Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies

Abstract

Obesity is a major public health concern and there are increasing calls for policy intervention. As obesity and the related health conditions develop during childhood, schools are being seen as important locations for obesity prevention, including multifaceted interventions incorporating policy elements. The objective of this systematic review was to evaluate the effects of policies related to diet and physical activity in schools, either alone, or as part of an intervention programme on the weight status of children aged 4 to 11 years. A comprehensive and systematic search of medical, education, exercise science, and social science databases identified 21 studies which met the inclusion criteria. There were no date, location or language restrictions. The identified studies evaluated a range of either, or both, diet and physical activity related policies, or intervention programmes including such policies, using a variety of observational and experimental designs. The policies were clustered into those which sought to affect diet, those which sought to affect physical activity and those which sought to affect both diet and physical activity to undertake random effects meta-analysis. Within the diet cluster, studies of the United States of America National School Lunch and School Breakfast Programs were analysed separately; however there was significant heterogeneity in the pooled results. The pooled effects of the physical activity, and other diet related policies on BMI-SDS were non-significant. The multifaceted interventions tended to include policy elements related to both diet and physical activity (combined cluster), and although these interventions were too varied to pool their results, significant reductions in weight-related outcomes were demonstrated. The evidence from this review suggests that, when implemented alone, school diet and physical activity related policies appear insufficient to prevent or treat overweight or obesity in children, however, they do appear to have an effect when developed and implemented as part of a more extensive intervention programme. Additional evidence is required before recommendations regarding the focus of policies can be made and therefore, increased effort should be made to evaluate the effect of policies and policy containing intervention programmes upon weight status.

Childhood Obesity Prevention: Does Policy Meet Research? Evidence-Based Reflections upon the Spanish Case

“…38 Some authors claim for longer follow-ups, which would allow assessing whether the changes last over time. [32][33][34][35][36][37][38][39][40][41] Regarding intervention characteristics, most reviews report actions based on nutritional education. While leaflets or two-hour activities can improve knowledge, they have not shown to modify behaviours sustainably.…”

“…However, more research is needed to confirm this hypothesis. [35][36][37][38][39][40][41][42][43] In addition, particularly at young ages, habit changes do not directly depend on children but rather on the adults in their environment, principally parents, but also other relatives, neighbors, teachers, and canteen educators. As expected, family involvement emerges as a crucial aspect [36][37][38][39][40][41][42][43][44][45][46][47][48] although a remaining major question concerns how they should be involved.…”

“…[35][36][37][38][39][40][41][42][43] In addition, particularly at young ages, habit changes do not directly depend on children but rather on the adults in their environment, principally parents, but also other relatives, neighbors, teachers, and canteen educators. As expected, family involvement emerges as a crucial aspect [36][37][38][39][40][41][42][43][44][45][46][47][48] although a remaining major question concerns how they should be involved. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Public policies against childhood obesity at European level As we can observe in Table 2, actions against childhood obesity have been undertaken from all institutional levels: the WHO, the WHO Regional Office for Europe, the EU Commission and the Spanish government has developed wide-range policies aiming at offering an integral solution to the dramatic rise of obesity rates.…”

Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

“…This view is reinforced by other research using data from the NCMP that suggested that there was no consistent school effect on childhood obesity. 143 Future studies need to develop interventions that aim to specifically affect the family environment, perhaps employing a more widely co-ordinated whole-systems approach, although it is unlikely that such an approach would be feasible to deliver within a school setting.…”

Análisis de los niveles de adiposidad y condición física en jóvenes escolares colombianos

“…Igualmente, en varias revisiones sistemáticas se ha señalado la necesidad de desarrollar políticas que fomenten el ejercicio físico, con el objetivo de aumentar la masa libre de grasa, mantener un peso corporal saludable y prevenir enfermedades en niños y jóvenes (18,19). A pesar de los avances en la divulgación de información y de las campañas y políticas públicas de prevención de la obesidad y de promoción de estilos de vida saludables y activos, en la sociedad actual se evidencia una elevada inactividad física, que ya se considera un problema de salud pública a escala global y que se perfila como el mayor del siglo XXI (20)(21)(22).…”