Obesity prevention - is school an effective place? A systematic review

Abstract Background Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation. Methods The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively. Results 48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition. Conclusions The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses. Funded by DIMDI Key messages School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.

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Clinical trial designs in anaesthesia

10.1093/med/9780199642045.003.0030 ◽

2017 ◽

Author(s):

Simon J. Howell

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Outcome Measures ◽

Control Group ◽

Or Groups ◽

Related Quality ◽

Health Related ◽

Economic Analyses ◽

Surrogate Measures ◽

The Impact

A clinical trial is a research study that assigns people or groups to different interventions and compares the impact of these on health outcomes. This chapter examines the design and delivery of clinical trials in anaesthesia and perioperative medicine covering the issues outlined below. The features of a high-quality clinical trial include well-defined inclusion and exclusion criteria, a control group, randomization, and blinding. Outcome measures may be broadly divided into counting the number of people who experience an outcome and taking measurements on people. The outcome measures selected for a clinical trial reflect the purpose of the study and may include ‘true’ clinical measures such as major postoperative complications or surrogate measures such as the results of a biochemical test. Outcome measures may be combined in a composite outcome. Assessment of health-related quality of life using a tool such as the SF-36 questionnaire is an important aspect of many clinical trials in its own right and also informs the economic analyses that may be embedded in a trial. Determining the number for recruits needed for a clinical trial requires both clinical and statistical insight and judgement. The analysis of a clinical trial requires a similarly sophisticated approach that takes into account the objectives of the study and balances the need for appropriate subgroup analyses with the risk of false-positive results. The safe and effective management of a clinical trial requires rigorous organizational discipline and an understanding of the ethical and regulatory structures that govern clinical research.

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Evaluation of a school-based cognitive–behavioral depression prevention program

Scandinavian Journal of Public Health ◽

10.1177/1403494817746537 ◽

2017 ◽

Vol 47 (2) ◽

pp. 182-189 ◽

Cited By ~ 5

Author(s):

Pernilla Garmy ◽

Eva K. Clausson ◽

Agneta Berg ◽

Katarina Steen Carlsson ◽

Ulf Jakobsson

Keyword(s):

Depressive Symptoms ◽

Outcome Measures ◽

Prevention Program ◽

Intervention Group ◽

Cost Utility ◽

Control Group ◽

Depression Prevention ◽

Self Rated Health ◽

School Based

Aim: The aim of this study was to investigate the feasibility and cost-utility of a school-based cognitive–behavioral (CB) depression prevention program. Methods: A quasi-experimental trial with an intervention group and a control group, with follow-up measurements obtained at three and 12 months after baseline, was conducted. The setting was six Swedish municipalities. The participants were students in grade 8 (median age: 14). A total of 462 students (79% girls) were allocated to the school-based CB prevention program, and 486 students (46% girls) were allocated to the control group. The school-based CB prevention program, Depression in Swedish Adolescents (DISA), was presented by school health service staff and teachers once per week for 10 weeks. Results: The main outcome measures were self-reported depressive symptoms and self-rated health; the secondary outcome measures were adherence and cost-utility. The intervention group decreased their self-reported depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale) and improved their self-rated health (as measured by the visual analog scale) at the 12-month follow-up more than the control group ( p < .05). Conclusions: Given the challenges of conducting a study in a complex, everyday school setting with baseline differences between the intervention and control group, it is difficult to make accurate interpretations of the effectiveness of the intervention. However, with these limitations in mind, the results indicate that the DISA program is a feasible school-based prevention program.

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Effectiveness of school–home intervention for adolescent obesity prevention: parallel school randomised study

British Journal Of Nutrition ◽

10.1017/s0007114519001818 ◽

2019 ◽

Vol 122 (9) ◽

pp. 1073-1080 ◽

Cited By ~ 1

Author(s):

Michele R. Sgambato ◽

Diana B. Cunha ◽

Bárbara S. N. Souza ◽

Viviana T. Henriques ◽

Renata R. M. Rodrigues ◽

...

Keyword(s):

Physical Activity ◽

Body Fat ◽

Obesity Prevention ◽

Eating Habits ◽

Intervention Group ◽

Prevention Programme ◽

Control Group ◽

School Based ◽

Home Based ◽

Healthy Eating Habits

AbstractMany school-based interventions for obesity prevention have been proposed with positive changes in behaviour, but with unsatisfactory results on weight change. The objective was to verify the effectiveness of a combined school- and home-based obesity prevention programme on excessive weight gain in adolescents. Teachers delivered the school-based primary prevention programme to fifth- and sixth-graders (nine schools, forty-eight control classes, forty-nine intervention classes), which included encouraging healthy eating habits and physical activity. A subgroup of overweight or obese adolescents also received a home-based secondary prevention programme delivered by community health professionals. Schools were randomised to intervention or control group. Intent-to-treat analysis used mixed models for repeated continuous measures and considered the cluster effect. The main outcomes were changes in BMI and percentage body fat (%body fat) after one school-year of intervention and follow-up. Against our hypothesis, BMI increased more in the intervention group than in the control group (Δ = 0·3 kg/m2; P = 0·05) with a greater decrease in %body fat among boys (Δ = –0·6 %; P = 0·03) in the control group. The intervention group increased physical activity by 12·5 min per week compared with the control group. Female adolescents in the intervention group ate healthier items more frequently than in the control group. The subgroup that received both the school and home interventions had an increase in %body fat than in the control group (Δ = 0·89 %; P = 0·01). In the present study, a behavioural change led to a small increase in physical activity and healthy eating habits but also to an overall increase in food intake.

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Effects of L-Arginine Supplementation on Lactating Mares and the Development of Foals

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.80904 ◽

2018 ◽

Vol 44 (1) ◽

pp. 10

Author(s):

Monica Miranda Hunka ◽

Elizabeth Regina Rodrigues da Silva ◽

Marianne Kutschenko ◽

Eduardo Terra Nogueira ◽

Helena Emília Cavalcanti da Costa Cordeiro Manso ◽

...

Keyword(s):

Uric Acid ◽

Amino Acid ◽

Animal Species ◽

Control Group ◽

Lactation Period ◽

Fat Percentage ◽

Biometric Parameters ◽

Endogenous Production ◽

Low Levels ◽

Almost All

Background: Most animal species are able to produce Arginine (Arg) under normal conditions. However, in some situations, its degradation can be higher than its production. For example, during a period of lactation or disease, there is an increase in the consumption of Arg. In this case, endogenous production is not enough for the animal’s demands. Indeed, Arg supplementation in animals has several benefits for the animal’s body, such as the increase of angiogenesis, improvements in immunity and the reproductive system, as well as the stimulation of lactogenesis. During the early phase of growth, a deficiency of Arg could cause a reduction in the growth rate and metabolic activity of animals. Therefore, this amino acid is considered essential in some phases of the life of animals. However, very few studies of the supplementation of this amino acid in horses have been carried out. The aim of the present study was to characterize the effects of supplementing lactating mares and their foals with Arg.Materials, Methods & Results: Lactating mares (n = 10) were divided into two groups (control group: n = 3 / supplemented group: n = 7) and maintained exclusively under grazing. The supplemented group received 50 g of Arg during the lactation period. Samples of milk and blood from mares and blood from foals were collected at different phases of the lactation period. The following parameters were measured in milk: Glutamine (Gln); Glutamate (Glu); protein; fat; casein; lactose; urea and total solids. The following parameters were measured in blood: Gln; Glu; total plasmatic protein (TPP); albumin; urea; creatinine; uric acid; triglycerides; total cholesterol; calcium (C); phosphorous (P); magnesium (Mg) and ferrous (Fe). In addition, the biometric parameters of Wither Height (WH), Chest Perimeter (CP), Cannon Bone Circumference (CBC) and Fat Percentage (FP) of foals were obtained. A significant increase of Gln was observed in the milk in both groups (P < 0.05). The highest concentration of Gln was detected in the third month of the lactation period in the supplemented group (~ 2.26 mmol/mL), and the control group (~ 1.91 mmol/mL) during the same period. Gln did not alter in the blood (P > 0.05), although Glu was higher in the control group in the first month of the lactation period (~ 0.21 mmol/mL) (P < 0.05). An increase in uric acid (~ 0.19 mmol/L) in both groups on the day of birth (P < 0.05). In the supplemented group, increases in triglycerides (~ 0.60 mmol/L), Ca (~ 2.90 mmol/L) and Mg (~ 0.52 mmol/L) were observed in the first month of the lactation (P < 0.05). At birth, foals exhibited high levels of urea (~ 4.67 mmol/L) and uric acid (~ 0.21 mmol/L), and low levels of P (~ 2.02 mmol/L) (P < 0.05). The levels of Gln in the blood of foals remained between 0.50 and 0.70 mmol/mL throughout the lactation period (P > 0.05). Even when they were added (Gln + Glu), no differences were observed (P > 0.05). However, when the biometric parameters were analyzed, significant variations were detected in almost all characteristics (weight, WH, CP and CBC). In particular, the control group exhibited higher body mass and CP in the fifth month, when compared with the group of foals born from supplemented mares (P < 0.05). The FP did not alter in either of the groups analyzed (P > 0.05).Discussion: The results indicate that the supplementation of lactating mares with Arg produced few alterations in the parameters analyzed for both mares and foals. In addition, the supplementation did not produce side effects among the supplemented animals.

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Obesity Prevention: A Systematic Review of Setting-Based Interventions from Nordic Countries and the Netherlands

Journal of Obesity ◽

10.1155/2018/7093260 ◽

2018 ◽

Vol 2018 ◽

pp. 1-34 ◽

Cited By ~ 2

Author(s):

Jacqueline Panter ◽

Pernille Tanggaard Andersen ◽

Arja R. Aro ◽

Anastasia Samara

Keyword(s):

Systematic Review ◽

The Netherlands ◽

Obesity Prevention ◽

Descriptive Analysis ◽

Nordic Countries ◽

Control Group ◽

Qualitative Synthesis ◽

School Based ◽

Prevention Interventions ◽

School Based Interventions

Aim. Effective evidence-based interventions have an important role in obesity prevention. Our aim was to present a qualitative synthesis of setting-based health promotion interventions on obesity, from Nordic countries and the Netherlands. Methods. A systematic review of the literature was completed for studies in the community, schools, and worksite, with BMI as an outcome. A descriptive analysis was completed for all full-text articles meeting the inclusion criteria. Results. Thirty-three articles were identified: 7 whole of community, 3 worksite, and 23 school-based interventions. The studies were largely quasiexperimental in design (21/33), with follow-up from 4 months to 8 years. The explicit use of theory was not featured in many of the studies (20/33). No consistent direction for BMI change could be identified in the whole of community interventions (2/7 positive, 2/7 negative, and 3/7 no effect) and no effect for worksite (3/3 no effect) or many of the school-based interventions (1/23 negative, 4/23 positive, 15/23 no effect, 1/23 BMI significant increase only for control group and 3/23 no data available). Conclusions. There is a need to prioritise interventions with study designs of high quality, theory, and a participatory approach, for optimal implementation and evaluation of obesity prevention interventions.

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Predictors of Health Behavior Change in School-Based Obesity Prevention

PsycEXTRA Dataset ◽

10.1037/e507822008-001 ◽

2008 ◽

Author(s):

Kara Harrington ◽

Maureen E. Kenny ◽

Deirdre Brogan ◽

Lynn Y. Walsh

Keyword(s):

Health Behavior ◽

Behavior Change ◽

Obesity Prevention ◽

Health Behavior Change ◽

School Based

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School-Based Obesity Prevention for Young Hispanic Children

PsycEXTRA Dataset ◽

10.1037/e633002010-001 ◽

2010 ◽

Author(s):

Elizabeth R. Pulgaron ◽

Jennifer Hernandez ◽

Manuela Villa ◽

Daniela Fernandez ◽

Tara Dijohn ◽

...

Keyword(s):

Obesity Prevention ◽

Hispanic Children ◽

School Based

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Donepezil for mild cognitive impairment in Parkinson’s disease

Scientific Reports ◽

10.1038/s41598-021-84243-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kyoungwon Baik ◽

Seon Myeong Kim ◽

Jin Ho Jung ◽

Yang Hyun Lee ◽

Seok Jong Chung ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Treatment Group ◽

Outcome Measures ◽

Rating Scale ◽

Secondary Outcome ◽

Control Group ◽

Significant Difference

AbstractWe investigated the efficacy of donepezil for mild cognitive impairment in Parkinson’s disease (PD-MCI). This was a prospective, non-randomized, open-label, two-arm study. Eighty PD-MCI patients were assigned to either a treatment or control group. The treatment group received donepezil for 48 weeks. The primary outcome measures were the Korean version of Mini-Mental State Exam and Montreal Cognitive Assessment scores. Secondary outcome measures were the Clinical Dementia Rating, Unified Parkinson’s Disease Rating Scale part III, Clinical Global Impression scores. Progression of dementia was assessed at 48-week. Comprehensive neuropsychological tests and electroencephalography (EEG) were performed at baseline and after 48 weeks. The spectral power ratio of the theta to beta2 band (TB2R) in the electroencephalogram was analyzed. There was no significant difference in the primary and secondary outcome measures between the two groups. However, the treatment group showed a significant decrease in TB2R at bilateral frontotemporoparietal channels compared to the control group. Although we could not demonstrate improvements in the cognitive functions, donepezil treatment had a modulatory effect on the EEG in PD-MCI patients. EEG might be a sensitive biomarker for detecting changes in PD-MCI after donepezil treatment.

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Association between Short Hours of Sleep and Overweight/Obesity in Mexican Adolescent Population: A School-Based Cross-Sectional Study

Healthcare ◽

10.3390/healthcare9080939 ◽

2021 ◽

Vol 9 (8) ◽

pp. 939

Author(s):

Ana Fresan ◽

Alma Delia Genis-Mendoza ◽

María Lilia López-Narváez ◽

Tania Guadalupe Gómez-Peralta ◽

Daniela Georgina Aguilar-Velázquez ◽

...

Keyword(s):

Cross Sectional Study ◽

The Body ◽

Categorical Variables ◽

Continuous Variables ◽

Sectional Study ◽

Cross Sectional ◽

Obese Adolescent ◽

School Based ◽

Prevalence Of Obesity ◽

Mexican Adolescents

Background/Aim: Obesity in adolescents is increasing; as such, the aim of this study was to determine the prevalence of obesity in Mexican adolescents and examine its possible association with hours of sleep. Methods: A school-based cross-sectional study was carried out. This study included 863 adolescents aged between 11 and 16 years. The prevalence of obesity was estimated using the body mass index (BMI). The duration of sleep (and other information) was assessed by a self-reported questionnaire. The Cochran–Mantel–Hansel test for categorical variables and a general linear model for continuous variables were used to evaluate the interaction effect of BMI and sex with respect to sleeping and assessed activity conditions. Results: It was found that 47.6% of the adolescents were overweight/obese. Men were more frequently overweight/obese than women (52.6% vs. 41.8%, p = 0.002). Moreover, overweight/obese adolescents were younger and spent fewer daily hours watching television (p < 0.05). Men practiced sports more hours per week than women (p = 0.04). However, women spent more daily time on the internet (p = 0.05), and overweight/obese adolescent women slept fewer hours than overweight/obese men and adolescents with normal weight (p = 0.008). Conclusions: The development of strategies for the prevention of overweight/obesity and the improvement of sleep duration should include a gender perspective to improve health habits in Mexican adolescents.

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School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies

British Journal Of Nutrition ◽

10.1017/s0007114521000076 ◽

2021 ◽

pp. 1-7

Author(s):

Renata da R. M. Rodrigues ◽

Bruna K. Hassan ◽

Michele R. Sgambato ◽

Bárbara da S. N. Souza ◽

Diana B. Cunha ◽

...

Keyword(s):

Eating Habits ◽

Intervention Group ◽

Pooled Analysis ◽

Control Group ◽

Intention To Treat ◽

School Year ◽

School Based ◽

Obesity Interventions ◽

The One ◽

And Control

Abstract School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

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