School-based obesity interventions: a literature review

BACKGROUND: Childhood obesity is an impending epidemic. This article is an overview of different interventions conducted in school settings so as to guide efforts for an effective management of obesity in children, thus minimizing the risk of adult obesity and related cardiovascular risk. METHODS: PubMed and OVID Medline databases were searched for school-based obesity interventions with anthropometric measures in children and adolescents between the ages of 7 and 19 years from June 1986 to June 2006. Studies were reviewed by duration, type of intervention, and defined qualitative and quantitative measures, resulting in a yield of 51 intervention studies. RESULTS: The interventions ranged from 4 weeks in length to as long as 8 continuing years. In total, 15 of the intervention studies exclusively utilized physical activity programs, 16 studies exclusively utilized educational models and behavior modification strategies, and 20 studies utilized both. In addition, 31 studies utilized exclusively quantitative variables like body mass indices and waist-to-hip ratios to measure the efficacy of the intervention programs, and another 20 studies utilized a combination of quantitative and qualitative measures that included self-reported physical activity and attitude toward physical activity and the tested knowledge of nutrition, cardiovascular health, and physical fitness. A total of 40 studies achieved positive statistically significant results between the baseline and the follow-up quantitative measurements. CONCLUSIONS: No persistence of positive results in reducing obesity in school-age children has been observed. Studies employing long-term follow-up of quantitative and qualitative measurements of short-term interventions in particular are warranted.     

Parent–child interactions and obesity prevention: a systematic review of the literature

Child obesity research has generally not examined multiple layers of parent–child relationships during weight-related activities such as feeding, eating and play. A literature review was conducted to locate empirical studies that measured parent–child interactions and child eating and child weight variables; five papers met the inclusion criteria and were included in the review. The findings of the review revealed that parent–child relationships are an important element in explaining the unhealthy trend of childhood obesity. We argue that prevention/intervention strategies must extend on the current models of parenting by targeting the family from a bi-directional perspective, and focusing, specifically, on the mutually responsive orientation that exists in the parent–child relationship.     

Native American childhood obesity prevention interventions: a systematic review

Native American populations are at higher risk for becoming obese and suffering from obesity-related illness compared with other populations. Concurrently, prevention methods have not been successful with this group, especially intervention attempts aimed at children, which have been few and ineffective. The purpose of this systematic review was to evaluate the effectiveness and methodologies of childhood obesity prevention interventions targeting Native American youth, and to make recommendations to future researchers and practitioners. Seven databases (Medline, Academic Search Premier, CINAHL, ERIC, Health Source Nursing, PsychINFO, and Sport Discus) were utilized to retrieve articles, using four sets of keywords; 1. Children AND Obesity AND Native American AND Program; 2. Children AND Obesity AND Native American AND Intervention; 3. Children AND Obesity AND Indian AND Program; and 4. Children AND Obesity AND Indian AND Intervention. Overall, six articles were found and evaluated for salient findings and key methodological issues such as use of theory, intervention duration, research design, outcome measures, process evaluation, and validated measures. Results indicated that theory was seldom used in planning the interventions, process evaluations were used some of the time, and half of the interventions were smaller pilot studies. This review suggests that there have been few interventions targeting obesity prevention among Native American youth over the past decade. Recommendations for enhancing such programs are discussed.     

Sleep problems in pre-school children: a review of the literature

Summary This paper reviews the literature on sleep problems in preschool children, aiming to raise awareness of the current knowledge in this field. The article begins with a discussion of the prevalence of sleep problems in young children. Disorders of initiating and maintaining sleep are by far the most common type of sleep problem in this age group, and are therefore the focus of this review. The effects of sleep disturbance are examined, focusing on how parents often feel desperate and in need of support outside the family. The causes of sleep problems are considered and the complexity in identifying causal factors is highlighted. The article continues with an exploration of the treatment of sleep problems, suggesting that much of the advice given to parents is contradictory. The literature demonstrates that the use of medication is common, but it appears that this method of treatment is of limited benefit. It seems that behaviour modification or a psychodynamic approach may be much more successful, and the use of self-help manuals/booklets has been shown to be useful by some authors. Finally, preventative strategies are discussed highlighting the need for further research in this area.     

A review of childhood obesity prevention interventions targeting African American children

Obesity is a significant public health concern. Unfortunately, obesity affects minority youth populations disproportionately, with African Americans (AAs) 1.4 times as likely to be obese as non-Hispanic whites. There are a variety of reasons for the disparity of the obesogenic risk in AA children. In addition to genetic factors, cultural differences related to the nutritional habits, level of physical activity and acceptance of surplus weight among AAs play a major role in the development of obesity in this population. Considering these high-risk behaviors, and the associated barriers, the Institute of Medicine has expressed an urgent need to initiate childhood obesity interventions among diverse ethnic groups. Therefore, the purpose of this article was to review existing childhood obesity prevention interventions targeting AA children that were published between 2005 and 2010. This review was limited to interventions in which the population included more than 35% of AA children and adolescents. There was an abundance of interventions related to childhood obesity prevention, but fewer targeting specifically AA children and adolescents. A total of 18 interventions have been summarized, including behavioral, social and environmental approaches. Recommendations are presented to enhance childhood obesity interventions among diverse ethnic groups.     

学龄前儿童肥胖的预防和干预

【目的】通过研究寻找出减少托幼机构肥胖儿童发生的有效方法。【方法】随机抽取闸北区2所托幼机构4~5岁60例超重及肥胖的学龄前儿童及相同条件的其他2所托幼机构4~5岁60例超重及肥胖的学龄前儿童分别作为干预组和对照组。干预组儿童,要求每天减少静态少动时间(30 min),增加运动量20%,用计步器作24 h运动强度记录(入园前、离园前记录两次)。在干预研究结束后,对两组儿童进行体格比较及体能测试。【结果】干预组儿童超重和肥胖程度的减轻或痊愈明显好于对照组,差异有显著性。【结论】托幼机构中开展肥胖儿童的预防和干预工作是可行并且是有效的。     

学龄期儿童肥胖与膳食钙关系

目的 了解目前上海市区学龄期儿童超重肥胖发生率和膳食钙摄入情况,分析肥胖与膳食钙关系。方法 对上海市杨浦区和宝山区10所小学二、三年级学生进行体检,并对其中6所小学学生进行钙摄入量调查,分析学生超重肥胖流行状况和膳食钙摄入情况及其相互关系。结果 上海市部分地区学龄期儿童超重肥胖率高达36.0%;总钙摄入量为647mg/d,达到推荐摄入量(RNI)的仅有26.4%;总钙摄入量与肥胖无关(χ²=0.319,P=0.956);单位体重钙摄入量与肥胖有关,单位体重钙摄入量越高,超重和肥胖的发生率越低(χ²=65.022,P=0.000);肥胖相关指标如体重(χ²=101.660,P=0.000)、体质指数(BMI)(χ²=85.223,P=0.000)、体脂百分比(PBF)(χ²=64.869,P=0.000)、收缩压(SBP)(χ²=35.626,P=0.000)、舒张压(DBP)(χ²=24.779,P=0.000)等随着单位体重钙摄入量的增高而降低。结论 单位体重钙摄入量为与肥胖有关,随着单位体重钙摄入量的增高,超重肥胖发生率降低,体重、BMI、PBF、SBP、DBP、腰围和肥胖度也明显降低(P<0.05)。     

学龄前超重、肥胖儿童群体综合干预研究

【目的】探讨群体综合干预措施对超重、肥胖的学龄前儿童生长发育及体重的影响,减少学龄前儿童单纯性肥胖症的发生。【方法】选择超重、肥胖的学龄前儿童按自愿参加的原则分别随机分为干预组和对照组,对干预组进行综合群体干预,措施包括膳食调整、行为矫正、运动处方、健康教育。一年后对两组进行比较分析。【结果】实施干预后研究组儿童28.5%由肥胖转为正常或超重,高于对照组的4.5%(χ2=8.147,P<0.05);干预后干预组Kaup指数平均下降1.5,而对照组平均上升1.3,差异具有显著性(t=5.97,P<0.05),同时对儿童的身高发育没影响。【结论】以膳食结构调整为主的综合干预措施对防治学龄前儿童超重、肥胖状况,是一种有效、可行的方法,值得推广。     

家庭环境对学龄前儿童肥胖的影响

目的 分析家庭环境对学龄前儿童肥胖的影响,为今后儿童肥胖防治工作的开展提供依据和指导。方法 采用随机整群抽样的方法,病例组和对照组按照1∶1配对,通过家长问卷调查儿童家庭环境情况。采用单因素、多因素回归分析,探讨影响儿童肥胖的危险因素或保护因素。结果 多因素结果显示,女童(OR=0.55,95%CI:0.32~0.96)、父母经常鼓励孩子多吃(OR=0.37,95%CI:0.22~0.65)、父母认为子女体力活动过多(OR=0.24,95%CI:0.08~0.71)是儿童超重或肥胖的保护因素,有超重肥胖家族史(OR=2.25,95%CI:1.21~4.20)、认为孩子胖(OR=12.99,95%CI:7.08~23.84)是儿童发生超重或肥胖的危险因素。结论 父母对儿童肥胖的认知态度是儿童超重肥胖的重要影响因素,可对肥胖儿童开展以家庭为基础的行为治疗措施。     

Deprivation and childhood obesity: a cross sectional study of 20,973 children in Plymouth, United Kingdom

OBJECTIVE: To study the association between socioeconomic deprivation and childhood obesity. DESIGN: Cross sectional study. SETTING: All state primary schools in Plymouth. Plymouth is a relatively deprived city in the United Kingdom, ranking 338th of 366 local authorities on the Department of the Environment Index of Local Conditions. SUBJECTS: 20 973 children between the ages of 5 and 14 years, 1994-96. MAIN OUTCOME MEASURE: Numbers of obese children (body mass index (BMI) above the 98th centile) by quarters of Townsend score. RESULTS: Plymouth had a rate of childhood obesity two and half times that expected nationally (5% v 2%). The obesity prevalence increased with age, being almost double in the oldest age quarter (boys 6.2%; girls 7.0%), compared with the youngest age quarter. Within Plymouth, there was a significant trend for higher rates of obesity related to increasing deprivation in both boys (p=0. 017) and girls (p=0.018). The odds ratio (OR) for childhood obesity (highest-lowest quarter of Townsend scores) had borderline significance in boys (OR 1.29, 95% confidence intervals (CI) 1.00 to 1.65, p=0.049) but was larger and more significant in the girls (OR 1.39, 95% CI 1.08 to 1.80, p=0.011). Unlike boys, the association between obesity in girls and Townsend scores became stronger with age such that in the oldest age quarter (over 11.7 years), girls in the highest quarter of Townsend scores were nearly twice as likely be obese, as compared with the lowest quarter (OR 1.95, 95% CI 1.23 to 3.08, p=0.005). State of pubertal development could not be accounted for as this information was not available. CONCLUSIONS: This study provides evidence for an association between deprivation and childhood obesity in this English population. The health of children from deprived households is affected by a number of adverse influences. The high prevalence of obesity in these children is yet another factor that could predispose to greater morbidity in adult life.     

甘油二酯转酰基酶-1基因多态性与汉族儿童单纯性肥胖症的相关性研究

【目的】探讨甘油二酯转酰基酶-1(DGAT1)基因多态性与儿童单纯性肥胖症的关系。【方法】分别测量69名单纯性肥胖症儿童和68名健康儿童的身高和体重,自动生化分析仪上测定血甘油三酯(TG)和总胆固醇(CHO)含量,应用PCR、限制性内切酶法和DNA序列测定法检测DGAT1基因C79T位点和K378N位点多态性。【结果】尚未发现中国汉族儿童DGAT1基因K378N位点存在基因多态性。不同性别儿童的C79T位点各基因型频率及等位基因频率差异无统计学意义。肥胖儿童DGAT1基因C79T位点的各基因型频率差异无统计学意义。肥胖儿童DGAT1基因C79T位点C等位基因频率与健康对照儿童差异无统计学意义。男童和女童的C79T位点基因型TT型和TC型间TG、CHO和BMI都不存在显著性差异。【结论】未发现DGAT1基因K378N位点存在基因多态性。肥胖儿童DGAT1基因C79T位点的TC基因型频率和CC基因型频率稍高于健康对照儿童,但差异无统计学意义。     

Healthy casetas: A potential strategy to improve the food environment in low-income schools to reduce obesity in children in Guatemala City

Developing countries have undergone transitions driven by globalization and development, accelerating increases in prevalence of overweight and obesity among children. Schools have been identified as effective settings for interventions that target children’s dietary behaviors. In Guatemala, public schools commonly have food kiosks (Casetas) that sell products to children. From July through October 2013, observations during recess, in-depth interviews with school principals (n = 4) and caseta vendors (n = 4), and focus groups with children (n = 48) were conducted. This article explores products available to children at casetas. Factors that affect what casetas offer include regulations and enforcement, vendor investment and earnings, vendor resources, product demand, pricing, and children’s preferences. These factors influence the products that are available and children’s tendency to purchase them. Potential strategies for improvement include healthy food preparation, price manipulation and promotions, raffles and games to encourage healthier choices, and policy to push toward development of healthier products.     

Estimates of overweight and obesity among samples of preschool-aged children in Melbourne and Sydney

Objective: Childhood obesity is a significant and increasing public health issue. We present results from two cross‐sectional surveys from Melbourne and Sydney that sought to estimate the level of overweight and obesity among preschool‐aged children. Methods: In Melbourne, weight and height of 196 children from 12 randomly selected preschools and kindergartens were measured and recorded. In Sydney, data on weight and height of 325 children attending four early childhood centres were extracted from client records. The two studies used the age and gender‐specific body mass index criteria for classifying overweight and obesity. Results: The prevalence of Melbourne preschool‐aged children considered overweight was 15.3% for boys and 17.3% for girls, with a further 7.1% of boys and 8.2% of girls considered obese. In Sydney, the proportion of children considered overweight was 15.3% for boys and 26.3% for girls. An additional 8.7% of boys and 8% of girls were considered obese. Conclusion: There is some evidence that childhood obesity may begin in the preschool years. Intervention programs targeting obesity should be considered for families with preschool‐aged children in urban Australia.     

Child obesity prevalence across communities in New Zealand: 2010–2016

Objective : To assess community‐level differences in four‐year‐old obesity prevalence in New Zealand (NZ), trends over time, and the extent to which differences can be explained by ethnicity, deprivation and urbanicity. Methods: Obesity measures from the Ministry of Health’s B4 School Check were available for 72–92% of NZ four‐year‐olds for fiscal years 2010/11–2015/16. Ethnicity, deprivation and urbanicity data for the 78 communities were obtained by linking to administrative records. Growth models were used to examine variability in obesity levels and trends over time, and the extent to which ethnicity, deprivation and urbanicity contributed to differences between communities. Results : There were large variations in obesity across communities (range 8.4% to 28.8%). A decline in the prevalence of childhood obesity was observed in most (48 of 78) communities from 2010/11 to 2015/16 (average change=0.2%, range=‐2.0% to 1.9%). Around 50% of the variance in obesity between territorial authorities could be explained by differences in socioeconomic deprivation and ethnic composition. Conclusions : Child obesity varies between NZ communities, but most territorial authorities have experienced a decrease in obesity over the period 2010/11–2015/16. Implications for public health : Addressing deprivation and ethnic inequalities in obesity could substantially reduce community‐level differences in obesity in NZ.     

Childhood obesity: successes and failures of preventive interventions

Despite progress toward assuring the health of today's young population, the 21^st century began with an epidemic of childhood obesity. There is general agreement that the situation must be addressed by means of primary prevention, but relatively little is known about how to intervene effectively. The evidence behind the assumption that childhood obesity can be prevented was discussed critically in this roundtable symposium. Overall, there was general agreement that action is needed and that the worldwide epidemic itself is sufficient evidence for action. As the poet, writer, and scholar Wittner Bynner (1881–1968) wrote, "The biggest problem in the world could have been solved when it was small".     

Food advertising targeted at school-age children: a content analysis

OBJECTIVE: To determine whether the contents of food and beverage advertisements are associated with physical activity and athletic ability more often than those for toys and games, and to describe persuasive techniques used in advertising food and beverages to children. DESIGN: A content analysis of advertisements during 31 hours of school-age children's television programming. ANALYSIS: Chi-square tests were used to examine differences in depictions of physical activity. Types of persuasive techniques were tabulated and, within each advertisement, categorized as implicit or explicit. RESULTS: Food and beverage ads depicted children engaged in physical activity and associated the advertised product with athletic ability significantly more than toy and game ads. Food was most often associated with fun and good times (75%), pleasant taste (54.1%), being hip or cool (43.2%), and feelings of happiness (43.2%). IMPLICATIONS FOR RESEARCH AND PRACTICE: These findings raise concern that greater levels of physical activity and athletic ability in food advertising, in which the product is frequently associated with fun, may promote overconsumption, especially of calorie-dense, nutrient-poor foods. Further research would elucidate whether this concern is warranted. On the other hand, since food advertisements are presumably effective, health educators can use these techniques to formulate messages for nutritious foods. This concept should be tested with well-designed interventions.