Many 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.

BackgroundThe prevalence of childhood obesity is increasing at a high rate in Brazil, making prevention a health priority. Schools are the central focus of interventions aiming the prevention and treatment of childhood obesity, however, randomized trials and cohort studies have not yet provided clear evidence of strategies to reduce prevalence of obesity.The aim of this study is to present a protocol to evaluate the efficacy of combining school and household level interventions to reduce excessive weight gain among students.MethodsThe intervention target fifth and sixth graders from 18 public schools (9 interventions and 9 controls) in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. A sample size of 2500 students will be evaluated at school for their weight status and those from the intervention group who are overweight or obese will be followed monthly at home by community health agents. Demographic, socioeconomic, anthropometric, eating behavior and food consumption data will be collected at school using a standardized questionnaire programmed in personal digital assistant. At school, all students from the intervention group will be encouraged to change eating habits and food consumption and to increase physical activity and reducing sedentary behavior.DiscussionThis study will provide evidence whether integration of school with primary health care can prevent excessive weight gain among adolescents. Positive results will inform a sustainable strategy to be disseminated in the health care system in Brazil.Trial registrationClinicalTrials.gov, NCT02711488. Date of registration: March 11, 2016.

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OBJECTIVE: This study aimed to evaluate sociodemographic and economic differences among Brazilian older adults according to region. METHODS: This cross-sectional, descriptive-analytical study was conducted with individuals ≥ 60 years of age based on a secondary analysis of public data from a nationally representative survey called the Family Budget Survey. The data were separated according to the 5 regions of the country and were associated with sociodemographic and economic characteristics. Analyses were performed of categorical and numerical variables and their associations using multinomial logistic regression. RESULTS: Among all participants in the Family Budget Survey, 26 199 (15%) were older adults. It was found that the southeast and south had better living conditions and higher proportions of older adults. Regarding race, the southern region had the highest proportion of self-declared Whites, the southeastern region had the highest mean education level, and the northern and northeastern regions had the lowest levels of education and household income. CONCLUSIONS: The results suggest that the aging process is heterogeneous due to marked regional inequalities, which are related to social issues. Regional differences can be determinant in socioeconomic and demographic inequalities among the older population.

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Objective:To evaluate the effectiveness of nudge activities at school on the students’ body mass index (BMI).Design:School-based factorial randomized community trial.Setting:Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil.Participants and intervention:The 18 schools will be randomized into 4 group arms: group 1—control (without any activity); group 2—will receive educational activities in the classroom; group 3—will receive changes in the school environment (nudge strategies); group 4—will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year.Main outcome measure(s):The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer.Analysis:Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.

Background This study aimed to evaluate the effectiveness of obesity prevention educational activities, isolated or combined with the modification of the school environment on total physical activity time. Methods This is a school-based randomized controlled trial, conducted with 2511 students from fifth and sixth-grade in Brazil, that employed a parallel, three-group experimental arms: control group (CG), PAAPPAS group (PG) and PAAPPAS-environment group (PEG). During the 2016 school year, the PG received educational activities in the classroom, providing a general basis for a healthy lifestyle. The PEG received the same educational activities and also modifications in the school environment to stimulate physical activity practice during one month. Physical activity was evaluated through a validated physical activity questionnaire. Intention-to-treat analysis was performed to evaluate the rate of change of physical activity time between groups using PROC GENMOD procedure. All analyses were performed using SAS. Results Total physical activity time increased by 22% in PEG compared with CG (P = 0.003). No difference was observed between PEG and PG (Δ = 60.20 vs. 36.37, respectively; P = 0.27) and between PG and CG (Δ = 36.37 vs. 9.70, respectively; P = 0.23). The proportion of individuals who attended at least 150 min week−1 of physical activity increased in PEG compared with PG (P = 0.04); however, no difference was observed between PEG and CG (P = 0.19) and between PG and CG (P = 0.26). For 300 min week−1, no difference was observed between groups. Conclusion A school-based multi-component intervention including modification of the school environment was effective for increasing physical activity time among adolescents.

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 analyzing 5926 students (mean age 11.5 years) from five randomized school-based interventions. These studies focused on encouraging students to change their drinking, 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 (body mass index) after one school year of positive changes in behaviors associated with obesity. Estimated mean BMI changed from 19.02 to 19.22 in the control group and from 19.08 to 19.32 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 to intervention (p-value= 0.05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviors associated with obesity.