A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

Abstract

Background Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. Methods A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10–19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. Results Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (− 0.06 [95% CI -0.10, − 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. Conclusions Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.

Perceived Stress and Increased Food Consumption during the ‘Third Wave’ of the COVID-19 Pandemic in Spain

“…Perceived stress interferes with eating behavior and can lead to increased food consumption [ 39 ]—this includes increased consumption, especially of foods high in calories and rich in sugar, fats, and salt [ 18 , 19 , 40 ]. In this study, 36.1% of respondents expressed that they had increased their frequency of consumption of some foods, while 14.1% were unsure whether they had done so.…”

Associations between Psychosocial Variables, Availability of Physical Activity Resources in Neighborhood Environment, and Out-of-School Physical Activity among Chinese Adolescents

“…Previous studies using the same questionnaire also indicated that parental support was positively associated with MVPA in American youths aged 9–18 years old [ 37 , 38 ]. Furthermore, a longitudinal study identified that parental support reported by teenagers in early adolescence had long-term associations with MVPA up to 5 years later [ 39 ].…”

“…In reverse, lack of PA can increase the risk of several chronic diseases, including obesity, cardiovascular disease [ 3 ], anxiety, and depression [ 4 ]. It has been reported that decreased moderate to vigorous physical activity (MVPA) was associated with an increased risk of all-cause mortality [ 5 ]. However, 28% of adults worldwide did not achieve the levels recommended by WHO [ 6 ].…”

Sociodemographic Correlates of Parental Co-Participation in Digital Media Use and Physical Play of Preschool-Age Children

“…Early childhood is a foundational period of life for the development of health behaviours [ 1 , 2 ]. Regular physical activity (PA) has favourable health effects in young children [ 3 , 4 ], and PA habits established in early childhood track in later childhood [ 5 , 6 ] and, subsequently, in adolescence and adulthood [ 7 ]. Sedentary behaviour habits also tend to track from childhood to later life [ 6 , 8 , 9 ].…”