Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Developing countries perspective on interventions to prevent overweight and obesity in children
approaches have been undertaken in order to deal
with the problem. These have been led by a variety of
actors, including parents, teachers, governments,
research institutions, not-for-profit organizations
and, in many cases, have come about through partnerships
and collaborations between some of the actors
previously mentioned. Regrettably, recent reviews of
the scientific literature, specifically looking at research -
based prevention efforts and their effectiveness, point
to only two research - based interventions that have
taken place in developing countries. 14,15 While a few of
the studies in developed countries have dealt with culturally
diverse populations, the bulk of the evidence
comes from the experience of programs in the United
States and the United Kingdom and therefore the
implied socio - economic context bears little resemblance
to that of developing countries.
It should be noted that other efforts, while not
strictly evidence - based interventions, have also been
undertaken in developing countries. Considering the
information drawn by monitoring systems and
surveys, the important role of large - scale community
wellness programs and the potential impact of public
policies related to nutrition and physical activity, these
types of efforts should not be completely disregarded
in our examination of the evidence on interventions.
Evaluating their results should be considered as part
of the process for the design of future interventions or
efforts to improve existing efforts. A review and brief
description of key efforts identified follows.
School interventions
While there are multiple advantages and disadvantages
associated with working at the school level, it is
usually asserted that the school environment offers
a unique opportunity to reach a large number of
children over an extended period of time. Therefore,
many consider it to be an optimal setting in which to
carry out interventions targeted at children and adolescents
(see Chapters 11 and 12 ). Not surprisingly,
the only science - based evidence on efficacy and feasibility
of childhood obesity interventions in developing
countries comes from research pilots carried out in
primary and secondary schools.
Following a longitudinal controlled evaluation
study design, an intervention by Kain and colleagues
sought to have an impact on the weight status of
Chilean children from the 1st grade through to the
8th.
16
The six - month nutrition and physical education
intervention program included the implementation of
an educational program for children, increased availability
of healthier foods at the school kiosks and the
implementation of an enhanced physical activity component,
along with the provision of the equipment
required to support it. Parents and teachers were also
considered as part of the intervention efforts and
specific activities were undertaken with them to raise
awareness about childhood obesity issues. While the
study did not show a reduction of BMI at end line,
other general improvements in nutrition and physical
fitness were observed.
In Thailand, Mo - suwan and colleagues conducted
an enhanced physical activity intervention with kindergarten
children and monitored the impact of their
intervention after six months. 17 Over the course of a
seven month intervention period children assigned to
the intervention group took part in a structured exercise
regimen three times per week in addition to the
regular physical education curriculum. The additinal
activities carried out included a walk prior to morning
classes and dance sessions after naptime. Contrary to
the results of the Chilean study period, at the end of
the study period the trial came close to showing a
significant reduction in BMI. Yet, the post - intervention
study revealed a rebound in the participating
children ’ s BMI scores. While the scores did not return
to the level of those recorded at baseline they suggest
a limited long - term impact of the intervention.
In the near future additional programmatic scientific
evidence on school - based interventions in developing
countries will be available from two interventions
being conducted in Mexico and Brazil at this time.
Funded as part of the Healthy Lifestyles Healthy
People Obesity Prevention Initiative sponsored by the
International Life Sciences Institute ( ILSI ) and the
Pan American Health Organization ( PAHO ), both
projects consist of multi - year community - based interventions
aimed at preventing obesity through the
modification of diet and physical activity patterns.
Both projects, one working with school - aged children
ages 8 – 11 (Mexico) and the other targeting adolescents
aged 15 – 19 years (Brazil), will yield evidence
that will allow us begin to fill the existing voids in the
scientific literature to informe in the design of effective
strategies in the context of everyday conditions.
Preliminary results from the study in Mexico 18,19 point
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