Skip to main content
Top
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Study protocol

A school-based comprehensive lifestyle intervention among chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China

Authors: Fei Xu, Robert S Ware, Lap Ah Tse, Zhiyong Wang, Xin Hong, Aiju Song, Jiequan Li, Youfa Wang

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

The prevalence of childhood obesity among adolescents has been rapidly rising in Mainland China in recent decades, especially in urban and rich areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited data regarding adolescent overweight prevention in China are available. Thus, we developed a school-based intervention with the aim of reducing excess body weight in children. This report described the study design.

Methods/design

We designed a cluster randomized controlled trial in 8 randomly selected urban primary schools between May 2010 and December 2013. Each school was randomly assigned to either the intervention or control group (four schools in each group). Participants were the 4th graders in each participating school. The multi-component program was implemented within the intervention group, while students in the control group followed their usual health and physical education curriculum with no additional intervention program. The intervention consisted of four components: a) classroom curriculum, (including physical education and healthy diet education), b) school environment support, c) family involvement, and d) fun programs/events. The primary study outcome was body composition, and secondary outcomes were behaviour and behavioural determinants.

Discussion

The intervention was designed with due consideration of Chinese cultural and familial tradition, social convention, and current primary education and exam system in Mainland China. We did our best to gain good support from educational authorities, school administrators, teachers and parents, and to integrate intervention components into schools’ regular academic programs. The results of and lesson learned from this study will help guide future school-based childhood obesity prevention programs in Mainland China.

Trial registration

Registration number: ChiCTR-ERC-11001819
Appendix
Available only for authorised users
Literature
1.
go back to reference Wang Y, Lobstein T: Worldwide trends in childhood obesity. Int J Pediatr Obes. 2006, 1: 11-25. 10.1080/17477160600586747.CrossRefPubMed Wang Y, Lobstein T: Worldwide trends in childhood obesity. Int J Pediatr Obes. 2006, 1: 11-25. 10.1080/17477160600586747.CrossRefPubMed
2.
go back to reference Wang Y, Mi J, Shan X, Wang QJ, Ge K: Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes. 2007, 31 (1): 177-188. 10.1038/sj.ijo.0803354.CrossRef Wang Y, Mi J, Shan X, Wang QJ, Ge K: Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes. 2007, 31 (1): 177-188. 10.1038/sj.ijo.0803354.CrossRef
3.
go back to reference Ji CY, Cheng TO: Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol. 2008, 131 (1): 1-8. 10.1016/j.ijcard.2008.05.078.CrossRefPubMed Ji CY, Cheng TO: Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol. 2008, 131 (1): 1-8. 10.1016/j.ijcard.2008.05.078.CrossRefPubMed
4.
go back to reference Zhao W, Zhai Y, Hu J, Wang J, Yang Z, Kong L, Chen C: Economic burden of obesity-related chronic diseases in Mainland China. Obes Rev. 2008, 9 (Suppl 1): 62-67.CrossRefPubMed Zhao W, Zhai Y, Hu J, Wang J, Yang Z, Kong L, Chen C: Economic burden of obesity-related chronic diseases in Mainland China. Obes Rev. 2008, 9 (Suppl 1): 62-67.CrossRefPubMed
5.
go back to reference Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK: Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008, 16 (10): 2323-2330. 10.1038/oby.2008.351.CrossRefPubMed Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK: Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008, 16 (10): 2323-2330. 10.1038/oby.2008.351.CrossRefPubMed
6.
go back to reference World Health Organization: Reducing Risks, Promoting Healthy Life. The World Health Report 2002. 2002, World Health Organization, Geneva World Health Organization: Reducing Risks, Promoting Healthy Life. The World Health Report 2002. 2002, World Health Organization, Geneva
7.
go back to reference Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T: Do obese children become obese adults? A review of the literature. Prev Med. 1993, 22: 167-177. 10.1006/pmed.1993.1014.CrossRefPubMed Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T: Do obese children become obese adults? A review of the literature. Prev Med. 1993, 22: 167-177. 10.1006/pmed.1993.1014.CrossRefPubMed
8.
go back to reference Seidell JC: The current epidemic of obesity. In Physical Activity and Obesity. Edited by: Bouchard C. 2000, Human Kinetics, Champaign Seidell JC: The current epidemic of obesity. In Physical Activity and Obesity. Edited by: Bouchard C. 2000, Human Kinetics, Champaign
9.
go back to reference Centers for Disease Control and Prevention: Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR. 1997, 46: 1-36. Centers for Disease Control and Prevention: Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR. 1997, 46: 1-36.
10.
go back to reference Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC: Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes Rev. 2006, 7: S7-S66. 10.1111/j.1467-789X.2006.00242.x.CrossRef Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC: Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes Rev. 2006, 7: S7-S66. 10.1111/j.1467-789X.2006.00242.x.CrossRef
12.
go back to reference Summerbell C, Waters E, Edmunds L, Kelly S, Brown T, Campbell K: Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005, 20 (3): 1-70. CD001871 Summerbell C, Waters E, Edmunds L, Kelly S, Brown T, Campbell K: Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005, 20 (3): 1-70. CD001871
13.
go back to reference 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: 703-10.1136/bmj.39320.843947.BE.CrossRefPubMedPubMedCentral 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: 703-10.1136/bmj.39320.843947.BE.CrossRefPubMedPubMedCentral
14.
go back to reference Doak CM, Visscher TLS, Renders CM, Seidell JC: The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obes Rev. 2006, 7: 111-136. 10.1111/j.1467-789X.2006.00234.x.CrossRefPubMed Doak CM, Visscher TLS, Renders CM, Seidell JC: The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obes Rev. 2006, 7: 111-136. 10.1111/j.1467-789X.2006.00234.x.CrossRefPubMed
15.
go back to reference Flodmark CE, Marcus C, Britton M: Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes (Lond). 2006, 30: 579-589. 10.1038/sj.ijo.0803290.CrossRef Flodmark CE, Marcus C, Britton M: Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes (Lond). 2006, 30: 579-589. 10.1038/sj.ijo.0803290.CrossRef
16.
go back to reference Jansen W, Raat H, Zwanenburg EJ, Reuvers I, Walsem RV, Brug J: A school-based intervention to reduce overweight and inactivity in children aged 6–2 years: study design of a randomized controlled trial. BMC Public Health. 2008, 8: 257-10.1186/1471-2458-8-257.CrossRefPubMedPubMedCentral Jansen W, Raat H, Zwanenburg EJ, Reuvers I, Walsem RV, Brug J: A school-based intervention to reduce overweight and inactivity in children aged 6–2 years: study design of a randomized controlled trial. BMC Public Health. 2008, 8: 257-10.1186/1471-2458-8-257.CrossRefPubMedPubMedCentral
17.
go back to reference Wang Y, Tussing L, Odoms-Young A, Braunschweig C, Flay B, Hedeker D, Hellison D: Obesity prevention in low socioeconomic status urban African-American adolescents: study design and preliminary findings of the HEALTH-KIDS Study. Eur J Clin Nutr. 2006, 60: 92-103. 10.1038/sj.ejcn.1602272.CrossRefPubMed Wang Y, Tussing L, Odoms-Young A, Braunschweig C, Flay B, Hedeker D, Hellison D: Obesity prevention in low socioeconomic status urban African-American adolescents: study design and preliminary findings of the HEALTH-KIDS Study. Eur J Clin Nutr. 2006, 60: 92-103. 10.1038/sj.ejcn.1602272.CrossRefPubMed
18.
go back to reference Singh AS, Chin A, Paw MJ, Brug J, van Mechelen W: Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Arch Pediatr Adolesc Med. 2009, 163: 309-317. 10.1001/archpediatrics.2009.2.CrossRefPubMed Singh AS, Chin A, Paw MJ, Brug J, van Mechelen W: Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Arch Pediatr Adolesc Med. 2009, 163: 309-317. 10.1001/archpediatrics.2009.2.CrossRefPubMed
19.
go back to reference Brug J, te Velde SJ, Chin A, Paw MJ, Bere E, de Bourdeaudhuij I, Moore H, Maes L, Jensen J, Manios Y, Lien N, Klepp KI, Lobstein T, Martens M, Salmon J, Singh AS: Evidence-based development of school-based and family-involved prevention of overweight across Europe: the ENERGY-project's design and conceptual framework. BMC Public Health. 2010, 10: 276-10.1186/1471-2458-10-276.CrossRefPubMedPubMedCentral Brug J, te Velde SJ, Chin A, Paw MJ, Bere E, de Bourdeaudhuij I, Moore H, Maes L, Jensen J, Manios Y, Lien N, Klepp KI, Lobstein T, Martens M, Salmon J, Singh AS: Evidence-based development of school-based and family-involved prevention of overweight across Europe: the ENERGY-project's design and conceptual framework. BMC Public Health. 2010, 10: 276-10.1186/1471-2458-10-276.CrossRefPubMedPubMedCentral
20.
go back to reference Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, Norman J, Story M, Stone EJ, Stephenson L, Stevens J: Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003, 78 (5): 1030-1038.PubMedPubMedCentral Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, Norman J, Story M, Stone EJ, Stephenson L, Stevens J: Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003, 78 (5): 1030-1038.PubMedPubMedCentral
21.
go back to reference Paradis G, Levesque L, Macaulay AC, Cargo M, McComber A, Kirby R: Impact of a diabetes prevention program on body size, physical activity, and diet among kanien’keha:ka (mohawk) children 6 to 11 years old: 8-year results from the kahnawake schools diabetes prevention project. Pediatrics. 2005, 115 (2): 333-339. 10.1542/peds.2004-0745.CrossRefPubMed Paradis G, Levesque L, Macaulay AC, Cargo M, McComber A, Kirby R: Impact of a diabetes prevention program on body size, physical activity, and diet among kanien’keha:ka (mohawk) children 6 to 11 years old: 8-year results from the kahnawake schools diabetes prevention project. Pediatrics. 2005, 115 (2): 333-339. 10.1542/peds.2004-0745.CrossRefPubMed
22.
go back to reference Connor MK, Smith LG, Fryer A, Erickson S, Fryer S, Drake J: Future Fit: a cardiovascular health education and fitness project in an after-school setting. J Sch Health. 1986, 56 (8): 329-333. 10.1111/j.1746-1561.1986.tb05764.x.CrossRefPubMed Connor MK, Smith LG, Fryer A, Erickson S, Fryer S, Drake J: Future Fit: a cardiovascular health education and fitness project in an after-school setting. J Sch Health. 1986, 56 (8): 329-333. 10.1111/j.1746-1561.1986.tb05764.x.CrossRefPubMed
23.
go back to reference Yang XZ, Liu BC: Cross-sectional comparison of study burden among students in different countries. Shanghai Education & Research. 2002, 4: 58-61. In Chinese Yang XZ, Liu BC: Cross-sectional comparison of study burden among students in different countries. Shanghai Education & Research. 2002, 4: 58-61. In Chinese
24.
go back to reference He XW: Comprehensive intervention and treatment on simple obesity among school children. Journal of Guangxi Medical University. 2003, 20: 406-407. In Chinese He XW: Comprehensive intervention and treatment on simple obesity among school children. Journal of Guangxi Medical University. 2003, 20: 406-407. In Chinese
25.
go back to reference Liu SQ, Zhang QH, Yue YL, Li YQ: School-based intervention for obese children. Chinese Journal of School Doctor. 2005, 19: 115-117. In Chinese Liu SQ, Zhang QH, Yue YL, Li YQ: School-based intervention for obese children. Chinese Journal of School Doctor. 2005, 19: 115-117. In Chinese
26.
go back to reference Xia GX, Zhong N, Xu XP, Wang RQ: Lifestyle intervention in obese Children in Longhua Shanghai. Chinese Journal of School Health. 2003, 24: 359-In Chinese Xia GX, Zhong N, Xu XP, Wang RQ: Lifestyle intervention in obese Children in Longhua Shanghai. Chinese Journal of School Health. 2003, 24: 359-In Chinese
27.
go back to reference Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U: The effects of a 3-year obesity intervention in school children in Beijing. Child Care Health Dev. 2007, 33 (5): 641-646. 10.1111/j.1365-2214.2007.00738.x.CrossRefPubMed Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U: The effects of a 3-year obesity intervention in school children in Beijing. Child Care Health Dev. 2007, 33 (5): 641-646. 10.1111/j.1365-2214.2007.00738.x.CrossRefPubMed
28.
go back to reference Flay BR, Petraitis J: The theory of triadic influence: a new theory of health behavior with implications for preventive interventions. Advances in Medical Sociology, Vol IV: A Reconsideration of Models of Health Behavior Change. Edited by: Albrecht GS. 1994, JAI Press, Greenwich, 19-44. Flay BR, Petraitis J: The theory of triadic influence: a new theory of health behavior with implications for preventive interventions. Advances in Medical Sociology, Vol IV: A Reconsideration of Models of Health Behavior Change. Edited by: Albrecht GS. 1994, JAI Press, Greenwich, 19-44.
29.
go back to reference Allensworth DD, Kolbe LJ: The comprehensive school health program: exploring an expanded concept. J School Health. 1987, 57: 409-412. 10.1111/j.1746-1561.1987.tb03183.x.CrossRefPubMed Allensworth DD, Kolbe LJ: The comprehensive school health program: exploring an expanded concept. J School Health. 1987, 57: 409-412. 10.1111/j.1746-1561.1987.tb03183.x.CrossRefPubMed
30.
go back to reference Birch LL, Davison KK: Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin N Am. 2001, 48: 893-907. 10.1016/S0031-3955(05)70347-3.CrossRef Birch LL, Davison KK: Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin N Am. 2001, 48: 893-907. 10.1016/S0031-3955(05)70347-3.CrossRef
31.
go back to reference Group of China Obesity Task force: Body mass index for reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol. 2004, 25: 97-102. Group of China Obesity Task force: Body mass index for reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol. 2004, 25: 97-102.
32.
go back to reference Xu LZ, Dibley MJ, D'Este C: Reliability and validity of a food-frequency questionnaire for Chinese postmenopausal women. Public Health Nutr. 2004, 7: 91-98.CrossRefPubMed Xu LZ, Dibley MJ, D'Este C: Reliability and validity of a food-frequency questionnaire for Chinese postmenopausal women. Public Health Nutr. 2004, 7: 91-98.CrossRefPubMed
33.
go back to reference Qu NN, Li KJ: Study on the reliability and validity of the international physical activity questionnaire (Chinese Version). Chin J Epidemiol. 2004, 25: 265-268. Qu NN, Li KJ: Study on the reliability and validity of the international physical activity questionnaire (Chinese Version). Chin J Epidemiol. 2004, 25: 265-268.
34.
go back to reference Ji CY, Sun JL, Chen TJ: Dynamic analysis on the prevalence of obesity and overweight school-age children and adolescents in recent 15 years in China. Chin J Epidemiol. 2004, 25: 103-108. Ji CY, Sun JL, Chen TJ: Dynamic analysis on the prevalence of obesity and overweight school-age children and adolescents in recent 15 years in China. Chin J Epidemiol. 2004, 25: 103-108.
35.
go back to reference Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J: School-based obesity prevention: a blueprint for taming the epidemic. Am J Health Behav. 2002, 26a: 486-493.CrossRef Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J: School-based obesity prevention: a blueprint for taming the epidemic. Am J Health Behav. 2002, 26a: 486-493.CrossRef
36.
go back to reference Li M, Li S, Baur LA, Huxley RR: A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obesity review. 2008, 9: 548-559. 10.1111/j.1467-789X.2008.00495.x.CrossRef Li M, Li S, Baur LA, Huxley RR: A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obesity review. 2008, 9: 548-559. 10.1111/j.1467-789X.2008.00495.x.CrossRef
37.
go back to reference Gao Y, Griffiths S, Chan EY: Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature. J Public Health. 2008, 30 (4): 436-448. 10.1093/pubmed/fdm057.CrossRef Gao Y, Griffiths S, Chan EY: Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature. J Public Health. 2008, 30 (4): 436-448. 10.1093/pubmed/fdm057.CrossRef
38.
go back to reference Xu F, Li JQ, Ware R, Owen N: Associations of television viewing time with excess body weight among urban and rural high school students in regional mainland China. Public Health Nutr. 2008, 11 (09): 891-896.CrossRefPubMed Xu F, Li JQ, Ware R, Owen N: Associations of television viewing time with excess body weight among urban and rural high school students in regional mainland China. Public Health Nutr. 2008, 11 (09): 891-896.CrossRefPubMed
Metadata
Title
A school-based comprehensive lifestyle intervention among chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China
Authors
Fei Xu
Robert S Ware
Lap Ah Tse
Zhiyong Wang
Xin Hong
Aiju Song
Jiequan Li
Youfa Wang
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-316

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue