Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program

Abstract

Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8–12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.

Impacts of School Nutrition Interventions on the Nutritional Status of School-Aged Children in Asia: A Systematic Review and Meta-Analysis

“…These studies included 15 cluster randomized control trials (CRCTs), 10 quasi-experiments, and 3 randomized controlled trials (RCTs), which accounted for 53.6%, 35.7%, and 10.7%, respectively. They were conducted in nine countries and two territories from different regions of Asia, namely mainland China [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], Hong Kong–China [ 37 , 38 ], Taiwan–China [ 39 ], Korea [ 40 ], Turkey [ 41 , 42 , 43 ], Lebanon [ 44 , 45 ], Israel [ 46 , 47 ], Iran [ 48 ], India [ 49 ], Malaysia [ 50 ], and Thailand [ 51 ]. The majority of the studies (75%) took place in upper-middle income countries [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 41 , 42 , 43 , 44 , 45 , 46 , 49 , 51 , 52...…”

“…The majority of the studies (75%) took place in upper-middle income countries [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 41 , 42 , 43 , 44 , 45 , 46 , 49 , 51 , 52 ], followed by high-income countries (21.4%) [ 37 , 38 , 39 , 40 , 46 , 47 ] and low-middle income countries (3.6%) [ 49 ]. Most of these studies (85.7%) were carried out in urban areas or large cities [ 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 ,…”

“…Among CRCTs and RCTs, nine studies were categorised as high risk of bias mostly due to the lack of information on controlling possible bias for either the outcome measurement or from non-adherence, and selective reporting of findings [ 25 , 27 , 30 , 31 , 32 , 41 , 42 , 43 , 44 , 45 , 52 ]. The rest were studies with some concerns [ 28 , 34 , 37 , 39 , 48 ] or low risk of bias [ 29 , 33 , 36 ].…”

“…Six studies were carried out primarily by researchers in the health sector [ 25 , 27 , 28 , 29 , 34 , 35 ], while most studies were conducted by academic institutions. Five interventions co-developed relevant curriculums or programmes in collaboration with government agencies such as the Ministry of Education [ 31 , 44 , 47 ], educational and health authorities [ 42 ], and the local council [ 46 ] to gain cooperation from schools and other local stakeholders. Six interventions were the health sectors’ initiatives [ 25 , 27 , 28 , 29 , 34 , 35 ], while the rest did not seek government support to work with the schools.…”

“…To implement the interventions, five studies were conducted entirely by investigators [ 32 , 38 , 39 , 40 , 43 ] and 23 studies engaged the schools and local actors. For the latter, teachers were engaged to provide nutrition education (NE) [ 28 , 29 , 45 ], physical activity promotion, such as physical education (PE), exercise prescriptions or/and enabling environment for active lifestyle [ 30 , 34 , 35 , 47 ], both NE and physical activity promotion [ 25 , 27 , 31 , 36 , 42 , 44 , 46 , 48 , 49 ], and to take students’ anthropometric measurement [ 51 ]. Kitchen or canteen staff were asked to provide healthier food [ 27 , 28 , 31 , 33 , 36 , 42 , 44 , 45 , 48 , 49 ].…”