School-based Obesity Prevention Program Research Articles

Reflections Regarding the Social Ecological Model to Address Obesity in Southern California Youth

Childhood overweight and obesity has been a significant public health concern in the United States for decades. School-based obesity prevention programs have been one strategy to address this issue. This article describes the implementation of a knowledge-based, healthy eating intervention delivered to 4th and 5th graders in a southern California school district. Trained graduate students implemented a nutrition education curriculum, consisting of three monthly lessons that would eventually be utilized and sustained by the schools’ Physical Education (PE) teachers in the following school year. As such, the intervention drew upon the Social Ecological Model (SEM) to describe how nutrition education could be implemented in a sustainable way to future generations of youth. Students were assessed on their knowledge and dietary behaviors at pre-test and after the final lesson. Students’ overall nutritional knowledge significantly increased from pre-test to post-test; however their self-reported eating behaviors (e.g., low fruit and vegetable consumption, and high consumption of chips, soda, and sweets) largely remained the same. Although the findings of this study were largely non-significant, we conclude that future interventions, which creatively address different levels of the target population’s environment, may have promise if they are sufficiently dosed.

Engaging Caregivers in School-Based Obesity Prevention Initiatives in a Predominantly Latino Immigrant Community: A Qualitative Analysis

ObjectivesTo explore caregiver perceptions of, and barriers and facilitators to, their involvement in school-based obesity prevention programs in underserved Latino immigrant communities. MethodsFocus groups discussions were conducted with caregivers (n = 42) at 7 elementary schools with an academic partnership-based obesity prevention program. Thematic analysis was used to identify key findings in the data. ResultsCaregivers described their role as (1) learners of new and often complex health information using their children as primary messengers and (2) champions within their homes in which healthier choices are assimilated. Barriers to involvement included lack of time, financial pressures, unhealthy family practices, and concern that attempts to engage peers would be perceived as intrusive. Facilitators included assurance that stigmatizing health issues would be addressed with sensitivity. Conclusions and ImplicationsCaregiver involvement in obesity prevention may be fostered by transmitting information through children, addressing cultural barriers, and avoiding potentially stigmatizing approaches to delivering health messages.

Assessing the sustained impact of a school-based obesity prevention program for adolescent boys: the ATLAS cluster randomized controlled trial.

BackgroundObesity prevention interventions targeting ‘at-risk’ adolescents are urgently needed. The aim of this study is to evaluate the sustained impact of the ‘Active Teen Leaders Avoiding Screen-time’ (ATLAS) obesity prevention program.MethodsCluster RCT in 14 secondary schools in low-income communities of New South Wales, Australia. Participants were 361 adolescent boys (aged 12–14 years) ‘at risk’ of obesity. The intervention was based on Self-Determination Theory and Social Cognitive Theory and involved: professional development, fitness equipment for schools, teacher-delivered physical activity sessions, lunch-time activity sessions, researcher-led seminars, a smartphone application, and parental strategies. Assessments for the primary (body mass index [BMI], waist circumference) and secondary outcomes were conducted at baseline, 8- (post-intervention) and 18-months (follow-up). Analyses followed the intention-to-treat principle using linear mixed models.ResultsAfter 18-months, there were no intervention effects for BMI or waist circumference. Sustained effects were found for screen-time, resistance training skill competency, and motivational regulations for school sport.ConclusionsThere were no clinically meaningful intervention effects for the adiposity outcomes. However, the intervention resulted in sustained effects for secondary outcomes. Interventions that more intensively target the home environment, as well as other socio-ecological determinants of obesity may be needed to prevent unhealthy weight gain in adolescents from low-income communities.Trial registrationAustralian Clinical Trial Registry ACTRN12612000978864.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0420-8) contains supplementary material, which is available to authorized users.

Unidirectional or Bidirectional Relationships of Behaviors: The Importance of Positive Behavioral Momentum.

Theoretically based behavioral interventions provide the most evidence for successful change; however, several issues should be considered when applying these interventions. For example, school-based obesity prevention programs can be used to teach children how to adopt healthy lifestyle behaviors from an early age. Ecological systems theory provides a framework to design, implement, and evaluate school-based obesity prevention programs. An ecological framework emphasizes that the characteristics within and between systems place children at risk for obesity. Although this developmental process is considered to occur continuously and simultaneously, in practice, we tend to consider the relationships to be unidirectional. Using a positive behavioral momentum approach in practice may assist in addressing these complexities.

School-based Obesity Prevention Programs in Adolescents: A Systematic Review of the Literature

School-based Obesity Prevention Programs in Adolescents: A Systematic Review of the Literature

Strategy for obesity prevention among school-age children (literature review)

Obesity is one of major threats to people health and life. It increases risk of many diseases, including type 2 diabetes, heart disease, arthritis, and several cancers. This is a serious problem for the Russian Federation. Half of adults in our country are considered to be overweight or obese. However, to assess objectively the prevalence of this pathology in children is very difficult. At present in Russia there is no single universally accepted system for child anthropometry. Several studies in Russian regions found that about 10% of children were overweight and obese. Main risk factors of obesity in intrauterine and perinatal periods: mother smoking during pregnancy, child accelerated weight gain during the first months of life, formula feeding and early complementary feeding. In older children main risk factors are high-calorie foods, lack of exercise and sedative behaviour. International expert community has defined preventive strategies that will support elimination of child obesity. These strategies include implementation of child development assessment system with body mass index measurement in accordance with the World Health Organization guidelines; training primary pediatricians on using this assessment system and effective obesity prevention counseling; and school-based obesity prevention programs. Physicians and teachers must understand how important obesity prevention for child health. Health and education stakeholders should actively support these preventive measures and ensure universal access to physical exercises and healthy diet in schools. Alfa-Endo Program will assist all these initiatives.

Implemented or not implemented? Process evaluation of the school-based obesity prevention program DOiT and associations with program effectiveness.

This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators: recruitment, reach, dosage, fidelity, satisfaction, effectiveness and continuation. Data collection involved teacher questionnaires (n= 110), adolescent questionnaires and adiposity measures (n= 938). Using multi-level confirmatory factor analyses, we applied an innovative method to obtain explorative implementation index scores. The percentage of accomplished activities ranged from 9% (for 'closure meeting') up to 93% (for 'obtaining support within the school for adoption'). The percentage of lessons delivered decreased from 74 to 18% towards the end of the program. Fidelity to the teacher manual ranged from 85 to 26%. In general, teachers were satisfied with the DOiT lessons and teaching materials. Despite teachers' satisfaction with the DOiT lessons and teaching materials, degree of program implementation was lower than expected, especially towards the end of the program. Further, some evidence was found for an association between a higher implementation index score and program effectiveness, but more research is needed to test the validity of the implementation index.

Barriers and facilitators to the nationwide dissemination of the Dutch school-based obesity prevention programme DOiT.

This article describes the barriers and facilitating factors to the adoption, implementation and continuation of the Dutch Obesity Intervention in Teenagers (DOiT) programme in the Netherlands. We evaluated the adoption, implementation and continuation of the programme at 20 voluntary prevocational schools, which adopted the programme. Interviews were conducted with DOiT coordinators and/or teachers (n = 44) at the end of the first and second school year of the 2-year implementation period. Interviews were recorded and transcribed verbatim. Data were coded by two researchers independently. Identified barriers and facilitating factors were categorized into four groups: (i) organizational factors, (ii) individual factors, (iii) characteristics of the programme and (iv) characteristics of the implementation strategy. Teachers and DOiT coordinators identified various implementation barriers (e.g. lack of planning, other urgent unforeseen priorities, no plan to cope with teacher turnover and high teacher workload) as well as facilitating factors (e.g. involvement of DOiT coordinator and support from the DOiT office, sufficient communication and collaboration between teachers, strong teacher motivation and flexibility of the programme). Overall, DOiT implementers were satisfied with the compatibility, layout, content and potential for tailoring the programme. Barriers for successful implementation were mainly at the school and teacher level. Findings of this study can be used for further improvement of the DOiT programme and for the development and improvement of other health promotion programmes in the school setting.

Preventing obesity among Brazilian adolescent girls: Six-month outcomes of the Healthy Habits, Healthy Girls–Brazil school-based randomized controlled trial

BackgroundSchool-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary. In Brazil, addressing adolescent obesity is a public health priority. ObjectiveTo evaluate the impact of a group randomized controlled trial involving a 6-month multicomponent school-based obesity prevention program targeting adolescent girls. MethodsThe Healthy Habits, Healthy Girls–Brazil program recruited participants (n=253; 16.05±0.05 years) from ten eligible public technical schools in São Paulo, Brazil. The program was adapted from an Australian intervention study, which is based on the Social Cognitive Theory. The primary outcome measure was body mass index (BMI), and secondary outcomes included BMI z score, waist circumference, and various sedentary and dietary health-related behaviours. ResultsAlthough changes in BMI were not statistically significant, differences favored the intervention group (adjusted mean difference, −0.26kg/m2,se SE=0.018, p=0.076). Statistically significant intervention effects were found for waist circumference (−2.28cm; p=, p=0.01), computer screen time on the weekends (0.63h/day, p; p=0.02), total sedentary activities on the weekends (−0.92h/day, p<0.01), and vegetable intake (1.16servings/day, p=0.01). ConclusionThese findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities.

Dietary intake and meal frequency of Brazilian girls attending a school-based randomized controlled trial

Purpose – This paper aims to evaluate the effects of a school-based obesity prevention program targeting Brazilian adolescent girls on dietary intake and meal frequency. Design/methodology/approach – It was a six-month school-based group randomized controlled trial with female adolescents. The intervention was based on the Social Cognitive Theory and focused on ten nutrition and physical activity key messages. Diet intake was measured using a validated food frequency questionnaire, and the food items were aggregate into the eight food groups of the Brazilian Food Guide Pyramid. The meals frequency assessed were breakfast, lunch, dinner and snack-in-between-meals, the frequency ranged from never to everyday. Linear mixed models were used to examine the dietary effects and chi-squared test to identify proportional differences among groups in meal frequency. All analyses followed intention-to-treat principles and alpha levels of p ≤ 0.05 were set. Findings – After six months from baseline, changes in the fruits (mean [SE] 12.48 kcal [7.86], p = 0.005), vegetables (8.80 kcal [7.11], p = 0.006) and sugar (−55.98 kcal [50.70], p = 0.036) groups were demonstrated. Proportional difference was shown for snack-in-between-meals (p = 0.001), and the frequency most cited was for “five to six days” per week. Originality/value – The “Healthy Habits, Healthy Girls-Brazil” showed promise in the adolescents’ dietary intake and could be used as framework for future interventions. Also, the methods used for dietary intake can be enhanced and implemented for future studies.

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.

Perceptions and attitudes towards food choice in adolescents in Gaborone, Botswana

The purpose of this qualitative study was to describe the factors that influence adolescent and adult perceptions and attitudes related to adolescent diet in Botswana. A series of 15 focus groups [12 adolescent focus groups (6 male and 6 female) & 3 parent focus groups] of approximately six to eleven members each were conducted in Gaborone, the capital city of Botswana in 2009–2010. Adolescents and parents of adolescents suggest that the main drivers of adolescent food choices have much to do with where the adolescent is in terms of time of day as well as with whom the adolescent is with. Outside of the home adolescents suggest that the real or perceived influence of companions place social standing on the ability to purchase and consume non-traditional foods, and that traditional foods leave adolescents open to ridicule. Additionally parents of adolescents suggest that while they prefer for their children to consume healthy foods, they frequently purchase unhealthy food items for their children based on the child's taste preferences as well as social influence to prove you can buy “nice things” for one's family. Adolescents and parents of adolescents suggest that increasing the availability and decreasing the costs of healthy food options are preferred possible interventions to increase healthful eating among adolescents. However, the adolescents also suggest that these healthy food options should not crowd out or completely replace unhealthy options, thus preserving the adolescents' freedom to choose. This could pose a major challenge in any school-based adolescent obesity prevention program.

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 national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China.

BackgroundThe prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited rigid data regarding children and adolescent overweight prevention in China are available. A national random controlled school-based obesity intervention program was developed in the mainland of China.Methods/DesignThe study was designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 children and adolescents aged 7–18 years from 7 provinces in China. In each center, about 12–16 primary and secondary schools, with totally at least 10000 participants were randomly selected (Primary: Secondary = 1:1). All of the selected schools were randomly allocated to either intervention or control group (Intervention: Control = 1:1).The multi-components school-based and family-involved scheme was conducted within the intervention group for 9 month, while students in the control group followed their usual health practice. The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.DiscussionThis is the first and largest multi-centered school-based obesity intervention program with the consideration of geographical and social-demographic characteristics of the rapidly increased obesity prevalence of Chinese children and adolescent. The intervention is based on Social Cognitive Theory and Social-Ecological Model of Health, and follows a stepwise approach guided by PRECEDE-PROCEED (P-P) Model and Intervention Map. The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China.Trial registrationJanuary 22, 2015; Registration number: NCT02343588

We can do that! Collaborative assessment of school environments to promote healthy adolescent nutrition and physical activity behaviors.

Evidence for effectiveness of school-based studies for prevention of adolescent obesity is equivocal. Tailoring interventions to specific settings is considered necessary for effectiveness and sustainability. The PRECEDE framework provides a formative research approach for comprehensive understanding of school environments and identification of key issues/areas to focus resources and energies. No reported studies have tested applicability of the PRECEDE framework in schools in relation to obesity. Adolescents (n = 362), parents (n = 349) and teachers (n = 146) from six secondary schools participated in two quantitative studies and two qualitative studies. Data collected from these studies permitted confirmation of adolescent overweight/obesity a health issue for schools; the need for secondary schools to focus health promotion efforts on healthy nutrition, with inclusion of parents/homes and appreciation for gender differences in developing interventions. Community buy-in and commitment to school-based obesity prevention programs may be dependent on initially addressing what may be perceived as minor issues, and developing policies to guide practices within schools in relation to supply and access to healthy foods, use of sporting equipment and participation in physical activities. The PRECEDE framework allows systematic assessment of school environments and provided opportunity to identify realistic and relevant interventions for promoting healthy adolescent physical activity and nutrition behaviors.

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.

A comprehensive review of school-based body mass index screening programs and their implications for school health: do the controversies accurately reflect the research?

Whereas legislation for body mass index (BMI) surveillance and screening programs has passed in 25 states, the programs are often subject to ethical debates about confidentiality and privacy, school-to-parent communication, and safety and self-esteem issues for students. Despite this debate, no comprehensive analysis has been completed that compares and contrasts how these issues differentially affect schools, parents, and students. A keyword search from electronic databases and a review of state legislation related to BMI surveillance and screening were used to identify relevant literature and data focused on surveillance and screening policies, BMI report cards, and parental perceptions of BMI screenings and their child's weight status [corrected]. This article addresses the gap of previous literature by outlining the ethical considerations and implications that BMI screening programs and report cards have for schools, parents, and students, and links these with outcome studies to address whether these controversies are supported by research. Despite the controversies surrounding these programs, this review shows that they can be valuable for all parties and demonstrates BMI screening programs to be vital to the development of robust school-based obesity prevention programs and promotion of healthy lifestyles in schools.

School meal programs and their potential to operate as school-based obesity prevention and nutrition interventions: case studies from France and Japan

Case studies of government-funded school meal programs in France and Japan are presented as potential school-based child obesity prevention and nutrition intervention programs. It is argued that this type of intervention takes a wider systems-level approach to obesity prevention by addressing the multiple dimensions of child obesity including: socioeconomic status and household food insecurity, and the need for experiential education about healthy eating and nutrition. These programs provide models of financially accessible school meal provision for all children without the social stigma that is sometimes associated with subsidized meal programs. We argue that these school meal programs are potential models for long-term and sustainable child nutrition interventions.

Evaluation of a Coordinated School-Based Obesity Prevention Program in a Hispanic Community: Choosing Healthy and Active Lifestyles for Kids/Healthy Schools Healthy Families

Background: Obesity is a public health concern that disproportionately affects underserved and minority communities. Purpose: To evaluate whether a comprehensive obesity prevention program that targets children and school staff in an underserved Hispanic community affects obesity related knowledge, attitudes, and behaviors among both students and staff. Methods: Using a longitudinal design over 2 years we administered surveys to fourth-grade students (N = 184) and school staff (N = 99) from 7 elementary schools involved in a comprehensive obesity prevention program. In year 2, a control group of students and staff from a neighboring school completed the same surveys for comparison. Results: Over 2 years, students and school staff participating in the program reported improved nutrition knowledge and behavior, and school staff reported improved self-efficacy for physical activity and a trend toward increased physical activity. In year 2 student nutrition behaviors improved preferentially for intervention versus control students. Discussion: Comprehensive programs that target students and school staff may be useful in underserved communities to improve certain knowledge, attitudes, and behaviors related to nutrition and physical activity. Translation to Health Education Practice: Working in concert with public health policy changes, these programs may help to address the disparity in the obesity rate.

An ecological and theoretical deconstruction of a school-based obesity prevention program in Mexico.

BackgroundEcological intervention programs are recommended to prevent overweight and obesity in children. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children. This study assessed the integration of ecological principles and Social Cognitive Theory (SCT) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City.MethodsTwo coders applied the Intervention Analysis Procedure (IAP) to “map” the program’s integration of ecological principles. A checklist gauged the use of SCT theory in program activities.ResultsThirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains.ConclusionsFindings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity.