Effect of a community-based childhood obesity intervention program on changes in anthropometric variables, incidence of obesity, and lifestyle choices in Spanish children aged 8 to 10 years
Results of community-based childhood obesity intervention programs do not provide strong evidence for their effectiveness. In this study, we evaluated the effect of the Thao-Child Health Program (TCHP), a community-based, multisetting, multistrategy intervention program for healthy weight development and lifestyle choices. In four Catalan cities, a total of 2250 children aged 8 to 10 years were recruited. Two cities were randomly selected for the TCHP intervention, and two cities followed usual health care policy. Children were selected from 41 elementary schools. Weight, height, and waist circumference were measured at baseline and after a mean follow-up of 15 months. Physical activity and adherence to the Mediterranean diet were measured with validated questionnaires. Generalized estimating equations (GEE) models were fitted to determine the intervention’s effect on body mass index (BMI) z-score, waist-to-height ratio, Mediterranean diet adherence, and physical activity. Fully adjusted models revealed that the intervention had no significant effect on the BMI z-score, incidence of general and abdominal obesity, Mediterranean diet adherence, and physical activity. Waist-to-height ratio was significantly lower in controls than in the intervention group at follow-up (p < 0.004).
What is Known:
• There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs.
• There is little evidence on the efficacy of childhood obesity intervention programs in other settings.
What is New:
• This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization.
• This CBI had no effect on the prevention and treatment of childhood obesity in the short term.
KeywordsChildhood obesity Community-based intervention Lifestyle
body mass index
community based intervention
Ensemble Prévenons l’Obésité Des Enfants
generalized estimating equations
physical activity questionnaire for children
Thao child health program
We thank the staff, pupils, parents, schools, and municipalities of Gavà, Molins de Rei, Sant Boi de Llobregat, and Terrassa for their participation, enthusiasm, and support. We appreciate the English revision by Elaine M. Lilly, Ph.D.
SFG, RC, and HS designed the study. SFG and HS conducted the analysis and prepared the manuscript, with significant input and feedback from all co-authors; SFG, RC, IS, LSM, MFT, CH, RAB, LE, MF, and HS execution of the study and contributed to the critical revision of the manuscript for important intellectual content; IS was responsible for imputation and general estimating equation models. All authors approved the final version of the manuscript.
This work was supported by grants from the Instituto de Salud Carlos III FEDER (PI11/01900 and CB06/02/0029), and AGAUR (2014 SGR 240). The CIBERESP and the CIBEROBN are initiatives of the Instituto de Salud Carlos III, Madrid, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The project was approved by the local Ethics Committee (CEIC-PSMAR, Barcelona, Spain).
Parental written consent was obtained on behalf of each of the participating children.
- 1.Ahrens W, Pigeot I, Pohlabeln H, De Henauw S, Lissner L, Molnár D, Moreno LA, Tornaritis M, Veidebaum T, Siani A, IDEFICS consortium (2014) Prevalence of overweight and obesity in European children below the age of 10. Int J Obes (Lond) 38:S99eS107. https://doi.org/10.1038/ijo.2014.140 CrossRefGoogle Scholar
- 5.Bemelmans WJ, Wijnhoven TM, Verschuuren M, Breda J (2014) Overview of 71 European community-based initiatives against childhood obesity starting between 2005 and 2011: general characteristics and reported effects. BMC Public Health 14:758. https://doi.org/10.1186/1471-2458-14-758 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Birch L, Savage JS, Ventura A (2007) Influences on the development of children’s eating behaviours: from infancy to adolescence. Can J Diet Pract Res 68/1:s1–s56Google Scholar
- 8.Borys JM, Valdeyron L, Levy E, Vinck J, Edell D, Walter L, Ruault du Plessis H, Harper P, Richard P, Barriguette (2013) A EPODE – amodel for reducing the incidence of obesity and weight-related comorbidities. Eur Endocrinol 9:116–120. https://doi.org/10.17925/USE.2013.09.01.32 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Chomitz VR, McGowan RJ, Wendel JM, Williams SA, Cabral HJ, King SE, Olcott DB, Cappello M, Breen S, Hacker KA (2010) Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness. Obesity (Silver Spring) 18/1:S45–S53. https://doi.org/10.1038/oby.2009.431 CrossRefGoogle Scholar
- 11.de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for schoolaged children and adolescents. Bull World Health Organ 85:6607Google Scholar
- 12.de Silva-Sanigorski AM, Bell AC, Kremer P, Nichols M, Crellin M, Smith M, Sharp S, de Groot F, Carpenter L, Boak R, Robertson N, Swinburn BA (2010) Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. Am J Clin Nutr 91(4):831–840. https://doi.org/10.3945/ajcn.2009.28826 CrossRefPubMedGoogle Scholar
- 14.Delgado-Floody P, Espinoza-Silva M, García-Pinillos F, Latorre-Román P (2018) Effects of 28 weeks of high-intensity interval training during physical education classes on cardiometabolic risk factors in Chilean schoolchildren: a pilot trial. Eur J Pediatr 177:1019–1027. https://doi.org/10.1007/s00431-018-3149-3 CrossRefPubMedGoogle Scholar
- 16.Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L, American Heart Association (2006) Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics 117/2:544–559Google Scholar
- 17.Gómez SF, Casas R, Palomo VT, Martin Pujol A, Fíto M, Schröder H (2014) Study protocol: effects of the Thao-child health intervention program on the prevention of childhood obesity—the POIBC study. BMC Pediatr 14:215. https://doi.org/10.1186/1471-2431-14-215 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Gómez SF, Santiago RE, Gil-Antuñano NP, Leis Trabazo MR, Tojo Sierra R, Cuadrado Vives C, Beltrán de Miguel B, Ávila Torres JM, Varela Moreiras G, Casas Esteve R (2015) Thao-child health Programme: community based intervention for healthy lifestyles promotion to children and families: results of a cohort study. Nutr Hosp 32/6:2584–2587. https://doi.org/10.3305/nh.2015.32.6.9736 CrossRefGoogle Scholar
- 22.Institute of Medicine (2012) Accelerating progress in obesity prevention: solving the weight of the nation. National Academies Press, Washington DCGoogle Scholar
- 25.Lawlor DA, Benfield L, Logue J, Tilling K, Howe LD, Fraser A, Cherry L, Watt P, Ness AR, Davey Smith G, Sattar N (2010) Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study. BMJ 25:341. https://doi.org/10.1136/bmj.c6224 CrossRefGoogle Scholar
- 33.Romon M, Lommez A, Tafflet M, Basdevant A, Oppert JM, Bresson JL, Ducimetière P, Charles MA, Borys JM (2009) Downward trends in the prevalence of childhood overweight in the setting of 12- year school- and community-based programmes. Public Health Nutr 12:1735–1742. https://doi.org/10.1017/S1368980008004278 CrossRefPubMedGoogle Scholar
- 36.Schröder H, Ribas L, Koebnick C, Funtikova A, Gomez SF, Fíto M, Perez-Rodrigo C, Serra-Majem L (2014) Prevalence of abdominal obesity in Spanish children and adolescents. Do we need waist circumference measurements in paediatric practice? PLoS One 9:e87549. https://doi.org/10.1371/journal.pone.0087549 CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Swinburn BA, Sacks G, Lo SK, Westerterp KR, Rush EC, Rosenbaum M, Luke A, Schoeller DA, DeLany JP, Butte NF, Ravussin E (2009) Estimating the changes in energy flux that characterize the rise in obesity prevalence. Am J Clin Nutr 89:1723–1728. https://doi.org/10.3945/ajcn.2008.27061 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Viggiano E, Viggiano A, Di Costanzo A, Viggiano A, Viggiano A, Andreozzi E, Romano V, Vicidomini C, Di Tuoro D, Gargano G, Incarnato L, Fevola C, Volta P, Tolomeo C, Scianni G, Santangelo C, Apicella M, Battista R, Raia M, Valentino I, Palumbo M, Messina G, Messina A, Monda M, De Luca B, Amaro S (2018) Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial. Eur J Pediatr. https://doi.org/10.1007/s00431-018-3091-4
- 41.Wang Y, Cai L, Wu Y, Wilson RF, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT, Zhang A, Segal J (2015) What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev 16:547–565. https://doi.org/10.1111/obr.12277 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.World Health Organization (WHO) (2012) Population-based approaches to childhood obesity prevention. WHO, GenevaGoogle Scholar
- 44.World Health Organization (WHO). Department of Nutrition for Health and Development (2008) Training course on child growth assessment. WHO, GenevaGoogle Scholar
- 45.World Health Orgzaniation (2012) Population-based approaches to childhood obesity prevention. World Health Organization, GenevaGoogle Scholar