Abstract
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.
Highlights
Overweight and obesity in children and adolescents is an escalating global public health problem.More than 60 million children around the world are identified as obese with the highest prevalence in North America and the Middle East [1]
Public and private primary schools were conveniently sampled. Both private and public schools were chosen to ensure the inclusion of a diverse group of students with various socioeconomic statuses (SES), since middle- to high-income families in Lebanon tend to enroll their children in private schools with high annual tuition fees, whereas lower income families tend to send their children to public schools for a nominal fee
Private schools were directly approached by the research team to participate in the study whereas public schools were recruited by the Lebanese Ministry of Education and Higher Education (MEHE)
Summary
Overweight and obesity in children and adolescents is an escalating global public health problem. More than 60 million children around the world are identified as obese with the highest prevalence in North America and the Middle East [1]. Obesity rates increased from less than 1% in 1975 to nearly. The number of obese five- to 19-year-olds rose more than. 10-fold globally, from 11 million in 1975 to 124 million in 2016 [2]. Childhood obesity rates continue to rise in some countries, such as Mexico, India, China and Canada, while it is slowly plateauing in other countries including United States (U.S.) and United Kingdom (UK) [2]. In Lebanon, a small country in the Middle East, trends of obesity from two national cross-sectional surveys conducted in 1997 and
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