School-based Childhood Obesity Prevention Research Articles

Effect of a community-based childhood obesity intervention program on changes in anthropometric variables, incidence of obesity, and lifestyle choices in Spanish children aged 8 to 10years.

The TCHP did not improve weight development, diet quality, and physical activity in the short term. What is Known: • There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs. • There is little evidence on the efficacy of childhood obesity intervention programs in other settings. What is New: • This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization. • This CBI had no effect on the prevention and treatment of childhood obesity in the short term.

Maternal concerns and perceptions of elementary school-age children's weight status.

The purpose of this study was to identify characteristics associated with maternal concerns for her child becoming overweight, and how these concerns are related to her perceptions of her child's weight. A school-based sample of 55 children and their mothers from Houston, Texas, participated in a cross-sectional survey. Mothers reported on their concerns and perceptions regarding their child's weight. Child and mother height and weight were directly assessed to calculate body mass index (BMI). Covariate-adjusted logistic regression models were conducted. Over one-third of mothers misperceived their child's weight status [9% (n=5) overestimated; 27% (n=15) underestimated]. Mothers of sons were less accurate compared with mothers of daughters. For every one unit increase in maternal BMI, mothers had 13% higher odds of being concerned of their child becoming overweight. Concerned mothers had 82% lower odds of underestimating their child's weight. In order for school-based childhood obesity prevention and intervention programs to be successful, parents must accurately perceive their elementary school-age child's weight status. School nurses can be vital to these efforts through proper training and resources. Nurses can use the "School Nurse Childhood Obesity Toolkit" and motivational interviewing techniques to address parental concerns and perceptions prior to teaching behavior modification strategies to children/families.

Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation.

Childhood obesity is a complex, worldwide problem. Significant resources are invested in its prevention, and high-quality evaluations of these efforts are important. Conducting trials in school settings is complicated, making process evaluations useful for explaining results. Intervention fidelity has been demonstrated to influence outcomes, but others have suggested that other aspects of implementation, including participant responsiveness, should be examined more systematically. During Food, Health & Choices (FHC), a school-based childhood obesity prevention trial designed to test a curriculum and wellness policy taught by trained FHC instructors to fifth grade students in 20 schools during 2012-2013, we assessed relationships among facilitator behaviors (i.e., fidelity and teacher interest); participant behaviors (i.e., student satisfaction and recall); and program outcomes (i.e., energy balance-related behaviors) using hierarchical linear models, controlling for student, class, and school characteristics. We found positive relationships between student satisfaction and recall and program outcomes, but not fidelity and program outcomes. We also found relationships between teacher interest and fidelity when teachers participated in implementation. Finally, we found a significant interaction between fidelity and satisfaction on behavioral outcomes. These findings suggest that individual students in the same class responded differently to the same intervention. They also suggest the importance of teacher buy-in for successful intervention implementation. Future studies should examine how facilitator and participant behaviors together are related to both outcomes and implementation. Assessing multiple aspects of implementation using models that account for contextual influences on behavioral outcomes is an important step forward for prevention intervention process evaluations.

The Impact of Family Rules on Children's Eating Habits, Sedentary Behaviors, and Weight Status.

Family rules may be influential in helping children to modify their dietary and sedentary behaviors, which are important modifiable risk factors for childhood obesity. However, data examining family rules in relation to children's health behaviors and weight status are limited. This cross-sectional study examined differences in family rules by demographic characteristics of students enrolled in the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) Initiative, a school-based childhood obesity prevention program. It also investigated the relationship between eating and screen time family rules and six eating and screen time behaviors: fast food consumption; soft drink consumption; fruit and vegetable intake; television viewing; computer use; and video game use, in addition to the association between family rules and children's weight status. Measures included self-reported behavioral data and anthropometric data from students in fourth to eighth grade at 16 schools (N=2819) in a tri-state area of the United States in spring 2012. Approximately one-third of students had each of the family rules examined. Whereas the profile of students who had specific rules varied, in general, younger, female, white, and low socioeconomic status students were more likely to have rules than their counterparts. Family rules were associated with healthier outcomes for each of the six behaviors examined (p<0.001), even after controlling for demographics (p<0.001). However, family rules were not associated with children's weight status. This study demonstrates that family rules are an underutilized strategy to promote healthier eating habits and reduce children's screen time hours and may serve as an intermediary mechanism to curb childhood obesity.

Nurse-Led School-Based Child Obesity Prevention.

School-based childhood obesity prevention programs have grown in response to reductions in child physical activity (PA), increased sedentariness, poor diet, and soaring child obesity rates. Multiple systematic reviews indicate school-based obesity prevention/treatment interventions are effective, yet few studies have examined the school nurse role in obesity interventions. Building on a previous study, this study examines a refined health messaging (Let's Go 5-2-1-0) program delivered to fourth and fifth graders (n = 72) by a school nurse with reinforcement on-site health coaching by senior nursing students. Two nursing schools and two elementary schools participated. Measures of PA, body mass index percentile, and self-reported health habits were collected at baseline (School A, September 2009 and School B, January 2010) and end of year (April 2010 for both schools). Findings included statistically significant increases in PA levels and improvements in child-reported health habits. School nurses can influence obesity prevention. Further research on adoption of school nurse-led obesity interventions is warranted.

A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity

Childhood obesity is a global concern. The objectives of this meta-analytical study were to evaluate the effectiveness of school-based childhood obesity prevention programs, and to examine program components (moderators). The methods included searching databases (PubMed, Google Scholar, and the university's EBSCOhost Web service) as well as handsearching reference lists of articles published in English. Selection criteria for studies to be included in the meta-analysis were limited to studies that reported body mass index (BMI) or skinfold thickness as outcome measures and were school-based obesity prevention interventions; cross-sectional design studies were excluded. We hypothesized the meta-analysis would yield a summary effect size of magnitude which would indicate that school-based interventions have been effective in improving children's BMI or skinfold thickness values. A total of 26 114 children from 27 school-based childhood obesity prevention programs provided 54 effect sizes. A random-effects model calculated a small summary effect size of 0.039 (95% confidence interval −0.013 to 0.092). Heterogeneity among studies was observed which disappeared after pooling studies that used a randomized controlled trial design with one program moderator (physical activity or nutrition). We failed to accept our hypothesis and concluded that overall, school-based interventions have not been effective for improving body mass index or skinfold thickness to curb childhood obesity; however, randomized controlled trials that focused on physical activity or nutrition appeared to produce promising results.

Predictors for moderate- and vigorous-intensity physical activity during an 18-month coordinated school health intervention

ObjectiveTo evaluate if the HEROES Initiative, a school-based childhood obesity prevention program based on the U. S. Centers for Disease Control and Prevention (CDC)'s coordinated school health approach was able to effectively increase physical activity among elementary and middle school students who were exposed to the program for 18months and to determine student and school-level predictors of success. MethodStudents who participated in physiological data collection were invited to participate in a survey at baseline, 6months, and 18months (N=1091, 8 schools). The dropout rate at 18months was 39.1% when graduates were counted. Data was analyzed using generalized estimating equations. ResultsA significant increase (p=.0067) was observed in vigorous-intensity physical activity (VPA) but a non-significant increase (p=.1753) was observed in moderate-intensity physical activity (MPA). Each school's implementation fidelity score was also only associated with VPA increases. Students' screen time and vegetable/fruit intake were independently associated with both VPA and MPA increases. Body mass index of students was not predictive of VPA or MPA changes. ConclusionAn 18-month school-based intervention that employs the CDC's coordinated school health approach appears to be effective in increasing physical activity among elementary and middle school children.

A school-based comprehensive lifestyle intervention among chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China.

BackgroundThe prevalence of childhood obesity among adolescents has been rapidly rising in Mainland China in recent decades, especially in urban and rich areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited data regarding adolescent overweight prevention in China are available. Thus, we developed a school-based intervention with the aim of reducing excess body weight in children. This report described the study design.Methods/designWe designed a cluster randomized controlled trial in 8 randomly selected urban primary schools between May 2010 and December 2013. Each school was randomly assigned to either the intervention or control group (four schools in each group). Participants were the 4th graders in each participating school. The multi-component program was implemented within the intervention group, while students in the control group followed their usual health and physical education curriculum with no additional intervention program. The intervention consisted of four components: a) classroom curriculum, (including physical education and healthy diet education), b) school environment support, c) family involvement, and d) fun programs/events. The primary study outcome was body composition, and secondary outcomes were behaviour and behavioural determinants.DiscussionThe intervention was designed with due consideration of Chinese cultural and familial tradition, social convention, and current primary education and exam system in Mainland China. We did our best to gain good support from educational authorities, school administrators, teachers and parents, and to integrate intervention components into schools’ regular academic programs. The results of and lesson learned from this study will help guide future school-based childhood obesity prevention programs in Mainland China.Trial registrationRegistration number: ChiCTR-ERC-11001819

A Meta-Analysis of School-Based Childhood Obesity Prevention Programs

A Meta-Analysis of School-Based Childhood Obesity Prevention Programs

Psychometric Characteristics of Process Evaluation Measures for a Rural School-Based Childhood Obesity Prevention Study: Louisiana Health

To evaluate the implementation of intervention components of the Louisiana Health study, which was a multicomponent childhood obesity prevention program conducted in rural schools. Content analysis. Process evaluation assessed implementation in classrooms, gym classes, and cafeterias. Classroom teachers (n = 232), physical education teachers (n = 53), food service managers (n = 33), and trained observers (n = 9). Five process evaluation measures were created: Physical Education Questionnaire (PEQ), Intervention Questionnaire (IQ), Food Service Manager Questionnaire (FSMQ), Classroom Observation (CO), and School Nutrition Environment Observation (SNEO). Interrater reliability and internal consistency were assessed on all measures. Analysis of variance and χ(2) were used to compare differences across study groups on questionnaires and observations. The PEQ and one subscale from the FSMQ were eliminated because their reliability coefficients fell below acceptable standards. The subscale internal consistencies for the IQ, FSMQ, CO, and SNEO (all Cronbach α > .60) were acceptable. After the initial 4 months of intervention, there was evidence that the Louisiana Health intervention was being implemented as it was designed. In summary, four process evaluation measures were found to be sufficiently reliable and valid for assessing the delivery of various aspects of a school-based obesity prevention program. These process measures could be modified to evaluate the delivery of other similar school-based interventions.

Dietary Education in School-Based Childhood Obesity Prevention Programs

The purpose of this article was to review school based interventions designed to prevent childhood and adolescent obesity that focused on modifying dietary behavior and were published between 2000 and May 2009. A total of 25 interventions met the criteria. The grade range of these interventions was from K to 12; 13 studies exclusively targeted elementary school, 2 targeted both elementary and middle school, 9 exclusively targeted middle school, and 1 targeted high school. The majority of the interventions focused on both dietary and physical activity behaviors, whereas 8 interventions focused exclusively on dietary behaviors. Approximately one-half of the interventions were based on a behavioral theory. In terms of duration, 13 were longer than 6 mo, 4 were less than 1 mo, and 8 had a duration between 1 and 6 mo. The majority of the interventions were implemented by teachers. In terms of activities, almost all interventions had a curricular component except 2 that distributed free fruit or vegetables. Besides curricular instructions, parental and family involvement was also utilized by several interventions. Environmental and policy changes were used in 7 interventions. For evaluation, the 2 most popular designs were experimental design with random assignment at group level and quasi experimental design, both of which were used by 9 interventions each. In terms of impact on adiposity indices, only 14 interventions measured it and only 6 of those were able to demonstrate significant changes. Recommendations for enhancing the effectiveness of school based dietary education interventions for childhood obesity prevention are presented.

No Change in Weight-Based Teasing When School-Based Obesity Policies Are Implemented

To examine rates of weight-based teasing before initiation of school-based childhood obesity prevention policies (Arkansas Act 1220 of 2003) and during the 2 years following policy implementation, as well as demographic factors related to weight-based teasing. Analysis of consecutive random cross-sectional statewide telephone surveys conducted annually across 3 years. Sample representative of Arkansas public school students with stratification by geographic region, school level (elementary, middle, and high school), and school size (small, medium, and large). Parents of children enrolled in Arkansas public schools and index adolescents 14 years or older. Intervention Statewide school-based obesity policies, including body mass index screening. Survey items about weight-based teasing, other teasing, body weight and height, and sociodemographic factors, as well as school characteristics obtained from the Common Core of Data of the National Center for Education Statistics. At baseline, 14% of children experienced weight-based teasing by parental report. The prevalence of weight-based teasing did not change significantly from baseline in the 2 years following school-based policy changes. Children and adolescents most likely to be teased because of weight were those who were overweight, obese, white, female, and 14 years or older, as well as those teased for other reasons. Adolescent report of weight-based teasing yielded similar patterns. Although the effectiveness of school-based obesity prevention policies remains unclear, policy changes did not lead to increased weight-based teasing among children and adolescents.

Integrative Review of School-based Childhood Obesity Prevention Programs

Childhood and adolescent overweight and obesity in the United States are rapidly becoming a major pediatric health concern. Schools are a critical part of the social environment that shape children's eating and physical activity patterns. While school-based programs may affect a student's perception of physical activity and the influence of dietary practices on overall health, the current variability in the theoretical underpinnings and methodological approaches used to implement these programs makes them difficult to evaluate for quality and evidence of effectiveness of the outcomes achieved across programs. The purpose of this study is to conduct an integrative research review using Cooper's framework to provide an overview of the degree of variability in the methodological approaches and theoretical frameworks of school-based obesity prevention programs that utilize one or more of the following interventions: dietary, physical activity, healthy lifestyle education, and/or parental involvement. This review will examine the variations in the duration of the interventions; whether the interventions were guided by the use of a theoretical framework; the strength of evidence supporting the studies; and whether the interventions demonstrated a reduction in body mass index or weight loss. A total of 16 articles were found based on the inclusion criteria for this study. Eight of the 16 studies (50%) applied theoretical frameworks. Significant variability was found in the duration of intervention between the studies analyzed. The range of duration was 5 weeks to 8 years, with an average of 16.8 months. Fourteen of 16 studies (88%) implemented dietary habit interventions. Fourteen of 16 studies (88%) implemented physical education programs. All 16 studies applied healthy lifestyle education. Nine of 16 studies integrated family involvement into the obesity intervention. Nine of 16 studies (56%) evaluated the effect of their intervention on body mass index.