Abstract
BackgroundObesity in early childhood is a robust predictor of obesity later in life. Schools provide unparalleled access to children and have subsequently become major intervention sites. However, empirical evidence supporting the effectiveness of school-based interventions against childhood obesity is of limited scope and unknown quality. The aim of this systematic review is to critically assess how researchers have characterized the school environment in determining its effect on childhood weight status in order to improve the quality and consistency of research in this area. We conducted a narrative review with a systematic search of the literature in line with PRISMA guidelines (2009). Original peer-reviewed research articles in English were searched from Medline, EMBASE, CENTRAL, CINAHL and PsycINFO databases from earliest record to January 2014. We included empirical research that reported at least one measure of the primary/elementary school environment and its relationship with at least one objective adiposity-related variable for students aged 4–12 years. Two authors independently extracted data on study design, school-level factors, student weight status, type of analysis and effect.ResultsFive studies met the inclusion criteria. Each study targeted different parts of the school environment and findings across the studies were not comparable. The instruments used to collect school-level data report no validity or reliability testing.ConclusionsOur review shows that researchers have used instruments of unknown quality to test if the school environment is a determinant of childhood obesity, which raises broader questions about the impact that schools can play in obesity prevention.
Highlights
Obesity in early childhood is a robust predictor of obesity later in life
Quality assessment This review was not restricted to any particular study design and as such we considered the Newcastle-Ottawa Scale (NOS) most suitable for assessing the quality of each article included in our review, as NOS provides a quality assessment for multiple designs
Sixty-five articles were excluded in our narrative synthesis despite having the data required to analyze the effect of school-level factors on student weight status
Summary
Schools provide unparalleled access to children and have subsequently become major intervention sites. Empirical evidence supporting the effectiveness of school-based interventions against childhood obesity is of limited scope and unknown quality. The aim of this systematic review is to critically assess how researchers have characterized the school environment in determining its effect on childhood weight status in order to improve the quality and consistency of research in this area. Governments have focused prevention efforts on improved dietary and activity choices. These programmes target children and adolescents, as obesity in youth is a robust predictor of adult obesity [5]. Empirical evidence supporting the effectiveness of school-based interventions against childhood obesity is limited and of unknown quality
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