Are primary/elementary school‐based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews

Abstract

This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies.Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools. K E Y W O R D S Childhood obesity, primary/elementary schools, systematic review 1 | INTRODUCTION Being overweight in childhood is associated with poorer quality of life 1 and excess morbidity and mortality in adulthood. 2 Research in the UK shows that BMI has been increasing among children entering reception class (aged 4/5) and accelerating through to the last year of primary school (year 6, aged 10/11 years). 3 This suggests that intervention with school-aged children should take place as early as possible, and the primary school setting offers a key opportunity to intervene early, at a crucial time in children's development. Early intervention has the potential to have short and long-term effects on a number of health, educational, and social outcomes 4 and to reduce health inequalities globally. 5 The aim of the present research was to review systematically what is known about the effectiveness and contents of primary/elementary school-based interventions to prevent or treat excess weight gain.Weight-management interventions are increasingly being evaluated in school settings, and subsequently the amount of research published on this topic, including reviews of reviews, has increased. 6,7 It is difficult to draw firm conclusions from these previous reviews of reviews on three grounds. First, they have generalized across children from early childhood to adolescence, at all stages of their schooling, 8 which is problematic because BMI naturally increases with age. 1 Second, previous reviews of reviews have focused on specific obesityprevention single strategies such as increasing physical activity in

Three-Year Follow-Up of the POIBA Intervention on Childhood Obesity: A Quasi-Experimental Study

“…A systematic review showed that school-based interventions are generally effective in reducing excess weight in children and may help contain the current increase in childhood obesity [ 16 ]. Likewise, there is also a strong consensus on the importance of preventive interventions for childhood obesity at these ages involving the family setting [ 12 , 13 , 48 ], as families are responsible for feeding their children and also for managing time and activities related to physical activity.…”

“…Schools have been proven to be a successful setting for interventions aimed at improving healthy habits, since children spend a large part of their time there [ 9 ]. The most effective school-based interventions are multicomponent initiatives, based on the social cognitive model [ 10 ] and with environmental implications [ 11 ], especially including the family environment [ 12 , 13 ].…”

“…Most studies have reported the effectiveness of physical activity interventions [ 14 , 15 , 16 ], especially those with a longer duration [ 17 ] and those with a community component [ 18 ]. Other studies, while highlighting the effects on physical activity, focus on the complementary effects of sedentary habits and screen use [ 12 , 19 ]. The Project Healthy Schools is an example of a combined educational strategy that aimed to increase intake of fruits and vegetables, to decrease intake of high-sugar beverages and fatty food, to perform at least 150 min of exercise per day, and to decrease screen time.…”

Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review

“…Two previous umbrella reviews have demonstrated the effectiveness of lifestyle interventions for the treatment of child and adolescent obesity [ 29 , 30 ], with one of the reviews focused on family-based treatment interventions [ 30 ]. Prevention-focused umbrella reviews are inconsistent about whether interventions are effective for preventing child and adolescent obesity [ 24 , 31 , 32 , 33 ]. There are differences in age ranges of the systematic reviews within those umbrella reviews, which may explain some of the inconsistency in findings.…”

Child obesity moderates the association between poverty and academic achievement

“…It is clear that we need continued research and development of cost‐effective behavioral and systems‐level interventions to curb obesity and promote more successful educational outcomes (Davies et al, 2007). Some nascent approaches appear to be promising, including implementation of nutrition policies in schools (e.g., alternatives to food‐based rewards/celebrations; Ickovics et al, 2019), promotion of healthy school food environments (Teo et al, 2019), classroom‐based lifestyle interventions (Hsiang et al, 2020; Salam et al, 2020), school‐based nutritional education programs (Hawkins et al, 2020), summer and after‐school weight management programs (Mabli et al, 2020; Reesor et al, 2018), as well as initiatives aimed at reducing sedentary behavior and screen time (Goldthorpe et al, 2020), with a synchronized focus on increased physical activity through after‐school clubs, class physical activity breaks (Jones et al, 2020; Santina et al, 2020; Yuksel et al, 2020), and play‐based interventions (Sanchez‐Lopez et al, 2020). Moreover, an important component of any intervention strategy is to incentivize decision‐makers to advocate for increased funding as a way to implement more large‐scale social policy changes to educate and train the next generation of school‐based health practitioners (e.g., occupational therapists) who will undoubtedly have a significant impact on child body weight management and obesity prevention (Hartley, 2019).…”