EFFECTIVENESS OF A SCHOOL-BASED MULTICOMPONENT INTERVENTION ON CHILDREN NUTRITIONAL STATUS AMONG PRIMARY SCHOOL CHILDREN IN BANGKOK, THAILAND
AbstractBackground: Childhood obesity has become a major public health issue today. The prevalence of obesity and overweight is increasing in both adult and children. Childhood obesity in Thailand has more than doubled since the 1960s and a recent study reported that overweight and obesity in Thai is the 5th highest in Asia. The present study objective is to evaluate the effectiveness of a life skills multicomponent school-based intervention on children’s nutritional status. Methods: A quasi-experimental design was conducted in two-groups (control and intervention schools) on 453 students attending grade levels 4–5 in Bangkok. Two schools were selected for control, and two schools for intervention groups. The intervention included education, dietary, physical activity, food-environment, school built-environment, and life skills components. Outcomes were measured at baseline and post-treatment measured after 6 months. Results: The intervention group had significant improvements in healthier practice (+1.5 mean difference, p=0.048) on dietary habits and physical activity, lowered cholesterol levels (-2.43 mean, p=0.019), and higher HDL levels (+4.06 p=0.028) as compared to control. A higher reduction of overweight individuals among the intervention group over the intervention period was observed. Physical activity and consumption of vegetable increased while consumption of high-caloric snacks and fasts food decreased in children after the intervention. Conclusion: Childhood overweight and obesity is a serious public health problem based on its increasing rates and the associated health risks. This study indicated that multidisciplinary approach on school-based interventions is likely most effective to prevent children becoming overweight in long term. More research should be conducted on school-based intervention with longer intervention periods with higher sustainability.Keywords: Obesity; Life skills; Multicomponent; Physical activity; Cholesterol; HDL
Anwar A, Anwar F, Joiya HU, Ijaz A, Rashid H, Javaid A, et al. Prevalence of obesity among the school-going children of Lahore and associated factors. J Ayub Med Coll Abbottabad 2010;22(4):27–32.
Karnik S, Kanekar A. Childhood obesity: a global public health crisis. Int J Prev Med 2012;3(1):1–7.
Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes (Lond) 2012;36(1):1–11.
Sirikulchayanonta C, Ratanopas W, Temcharoen P, Srisorrachatr S. Self discipline and obesity in Bangkok school children. BMC Public Health 2011;11:158.
WHO. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. 2008.
Katz DL, Daniels S, Gardner CD, Goodman E, Hassink S, Sothern M. What we don't know: unanswered questions about childhood obesity. Child Obes 2012;8(1):7–12.
Dietz WH. Periods of risk in childhood for the development of adult obesity—what do we need to learn? J Nutr 1997;127(9):S1884–6.
WHO. Global strategy on diet, physical activity and health: a framework to monitor and evaluate implementation. 2006.
Ebbeling CB, Feldman HA, Chomitz VR, Antonelli TA, Gortmaker SL, Osganian SK, et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med 2012;367(15):1407–16.
Stevens J, Story M, Becenti A, French SA, Gittelsohn J, Going SB, et al. Weight‐Related Attitudes and Behaviors in Fourth Grade American Indian Children. Obes Res 1999;7(1):34–42.
Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev 2006;7(Suppl 1):7–66.
Lissau I. Prevention of overweight in the school arena. Acta Paediatr 2007;96(454):12–8.
Swinburn BA, Caterson I, Seidell JC, James WP. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004;7(1A):123–46.
Baranowski T, Baranowski JC, Cullen KW, Thompson DI, Nicklas T, Zakeri IE, et al. The fun, food, and fitness project (FFFP): the Baylor GEMS pilot study. Ethn Dis 2003;13(1 Suppl 1):S1–30.
Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, Finegood DT, et al. Changing the future of obesity: science, policy, and action. Lancet 2011;378(9793):838–47.
Ermetici F, Zelaschi RF, Briganti S, Dozio E, Gaeta M, Ambrogi F, et al. Association between a school‐based intervention and adiposity outcomes in adolescents: The Italian “EAT” project. Obesity (Silver Spring) 2016;24(3):687–95.
Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 2001;323(7320):1029–32.
Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, et al. What childhood obesity prevention programmes work? A systematic review and meta‐analysis. Obes Rev 2015;16(7):547–65.
Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008;121(4):e794–802.
Meng L, Xu H, Liu A, van Raaij J, Bemelmans W, Hu X, et al. The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China. PLoS One 2013;8(10):e77971.
Waters E, de Silva Sanigorski A, Hall B, Brown T, Campbell K, Gao Y, et al. Interventions for preventing obesity in children (review). Cochrane Collab 2011;(12):1–212.
Rush E, Reed P, McLennan S, Coppinger T, Simmons D, Graham D. A school-based obesity control programme: Project Energize. Two-year outcomes. Br J Nutr 2012;107(4):581–7.
Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A. Short-and long-term beneficial effects of a combined dietary–behavioral–physical activity intervention for the treatment of childhood obesity. Pediatrics 2005;115(4):e443–9.
Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood—does weight status alone matter? Metabolism 2014;63(9):1084–92.
Hollar D, Lombardo M, Lopez-Mitnik G, Hollar TL, Almon M, Agatston AS, et al. Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children. J Health Care Poor Underserved 2010;21(2 Suppl):93–108.
Greening L, Harrell KT, Low AK, Fielder CE. Efficacy of a school‐based childhood obesity intervention program in a rural southern community: TEAM Mississippi Project. Obesity (Silver Spring) 2011;19(6):1213–9.
Shamah Levy T, Morales Ruán C, Amaya Castellanos C, Salazar Coronel A, Jiménez Aguilar A, Méndez Gómez Humarán I. Effectiveness of a diet and physical activity promotion strategy on the prevention of obesity in Mexican school children. BMC Public Health 2012;12:152.
Belay B, Belamarich P, Racine AD. Pediatric precursors of adult atherosclerosis. Pediatr Rev 2004;25(1):4–16.
Ayer J, Charakida M, Deanfield JE, Celermajer DS. Lifetime risk: childhood obesity and cardiovascular risk. Eur Heart J 2015;36(22):1371–6.
Chomitz VR, McGowan RJ, Wendel JM, Williams SA, Cabral HJ, King SE, et al. Healthy Living Cambridge Kids: A Community‐based Participatory Effort to Promote Healthy Weight and Fitness. Obesity (Silver Spring) 2010;18(Suppl 1):S45–53