School-Based Intervention as a Component of a Comprehensive Community Program for Overweight and Obesity Prevention, Sousse, Tunisia, 2009–2014

Abstract

IntroductionCombating obesity at an early age, by improving physical activity and nutrition-related behaviors, is vital to the prevention of more critical health concerns in adulthood. This intervention study evaluated the effectiveness of a school-based component of a community behavioral intervention on overweight and obesity rates of adolescents in Sousse, Tunisia.MethodsA quasi-experimental school-based intervention was conducted with an intervention group (in Sousse Jawhara and Sousse Riadh) and a control group (in Sousse Msaken). The intervention (which was a physical activity and nutrition program) lasted 3 years, with data at preintervention collected during the 2009–2010 school year and at postintervention collected during the 2013–2014 school year. Descriptive statistics and multivariate analysis were used to determine the effect of the intervention on risk of excess weight.ResultsResults showed a significant increase in fruit and vegetable intake by the intervention group (P = .04). The intervention group had an increase in students in the normal weight category (P = .03) and a decrease in students in the overweight category (P = .03).The intervention effect was a protective factor against excess weight for the participating schoolchildren (OR, 0.84; P = .02).ConclusionThis study showed that a school-based intervention is successful in increasing healthy dietary habits and in reducing risk of excess weight. It also showed the importance of a multisectoral approach to provide an environment conducive to healthy behaviors for adolescents.

Delivering in‐school interventions to improve dietary behaviours amongst 11‐ to 16‐year‐olds: A systematic review

“…The target behaviours in the reviewed studies included increasing fruit and/or vegetable consumption (n = 19); improving snacking behaviours (n = 8) (this included both decreasing the intake of energy‐dense nutrient‐poor snacks) and increasing healthy snacks like fruits and vegetables; decreasing sugar‐sweetened beverage (SSB) intake (n = 8); encouragement to eat meals on a regular basis (n = 4); improving general eating behaviours (eg, increase daily nutritional recommended intake of carbohydrates, fibre minerals, protein, and vitamins, n = 5), and reducing daily fat and sugar intake (n = 3) . A number of studies (n = 13) targeted more than one dietary behaviour in their intervention (eg, increasing fruit and vegetable consumption, decreasing SSB and unhealthy snacks consumption) …”

“…In terms of eating behaviour assessments, behavioural measures included food frequency questionnaires (FFQ) (n = 24), food diaries over periods of time ranging from 24 hours to 7 days (n = 3; including one online), dietary interviews including general structured interviews on daily dietary consumption (n = 2), a paired food questionnaire (one healthy and one unhealthy option; n = 2), and a “true or false” food statement questionnaire (would you eat a foodstuff, “true or false”; n = 1). All of the reviewed studies had a “before and after” measurement of dietary behaviour, and 14 studies included a longer‐term follow‐up assessment (ranging from 6 weeks to 4 years), whilst two studies also included a measure mid‐intervention …”

“…The majority of the studies (n = 22) included at least one other measure that was not dietary behaviour, such as the amount of physical activity (n = 14), anthropometric assessment (body mass index; n = 8), physical and dietary social norms (subjective and group; n = 4), self‐efficacy (n = 3), perceived behavioural control (n = 3), behaviour intention (physical activity and dietary) (n = 5), sedentary behaviours (including television viewing; n = 5), habit strength (n = 1), blood pressure (n = 1), tobacco use (n = 1), and self‐perception (self‐esteem and body dissatisfaction measures; n = 1) …”

“…The main intervention components of the 29 studies are outlined in Supplementary Table 2. The majority of studies included a healthy eating lesson component (n = 20), healthy eating activities (eg, practical activities—role‐playing; n = 13), a worksheet (eg, problem solving; n = 16), and/or a practical lesson (n = 11) . Ten studies included a combination of healthy eating lesson, activities, and a worksheet .…”

“…An additional seven studies were judged to be at high risk of bias primarily because the individual study designs were identified as not being randomised controlled trials (RCTs). Most of the studies were judged to have at least one domain of unclear risk of bias; this was mainly owing to the selective reporting of features of these studies. The main feature that was not reported was the blinding of participants and/or researchers to group allocation.…”