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School-based obesity intervention programmes

School-based obesity intervention programmes not effective

(Credit: Obesity Action Coalition)
Wider influences from families, local communities and the food industry may have a greater effect than any school run intervention

School-based programmes aimed at preventing obesity in children are unlikely to have much impact on the childhood obesity epidemic, according to a randomised controlled trial lead by researchers from the University of Birmingham. Although school is an important setting for supporting healthy lifestyles, the researchers say wider influences - for example from families, local communities, and the food industry - may have a greater effect than any school run intervention.

The paper, ‘Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)’, published in The BMJ, assessed the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity.

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. On hundred and forty-four eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year one pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. Fifty-three 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.

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.

Outcomes

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).

The researchers point to some limitations, such as possible imbalances between the groups at the start of the trial, but say strengths include the large number of schools involved, and lengthy follow-up.

They suggest that ‘nudge’ interventions - for example using financial incentives to prompt healthier behaviour - merit further investigation, but they conclude that school based motivational, educational approaches "are unlikely to halt the childhood obesity epidemic."

“These findings are important and could perhaps help break the cycle of policymakers continuing with ineffective educational preventive approaches that can never hope to greatly impact on the obesity epidemic," writes Professor Melissa Wake, paediatrician and scientific director at the GenV initiative in Victoria, Australia, in the linked editorial, ‘The failure of anti-obesity programmes in schools’. “Effective, scalable, and affordable strategies are needed that reduce childhood obesity, can be implemented locally and do not widen health inequities…It is time to step back, take stock, carefully examine longitudinal data from contemporary children, and generate new, solution-focused approaches that could maximise health gain and be rigorously and speedily tested."

To access this paper, please click here

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