Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Obesity prevention in primary school settings: evidence from intervention studies
focused primarily on reducing obesity, or this can be
a component of an intervention with another main
goal (e.g., interventions for preventing childhood diabetes).
Furthermore, the targeting can be primary
prevention (addressing the general population), secondary
prevention (addressing the population at risk
of obesity), tertiary prevention (treating the obese
population), or integrated/comprehensive (combination
of the three level preventions).
Intervention programs may take place only in one
school (single level), or multiple schools at the community,
region, national, and even international levels
(multiple levels). The intervention may engage any
combination of stakeholders including individual
participants or organizations from the health sector,
non - health sector, policy - makers, teachers, school
nurse, parents and grandparents. A number of determinants
can be addressed, including one or any combination
of the determinants as described in Table
10.1 . In general, interventions lasting less than one
year are defined as short - term, while those lasting one
year or more are long term. 15 Considering that behavior
change is central to preventing obesity, the
effectiveness of short - term interventions may be
biased and even regressive whereas effective long - term
interventions are more promising. Commonly used
outcomes can be divided into the following categories:
body composition (e.g., BMI, fat distribution, prevalence
of obesity/overweight, skin - fold thicknesses);
nutrition/dietary habits (e.g., food choice, food
consumption, energy intake and sources); physical
activity (e.g., frequency, duration, intensity, sedentary
behaviors); psycho - social factors (e.g., self - esteem,
body image, stress level, feelings of support); knowledge
(e.g., knowledge of chronic disease risk factors,
nutrition and physical activity requirements for
optimal health); and policy options (e.g., using a panel
of experts and an appropriate framework such as
a socio - ecological model/life - course/social model of
health.
16
In the absence of other evidence, experts suggest
that these should be multi - component in nature. It
is important to take into consideration that schools
are faced with multiple curricular obligations
with limited financial and staff resources. Even well -
intentioned and motivated teachers have reported
limited classroom time to address health education
adequately.
Table 10.1 Intervention components.
Level of determinants
Individual determinants
Familial determinants
Environmental determinants
Components
Substantial dietary modifications
Substantial physical activity
modifications
Psycho - social interventions
focusing on self - esteem, body
image, peer support and stress
management
Behavior modifications focusing
on motivational reinforcement
Health education on diet and
physical activity
Tailored individually
Subject - directed (subjects actively
engaged in the programs)
Health education
Dietary modifications
Physical activity modifications
Knowledge and attitude
Support from family members
Create or advocate for healthy
social environments
Physical environments (e.g.,
sports equipment, time and place,
transport, canteen, snack shop,
vending machines)
Cultural environments (e.g., media
and culture)
What h as b een p roven e ffective
The primary focus of this chapter is interventions that
include a primary prevention approach at the school -
based level on which a number of reviews have been
conducted.
15 – 24
The aim of the intervention is a key
inclusion/exclusion criterion used by various reviews.
The Cochrane review series, most recently updated by
Summerbell et al, 15 aimed to examine the effectiveness
of interventions on overweight/obesity prevention,
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