Original ArticleSchool-based obesity prevention interventions: Practicalities and considerations
Introduction
Childhood obesity prevention is a global public health priority. An extensive body of evidence highlights the deleterious effects of obesity on both short- and long-term physiological and psychological well-being [1]. Internationally, child obesity rates have been increasing over the last 20–30 years, although recent evidence suggests rates are plateauing in some countries [2] whilst continuing to rise in others. As obesity is difficult to reverse [3] and has been shown to track throughout life [4] early intervention is warranted. A recent systematic review of 55 interventions for preventing obesity in children and adolescents found some beneficial effects on body mass index, with an effect size that provides confidence of the effectiveness of prevention strategies and the possibility of making a long term impact on weight status [5]. Within the review the strongest and largest body of evidence comes from research targeting children aged 6–12 years (39 of the 55 studies) with 32 of those, i.e. the majority of successful studies, conducted in education settings [5].
Education settings (i.e. preschools, primary and secondary schools; referred to as schools from here on in) represent a popular setting for interventions as most children attend them and many (but not all) have the existing infrastructure to support the implementation of interventions. Furthermore, schools generally have the necessary personnel, curriculum and facilities to promote physical activity and healthy eating [6] and teachers are generally supportive of approaches to improve the health behaviours of children [7]. Recent reviews analyzing school-based interventions [8], [9], [10], [11] have reported the effectiveness of interventions conducted in this setting. As most of the studies are short-term, the recommendations are inevitably for short-term effectiveness. However, many challenges of school-based study designs have been identified, including issues associated with study design (e.g. cluster randomization; statistical power), evaluation (short-term follow-up; lack of process, economic or equity measures), and intervention implementation (failure to consider sustainability and generalizability) [9], [11]. Therefore, the aim of this paper was twofold: (i) to make recommendations regarding the design, implementation and evaluation of school-based interventions; and (ii) to provide insights to researchers for overcoming some of the key practical challenges faced when undertaking these activities.
Section snippets
Recent Australian school-based trials to prevent obesity
The Prevention Stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) has collectively implemented and evaluated more than 30 school-based obesity prevention interventions across Australia. These studies have been diverse in design, sample size, theoretical framework, intervention components, implementation strategies, duration, system level interactions, and outcome measures. To highlight some of the key recommendations and practical challenges associated with
Design and analysis
The overall design, including randomisation (if implementing a group randomised controlled trial), selection of outcome measures and theoretical frameworks and the analysis procedures must be carefully considered given the complex nature of the school environment. Randomised controlled trials are considered to be the gold standard for evaluating obesity prevention interventions [18], however other designs such as quasi-experimental trials, single group pre-test post-test trials or wait-list
Conclusions
There is currently no identified single, school-based intervention that can be implemented universally to prevent childhood obesity. The education system however has an important role in obesity prevention and schools represent one mechanism to bring about societal change. This paper presents six areas for consideration for future school-based obesity prevention interventions. Ensuring strong engagement between schools and researchers, the selection of appropriate study designs, the collection
Conflict of interest
There were no conflicts of interest.
Funding
No competing financial interests exist.
Acknowledgements
ADO is supported by a National Heart Foundation of Australia Career Development Fellowship (CR11S 6099). NP is supported by National Health and Medical Research Council Program Grant funding (#320860 and 631947).
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