School-Based Interventions on Childhood Obesity

Abstract Objective Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. Design Eight databases were searched from inception till May 30, 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random-effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2. Setting Cluster randomised trials (cluster-RCTs) delivered in school. Participants Children and adolescents (6-18 years of age) with overweight and obesity. Results Twelve cluster-RCTs from seven countries with 1,755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced body mass index (BMI) and BMI z-scores with a medium effect (g=0·52). Subgroup analyses showed the greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41.2% of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency. Conclusions School-based interventions is a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCTs with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).

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Abstract 17944: Effects of School-Based Interventions on Body Mass Index in Children and Adolescents: a Systematic Overview and Meta-analysis

Circulation ◽

10.1161/circ.130.suppl_2.17944 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jiyoon J Park ◽

Randa Bakhet ◽

Danica Karl ◽

Fei Yuan ◽

Eva Lonn

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Childhood Obesity ◽

Body Mass ◽

Meta Analysis ◽

Control Groups ◽

School Based ◽

School Based Interventions ◽

The Difference ◽

Dietary Modifications

Background: Childhood obesity is a major public health threat. Various school-based interventions (SBIs) to prevent obesity through physical activity and/or dietary modifications were implemented. However, the effectiveness of such SBIs remains unproven. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) of SBIs. Methods: We searched for RCTs of SBIs published since 1990. To be eligible studies had to have an RCT design, to include children aged 6-18 years and SBIs were defined as non-pharmacological and non-surgical interventions carried out in a school setting with a minimum duration of 12 weeks. The primary outcome was change in body mass index (BMI. For each study the difference in the mean change in BMI between the intervention and the control groups was computed. The summary estimate for the difference in mean change in BMI and the 95% confidence interval (CI) was computed using a weighted inverse variance approach and a random- effects model. The I 2 statistic was used to test for heterogeneity. Results: Of 504 studies identified, 41 involving 42 430 participants met the inclusion criteria. SBIs varied greatly between studies by type, duration and delivery. In 10 RCTs the SBI focused on physical activity, in 6 on dietary modifications and in 25 on both physical activity and dietary modifications. SBIs duration ranged from 12 weeks to 4 years. There was no significant difference in mean BMI change between the intervention and the control groups (mean difference = -0.281kg/m 2 ; 95% CI -0.584 to 0.022), although there was significant heterogeneity between the RCTs’ findings (Figure). We found also no consistent impact on other measures of adiposity, physical activity patterns, dietary intakes and psychosocial health and wellbeing. Conclusions: SBIs had no substantial impact on BMI in children aged 6-18 years. Further research is needed to identify effective interventions to prevent childhood obesity.

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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-019-0848-8 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 8

Author(s):

Zheng Liu ◽

Han-Meng Xu ◽

Li-Ming Wen ◽

Yuan-Zhou Peng ◽

Li-Zi Lin ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Childhood Obesity ◽

Obesity Prevention ◽

Single Component ◽

Z Score ◽

Physical Activity Interventions ◽

School Based ◽

Prevention Interventions ◽

School Based Interventions

Abstract Background Childhood obesity is a serious public health concern. School-based interventions hold great promise to combat the rising trend of childhood obesity. This systematic review aimed to assess the overall effects of school-based obesity prevention interventions, and to investigate characteristics of intervention components that are potentially effective for preventing childhood obesity. Methods We systematically searched MEDLINE, CENTRAL and Embase databases to identify randomized- or cluster randomized- controlled trials of school-based obesity interventions published between 1990 and 2019. We conducted meta-analyses and subgroup analyses to determine the overall effects of obesity prevention programs and effect differences by various characteristics of intervention components on body mass index (BMI) or BMI Z-score of children. Results This systematic review included a total of 50 trials (reported by 56 publications). Significant differences were found between groups on BMI (− 0.14 kg/m2 (95% confidence interval: − 0.21, − 0.06)) and BMI Z-score (− 0.05 (− 0.10, − 0.01)) for single-component interventions; significant differences were also found between groups on BMI (− 0.32 (− 0.54, − 0.09) kg/m2) and BMI Z-score (− 0.07 (− 0.14, − 0.001)) for multi-component interventions. Subgroup analyses consistently demonstrated that effects of single-component (physical activity) interventions including curricular sessions (− 0.30 (− 0.51, − 0.10) kg/m2 in BMI) were stronger than those without curricular sessions (− 0.04 (− 0.17, 0.09) kg/m2 in BMI); effects of single-component (physical activity) interventions were also strengthened if physical activity sessions emphasized participants’ enjoyment (− 0.19 (− 0.33, − 0.05) kg/m2 in BMI for those emphasizing participants’ enjoyment; − 0.004 (− 0.10, 0.09) kg/m2 in BMI for those not emphasizing participants’ enjoyment). The current body of evidence did not find specific characteristics of intervention components that were consistently associated with improved efficacy for multi-component interventions (P > 0.05). Conclusions School-based interventions are generally effective in reducing excessive weight gain of children. Our findings contribute to increased understandings of potentially effective intervention characteristics for single-component (physical activity) interventions. The impact of combined components on effectiveness of multi-component interventions should be the topic of further research. More high-quality studies are also needed to confirm findings of this review.

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Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools

Journal of Endocrinological Investigation ◽

10.1007/s40618-014-0153-y ◽

2014 ◽

Vol 37 (12) ◽

pp. 1155-1164 ◽

Cited By ~ 40

Author(s):

A. Verrotti ◽

L. Penta ◽

L. Zenzeri ◽

S. Agostinelli ◽

P. De Feo

Keyword(s):

Systematic Review ◽

Childhood Obesity ◽

Obesity Prevention ◽

Primary Schools ◽

Childhood Obesity Prevention ◽

School Based ◽

School Based Interventions

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Dietary Interventions to Prevent Childhood Obesity: A Literature Review

Nutrients ◽

10.3390/nu13103447 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3447

Author(s):

Ana Rita Pereira ◽

Andreia Oliveira

Keyword(s):

Childhood Obesity ◽

Environmental Changes ◽

The Body ◽

Healthy Foods ◽

Dietary Interventions ◽

Obesity Epidemic ◽

Vending Machines ◽

School Based ◽

Promotion Of Physical Activity ◽

School Based Interventions

Several dietary interventions have been conducted to prevent/reduce childhood obesity, but most of them are known to have failed in tackling the obesity epidemic. This study aimed to review the existing literature on dietary interventions for the prevention of childhood obesity and their effectiveness. A literature search was conducted using PubMed Central®. Only articles published between 2009 and 2021, written in English, conducted in humans, and including children and/or adolescents (<18 years old) were considered. The majority of studies were school-based interventions, with some addressing the whole community, and including some interventions in the food sector (e.g., taxation of high fat/sugar foods, front-of-pack labelling) and through mass media (e.g., restrictions on food advertising for children) that directly or indirectly could help to manage childhood obesity. Most of the programs/interventions conducted focus mainly on person-based educational approaches, such as nutrition/diet education sessions, allied to the promotion of physical activity and lifestyles to students, parents, and school staff, and less on environmental changes to offer healthier food choices. Only a few trials have focused on capacity building and macro-policy changes, such as the adaptation of the built environment of the school, serving smaller portion sizes, and increasing the availability and accessibility of healthy foods and water in schools, and restricting the access to vending machines, for example. Overall, most of the intervention studies showed no consistent effects on changing the body mass index of children; they have only reported small weight reductions, clinically irrelevant, or no effects at all. Little is known about the sustainability of interventions over time.

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Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413395 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13395

Author(s):

Sharea Ijaz ◽

James Nobles ◽

Laura Johnson ◽

Theresa Moore ◽

Jelena Savovic ◽

...

Keyword(s):

Childhood Obesity ◽

Primary Schools ◽

Parental Education ◽

Cochrane Review ◽

Realist Review ◽

Health Concern ◽

Global Public Health ◽

Programme Theory ◽

School Based ◽

School Based Interventions

Childhood obesity is a global public health concern. While evidence from a recent comprehensive Cochrane review indicates school-based interventions can prevent obesity, we still do not know how or for whom these work best. We aimed to identify the contextual and mechanistic factors associated with obesity prevention interventions implementable in primary schools. A realist synthesis following the Realist And Meta-narrative Evidence Syntheses–Evolving Standards (RAMESES) guidance was with eligible studies from the 2019 Cochrane review on interventions in primary schools. The initial programme theory was developed through expert consensus and stakeholder input and refined with data from included studies to produce a final programme theory including all of the context-mechanism-outcome configurations. We included 24 studies (71 documents) in our synthesis. We found that baseline standardised body mass index (BMIz) affects intervention mechanisms variably as a contextual factor. Girls, older children and those with higher parental education consistently benefitted more from school-based interventions. The key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification and the intervention components working together as a whole. Education alone was not associated with favourable outcomes. Future interventions should go beyond education and incorporate a sufficient dose to trigger change in BMIz. Contextual factors deserve consideration when commissioning interventions to avoid widening health inequalities.

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