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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components.

ABSTRACT: BACKGROUND:Childhood obesity is a serious public health concern. School-based interventions hold great promise to combat the rising trend of childhood obesity. This systematic review aimed to assess the overall effects of school-based obesity prevention interventions, and to investigate characteristics of intervention components that are potentially effective for preventing childhood obesity. METHODS:We systematically searched MEDLINE, CENTRAL and Embase databases to identify randomized- or cluster randomized- controlled trials of school-based obesity interventions published between 1990 and 2019. We conducted meta-analyses and subgroup analyses to determine the overall effects of obesity prevention programs and effect differences by various characteristics of intervention components on body mass index (BMI) or BMI Z-score of children. RESULTS:This systematic review included a total of 50 trials (reported by 56 publications). Significant differences were found between groups on BMI (- 0.14 kg/m2 (95% confidence interval: - 0.21, - 0.06)) and BMI Z-score (- 0.05 (- 0.10, - 0.01)) for single-component interventions; significant differences were also found between groups on BMI (- 0.32 (- 0.54, - 0.09) kg/m2) and BMI Z-score (- 0.07 (- 0.14, - 0.001)) for multi-component interventions. Subgroup analyses consistently demonstrated that effects of single-component (physical activity) interventions including curricular sessions (- 0.30 (- 0.51, - 0.10) kg/m2 in BMI) were stronger than those without curricular sessions (- 0.04 (- 0.17, 0.09) kg/m2 in BMI); effects of single-component (physical activity) interventions were also strengthened if physical activity sessions emphasized participants' enjoyment (- 0.19 (- 0.33, - 0.05) kg/m2 in BMI for those emphasizing participants' enjoyment; - 0.004 (- 0.10, 0.09) kg/m2 in BMI for those not emphasizing participants' enjoyment). The current body of evidence did not find specific characteristics of intervention components that were consistently associated with improved efficacy for multi-component interventions (P > 0.05). CONCLUSIONS:School-based interventions are generally effective in reducing excessive weight gain of children. Our findings contribute to increased understandings of potentially effective intervention characteristics for single-component (physical activity) interventions. The impact of combined components on effectiveness of multi-component interventions should be the topic of further research. More high-quality studies are also needed to confirm findings of this review.

SUBMITTER: Liu Z

PROVIDER: S-EPMC6819386 | biostudies-other | 2019 Oct

REPOSITORIES: biostudies-other

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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components.

Liu Zheng Z Liu Zheng Z Xu Han-Meng HM Wen Li-Ming LM Peng Yuan-Zhou YZ Lin Li-Zi LZ Zhou Shuang S Li Wen-Hao WH Wang Hai-Jun HJ

The international journal of behavioral nutrition and physical activity 20191029 1

<h4>Background</h4>Childhood obesity is a serious public health concern. School-based interventions hold great promise to combat the rising trend of childhood obesity. This systematic review aimed to assess the overall effects of school-based obesity prevention interventions, and to investigate characteristics of intervention components that are potentially effective for preventing childhood obesity.<h4>Methods</h4>We systematically searched MEDLINE, CENTRAL and Embase databases to identify rand ...[more]

PMID: 31665040

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Project description:BackgroundOverweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology.Methods/designA systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB Abstracts, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4-18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs.DiscussionThis systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings.Systematic review registrationPROSPERO: CRD42020220451 .

Project description:BackgroundUntil now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods.MethodsStudies published between January 2001-October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4-18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (>?75% positive), moderate (50-75%) or low (<?50%).ResultsOf the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N =?50), followed by responsiveness (N =?36), adherence (N =?26) and quality of delivery (N =?8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n =?77).ConclusionsThere is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective.

Project description:School-based programs seem promising for child abuse prevention. However, research mainly focused on sexual child abuse and knowledge is lacking on how individual program components contribute to the effectiveness of school-based prevention programs for any form of child abuse. This study aimed to examine the overall effect of these school-based programs on (a) children's child abuse-related knowledge and (b) self-protection skills by conducting two three-level meta-analyses. Furthermore, moderator analyses were performed to identify how program components and delivery techniques were associated with effectiveness. A literature search yielded 34 studies (158 effect sizes; N = 11,798) examining knowledge of child abuse and 22 studies (99 effect sizes; N = 7804) examining self-protection skills. A significant overall effect was found of school-based programs on both knowledge (d = 0.572, 95% CI [0.408, 0.737], p < 0.001) and self-protection skills (d = 0.528, 95% CI [0.262, 0.794], p < 0.001). The results of the first meta-analysis on children's child abuse knowledge suggest that program effects were larger in programs addressing social-emotional skills of children (d = 0.909 for programs with this component versus d = 0.489 for programs without this component) and self-blame (d = 0.776 versus d = 0.412), and when puppets (d = 1.096 versus d = 0.500) and games or quizzes (d = 0.966 versus d = 0.494) were used. The second meta-analysis on children's self-protections skills revealed that no individual components or techniques were associated with increased effectiveness. Several other study and program characteristics did moderate the overall effects and are discussed. In general, school-based prevention programs show positive effects on both knowledge and self-protection skills, and the results imply that program effectiveness can be improved by implementing specific components and techniques.

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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components.

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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components.

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