Abstract
Objective:
To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children.
Design:
Cluster-randomized, controlled study.
Subjects:
A total of 3135 boys and girls in grades 1–4 were included in the study.
Methods:
Ten schools were selected in Stockholm county area and randomized to intervention (n=5) and control (n=5) schools. Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. Physical activity (PA) was aimed to increase by 30 min day−1 during school time and sedentary behaviour restricted during after school care time. PA was measured by accelerometry. Eating habits at home were assessed by parental report. Eating disorders were evaluated by self-report.
Results:
The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P<0.05). The results showed no difference between intervention and controls, after cluster adjustment, in the longitudinal analysis of BMIsds changes. However, a larger proportion of the children who were initially overweight reached normal weight in the intervention group (14%) compared with the control group (7.5%), P=0.017. PA did not differ between intervention and control schools after cluster adjustment. Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention. There was no difference between children in intervention and control schools in self-reported eating disorders.
Conclusions:
A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating habits at home. The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA.
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References
Lobstein T, Baur L, Uauy R . Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5: S4–104.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM . Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 2004; 291: 2847–2850.
Petersen S, Brulin C, Bergstrom E . Increasing prevalence of overweight in young schoolchildren in Umea, Sweden, from 1986 to 2001. Acta Paediatr 2003; 92: 848–853.
Rasmussen F, Johansson M, Hansen HO . Trends in overweight and obesity among 18-year-old males in Sweden between 1971 and 1995. Acta Paediatr 1999; 88: 431–437.
Asp N-G, Björntorp P, Britton M, Carlsson P, Kjellström T, Marcus C et al. Treating obesity in children and adolescents. In: Östman J, Britton M, Jonsson E (eds). Treating and Preventing Obesity. Wiley-VCH Verlag GmbH & Co KgaA: Weinheim, 2004, pp 227–259.
Sundblom E, Petzold M, Rasmussen F, Callmer E, Lissner L . Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist. Int J Obes 2008; 32: 1525–1530.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH . Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869–873.
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.
Strauss RS . Childhood obesity and self-esteem. Pediatrics 2000; 105: e15.
Baker JL, Olsen LW, Sorensen TI . Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007; 357: 2329–2337.
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB . Years of life lost due to obesity. JAMA 2003; 289: 187–193.
Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138–1145.
Daniels SR . The consequences of childhood overweight and obesity. Future Child 2006; 16: 47–67.
Tucker DM, Palmer AJ, Valentine WJ, Roze S, Ray JA . Counting the costs of overweight and obesity: modeling clinical and cost outcomes. Curr Med Res Opin 2006; 22: 575–586.
Asp NG, Björntorp P, Britton M, Carlsson P, Kjellström T, Marcus C et al. Treating and Preventing Obesity. Wiley-VCH Verlag GmbH & Co KgaA: Weinheim, 2004.
Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA . Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 2005; 116: e125–e144.
Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL . Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA 2003; 289: 1805–1812.
Godoy-Matos A, Carraro L, Vieira A, Oliveira J, Guedes EP, Mattos L et al. Treatment of obese adolescents with sibutramine: a randomized, double-blind, controlled study. J Clin Endocrinol Metab 2005; 90: 1460–1465.
Berkowitz RI, Fujioka K, Daniels SR, Hoppin AG, Owen S, Perry AC et al. Effects of sibutramine treatment in obese adolescents: a randomized trial. Ann Intern Med 2006; 145: 81–90.
Daniels SR, Long B, Crow S, Styne D, Sothern M, Vargas-Rodriguez I et al. Cardiovascular effects of sibutramine in the treatment of obese adolescents: results of a randomized, double-blind, placebo-controlled study. Pediatrics 2007; 120: e147–e157.
Garcia-Morales LM, Berber A, Macias-Lara CC, Lucio-Ortiz C, Del-Rio-Navarro BE, Dorantes-Alvarez LM . Use of sibutramine in obese mexican adolescents: a 6-month, randomized, double-blind, placebo-controlled, parallel-group trial. Clin Ther 2006; 28: 770–782.
Van Mil EG, Westerterp KR, Kester AD, Delemarre-van de Waal HA, Gerver WJ, Saris WH . The effect of sibutramine on energy expenditure and body composition in obese adolescents. J Clin Endocrinol Metab 2007; 92: 1409–1414.
Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J et al. The Tackling Obesities: Future Choices. In: UGsF (ed). Programme 2nd edn, Government Office for Science, Department of Innovation, University and Skills: London, 2007. pp 1–164.
Asp N-G, Björntorp P, Britton M, Carlsson P, Kjellström T, Marcus C et al. Prevention of childhood obesity. Preventing Obesity in Children and Adolescents. In: Östman J, Britton M, Jonsson E (eds). Treating and Preventing Obesity. Wiley-VCH Verlag GmbH & Co KgaA: Weinheim, 2004, pp 75–92.
Flodmark CE, Marcus C, Britton M . Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes 2006; 30: 579–589.
Sharma M . School-based interventions for childhood and adolescent obesity. Obes Rev 2006; 7: 261–269.
Kubik MY, Lytle LA, Story M . Schoolwide food practices are associated with body mass index in middle school students. Arch Pediatr Adolesc Med 2005; 159: 1111–1114.
James J, Thomas P, Cavan D, Kerr D . Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004; 328: 1237.
van Sluijs EM, McMinn AM, Griffin SJ . Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ 2007; 335: 703.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
de Vries SI, Bakker I, Hopman-Rock M, Hirasing RA, van Mechelen W . Clinimetric review of motion sensors in children and adolescents. J Clin Epidemiol 2006; 59: 670–680.
Nyberg G, Ekelund U, Marcus C . Physical activity in children measured by accelerometry: stability over time. Scand J Med Sci Sports 2008; 19: 30–35 e-pub ahead of print 2 February, PMID 18248540.
Edlund B, Hallqvist G, Sjoden PO . Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children. Acta Paediatr 1994; 83: 572–577.
Lundstedt G, Edlund B, Engstrom I, Thurfjell B, Marcus C . Eating disorder traits in obese children and adolescents. Eat Weight Disord 2006; 11: 45–50.
Rolland-Cachera MF, Sempe M, Guilloud-Bataille M, Patois E, Pequignot-Guggenbuhl F, Fautrad V . Adiposity indices in children. Am J Clin Nutr 1982; 36: 178–184.
Kropski JA, Keckley PH, Jensen GL . School-based obesity prevention programs: an evidence-based review. Obesity (Silver Spring) 2008; 16: 1009–1018.
Sharma AM . The value of current interventions for obesity. Nat Clin Pract Cardiovasc Med 2008; 5: S3–S9.
Robinson TN, Chang JY, Haydel KF, Killen JD . Overweight concerns and body dissatisfaction among third-grade children: the impacts of ethnicity and socioeconomic status. J Pediatr 2001; 138: 181–187.
Wardle J, Watters R . Sociocultural influences on attitudes to weight and eating: results of a natural experiment. Int J Eat Disord 2004; 35: 589–596.
Halvarsson K, Lunner K, Sjoden PO . Assessment of eating behaviours and attitudes to eating, dieting and body image in pre-adolescent Swedish girls: a one-year follow-up. Acta Paediatr 2000; 89: 996–1000.
Carter FA, Bulik CM . Childhood obesity prevention programs: how do they affect eating pathology and other psychological measures? Psychosom Med 2008; 70: 363–371.
Gutin B, Yin Z, Johnson M, Barbeau P . Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: the Medical College of Georgia Fitkid Project. Int J Pediatr Obes 2008; 3: S3–S9.
Acknowledgements
We thank all participating schools for their efforts. The study was supported by grants from Stockholm County Council, Swedish Council for working life and social research, Swedish Research Council, Freemason's in Stockholm Foundation for Children's Welfare and Signhild Engkvist Foundation.
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Marcus, C., Nyberg, G., Nordenfelt, A. et al. A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP. Int J Obes 33, 408–417 (2009). https://doi.org/10.1038/ijo.2009.38
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DOI: https://doi.org/10.1038/ijo.2009.38
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