Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon

Abstract

BackgroundIn Lebanon, childhood obesity doubled during the past decade. Preventive measures should start early in life and Schools are considered an important environment to promote energy balance health behaviours. School-based programmes promoting healthy lifestyles are lacking. The purpose of this study was to evaluate the feasibility and effectiveness of a multicomponent school-based intervention to promote healthy eating and physical activity (and prevent obesity) with school children aged 9–11 years in Lebanon.MethodsThe intervention was developed based on the constructs of the Social Cognitive Theory and adapted to the culture of Lebanese and Arab populations. It consisted of three components: class curriculum, family involvement and food service. Eight schools were purposively selected from two communities of different socioeconomic status (SES) in Beirut and, within each school type, were matched on SES, religious sect profile, and then randomly assigned to either the intervention or control group. Anthropometric measurements and questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted in intervention schools at the end of the study. Challenges encountered during the programme implementation were also identified, since Lebanon is considered a country with political unrest and no similar research projects were conducted in the area.ResultsStudents in the intervention group reported purchasing and consuming less chips and sweetened drinks post-intervention compared with controls (86% & 88% less respectively p < 0.001). Knowledge and self-efficacy scores increased for the intervention (+2.8 & +1.7 points respectively p < 0.001) but not for the control group. There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Interview data from focus groups showed that the programme was generally well accepted. Limitations for better outcomes include the length of the programme and the school environment.Conclusion“Health-E-PALS” intervention is a promising innovative, theory-based, culturally sensitive intervention to promote healthy eating habits and physical activity in Lebanese school children with a potential to be scaled up, replicated and sustained.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-940) contains supplementary material, which is available to authorized users.

Educational strategies for the prevention of diabetes, hypertension, and obesity

“…41 Healthy eating: the first step to living longer and better The risk regarding the acquisition of chronic diseases such as obesity, diabetes and hypertension, especially in childhood, decreases considerably with a diversified and balanced diet rich in almonds, fruits, legumes, and vegetables, with an adequate intake of water, and avoiding the consumption of highly processed foods, carbonated beverages, and artificial juices. [48][49][50][51] However, the high cost of healthier foods has made the access more difficult by economically disadvantaged populations. 52 Meanwhile, the supply and demand for low-cost foods with lower nutritional value has increased, particularly in educational institutions for children and young people.…”

Systematic Review of School‐Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness?

“…Table presents the intensity evaluation of studies aiming to modify behavior across different nutrition categories. Interventions in each category were highly effective: fruit and vegetable (N = 33; effective N = 27, ineffective N = 4, unknown effectiveness N = 2), general healthy eating (N = 53; effective N = 41, ineffective N = 10, unknown effectiveness N = 2), single food or food group (N = 12; effective N = 8, ineffective N = 3, unknown effectiveness N = 1), and single nutrient (N = 7; effective N = 5, ineffective N = 1, unknown effectiveness N = 1). Comparing the frequency of effective studies in different categories showed that the mean frequency of interventions in the single food or food group category was significantly higher than for the general healthy eating category (ANOVA p = .04, Tukey's post hoc test p = .03).…”

Development of Dietary Knowledge and Adherence Questionnaires for Lebanese Adolescents and Their Parents

“…The parental version had a somewhat higher Cronbach's alpha value, which can be explained by the fact that the current DKQ was based on a knowledge questionnaire that was originally developed for adults [17]. The internal validity of the current questionnaire is higher compared to previously developed knowledge questionnaires for younger Lebanese children (aged 9-11 years; alpha: 0.66) [25], and for older adolescents (aged 17-18 years; alpha ranged from 0.5 to 0.75) [41].…”

“…However, prior to planning any health promotion program targeting this particular age category, it is necessary to have reliable tools to assess the current levels of dietary knowledge and adherence to determine the effectiveness of such interventions later on. To our knowledge, studies assessing the relationship between dietary knowledge and adherence are scarce [25], particularly in the Middle East. Correspondingly, there is a paucity of reliable Arabic questionnaires measuring dietary knowledge and adherence.…”

“…In addition, the few available studies involving Lebanese youth did not describe the details of the process for developing such questionnaires. In addition, despite the difference between urban and rural regions as described above, previous studies often did not include participants living in rural regions [25]. This highlights the need to develop reliable and valid, user-friendly and inexpensive tools to assess levels of dietary knowledge and adherence among Lebanese adolescents living in urban and rural areas.…”