A Natural Experiment Comparing the Effectiveness of the "Healthy Eagles" Child Weight Management Intervention in School Versus Community Settings.

Melissa Little,Shirley Serber-Souza,Paul N Aveyard,Maryam Kebbe,Susan A Jebb

doi:10.3390/nu13113912

Abstract

Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme; 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = −0.04, 95% CI = −0.08, −0.01) for participants above a healthy weight, especially in those with severe obesity (M = −0.09, 95% CI = −0.15, −0.03); there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = −0.06, 95% CI = −0.09, −0.02) and from the two most deprived quintiles (M = −0.06, 95% CI = −0.11, −0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting.

Highlights

Introduction iationsIn England, over one in five reception age children and over one in three year six children are above a healthy weight [1]
The school programme had the highest percentage of participants with complete data at 74.3% for participants above a healthy weight and 43.1% for healthy weight participants
This natural experiment aimed to assess the change in body mass index (BMI) z-score of children who attended the Healthy Eagles child weight management programme and to compare these changes in the school versus the community setting

Summary

Introduction

Introduction iationsIn England, over one in five reception age children (aged 4–5) and over one in three year six children (aged 10–11) are above a healthy weight [1]. Excess weight in childhood leads to adverse physical and psychosocial health consequences, often persists into adulthood, and is associated with morbidity and early mortality [2,3]. Exposure to excess weight in childhood is a risk factor for a number of non-communicable chronic diseases in adulthood and represents an additional economic strain on health services [4]. The National Institute for Health and Care Excellence (NICE) recommend familybased lifestyle and behavioural weight management interventions to treat excess weight in children [5]. These are 10–12-week family-based interventions run in a community setting and incorporating nutrition, physical activity and behaviour change counselling.

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Conclusion