A controlled, class-based multicomponent intervention to promote healthy lifestyle and to reduce the burden of childhood obesity

Authors

  • E. Centis,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • R. Marzocchi,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • R. Di Luzio,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • S. Moscatiello,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • S. Salardi,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • N. Villanova,

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • G. Marchesini,

    Corresponding author
    • Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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  • the ‘G. C. Croce’ School of Health Promotion

    1. Unit of Metabolic Diseases & Clinical Dietetics, ‘Alma Mater Studiorum’ University, Bologna, Italy
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    • Participants: Sasso Marconi City Council (M Fabbri, S Federici, M Marescalchi, AM Quaranta); Unit of Clinical Dietetics (G Forlani, N Villanova, S Moscatiello, R Marzocchi, E Centis, C Nuccitelli); Postgraduate School of Nutritional Sciences (F Agostini, R Di Luzio, V Soverini, C Zannoni, V Nepoti, F Michelacci, R Tafuri), Local Heath Unit (G Poletti, E Guberti), M D'Amicis, G Tola (Faculty of Exercise and Sport Sciences), A Lisotti (Postgraduate School of Gastroenterology), F Montanari, F Tamburrino, M Torella (Postgraduate School of Pediatrics).

  • GB Croce School of Health Promotion
  • Steering Committee: G Marchesini, E Roda, S Casanova, S Salardi, GL Cornia.

Address for correspondence: Professor G Marchesini, ‘Alma Mater Studiorum’ University, S. Orsola-Malpighi Hospital, Unit of Metabolic Diseases & Clinical Dietetics, Via Massarenti, 9, I-40138 Bologna, Italy. E-mail: giulio.marchesini@unibo.it

Summary

What is already known about this subject

  • Overweight and obesity prevention in childhood and adolescence represent a priority target for public health. Scientific literature recommends multidisciplinary (multicomponent) interventions in order to modify the time trend of childhood obesity and the school is considered one of the most favourable settings.
  • Children in the age range 8 to 10 (end of primary school) already have preferences on food choices and physical activity, but they still are susceptible to change in response to positive reinforcement by parents, teachers, friends and schoolmates.
  • The strategy of empowering parents during intervention by telephone calls, following an intense motivational programme, to stimulate adherence to physical activity targets and to remove barriers has been receiving increased attention.

What this study adds

  • A multicomponent intervention in a school district, proposed as playful activity to children, addressing the needs of teachers and empowering parents, was able to modify the time trend of progressive increase in body mass index (BMI), compared to data obtained in a control group.
  • Reduced standard deviation score BMI was accompanied by changes in behaviour activity, in the time spent in outdoor games and physical activity.
  • Concerted actions to reduce the burden of childhood obesity must be implemented on a large scale. They should aim at modifying unhealthy behaviours (i.e. incorrect nutritional habits and sedentary life), having the effects on body weight as secondary target.

Background

Overweight and obesity prevention in childhood and adolescence represent a priority for public health; school is a privileged place for health promotion interventions.

Objectives

The study aimed to test the effectiveness of a multicomponent 5-month intervention on the habits of primary school children, making the families aware of the importance of healthy choices.

Methods

Two hundred nine children attending the fourth class of primary school, divided into interventional (n = 103) and control arm (n = 106) were included in the study. In the intervention group, parents and teachers received more intense lifestyle counseling, associated with weekly motivational telephone calls to families to motivate further their lifestyle changes. Standard deviation score (SDS) body mass index (BMI) was the primary outcome measure; on open-air games and TV watching were secondary outcomes.

Results

At baseline, no differences were observed between groups. At 8-month follow-up, mean SDS BMI had decreased by 0.06 units in the intervention arm and increased by 0.12 in controls (time × treatment anova, P < 0.002). Outdoor activities increased from 6.23 h week−1 to 9.93 in the intervention group (P < 0.001), not in controls. This change was associated differences in TV watching from baseline (intervention, −0.96 h week−1; P = 0.037; controls, +1.33 h week−1; P = 0.031).

Conclusion

A multicomponent school-based intervention addressing the needs of children, teachers and families produced a significant and favourable short-term effect on overweight/obese schoolchildren.

Ancillary