Systematic review and meta-analysis of school-based obesity interventions in mainland China.

Lin Feng,Yang Gao,Cliona Ni Mhurchu,Dong-Mei Wei,Yannan Jiang,Ralph Maddison,Shen-Ting Lin,Hai-Jun Wang,Harry Zhang

doi:10.1371/journal.pone.0184704

Abstract

BackgroundNumerous school-based interventions for childhood obesity have been emerging in mainland China in recent decades, but little is known about the effectiveness of such interventions. This study aims to assess the effectiveness of school-based interventions for childhood obesity conducted in mainland China.MethodsA systematic search was undertaken in eight databases to identify both randomized and non-randomized controlled trials from January 1990 to December 2015 examining the effectiveness of school-based obesity interventions. A random effects meta-analysis was conducted assessing the impact of included interventions on (body mass index) BMI. The quality of each included studies were assessed using Effective Public Health Practice Project Quality Assessment Tool. A P value <0.05 (two-sided) was considered statistically significant.ResultOf the seventy-six included studies, we found physical activity and health education were the two most common components of interventions. More treatment studies were effective compared with prevention studies (85.0% vs. 58.3%). Comprehensive interventions involving physical activity and health education appeared more effective than the physical activity only interventions in both obesity treatment and prevention studies. The meta-analyses showed comprehensive interventions involving physical activity and health education had larger effect on the change of BMI than physical activity only interventions (treatment studies: -1.80 kg/m2 (95% CI: -2.15,-1.44) vs. -0.91 kg/m2 (95% CI: -1.15,-0.67); prevention studies: -0.19 kg/m2 (95% CI: -0.27, -0.11) vs. +0.05 kg/m2 (95% CI: -0.04, +0.15)).ConclusionsComprehensive school-based interventions may assist in tackling the rising prevalence of childhood obesity in mainland China.

Highlights

Childhood obesity is a major threat to public health
A systematic search was undertaken in eight databases to identify both randomized and non-randomized controlled trials from January 1990 to December 2015 examining the effectiveness of school-based obesity interventions
Inclusion criteria were: (1) randomized or non-randomized controlled trials (RCTs or nonRCTs); (2) interventions based on primary and secondary schools in mainland China; (3) outcomes assessed by anthropometric measures including body mass index (BMI), prevalence of overweight and obesity, waist or hip circumference, skin fold thickness, body fat percentage (BFP), percentage of over standard weight-for-height (i.e. / standard weight-for-height × 100%, commonly used in Chinese studies); (4) the duration of interventions were at least 3 months; (5) full-text is available

Summary

Introduction

Childhood obesity is a major threat to public health. Worldwide, the prevalence of childhood obesity has increased significantly over recent decades. The prevalence of overweight and obesity increased from 16.9% in 1980 to 23.8% in 2013 for boys and 16.2% in 1980 to 22.6% in 2013 for girls in high-income countries. In low- and middle-income countries, the overweight and obesity prevalence increased from 8.1% in 1980 to 12.9% in 2013 for boys and 8.4% in 1980 to 13.4% in 2013 for girls [1]. Results from the Chinese National Survey on Students’ Constitution and Health (CNSSCH), conducted every five years since 1985, revealed that 23.2% of boys and 12.7% of girls in urban areas were overweight or obese in 2010, compared to 1.3% of boys and 1.5% of girls in 1985. Numerous school-based interventions for childhood obesity have been emerging in mainland China in recent decades, but little is known about the effectiveness of such interventions.

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