Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 9
were behavioral (parent - reported) and anthropometric.
It was found that after the intervention period,
children in the intervention group ( n = 90) decreased
their television/video viewing by about 3 hours/week,
whereas children in the control group ( n = 73)
increased their viewing by 1.6 hours/week, for a significant
adjusted difference between the groups of
− 4.7 hours/week. In addition, the percentage of children
watching television/videos more than 2 hours per
day also decreased significantly among the intervention
group, compared with an increase in the control
group. Despite these behavioral changes, no statistically
significant differences were found in children ’ s
BMI or triceps skin - fold between groups. 38
Fitzgibbon et al assessed the impact of a randomized
controlled trial with culturally proficient
dietary/physical activity, the Hip - Hop to Health Jr, on
changes in body mass index of 3 - to 5 - year - old minority
children from schools randomized to a weight
control intervention or to a control group that received
a general health intervention. 39,40 Two cohorts of children
participated in the trial: the first group of children
attended 12 predominantly black preschools, 39
whereas the second cohort attended 12 predominantly
Latino preschools. 40 Children in the six intervention
schools received thrice - weekly lesson plans that
incorporated two major components: (1) a 20 - minute
lesson that introduced a healthy eating or exercise
concept with an activity, and (2) 20 minutes of
ongoing physical activity for 14 weeks. Their parents
received weekly newsletters with information mirroring
the children ’ s curriculum. The control children in
the other six centers received a general health intervention
that did not address either diet or physical
activity. The intervention children (99% Black) had
significantly smaller increases in BMI compared with
control children (80.7% Black, 12.7% Latino) at
1-year follow-up, 0.06 vs. 0.59 kg/m 2 ; difference
− 0.53 kg/m 2 (95% CI − 0.91 to − 0.14), P = 0.01; and at
2-year follow-up, 0.54 vs. 1.08 kg/m 2 ; difference
− 0.54 kg/m 2 (95% CI − 0.98 to − 0.10), P = 0.02, with
adjustment for baseline age and BMI. The only significant
difference between intervention and control children
in food intake/physical activity was the Year 1
difference in percentage of calories from saturated fat,
11.6% vs. 12.8% ( P = 0.002). In the second cohort,
with Latino children, there were no significant differences
between intervention and control schools highlighting
the need to modify intervention activities to
the cultural context.
Mo-suwan et al
41
examined the effect of a school -
based aerobic exercise program on overweight indices
of preschool children in Thailand. Half of the classes
of second - year pupils of two schools were randomized
into the intervention (mean age 4.5 ± 0.4 years,
n = 145) or control (mean age 4.5 ± 0.4 years, n = 147)
group. The intervention program included an extra
15 - minute walk in the morning and a 20 - minute
aerobic exercise session in the afternoon three times
per week. The exercise program was led by trained
personnel and lasted about 30 weeks. This intervention
program was provided in addition to the usual
practices of the schools. At the initial evaluation
at 29.6 weeks, a reduction of the prevalence of obesity
in the intervention preschool children reached near
statistical significance ( P = 0.057). The study showed
that intervention girls had a lower likelihood of having
an increased BMI slope than control girls (odds ratio
0.32; 95%CI 0.18 to 0.56), while the opposite was true
for boys (odds ratio 1.08; 95% CI 0.62 to 1.89).
The significant difference may be related to gender
roles and expectations in Thailand. At six months
post - intervention, the prevalence of obesity in the
control group decreased from 12.2% at baseline
to 9.4% after the intervention, and was 10.8% at 29.6
weeks plus six months. In the exercise intervention
group, the prevalence of obesity was 12.9% at
baseline, 8.8% at 29.6 weeks and 10.2% six months
later. 43
A randomized control trial carried out by Reilly et
al 42 examined the effect of an enhanced physical activity
program implemented in nurseries in Scotland.
The program consisted of three 30 - minute sessions a
week over 24 weeks, delivered by trained personnel,
with additional home - based health education aimed
to increase children ’ s physical activity through play
and reduce sedentary behaviors. The total of 545 children
from 36 nurseries in Glasgow, Scotland were
randomized to either intervention (mean aged 4.2 ±
0.3 years, n = 268) or control group (mean aged 4.1 ±
0.3 years, n = 277). The evaluation found that the
program had no significant effect on physical activity,
sedentary behavior or body mass index. The only significant
effect of the physical activity program was
enhanced fundamental movement skills for intervention
children compared to children in the control
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