BACKGROUND

Efficacious school-based interventions among ethnic minority youth are often intensive and difficult to disseminate.

OBJECTIVE

This parallel, open-label-randomized controlled trial aimed to compare changes in adolescent-standardized body mass index (zBMI) from a school-based obesity intervention given 0, 1, 3, or 5 days a week.

METHODS

Mexican-American youth (n = 243) with overweight or obesity were recruited from a Houston school district and randomized to receive an obesity intervention with established efficacy 0 (control), 1, 3, or 5 d/wk (respectively, equating to 0, 40, 120, or 200 min of contact each week). In each condition, 80% of intervention time was allocated to physical activity and 20% to nutrition, with behavioural modification overlaid throughout. zBMI was calculated from directly measured height and weight. A linear mixed model evaluated differences in zBMI over time between conditions.

RESULTS

Participants were 12.02 ± 0.57 years old with a zBMI of 1.80 ± 0.46 at baseline. Among those with complete data at 1 year (n = 203), a significant condition by time interaction was indicated (F = 9.42, P < .001). Those who received the intervention 3 or 5 d/wk had significantly greater decreases in zBMI than control (respectively, -0.19 zBMI units/y; 95% CI, -0.28 to -0.11; and -0.18 zBMI units/y; 95% CI, -0.27 to -0.10, both P < .001). No differences were found between 3 and 5 d/wk (95% CI, -0.09-0.08, P = .87).

CONCLUSIONS

The intervention provided 3 d/wk resulted in similar zBMI improvements as the intervention provided 5 d/wk. This information can be used to develop scalable school-based obesity interventions.

An Onsite Fitness Facility and Integrative Wellness Program Positively Impacted Health-Related Outcomes Among Teachers and Staff at an Urban Elementary/Middle School

Background

Given the large number of obesity-focused studies conducted in schools, there is a surprising lack of data regarding teacher workplace health behaviors in the United States.

Objective

To determine the feasibility and effectiveness of an onsite fitness facility with a structured integrative wellness program to improve health-related outcomes among teachers and staff at an urban elementary/middle school.

Methods

A 2-year mixed-methods analysis using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews included 39 teachers and staff employed at an urban elementary/middle school in Baltimore, Maryland. The fitness facility was dedicated exclusively to teachers and staff and the integrative wellness program included group exercise classes, yoga, mindfulness, and nutrition competitions. T tests were used to compare quantitative outcomes at baseline, the end of year 1, and the end of year 2.

Results

Compared to baseline, at year 1, there was a significant improvement in the PROMIS Sleep Disturbance score. From baseline to end of year 2, there were significant increases in the PROMIS Global Physical Health as well as significant decreases in Sleep Disturbances, Fatigue, and Social Isolation. Qualitative interviews conducted at the end of year 1 indicated that teachers who used the facility felt that it improved their mood, increased their energy, motivated them to eat healthily, and gave them opportunities to socialize with their colleagues in new ways. This impact was further enhanced in year 2.

Conclusions

An onsite fitness facility with an integrative wellness program may improve health-related outcomes among urban elementary school teachers and staff, with the greatest benefits seen after 2 years of implementation.

Challenges and opportunities to tackle the rising prevalence of diet-related non-communicable diseases in Africa

Africa is experiencing a sharp rise in non-communicable diseases (NCD) related to rapid globalisation and urbanisation leading to shifts in dietary and lifestyle patterns characterised by increased energy intake and physical inactivity. However, unlike more resource-endowed regions, Africa has a double burden of disease: NCD co-exist with infectious diseases including lower respiratory tract infections, HIV/AIDS and diarrhoeal diseases. The African economy is also relatively weaker, making it difficult to cope with this burden. It is postulated that NCD will soon overtake infectious diseases as the number one cause of death in the African region. The recognition of NCD as diseases and obesity as a related risk factor is weak in Africa, compounded by stigma associated with wasting in HIV/AIDS and obesity being perceived as a sign of wealth, achievement and care. There is also a dearth of data on overweight and obesity in the region and little knowledge that infant feeding practices, such as breast-feeding, are linked to reduced risk of NCD in both children and mothers. While complex multi-sectoral approaches to address this NCD menace are needed, Africa may benefit from taking simple initial steps to address NCD risk factors including: (1) behaviour change communication to challenge perceptions on NCD; (2) promoting and protecting breast-feeding; (3) formulating policies and regulations limiting wide availability of unhealthy foods; (4) mainstream nutrition education in school curricula and (5) collection of accurate data based on indicators that can reflect the double burden of disease and malnutrition; and fostering multi-sectoral actions against NCD.

A long-term maternal diet transition from high-fat diet to normal fat diet during pre-pregnancy avoids adipose tissue inflammation in next generation

Recent studies have suggested that maternal high-fat (HF) diet caused inflammation changes in adipose tissue; however, it remains unclear if maternal diet intervention before pregnancy rescues such effects in offspring. To address this question, female mice were continued on a normal-fat (NF group), or a HF diet (HF group) or transitioned from a HF diet to a NF diet at 1 (H1N group), 5 (H5N group) or 9 weeks (H9N group) prior to pregnancy. Among the three intervention groups, the H9N offspring displayed less and steady body weight gain, and maintained glucose tolerance, whereas the H1N and H5N offspring showed exacerbate these phenotypes. The H1N and H5N, but not the H9N offspring, displayed adipocyte hypertrophy associated with increased expression of genes involved in fat deposition. The H1N and H5N, but not the H9N adipose tissue, displayed increased macrophage infiltration with enhanced expression of inflammatory cytokine genes. In addition, overactivation of the NF-κB and the JNK signaling were observed in the H1N adipose tissue. Overall, our study showed that a long-term but not a short- or medium-term diet intervention before pregnancy released offspring adipose tissue inflammation induced by maternal HF diet, which adds details in our understanding how the maternal environment either promotes or discourages onset of disease in offspring. Clinically, this study is of great value for providing evidence in the design of clinical trials to evaluate the urgently required intervention strategies to minimize the intergenerational cycle of obesity.

Good practice criteria for childhood obesity prevention in kindergartens and schools-elaboration, content and use

Background

In accordance with the policy actions that address childhood overweight and obesity at European level and as a contribution to the EU Action Plan on Childhood Obesity 2014-20, a Joint Action on Nutrition and Physical Activity (JANPA) was established. As part of JANPA work package 6, an evaluation framework to identify good practices, targeting childhood obesity prevention in kindergartens and schools, was developed. This article describes the WP 6 JANPA framework of good practice criteria and its development, compares it to other frameworks and discusses its potential for future use.

Methods

Based on the analysis of scientific literature, a set of 47 potential good practice criteria was drafted, that was then revised and complemented through a series of online Delphi consultations.

Results

A final list of 48 good practice criteria (9 of which were rated as core criteria) was developed and grouped into three categories: intervention characteristics (n = 17), implementation (n = 17) and monitoring and evaluation (n = 14).

Conclusion

The identified JANPA framework of good practice criteria complements the existing frameworks by focussing on kindergarten- and school-based initiatives and provides guidance for evaluators, programme planners and decision makers bearing in mind that a one-size-fits-all approach is inadequate. To ensure the effectiveness of future practices, programme planners should endeavour to meet at least the nine JANPA core criteria.

"Wellness Champions for Change," a multi-level intervention to improve school-level implementation of local wellness policies: Study protocol for a cluster randomized trial

Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students' behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.

Memphis FitKids: implementing a mobile-friendly web-based application to enhance parents' participation in improving child health

Background

Child obesity is a major public health challenge, increasing the risk of chronic medical conditions such as type 2 diabetes, metabolic syndrome, and hypertension. Among U.S. states, Tennessee has one of the highest rates of child obesity. Emerging communication technologies can help to deliver highly disseminable population-level interventions to improve health behavior. The aim of this paper is to report the implementation and the evaluation of the reach of Memphis FitKids, a web-based application, intended to promote healthy behaviors for families and children.

Methods

A community-level demonstration project, Memphis FitKids, was developed and implemented in Tennessee’s Greater Memphis Area. This application (www.memphisfitkids.org) was designed for parents to assess their children’s obesity risk through determinants such as weight, diet, physical activity, screen time, and sleep adequacy. A built-in “FitCheck” tool used this collected information to create a report with tailored recommendations on how to make healthy changes. A Geographic Information Systems component was implemented to suggest low-cost neighborhood resources that support a healthy lifestyle. A social marketing framework was used to develop and implement FitKids, and a Community Advisory Board with representatives from community partners (e.g., the YMCA of Memphis, the Pink Palace Family of Museums, and the Memphis Public Library) supported the implementation of the project. Five kiosks distributed in the community served as public access points to provide a broad reach across socioeconomic strata. Presentations at community events and the use of Facebook facilitated the promotion of FitKids. Website traffic and Facebook usage were evaluated with Google Analytics and Facebook Insights, respectively.

Results

In Tennessee, 33,505 users completed 38,429 FitCheck sessions between July 2014 and December 2016. Among these, 6763 sessions were completed at the five kiosks in the community. FitKids was presented at 112 community events and the social media posts reached 23,767 unique Facebook users.

Conclusions

The Memphis FitKids demonstration project showed that web-based health tools may be a viable strategy to increase access to information about healthy weight and lifestyle options for families. Mobile-friendly web-based applications like Memphis FitKids may also serve health professionals in their efforts to support their clients in adopting healthy behaviors.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5968-6) contains supplementary material, which is available to authorized users.

Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs

PURPOSE OF REVIEW

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives.

RECENT FINDINGS

Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

Psychometric testing of the healthy eating and physical activity self-efficacy questionnaire and the healthy eating and physical activity behavior recall questionnaire for children

PURPOSE

The purpose of this study was to develop and assess the psychometric properties for two related questionnaires: the Healthy Eating and Physical Activity Self-Efficacy Questionnaire for Children (HEPASEQ-C) and the Healthy Eating and Physical Activity Behavior Recall Questionnaire for Children (HEPABRQ-C).

DESIGN AND METHODS

HEPASEQ-C and HEPABRQ-C were administered to 517 participating children with 492 completing. Data were analyzed to evaluate for reliability and validity of the questionnaires.

RESULTS

Content validity was established through a 10-person expert panel. For the HEPASEQ-C, item content validity index (CVI) ranged from 0.80 to 1.00. The CVI for the total questionnaire was 1.0. All HEPASEQ-C items loaded on a single factor. Cronbach's alpha was deemed acceptable (.749). For the HEPABRQ-C, item CVI ranged from 0.88 to 1.00. CVI for the total questionnaire was 1.0. Pearson product moment correlation between HEPASEQ-C and HEPABRQ-C scores was significant (r = .501, p = .000).

PRACTICE IMPLICATIONS

The HEPASEQ-C and HEPABRQ-C are easily administered and provide helpful insights into children's self-efficacy and behavior recall. They are easy to use and applicable for upper elementary school settings, in clinical settings for individual patients, and in health promotion settings.

Interventions to prevent global childhood overweight and obesity: a systematic review

In view of the prevalence, health consequences, and costs of childhood obesity, there has been substantial interest in identifying effective interventions to prevent excess weight gain in young people. In this systematic review, we expand on previous reviews of obesity prevention interventions by including recent studies (until May 23, 2017) from all parts of the world. We searched MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts, and PAIS Index and included randomised controlled trials, quasi-experimental studies, or natural experiments with: (1) a control group; (2) minimum follow-up of 12 months for community-based and home-based interventions or 6 months for school-based and preschool-based interventions; and (3) a primary outcome of BMI, BMI Z score, BMI percentile, body fat percentage, skinfold thickness, waist circumference, or prevalence of overweight or obesity. School-based interventions with combined diet and physical activity components and a home element (n=41) had greatest effectiveness; evidence in support of the effect of preschool-based (n=6), community-based (n=7), and home-based (n=2) interventions was limited by a paucity of studies and heterogeneity in study design. The effectiveness of school-based interventions that combined diet and physical activity components suggests that they hold promise for childhood obesity prevention worldwide. More research with rigorous evaluation and consistent reporting is needed in non-school settings and in combinations of settings.

Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

Effective obesity prevention and treatment interventions are lacking in the United States, especially for impoverished minority youths at risk for health disparities, and especially in accessible community-based settings. We describe the launch and pilot implementation evaluation of the first year of the B'N Fit POWER initiative as a middle school-based comprehensive wellness program that integrates weight management programming into existing onsite preventive and clinical services. Consistent with the existing implementation science literature, we focused on both the organizational structures that facilitate communication and the development of trust among stakeholders, students, and families and the development of realistic and timely goals to implement and integrate all aspects of the program. New implementation and programming strategies were developed and tested to increase the proportion of students screened, support the linkage of students to care, and streamline the integration of program clinical and afterschool components into routine services already offered at the school. We report on our initial implementation activities using the Standards for Reporting Implementation Studies (StaRI) framework using hybrid outcomes combining the Reach element from the RE-AIM framework with a newly conceptualized Wellness Cascade.

Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses

BACKGROUND

Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years.

METHODS AND RESULTS

We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD -0.99 (95% CI -1.36 to -0.61)), 12 months (MD -0.67 (95% CI -1.01 to -0.32)), and 24 months (MD -0.96 (95% CI -1.63 to -0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMI Z scores after 6 months (MD -0.12 (95% CI -0.17 to -0.06)), 12 months (MD -0.16 (95% CI -0.21 to -0.11)), and 24 months (MD -0.16 (95% CI -0.21 to -0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention.

CONCLUSION

Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6, 12, and 24 months compared with standard, minimal, and no treatment.

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

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

Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial

OBJECTIVES

To evaluate the potential benefits on students' eating habits, of incorporating healthy nutrition education as part of a school food aid program.

METHODS

146 schools participating in the DIATROFI Program in Greece during the 2013-2014 school year were randomly allocated to the environmental intervention (received a healthy daily meal) and the multicomponent intervention (MI) group (in addition to the meal, a healthy nutrition educational program was applied). The analysis, based on 3627 pre-post intervention questionnaire pairs, was stratified for children (ages 4-11 years) and adolescents (ages 12-18 years).

RESULTS

Children participating in the MI group displayed 25 % higher odds of increasing the weekly consumption of milk/yoghurt and fruits, 61 % higher odds of improving BMI from overweight/obese to normal and 2.5 times higher odds of improving from underweight to normal. For adolescents in the MI group, the odds of increasing the consumption of vegetables were 40 % higher. In both intervention groups, approximately one in four overweight/obese adolescents reached normal weight.

CONCLUSIONS

Educational programs on healthy nutrition might be considered worth implementing in the framework of school food aid programs.

[Effect of an intervention based on child-care centers to reduce risk behaviors for obesity in preschool children]

BACKGROUND

Preschool age is a critical stage for health promotion and prevention of obesity, which is an emerging public health problem in children. The aim of this study was to design and evaluate the effect of a multifaceted intervention based on child-care centers to reduce risk behaviors for obesity among preschool children.

METHODS

A 12-month cluster-randomized community trial was conducted in 16 Mexican Institute of Social Security child-care centers in Mexico City. Children between 2 and 4 years of age enrolled in the selected child-care centers participated in the study. Intervention comprised 12 weekly curriculum sessions for the children, and six family workshops. Changes in children's dietary and physical activity, food availability at home, and maternal feeding styles were determined after 6 and 12 months. Changes within groups among stages, and between groups by stage were analyzed through χ² test.

RESULTS

The intervention showed decrease of home availability for some non-recommended foods and increase in physical activity in the intervention group compared to the usual care group.

CONCLUSIONS

Improvement in physical activity can be effective in the long term; innovative strategies aimed to modify family dietary risk behaviors are required.

School-Based Intervention as a Component of a Comprehensive Community Program for Overweight and Obesity Prevention, Sousse, Tunisia, 2009-2014

Introduction

Combating obesity at an early age, by improving physical activity and nutrition-related behaviors, is vital to the prevention of more critical health concerns in adulthood. This intervention study evaluated the effectiveness of a school-based component of a community behavioral intervention on overweight and obesity rates of adolescents in Sousse, Tunisia.

Methods

A quasi-experimental school-based intervention was conducted with an intervention group (in Sousse Jawhara and Sousse Riadh) and a control group (in Sousse Msaken). The intervention (which was a physical activity and nutrition program) lasted 3 years, with data at preintervention collected during the 2009–2010 school year and at postintervention collected during the 2013–2014 school year. Descriptive statistics and multivariate analysis were used to determine the effect of the intervention on risk of excess weight.

Results

Results showed a significant increase in fruit and vegetable intake by the intervention group (P = .04). The intervention group had an increase in students in the normal weight category (P = .03) and a decrease in students in the overweight category (P = .03).The intervention effect was a protective factor against excess weight for the participating schoolchildren (OR, 0.84; P = .02).

Conclusion

This study showed that a school-based intervention is successful in increasing healthy dietary habits and in reducing risk of excess weight. It also showed the importance of a multisectoral approach to provide an environment conducive to healthy behaviors for adolescents.

The association between sleep patterns and overweight/obesity in Chinese children: a cross-sectional study

OBJECTIVE

This study evaluated the association between sleep patterns and the risk of being overweight/obese in Chinese children.

METHODS

A total of 3,086 children (1,608 boys and 1,478 girls) between 7 and 14 years of age and studying in primary schools were recruited as eligible study participants in this study. We collected the information about children regarding sleep patterns, body height and weight, insomnia, healthy status, time allocation of daily activities, and demographic characteristics using a parental-reported questionnaire.

RESULTS

Overweight/obese children were younger, predominantly male, and more prone to have suffered from illness in the past 12 months compared to normal-weight peers. They were also less prone to compensate for sleep deficits during weekends (47.6% vs 39.1%; χ (2)=11.637, P<0.001) and holidays (52.0% vs 42.0%; χ (2)=16.057, P<0.001). Sleep duration on weekdays did not affect the risk of being overweight/obese. The adjusted odds ratios for overweight/obesity (noncompensated) group using the compensated group as a reference were 1.197 (95% confidence interval [CI]: 1.004-1.493) during weekends and 1.309 (95% CI: 1.052-1.630) during holidays.

CONCLUSION

Compensation for sleep deficits on non-weekdays may ameliorate the risk of being overweight/obese in Chinese children. Moreover, no significant association between the risk of being overweight/obese and sleep duration on weekdays was demonstrated in the current study, which may be due to pervasive sleep insufficiency on weekdays in Chinese children.

Effectiveness of a school-based physical activity intervention on obesity in school children: a nonrandomized controlled trial

BACKGROUND

Childhood obesity has been a serious public health problem. An effective school-based physical activity (PA) intervention is still lacking in China. This study aimed to assess the effectiveness of a school-based physical activity intervention during 12 weeks on obesity and related health outcomes in school children.

METHODS

It was a non-randomized controlled trial. Altogether 921 children aged 7 to 15 years were recruited at baseline survey. Children in the intervention group (n = 388) participated in a multi-component physical activity intervention during 12 weeks that included improvement of physical education, extracurricular physical activities for overweight/obese students, physical activities at home, and health education lectures for students and parents. Children (n = 533) in the control group participated in usual practice.

RESULTS

Participants had mean age of 10.4 years, mean body mass index (BMI) of 19.59 kg/m2, and 36.8 % of them were overweight or obese at baseline survey. The change in BMI in intervention group (-0.02 ± 0.06 kg/m2) was significantly different from that in control group (0.41 ± 0.08 kg/m2). The adjusted mean difference was -0.43 kg/m2 (95% CI: -0.63 to -0.23 kg/m2, P < 0.001). The effects on triceps, subscapular, abdominal skinfold thickness and fasting glucose were also significant in intervention group compared with control group (all P < 0.05). The change in duration of moderate to vigorous physical activity (MVPA) in intervention group (8.9 ± 4.3 min/day) was significantly different from that in control group (-13.8 ± 3.3 min/day). The adjusted mean difference was 22.7 min/day (95% CI: 12.2 to 33.2 min/day, P < 0.001).

CONCLUSIONS

The school-based, multi-component physical activity intervention was effective to decreasing levels of BMI, skinfold thickness, fasting glucose and increasing duration of MVPA. These findings provided evidence for the development of effective and feasible school-based obesity interventions.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT02074332 (2014-02-26).

The development of a bilingual interactive video to improve physical activity and healthful eating in a head start population

The prevalence of obesity in the Hispanic preschool population remains elevated, particularly among children in low income families below the poverty level. Obesity leads to the early onset of metabolic syndrome and Type 2 diabetes. The Head Start population of Texas is largely comprised of this high risk group. Their physical activity level is suboptimal in part due to lack of available outside play areas and time spent watching television and playing sedentary video games. Dietary intake is frequently high in sugar sweetened beverages and low in vegetables. The group is frequently bilingual with limited vocabulary and has not learned to read. Preserving their Mexican American culture is a concern. This article describes the development and assessment of a group of bilingual interactive video interventions to improve age appropriate physical activity while providing basic nutrition education focusing on increasing vegetable and water intake and decreasing sugar sweetened beverages. Suggestions for development and assessment of content were provided by focus groups of Head Start teachers, managers and dietitians in the Texas counties of Bastrop, Hidalgo and McLennon. A demonstration of the videos was conducted in Bastrop County. Teachers, students and managers felt that the videos provided excellent information, improved exercise participation and engaged the children.