Research article
School-Based Interventions on Childhood Obesity: A Meta-Analysis

https://doi.org/10.1016/j.amepre.2009.07.012Get rights and content

Background

Over the past decade, childhood obesity has been recognized as an increasing health problem worldwide. It is a predictor of obesity during adulthood, which is strongly linked to chronic lifestyle diseases.

Purpose

This paper aims to evaluate the effectiveness of school-based programs in the prevention and management of childhood obesity.

Methods

A comprehensive literature search was undertaken for RCTs and clinical controlled trials on school-based interventions that addressed childhood obesity, published between 1995 and 2007. The papers included for the meta-analysis were those in which ORs or standardized mean differences and their 95% CIs were reported or could be calculated from available data.

Results

Meta-analysis showed that the odds of participants' being overweight and obese in the school-based intervention programs compared with the control arm were significantly protective in the short term (OR=0.74, 95% CI=0.60, 0.92). Interventions that were conducted for more than 1 year had a higher OR of decreasing the prevalence of obesity. However, intervention programs were not effective in decreasing BMI compared with control treatments, with a weighted mean difference of −0.62 (95% CI=−1.39, 0.14).

Conclusions

This meta-analysis showed that there was convincing evidence that school-based interventions are effective, at least short-term, in reducing the prevalence of childhood obesity. Longer-running programs were more effective than shorter programs.

Section snippets

Background

Childhood obesity has been recognized as an increasing health problem worldwide over the past decade. In the U.S., the prevalence of overweight children aged 5–14 years rose from 15% in 1973 to 32% in 1994, while that of obesity increased from 5% in 1973 to 22% in 1994.1 Similar increases have been reported in countries such as the United Kingdom, Germany, Australia, and China.2, 3, 4, 5

Childhood obesity has been associated with diseases in childhood such as asthma, early-onset diabetes

Participants

The review considered schoolchildren of any nationality who were of normal BMI, overweight or obese, and in pre-adolescent and adolescent phases, with fatness classified by an age- and gender-specific cutoff point system developed by the International Obesity Task Force or by country-specific norms. Children of normal BMI were included in the study because the study investigated both the prevention and treatment of overweight and obesity.

Intervention

The interventions that were considered for inclusion in

Results

The search identified 41 papers based on their title for possible inclusion in the review, of which 19 papers were included in the meta-analysis (Figure 1).

Prevalence of Overweight and Obesity

Figure 2 shows the forest plot of the comparison of intervention and control arms in decreasing the number of participants who were overweight and obese. The odds of participants being overweight and obese in the combined intervention arms compared with the combined comparison arms were significantly protective (OR=0.74, 95% CI=0.60, 0.92). This highlights that the intervention arm was more effective in decreasing the number of participants who become overweight or obese. In analyzing the

Discussion

This meta-analysis provided sound evidence to support schools as favorable settings for obesity prevention in children. Although the Katz et al. study19 was the most recent comparable meta-analysis, Table 3 outlines the differences between the two meta-analyses. The current meta-analysis is more comprehensive in terms of recency and number of studies, number of outcome measures included, as well as coverage of both short- and long-term effects.

This meta-analysis found that school-based

Conclusion

This meta-analysis showed that long-running school-based interventions were effective in preventing childhood overweight and obesity. It found that combined interventions of physical activity and classroom curriculum were effective in preventing childhood overweight and obesity. The duration of the intervention was positively associated with its effectiveness. Given these results, school principals and policymakers should consider implementing school-based interventions as long-term strategies

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