Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 9
changes regarding participation either in the school
meals program or in the take - home activities included
in this program were not measured. At the end of the
school year, there was a statistically significant difference
in the change in weight – height ratio between the
intervention and control groups among white children
( n = 130), mean difference 0.034 (95% CI 0.023
to 0.045). However, no differences were observed for
Black or Latino children. Despite some limitations,
these results are encouraging in that a relatively simple
intervention aimed at changing an important environmental
component of school health (the food
service) can have direct effects on energy intake and
promote a healthier rate of weight gain as well as
reduce a major CVD risk factor in a young minority
population.
These approaches hold promise for creating communities
that promote healthy weight for young children.
They have the ability to shift social norms with
regards to the policies and practices in child - care
centers and subsequently affect individual behavior
change in a way that is meaningful and sustainable.
These studies now need to go further to evaluate the
effectiveness of these environmental changes themselves,
in order to reduce unhealthy weight gain in the
children attending these centers over time.
Conclusion and i mplication
The early childhood period holds promise as a time in
which obesity prevention may be most effective.
Interventions during pregnancy to promote optimum
birth weight and interventions during early childhood
to promote healthy eating and physical activity have a
great potential to prevent childhood obesity.
Despite ample evidence on modifiable risk factors
of overweight in early childhood which are amenable
to effective prevention programs, relatively few published
interventions focused on changes in weight
status among infants and preschool children. In addition
to the paucity of current published studies, the
heterogeneous nature of the settings, methodologies,
intervention strategies, definitions of obesity and
outcome measures make it difficult to determine the
most effective strategy or make recommendations on
how to prevent obesity in the early childhood period.
Despite the limitations of the available evidence,
findings from these interventions provide a basis for
further development of effective intervention strategies.
Two of the four effective interventions included parent
education programs 33,39 and another sent materials
home to parents on a weekly basis. 48 As supported by the
recent review of Bluford et al, 23 it seems sensible to recommend
that interventions for children include parents
and other adult role models (e.g., teachers) rather than
children alone. However, more work is needed to
examine how active parental involvement needs to be in
intervention programs for young children.
Diet and exercise are the common strategies used.
Gender and cultural differences were found to influence
the effectiveness of the interventions, 39 – 41 thus an
intervention program should be designed in a way to
appropriately address inequalities, gender, ethnic and
cultural aspects. Moreover, given the dynamicity of
child development abilities during the early years, the
nutrition and the physical activity components of the
interventions also need to be tailored to age - specific
abilities.
23
Consideration also needs to be given to the duration
of intervention programs as the evidence demonstrates
the need for a longer follow - up period of 1 – 2
years to assess change in weight status and increase the
likelihood of adequately evaluating program impacts
and sustainability. 23
In conclusion, given the potential for early intervention
to have long - lasting impacts on individual
and population health, more interventions need to be
implemented and comprehensively evaluated to
determine their effectiveness on reducing the prevalence
of childhood obesity. A focus on interventions
that involve the family and create sustainable environmental
changes to promote quality nutrition and
physical activity should be a priority.
References
1 Bundred P , Kitchiner D , Buchan L : Prevalence of overweight
and obese children between 1989 and 1998: population
based series of cross - sectional studies . BMJ 2001 ;
322 : 313 – 314 .
2 Herpertz - Dahlmann B , Geller F , B ö hle C , Khalil C ,
Trost - Brinkhues G , Ziegler A , et al: Secular trends in body
mass index measurements in preschool children from the
City of Aachen, Germany . Eur J Pediatr 2003 ; 162 : 104 – 109 .
3 Ogden CL , Troiano RP , Briefel RR , Kuczmarski RJ , Flegal
KM , Johnson CL , et al: Prevalence of overweight among
preschool children in the United States, 1971 through 1994 .
Pediatrics 1997 ; 99 : e1 .
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