A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China.

Yajun Chen,Xin Zhang,Dehong Pan,Zhiyong Zou,Chunyan Luo,Yinghua Ma,Jun Ma,Yanna Zhu,Wenhan Yang,Lu Ma,Jiayou Luo,Haiping Zhao,Hong Wang,Haijun Wang,Li Cai,Jin Jing

doi:10.1186/s12889-015-1516-9

Abstract

BackgroundThe prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited rigid data regarding children and adolescent overweight prevention in China are available. A national random controlled school-based obesity intervention program was developed in the mainland of China.Methods/DesignThe study was designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 children and adolescents aged 7–18 years from 7 provinces in China. In each center, about 12–16 primary and secondary schools, with totally at least 10000 participants were randomly selected (Primary: Secondary = 1:1). All of the selected schools were randomly allocated to either intervention or control group (Intervention: Control = 1:1).The multi-components school-based and family-involved scheme was conducted within the intervention group for 9 month, while students in the control group followed their usual health practice. The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.DiscussionThis is the first and largest multi-centered school-based obesity intervention program with the consideration of geographical and social-demographic characteristics of the rapidly increased obesity prevalence of Chinese children and adolescent. The intervention is based on Social Cognitive Theory and Social-Ecological Model of Health, and follows a stepwise approach guided by PRECEDE-PROCEED (P-P) Model and Intervention Map. The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China.Trial registrationJanuary 22, 2015; Registration number: NCT02343588

Highlights

The prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas
The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China
Design The study is designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 participants from Liaoning, Tianjin, Ningxia, Shanghai, Chongqing, Hunan, and Guangdong to determine the effectiveness of the Health Lifestyles Interventions in preventing Chinese children and adolescent obesity at 9 month

Summary

Discussion

The Health Lifestyles Interventions was a national health promotion program being designed to benefit and educate all students irrespective of their weight status and socio-demographic backgrounds [10] Both major and western cities, urban and rural schools were included in this study. Health Lifestyles Interventions is based on Social Cognitive Theory and Social-Ecological Model of Health, which emphasizes a dynamic interaction among biological, cultural, and environmental factors over the life course of individuals, families, and communities contributing to the health of populations [24] It follow a stepwise approach guided by Precede-Proceed (P-P) Model and Intervention Map (IM), which has been considered to be the best among 10 planning models on usefulness for research and usefulness for practice [25], and initially carries out a systematic review of prospective studies and a secondary data analysis of existing data to identify key behaviors related to obesity in children and adolescent. All authors were involved in the manuscript revision and have approved this final version

Background

Methods/Design

Method

Enzymatic methods

Findings