Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 11
translation (see Chapter 22 , Knowledge translation
and exchange for obesity prevention) is the notion
that there needs to be an exchange between all stakeholders.
Therefore adolescents should be consulted on
matters concerning the promotion of their healthy
eating and physical activity behaviors.
School - b ased a pproach
A “ whole school ” approach (i.e., one involving all
members of the school community) can be effective
in promoting healthy eating. 11 If schools make changes
to the availability of foods within their canteens/
tuck - shops, complemented by classroom activities,
providing information on nutrition can be effective. 11
Classroom - based activities that promote healthy
eating have been most successful when working in
small group discussions and peer - led activities. These
activities can also be complemented by learning about
the environmental influences on food as this has been
judged effective for reported healthy eating, particularly
among young women in secondary schools. It is
important that teacher preparation time must be kept
to a minimum in order to ensure successful implementation
within classrooms. 10
Currently, there is limited evidence for the effectiveness
of single component interventions, such as
classroom lessons alone or providing fruit - only tuck -
shops.10 However, in South Wales and South - west
England one particular study provided promising
results, finding that children who attend schools that
run fruit tuck shops are much more likely to eat fruit
if they and their friends are also banned from bringing
unhealthy snacks on to the school premises. 12 This
parallel between school - driven initiatives and policies
seems to have more impact on students than those
who do not implement joint strategies. For example,
changing attitudes and perspectives about what comprises
a “ normal ” school lunch can be accelerated
through school food policies. 13
Despite the lack of evidence for implementing
single component strategies, it is still important that
schools continue to work towards these initiatives.
Overall, school - based interventions will lead to, on
average, an increase in children ’ s intake of fruit and
vegetables equivalent to one fifth of a portion of fruit
per day, and a little less than one fifth of a portion of
vegetables per day. 10 Strategies such as these do raise
concerns that parents are no longer providing fruit
and vegetables within the home or in school lunch
boxes when children are being given “ free ” fruit or
attend a school with a fruit - only tuck - shop. This is yet
to be evaluated across countries, but may be an
anecdotal caution when implementing such initiatives.
The offering of fruit and vegetables in schools
needs to be examined in more depth and for longer
follow - up periods, and its effectiveness and cost –
effectiveness (e.g., Pomerleau et al) 14 needs to be
evaluated. However, it is important to understand
that a single component strategy in weight gain prevention
will never do on its own. Weight gain prevention
in general will have to deal with multiple
determinants of obesity, targeting multiple stakeholders.
Therefore, portfolios are needed with different
available strategies.
Three studies evaluated school travel interventions
aimed at changing the mode of children ’ s travel to
school. Only one — a small non - randomized trial of
an active commuting pack — found a significant
net increase in self - reported walking on the school
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journey.
Family - b ased a pproach
Parental involvement in obesity prevention is a very
important factor. Parents who are motivated to
change their own behavior will have a large influence
on changing the behavior of their adolescent children.
10 The complex make - up of families makes it
difficult to provide large - scale strategies that will be
effective in reducing overweight and obesity, hence,
the lack of evidence for family - based approaches.
A large - scale study found that counseling and
lectures on prevention by trained instructors was
effective in reducing body mass index 31 . This same
study also found reduced body mass index among
children with risk factors for overweight and obesity
who were invited with their parents to a single
individual counseling session. Also, when the primary
setting is not the family setting, parental involvement
is important and is among the few clear
determinants for success of weight gain prevention in
the young. 16
Further research into this area should include
family - based interventions and link to theory, research
and clinical practice. Health promotion programs
should include one or both parents or siblings, should
use different interventions for parents, children and
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