PAAPPAS community trial protocol: a randomized study of obesity prevention for adolescents combining school with household intervention

Abstract

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.

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

“…The sample size calculation of 2500 students was based on a change of 1•1 BMI units in the experimental group compared with the control group for the secondary intervention based on a previous study (15) , with a standard deviation (SD) of 3•0 kg/m 2 , 80 % power and a 5 % significance level. School classes from each one of the shifts (morning, afternoon and late afternoon) were the cluster unit with an intracluster correlation of 0•02 (16) .…”

“…The content of the interventions was previously discussed with teachers of the eligible schools and adjusted according to the school programme. Details of the study design and interventions were previously published (16) . In short, interventions at schools were based on educational games, group debates and culinary classes with focus on: (1) reducing the intake of cookies and sugar-sweetened beverages; (2) assembling colourful and tasty salads using vegetables and fruits through culinary classes; (3) encouraging water consumption; (4) increasing physical activity and reducing sedentary behaviour; (5) serving a healthy meal; and (6) reducing the dependence on processed food.…”

“…The study design and intervention strategies were discussed and approved by the health and education municipal authorities. The trial protocol has been previously reported (16) in accordance with the Consolidated Standards of Reporting Trials Statement (22) . The study protocol was approved by the Ethical Committee of the Social Medicine Institute (State University of Rio de Janeiro, Brazil).…”

“…The protocol registration was CAAE 10471313.2.0000.5260. Further details on recruitment, sample size estimation, data collection, PAAPPAS interventions at school and statistical analysis are found in Sgambato et al (16) .…”

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity

“…This project is a factorial trial which continues previous research called PAAPPAS study (Portuguese abbreviation of “parents, students, community health agents and teachers for healthy eating”). [ 19 ] The present project will be conducted in schoolchildren, keeping the already consolidated components of primary prevention and including actions that aim to improve the adherence response to the interventions and providing a broad spectrum of actions to reach adolescence-based obesity prevention, including changes in School environment. More specifically, the present research aims to estimate the effect of “nudge” strategies on the students’ body mass index (BMI), from changes at the school environment, with the aim of creating school cafeterias that guide smarter food choices.…”