Schools alone cannot help to prevent childhood obesity

I’m keeping track what schools need to do for Flanders as stated in the media. One that has been popular in the past is preventing childhood obesity. This new British study shows that schools can’t do this in on their own.

From the press release:

The warning comes after one of the largest childhood obesity prevention trials undertaken to date has found that a healthy lifestyle intervention carried out in dozens of schools did not lead to significant changes in pupils’ weight.

Led by the University of Birmingham, the West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study was a trial funded by the National Institute for Health Research (NIHR). It aimed to assess the clinical and cost-effectiveness of a programme of activities designed to support children aged six and seven in keeping their weight at a healthy level by promoting healthy eating and physical activity.

Excess weight in childhood is a global problem, affecting around 41 million children under the age of 5 years1. In addition to physical and psychosocial health consequences in these early years, childhood excess weight is an important predictor of obesity in adulthood2, with additional adverse health and economic3 effects. In the UK around a quarter of children have excess weight at school entry (age four to five years)4. The proportion of very overweight children doubles during the subsequent six years (from approximately 9% to 19%)4, highlighting this time period as critical for preventive action.

The 12-month WAVES study intervention included a daily additional 30 minute school-time physical activity opportunity, and a six-week interactive skill based programme in conjunction with a premiership football club. It also included signposting of local family physical activity opportunities through six-monthly mail-outs and termly school led family healthy cooking skills workshops.

Almost 1,500 pupils from 54 state primary schools in the West Midlands took part in the trial. Their measurements — including weight, height, percentage body fat, waist circumference, skinfold thickness, and blood pressure — were taken when they started the trial. They also wore an activity tracker for five days, recorded their dietary intake and took part in assessments to establish their perceived quality of life, social acceptance and body image. These measurements were taken again 15 months and 30 months later and were compared among pupils who were or were not taking part in the intervention.

The results of the randomised controlled trial, published today in The BMJ, found that the intervention did not result in a significant difference in participants’ weight status.

Professor Peymané Adab, of the University of Birmingham’s Institute of Applied Health Research, said: “Our research, combined with wider evidence, suggests that schools cannot lead on the childhood obesity prevention agenda.”

Dr Miranda Pallan, also of the University of Birmingham’s Institute of Applied Health Research, added: “Whilst school is an important setting for influencing children’s health behaviour, and delivery of knowledge and skills to support healthy lifestyles is one of their mandatory functions, widespread policy change and broader influences from the family, community, media and the food industry is also needed.”

The research team added: “although wider implementation of this WAVES study intervention cannot be recommended for obesity prevention, the lower cost components could in the future be considered by schools to fullfil their mandated responsibilities for health and wellbeing education.”

Abstract of the study:

Objective To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity.

Design Cluster randomised controlled trial.

Setting UK primary schools from the West Midlands.

Participants 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively.

Interventions The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills.

Main outcome measures The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset.

Results Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference −0.075 (95% confidence interval −0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was −0.027 (−0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm).

Conclusions The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments.

 

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Filed under At home, Education, Research

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