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

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.

scholarly journals Preventing childhood obesity primary schools: a realist review from UK perspective

2021 ◽  
Author(s):  
S Ijaz ◽  
James Nobles ◽  
Laura Johnson ◽  
Theresa Moore ◽  
Jelena Savovic ◽  
...  
Keyword(s):  
Childhood Obesity ◽  
Primary Schools ◽  
Parental Education ◽  
Contextual Factors ◽  
Cochrane Review ◽  
Realist Review ◽  
Older Children ◽  
Programme Theory ◽  
School Based ◽  
Stakeholder Input

Objective: to identify contextual and mechanistic factors associated with outcomes of school-based obesity prevention interventions which may be implementable in UK primary schools. Design: realist synthesis following REMESES guidance. We developed an initial programme theory through expert consensus and stakeholder input and refined it with data from included studies to produce a final programme theory including all context-mechanism-outcome configurations. Setting: primary schools Participants: children aged 4-12 Interventions: included in the 2019 Cochrane review on prevention of childhood obesity Outcomes: BMIz Results: We included 24 studies comprised of 71 documents in our synthesis. We found that contextual factors such as baseline BMIz affects intervention mechanisms variably, while girls, older children and those with higher parental education consistently benefitted more from school-based interventions. Key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification, and the intervention components working together as a whole. Education alone did not produce favourable outcomes. Conclusions 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.

School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials

2021 ◽  
pp. 1-28
Author(s):  
Tarcisus Ho ◽  
Ling Jie Cheng ◽  
Ying Lau
Keyword(s):  
Childhood Obesity ◽  
Children And Adolescents ◽  
Meta Analysis ◽  
Overweight And Obesity ◽  
Risk Of Bias ◽  
Medium Effect ◽  
School Based ◽  
Cluster Randomised ◽  
School Based Interventions ◽  
Meta Regression

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).

School-Based Interventions on Childhood Obesity

2009 ◽  
Vol 37 (5) ◽  
pp. 418-427 ◽  
Author(s):  
Consuelo Gonzalez-Suarez ◽  
Anthea Worley ◽  
Karen Grimmer-Somers ◽  
Valentine Dones
Keyword(s):  
Childhood Obesity ◽  
School Based ◽  
School Based Interventions

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

Circulation ◽  
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.

scholarly journals School-Based Interventions Targeting Nutrition and Physical Activity, and Body Weight Status of African Children: A Systematic Review

Nutrients ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 95 ◽  
Author(s):  
Theodosia Adom ◽  
Anniza De Villiers ◽  
Thandi Puoane ◽  
André Pascal Kengne
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Children And Adolescents ◽  
Weight Status ◽  
Primary School Children ◽  
Health Concern ◽  
African Children ◽  
School Based ◽  
School Based Interventions ◽  
Nutrition And Physical Activity

Background: Overweight/obesity is an emerging health concern among African children. The aim of this study was to summarise available evidence from school-based interventions that focused on improving nutrition and physical activity knowledge, attitude, and behaviours, and weight status of children aged 6–15 years in the African context. Methods: Multiple databases were searched for studies evaluating school-based interventions of African origin that involved diet alone, physical activity alone, or multicomponent interventions, for at least 12 weeks in duration, reporting changes in either diet, physical activity, or body composition, and published between 1 January 2000 and 31 December 2018. No language restrictions were applied. Relevant data from eligible studies were extracted. Narrative synthesis was used to analyse and describe the data. Results: This systematic review included nine interventions comprising 10 studies. Studies were conducted among 9957 children and adolescents in two African countries, namely South Africa and Tunisia, and were generally of low methodological quality. The sample size at baseline ranged from 28 to 4003 participants. Two interventions reported enrolling children from both urban and rural areas. The majority of the study participants were elementary or primary school children and adolescents in grades 4 to 6. Participants were between the ages of 12.4 and 13.5 years. All but one intervention targeted children of both sexes. Four studies were described as randomised control trials, while five were pre- and post-test quasi-experiments. Except for one study that involved the community as a secondary setting, all were primarily school-based studies. The duration of the interventions ranged from four months to three years. The interventions focused largely on weight-related behaviours, while a few targeted weight status. The results of the effectiveness of these interventions were inconsistent: three of five studies that evaluated weight status (body mass index (BMI), BMI z-score, overweight/obesity prevalence), three of six studies that reported physical activity outcomes (number of sports activities, and physical activity duration ≥ 30 min for at least six days/week), and four of six reporting on nutrition-related outcomes (number meeting fruit and vegetable intake ≥ 5 times/day) found beneficial effects of the interventions. Conclusion: Given the dearth of studies and the inconsistent results, definite conclusions about the overall effectiveness and evidence could not be made. Nonetheless, this study has identified research gaps in the childhood obesity literature in Africa and strengthened the need for further studies, the findings of which would contribute valuable data and inform policy.

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

2019 ◽  
Vol 16 (1) ◽  
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.

scholarly journals Drivers of stunting reduction in Ethiopia: a country case study

2020 ◽  
Vol 112 (Supplement_2) ◽  
pp. 875S-893S
Author(s):  
Hana Tasic ◽  
Nadia Akseer ◽  
Seifu H Gebreyesus ◽  
Anushka Ataullahjan ◽  
Samanpreet Brar ◽  
...  
Keyword(s):  
Parental Education ◽  
Health Workers ◽  
Health Concern ◽  
Demographic And Health Surveys ◽  
Global Public Health ◽  
Access To Health Services ◽  
Open Defecation ◽  
Chronic Undernutrition ◽  
Policies And Programs ◽  
Change In Mean

ABSTRACT Background Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y. Objectives The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level. Methods This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000–2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken. Results National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls’ education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls’ education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction. Conclusions Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.

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