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Effect of an obesity prevention program focused on motivating environments in childhood: a school-based prospective study

Abstract

Background/Objectives:

There has been an increasing global recognition of the need for effective strategies to prevent and control childhood obesity. In this study, we aimed to identify the effectiveness of an obesity prevention program focused on motivating environments in school.

Subjects/Methods:

In this school-based, prospective, quasi-experimental study, we enrolled three elementary (fourth graders) and two middle (seventh graders) schools located in Chungju, Korea. We assigned three of the schools to the intervention group and two schools to the control group. The intervention group received 1 year of environmental intervention. Diet- and exercise-related educational video content was provided by internet protocol television services during rest time, and various design materials were painted along the school staircase and hallway to encourage physical activities. Overweight and obese students were recommended to join the summer vacation obesity care program.

Results:

The final number of total participants was 768 (control 350 and intervention 418). After 1 year of follow-up, there was no significant difference in the overweight/obesity incidence rates and remission rates between the two groups. However, the intervention group showed a greater decrease in the body mass index (BMI) z-score (−0.11 (95% confidence interval (CI) −0.16 to −0.06), P<0.001), increase in height (1.1 cm (95% CI 0.8 to 1.4), P<0.001), reduction of body fat, and increase in muscle mass compared with the control group. In addition, blood pressure (BP) was significantly reduced, and significant improvement in physical fitness followed. In subgroup analysis, students of normal weight, boys and younger participants showed the most beneficial results in weight-related outcomes. In addition, the BP reduction was more pronounced in the higher BMI group, boys and older children.

Conclusions:

A simple environmental intervention could effectively influence children. By adding to previously studied strategies, we can develop a more effective obesity prevention program for children.

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References

  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–781.

    Article  Google Scholar 

  2. Chestnov O . Global Status Report on Noncommunicable Diseases 2014. World Health Organization: Geneva, 2014.

    Google Scholar 

  3. Reilly JJ . Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005; 19: 327–341.

    Article  Google Scholar 

  4. Han JC, Lawlor DA, Kimm SY . Childhood obesity. Lancet 2010; 375: 1737–1748.

    Article  Google Scholar 

  5. Maffeis C, Tato L . Long-term effects of childhood obesity on morbidity and mortality. Horm Res 2001; 55 (Suppl 1): 42–45.

    CAS  Google Scholar 

  6. Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ . Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008; 9: 474–488.

    Article  CAS  Google Scholar 

  7. Story M, Kaphingst KM, French S . The role of schools in obesity prevention. Future Child 2006; 16: 109–142.

    Article  Google Scholar 

  8. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J . School-based obesity prevention: a blueprint for taming the epidemic. Am J Health Behav 2002; 26: 486–493.

    Article  Google Scholar 

  9. Lavelle HV, Mackay DF, Pell JP . Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health (Oxf) 2012; 34: 360–369.

    Article  CAS  Google Scholar 

  10. 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: 547–565.

    Article  CAS  Google Scholar 

  11. Group HS, Foster GD, Linder B, Baranowski T, Cooper DM, Goldberg L et al. A school-based intervention for diabetes risk reduction. N Engl J Med 2010; 363: 443–453.

    Article  Google Scholar 

  12. Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H et al. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ 2010; 340: c785.

    Article  Google Scholar 

  13. de Ruyter JC, Olthof MR, Seidell JC, Katan MB . A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012; 367: 1397–1406.

    Article  CAS  Google Scholar 

  14. Dobbins M, Husson H, DeCorby K, LaRocca RL . School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2013; 28: CD007651.

    Google Scholar 

  15. Williamson DA, Copeland AL, Anton SD, Champagne C, Han H, Lewis L et al. Wise mind project: a school-based environmental approach for preventing weight gain in children. Obesity (Silver Spring) 2007; 15: 906–917.

    Article  Google Scholar 

  16. JS M SY L CM N Choe JM C, BK JW S . 2007 Korean National Growth Charts: reveiw of developmental process and an outlook. Korean J Pediatr 2008; 51: 1–25.

    Article  Google Scholar 

  17. Ministry of Education, Science and Technology. The pilot school management report of physical activity promotion system, 2009.

  18. Korean Society for the Study of Obesity. Childhood and adolescents obesity. 2012.

  19. Ford AL, Hunt LP, Cooper A, Shield JP . What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Arch Dis Child 2010; 95: 256–261.

    Article  Google Scholar 

  20. Weili Y, He B, Yao H, Dai J, Cui J, Ge D et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity (Silver Spring) 2007; 15: 748–752.

    Article  Google Scholar 

  21. Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C et al. Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis. Agency for Healthcare Research and Quality: Rockville, MD, USA, 2013.

    Google Scholar 

  22. Sobol-Goldberg S, Rabinowitz J, Gross R . School-based obesity prevention programs: a meta-analysis of randomized controlled trials. Obesity (Silver Spring) 2013; 21: 2422–2428.

    Article  Google Scholar 

  23. Loche S, Cappa M, Borrelli P, Faedda A, Crino A, Cella SG et al. Reduced growth hormone response to growth hormone-releasing hormone in children with simple obesity: evidence for somatomedin-C mediated inhibition. Clin Endocrinol (Oxf) 1987; 27: 145–153.

    Article  CAS  Google Scholar 

  24. Williams T, Berelowitz M, Joffe SN, Thorner MO, Rivier J, Vale W et al. Impaired growth hormone responses to growth hormone-releasing factor in obesity. A pituitary defect reversed with weight reduction. N Engl J Med 1984; 311: 1403–1407.

    Article  CAS  Google Scholar 

  25. Coutant R, Lahlou N, Bouvattier C, Bougneres P . Circulating leptin level and growth hormone response to stimulation tests in obese and normal children. Eur J Endocrinol 1998; 139: 591–597.

    Article  CAS  Google Scholar 

  26. Kelijman M, Frohman LA . Enhanced growth hormone (GH) responsiveness to GH-releasing hormone after dietary manipulation in obese and nonobese subjects. J Clin Endocrinol Metab 1988; 66: 489–494.

    Article  CAS  Google Scholar 

  27. Rogol AD, Clark PA, Roemmich JN . Growth and pubertal development in children and adolescents: effects of diet and physical activity. Am J Clin Nutr 2000; 72: 521S–528S.

    Article  CAS  Google Scholar 

  28. Malina RM . Physical activity and training: effects on stature and the adolescent growth spurt. Med Sci Sports Exerc 1994; 26: 759–766.

    Article  CAS  Google Scholar 

  29. Cai L, Wu Y, Wilson RF, Segal JB, Kim MT, Wang Y . Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis. Circulation 2014; 129: 1832–1839.

    Article  Google Scholar 

  30. Lee HS, Park YM, Kwon HS, Lee JH, Park YJ, Lim SY et al. Prevalence, awareness, treatment, and control of hypertension among people over 40 years old in a rural area of South Korea: the Chungju Metabolic Disease Cohort (CMC) Study. Clin Exp Hypertens 2010; 32: 166–178.

    Article  Google Scholar 

  31. Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr 2013; 167: 759–768.

    Article  Google Scholar 

  32. Reinehr T, Andler W . Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child 2004; 89: 419–422.

    Article  CAS  Google Scholar 

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Acknowledgements

This research was supported by the R&D Program of the Society of the National Research Foundation (NRF) funded by the Korean Ministry of Science, ICT and Future Planning (NRF-2013M3C8A2A02078508).

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Correspondence to K-H Yoon.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Yang, Y., Kang, B., Lee, E. et al. Effect of an obesity prevention program focused on motivating environments in childhood: a school-based prospective study. Int J Obes 41, 1027–1034 (2017). https://doi.org/10.1038/ijo.2017.47

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