Effectiveness of school programs in preventing childhood obesity: a multilevel comparison.
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OBJECTIVES: In light of the alarming increase in childhood obesity and lack of evidence for the effectiveness of school programs, we studied the effects of school programs in regard to preventing excess body weight. METHODS: In 2003, we surveyed 5200 grade 5 students along with their parents and school principals. We measured height and weight, assessed dietary intake, and collected information on physical and sedentary activities. We compared excess body weight, diet, and physical activity across schools with and without nutrition programs using multilevel regression methods while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods. RESULTS: Students from schools participating in a coordinated program that incorporated recommendations for school-based healthy eating programs exhibited significantly lower rates of overweight and obesity, had healthier diets, and reported more physical activities than students from schools without nutrition programs. CONCLUSIONS: Our finding that school programs are effective in preventing childhood obesity supports the need for broader implementation of successful programs, which will reduce childhood obesity and, in the longer term, comorbid conditions and health care spending. (+info)
Design and descriptive results of the "Growth, Exercise and Nutrition Epidemiological Study In preSchoolers": the GENESIS study.
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BACKGROUND: The Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) attempts to evaluate the food and nutrient intakes, as well as growth and development of a representative sample of Greek toddlers and preschool children. In the current work the study design, data collection procedures and some preliminary data of the GENESIS study are presented. METHODS: From April 2003 to July 2004, 1218 males and 1156 females 1 to 5 years old, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties. Approximately 300 demographic, lifestyle, physical activity, dietary, anthropometrical and DNA variables have been recorded from the study population (children and parents). RESULTS: Regarding anthropometrical indices, boys were found to be taller than girls at all ages (P < 0.05) and heavier only for the age period from 1 to 3 years old (P < 0.05). No significant differences were found between genders regarding the prevalence of at risk of overweight (16.5% to 18.6% for boys and 18.5 to 20.6 % for girls) and overweight (14.0% to 18.9% for boys and 12.6% to 20.0% for girls). Additionally, boys older than 2 years of age were found to have a higher energy intake compared to girls (P < 0.05). A similar tendency was observed regarding the mean dietary intake of fat, saturated fat, carbohydrates and protein with boys exhibiting a higher intake than girls in most age groups (P < 0.05). CONCLUSION: The prevalence of overweight in the current preschool population is considerably high. Future but more extensive analyses of the GENESIS data will be able to reveal the interactions of the parameters leading to this phenomenon. (+info)
Process evaluation determines the pathway of success for a health center-delivered, nutrition education intervention for infants in Trujillo, Peru.
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Process evaluation was used to explain the success of a randomized, controlled trial of an educational intervention to improve the feeding behaviors of caregivers and the nutritional status of infants in Trujillo, Peru. Health personnel delivered a multicomponent intervention within the environment of usual care at government health centers. We created a model of the expected intervention pathway to successful outcomes. Process data were then collected on health center implementation of the intervention and caregiver reception to it. Using multivariate models, we found that variables of health center implementation, caregiver exposure, and caregiver message recall were all significant determinants in the pathway leading to improved feeding behaviors. These outcomes were consistent with our original intervention model. Further support for our model arose from the differences in caregiver reception between intervention and control centers. Process data allowed us to characterize the pathway through which an effective nutrition intervention operated. This study underscores the importance of including process evaluation, which will lead to the development and implementation of more effective nutrition interventions. (+info)
Nutrition education improves serum retinol concentration among adolescent school girls.
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Dietary diversification has been identified as a sustainable intervention method in developing countries where subclinical vitamin A deficiency exists. Nutrition education is central to all methods of nutrition intervention including dietary diversification. The paucity of available data currently limits the effective use of nutrition education in national programs in Sri Lanka. We assessed the effect of nutrition education on nutrition related knowledge, food consumption patterns and serum retinol concentrations among 229 adolescent school girls, aged between 15-19 years. Knowledge on nutrition, food consumption patterns and serum retinol concentration was assessed at baseline. Intervention included nutrition education as lecture discussions, interactive group discussions and four different methods of reinforcement. Knowledge, food consumption patterns and serum retinol concentrations were reassessed after a ten week period of intervention. Educational intervention resulted in a significant increase in knowledge (P < 0.001) and consumption of local vitamin A rich foods. The percentage of subjects with low serum retinol concentrations (<20 microg/dL) decreased from 17% to 4.8%. The effect of nutrition education on serum retinol concentration was highly significant (P<0.001) in subjects with baseline serum retinol concentrations below 20 microg/L. Nutrition education was effective in improving knowledge and food consumption patterns among these girls. Effectiveness was of biological significance, as a positive change in serum retinol concentration was observed in subjects with initially low concentrations, and not in subjects with initially normal serum concentrations. (+info)
Swimming upstream: faculty and staff members from urban middle schools in low-income communities describe their experience implementing nutrition and physical activity initiatives.
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INTRODUCTION: Addressing childhood overweight has become a top priority in the United States. Modification of school policies and practices has been used in an attempt to address the overweight epidemic among children and adolescents. Culturally diverse urban schools in low-income communities attempting to improve nutrition and increase physical activity may face unique challenges in the school environment. A better understanding is needed about school environments and how they may affect the implementation, efficacy, and sustainability of initiatives designed to improve nutrition and physical activity. METHODS: We carried out a qualitative study in five urban middle schools in low-income communities that had recently implemented Planet Health, a nutrition and physical activity intervention, to assess which aspects of the schools' physical, social, and policy environments were facilitating or impeding the implementation of health promotion initiatives. Thirty-five faculty and staff members participated. We conducted one focus group per school, with an average of seven participants per group. We analyzed focus group transcripts using the thematic analysis technique to identify key concepts, categories, and themes. RESULTS: Teachers and staff members in our study identified many school-related environmental barriers to successful implementation of nutrition and physical activity initiatives in their schools. School personnel recommended that classroom-based nutrition interventions such as Planet Health be coordinated with school food services so that the healthy messages taught in the classroom are reinforced by the availability of healthy, culturally appropriate cafeteria food. They identified household food insufficiency and overly restrictive eligibility criteria of the federally subsidized meal program as critical barriers to healthy nutritional behaviors. They also identified weight-related teasing and bullying and unhealthy weight-control behaviors as challenges to promotion of healthy nutrition and physical activity. CONCLUSION: To maximize intervention efforts, researchers and practitioners must consider the effects of school environments on nutrition and physical activity initiatives. (+info)
The cost-effectiveness of a child nutrition education programme in Peru.
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This article reports impact and cost results from a health facility-based nutrition education programme targeting children less than 2 years of age in Trujillo, Peru. Key elements of the programme included participative complementary feeding demonstrations, growth monitoring sessions and an accreditation process. Data were collected from six intervention and six control health facilities to measure utilization and costs associated with the intervention. To calculate the unit costs of services, these costs are allocated using activity-based costing. To measure the effects of the intervention, 338 children were followed through household surveys at regular intervals from birth until the age of 18 months. The intervention had a clear positive impact both on the use of nutrition-related services and on children's growth outcomes. Children in the intervention areas made 17.6 visits to health facilities in the first 18 months of life, compared with 14.1 visits for children in the control areas (P < 0.001). This pattern holds true for all socioeconomic groups. The intervention prevented 11.1 cases of stunting per 100 children. In multivariate logistic regression analysis, children in the intervention were 0.33 times as likely to be stunted as the controls (P = 0.002). The marginal cost of the intervention - including external costs, training, health education materials and extra travel and equipment - is 6.12 US dollars per child reached and 55.16 US dollars per case of stunting prevented. The estimated marginal cost of the intervention per death averted is 1952 US dollars. (+info)
The extent and nature of food promotion directed to children in Australian supermarkets.
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The aim of this study was to describe the nature and amount of sales promotion use on food packaging in selected Australian supermarkets, specifically those directed at children through the use of premium offers, such as giveaways and competitions, and cartoon and movie character promotions. The study also examined the promotion of healthy versus unhealthy foods. Nine supermarkets located across the metropolitan area of Sydney, Australia were surveyed to assess the extent and nature of food promotion directed at children. The number and types of promotions were measured within seven food categories: sweet biscuits, snack foods, confectionery, chips/savoury snacks, cereals, dairy snacks and ice cream. Any foods that utilized promotional tactics were categorized as either healthy or unhealthy, according to set criteria. The study found that within the seven food categories between 9 and 35% of food products used promotional tactics. The use of television, movie celebrities and cartoon characters for promotion was most common, making up 75% of all promotions. Giveaways accounted for 13% of all promotions. When used, giveaways were commonly used in conjunction with another promotional method. Data from this study also confirmed that 82% of all food promotions were for unhealthy foods and only 18% were used to promote healthy foods. However, for dairy snacks and ice cream the majority of promotions, 99 and 65%, respectively, were healthier choices. This was the first study to describe the extent and nature of food promotions used in supermarkets. The promotion of unhealthy foods in supermarkets is common and is one of the many factors contributing to today's obesity promoting environment. Further research is required to determine the impact of food promotions on children's dietary intake, and to determine the most effective ways to restrict the promotion of unhealthy foods. (+info)
Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention.
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BACKGROUND: Data concerning the long-term improvement of cardiovascular disease (CVD) risk factors after an obesity intervention in children are limited. OBJECTIVE: We studied changes in weight status and CVD risk factors in children in an intervention program and evaluated whether these changes were sustained 1 y after the end of the intervention. DESIGN: We analyzed changes in the SD score (SDS) of body mass index [BMI; in kg/m2 (SDS-BMI)], blood pressure (BP), lipids, and homeostasis model assessment index of insulin resistance (HOMA-IR) over the course of 2 y in 240 obese (BMI > 97th percentile) children aged 6-14 y (x age: 10.4 y; x BMI: 26.9). Of these 240 children, 203 participated in a 1-y intervention program of physical exercise, nutrition education, and behavior therapy. We compared these children with 37 obese children who underwent no intervention and with 12 normal-weight children of the same age and sex. RESULTS: Obese children had significantly (P < 0.05) higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower HDL-cholesterol concentrations than did normal-weight children. Twenty-nine children dropped out of the intervention. Only in the 126 children who reduced their SDS-BMI did BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL cholesterol, respectively; 7% increase in HDL cholesterol), insulin (13% decrease), and HOMA-IR (17% decrease) improve significantly (P < 0.05). Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained 1 y after the end of the intervention in the children whose SDS-BMI decreased. CONCLUSIONS: Long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the obese children 1 y after the end of the intervention. Reduction in SDS-BMI was accompanied by an improvement in CVD risk factors. (+info)