Effectiveness of school–home intervention for adolescent obesity prevention: parallel school randomised study

Abstract

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.

Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review

“…Overall, twelve studies (33.3%) were conducted in the U.S., five studies (14.7%) were conducted in Australia and other countries in Oceania [ 24 , 25 , 26 , 27 , 28 ], and three studies (8.8%) in Brazil [ 5 , 29 , 30 ] and in Spain [ 31 , 32 , 33 ]. Other studies included countries within Europe [ 34 , 35 , 36 , 37 , 38 ] and Asia [ 39 , 40 , 41 ], Canada [ 42 ], Mexico [ 43 ], and Israel [ 44 ].…”

“…For the energy-balance programs, 20 studies were found [ 24 , 25 , 30 , 32 , 34 , 37 , 38 , 39 , 40 , 41 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]; of these, five studies were conducted in the USA [ 45 , 46 , 47 , 49 , 50 ], six in Europe [ 32 , 34 , 35 , 37 , 38 ], four in Australia [ 24 , 25 , 26 , 27 ], three in Asia [ 39 , 40 , 44 ], and one in Brazil [ 30 ] and in Tonga [ 41 ]. When considering the study design, 13 studies were randomized controlled trials (RCT) [ 25 , 26 , 27 , 30 , 36 , 37 , 38 , 40 , 45 , 46 , 47 , 49 , 50 , 51 ]...…”

“…The majority ( n = 13, 65%) of the energy-balance programs used schools as the main settings for integrating diet and PA for promoting behavioral changes [ 24 , 25 , 26 , 27 , 32 , 34 , 37 , 38 , 39 , 41 , 44 , 45 , 50 ], 3 (15%) use the home setting [ 30 , 47 , 50 ], and two (10%) developed a web-based platform to deliver the intervention [ 40 , 46 ]. Some programs, which used schools as the main setting, combined multiple components to deliver the intervention, such as combining weekly text messages and other mobile device technology (e.g., developing an app) [ 25 , 26 ], or integrating the family context (e.g., parents newsletters, homework, and booklets) [ 26 , 34 , 50 ].…”

“…Some of these studies ( n = 13, 65.0%) [ 25 , 26 , 27 , 30 , 36 , 37 , 38 , 39 , 41 , 44 , 49 , 50 ] combined other measurements to assess anthropometric outcomes, such as body fat percentage, waist circumference, and/or waist-to-hip ratio. Dietary intake was assessed with either food frequency questionnaires [ 25 , 26 , 27 , 30 , 44 ] or 24 h recalls [ 34 , 45 , 46 , 49 ]. Those studies that utilized 24 h recalls used at least two records to estimate participants’ usual intake.…”

“…Those studies that utilized 24 h recalls used at least two records to estimate participants’ usual intake. For those studies that measured PA, some used questionnaires [ 24 , 30 , 34 , 39 , 45 ], while others used objective measurements such as accelerometers [ 25 , 26 , 27 , 49 ] or pedometers [ 34 ]. Some studies ( n = 6, 30.0%) evaluated the youth’s physical fitness (e.g., cardiovascular, flexibility, muscular, strength, and agility) [ 25 , 27 , 36 , 39 , 45 , 50 ].…”