Childhood obesity is a rising public health concern. Over the last twenty years, worldwide prevalence of obesity amongst children has been steadily on the rise (Ebbeling, Pawlak and Ludwig, 2002). Global estimates for overweight and obese children are currently as high as 43 Million, and rising each year (Pulgaron 2013). Childhood obesity predisposes the affected individuals to morbidity and mortality from cardiovascular disease, as a result of lipid level derangements, blood pressure derangements, insulin derangements and coronary heart disease (Freedman et al, 2001). The most common medical co-morbidities associated with childhood obesity include asthma, dental health issues and metabolic risk factors (Pulgaron 2013). Childhood obesity has also been associated with psychological co-morbidities, including sleep disorders, attention deficit hyper-activity disorder (ADHD) and internalizing & externalizing disorders (Pulgaron 2013). Since majority of children are individuals of school-going age, the school appears to provide an appropriate avenue through which interventions may be instituted, and involves a large number of children from diverse backgrounds (Zahner et al, 2006). This paper provides a systematic literature review, assessing the effectiveness of a variety of school-based interventions in relation to bringing about the reduction and prevention of childhood obesity.
Many of the studies done on school-based interventions geared at the reduction and prevention of childhood obesity have reported varying degrees of success, with a variety of parameters used in assessment of outcomes. A randomized trial of behavioral interventions involving changes in lifestyle, exercise and diet was carried out in Canadian children between the ages of 0 and 18 (Peirson et al, 2015). This study established that the aforementioned combination of behavioral factors, relevant to primary care, led to a small but statistically significant reduction in Body Mass Index (BMI) and overweight prevalence in the intervention group as compared to the control group (Peirson et al, 2015). The impact of a School Nutrition Policy initiative consisting of multiple components (parent outreach, social marketing, nutritional policy, nutritional education and school self-assessment) was assessed on 1349 students between fourth and sixth grade, drawn from 10 schools in the United States (Foster et al, 2008). This study assessed the effect of this intervention over a 2-year period, and considered the incidence of obesity a primary outcome, deeming the prevalence & remission of obesity, Body Mass Index, hours of activity and inactivity, body dissatisfaction, fruit and vegetable intake, total fat and energy intake as secondary outcomes (Foster et al, 2008). The researchers found that there was a 50% reduction in the incidence of obesity in the study population (Foster et al, 2008). The prevalence of overweight was also found to be lower in schools where this intervention was instituted.
Physical inactivity has been investigated as a cause of childhood obesity by several studies, eliciting mixed results. Some studies have found physical activity to have a positive impact on weight reduction, lowering of resting heart rate, skin fold thickness and body mass index (Pate et al, 2006). A school fitness program aimed at increasing physical activity over a 9-month period also reported a 4.1% reduction in body fat, greater increase in cardiovascular fitness and a 5% improvement I fasting insulin level (Carrel et al, 2005). A two-year study was carried out on 8th grade girls, in which a staff-directed intervention aimed at increasing physical activity through incentives (Webber et al, 2008). The girls were tasked with carrying out programmes linked to social marketing, physical education, health education and community agency activities (Webber et al, 2008). This study found that in spite of increase in physical activity, there was no significant decrease in body fat percentage of the girls (Webber et al, 2008). Dietary changes such as implementation of healthy food choices in schools and discouraging consumption of fast-food by students has been recommended as an intervention for weight reduction programmes involving high-school students (Beaulieu and Godin, 2012). A health promotion program imparting education on healthy body image, physical activity and nutrition to students between 4th and 7th grade realized less weight gain and systolic blood pressure levels in the intervention group as compared to the control group (Stock et al, 2007). These findings suggest dietary alterations may have a more significant effect on childhood obesity as compared to physical activity in isolation.
Combinations of factors thought to positively influence weight reduction have also been investigated. Nutritional education for 6 months and increased physical activity during this period has been shown to increase physical fitness and reduce BMI especially in boys (Kain et al, 2004). A multi-disciplinary school-based intervention dubbed ‘Wellness, Academics and You’ which was carried out in 4 States and encouraged physical activity as well as consumption of fruits and vegetables, reported a statistically significant drop in BMI in the intervention group (Spiegel and Foulk, 2006). A meta-analysis found that 15 out of 20 school-based interventions that combined physical activity and education reported statistically significant positive outcomes in quantitative measures (Shaya et al, 2008). School-based interventions that reduce and prevent childhood obesity have also been shown to have significant effect in reduction of possible future morbidity, such as breast cancer, through its association with early menarche as a result of obesity (Chavarro et al, 2005). The significance of such benefits cannot be under-emphasized or overlooked.
Childhood obesity is a cause of major public health concern. Over several years, studies have linked childhood obesity to premature occurrence of illnesses, a wide range of health complications and eventual death. A combination of school-based interventions has been shown to be more effective than interventions employing one component in isolation. These interventions have generally been shown to have statistically significant positive outcomes on the reduction of childhood obesity, and should therefore be continually improved to achieve even better outcomes.
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