European Journal of Pediatrics

, Volume 177, Issue 10, pp 1531–1539 | Cite as

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

  • Santiago Felipe Gómez
  • Rafael Casas Esteve
  • Isaac Subirana
  • Lluis Serra-Majem
  • Marta Fletas Torrent
  • Clara Homs
  • Rowaedh Ahmed Bawaked
  • Lidia Estrada
  • Montserrat Fíto
  • Helmut SchröderEmail author
Original Article


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).

Conclusions: The TCHP did not improve weight development, diet quality, and physical activity in the short term.

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.


Childhood obesity Community-based intervention Lifestyle 



body mass index


community based intervention


Ensemble Prévenons l’Obésité Des Enfants


generalized estimating equations


physical activity


physical activity questionnaire for children


Thao child health program


waist circumference


waist-to-height ratio



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.

Authors’ contribution

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.

Ethical approval

The project was approved by the local Ethics Committee (CEIC-PSMAR, Barcelona, Spain).

Informed consent

Parental written consent was obtained on behalf of each of the participating children.

Supplementary material

431_2018_3207_Fig1_ESM.png (106 kb)

(PNG 106 kb)

431_2018_3207_MOESM1_ESM.tif (93 kb)
High resolution image (TIF 92 kb)
431_2018_3207_MOESM2_ESM.docx (14 kb)
ESM 2 (DOCX 14 kb)
431_2018_3207_Fig2_ESM.png (258 kb)

(PNG 257 kb)

431_2018_3207_MOESM3_ESM.tif (261 kb)
High resolution image (TIF 261 kb)
431_2018_3207_MOESM4_ESM.docx (7.3 mb)
ESM 4 (DOCX 7494 kb)
431_2018_3207_MOESM5_ESM.docx (14 kb)
ESM 5 (DOCX 14 kb)
431_2018_3207_MOESM6_ESM.docx (15 kb)
ESM 6 (DOCX 14 kb)


  1. 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. CrossRefGoogle Scholar
  2. 2.
    Akinbami LJ, Ogden CL (2009) Childhood overweight prevalence in the United States: the impact of parent-reported height and weight. Obesity 17:1574–1580. CrossRefPubMedGoogle Scholar
  3. 3.
    Aparicio E, Canals J, Arija V (2016) The role of emotion regulation in childhood obesity: implications for prevention and treatment. Nutr Res Rev 29/1:17–29CrossRefGoogle Scholar
  4. 4.
    Bautista-Castaño I, Doreste J, Serra-Majem L (2004) Effectiveness of interventions in the prevention of childhood obesity. Eur J Epidemiol 19:617–622CrossRefPubMedGoogle Scholar
  5. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 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
  7. 7.
    Bleich SN, Segal J, Wu Y, Wilson R, Wilson R, Wang Y (2013) Systematic review of community-based childhood obesity prevention studies. Pediatrics 132/1:203–210. CrossRefGoogle Scholar
  8. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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. CrossRefGoogle Scholar
  10. 10.
    Dahlgren G, Whitehead M (1991) Policies and strategies to promote social equity in health. Institute for Futures Studies, Stockholm at Google Scholar
  11. 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. 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. CrossRefPubMedGoogle Scholar
  13. 13.
    De Vries H, Dijkstra M, Kuhlman P (1988) Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioral intentions. Health Educ Res 3:273–282CrossRefGoogle Scholar
  14. 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. CrossRefPubMedGoogle Scholar
  15. 15.
    Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ, Nelson ME (2007) A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity (Silver Spring) 15(5):1325–1336CrossRefGoogle Scholar
  16. 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. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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. CrossRefGoogle Scholar
  19. 19.
    Grier S, Bryant CA (2005) Social Marketing in Public Health. Annu Rev Public Health 26:319–339CrossRefPubMedGoogle Scholar
  20. 20.
    Hardy LL, Mihrshahi S, Gale J, Nguyen B, Baur LA, O'Hara BJ (2015) Translational research: are community-based child obesity treatment programs scalable? BMC Public Health 15:652. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hoffmann TC, Glasziou PP, Boutron I, De Henauw S, Michels N (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687–g1629. CrossRefPubMedGoogle Scholar
  22. 22.
    Institute of Medicine (2012) Accelerating progress in obesity prevention: solving the weight of the nation. National Academies Press, Washington DCGoogle Scholar
  23. 23.
    King L, Gill T, Allender S, Swinburn B (2011) Best practice principles for community-based obesity prevention: development, content and application. Obes Rev 12(5):329–338. CrossRefPubMedGoogle Scholar
  24. 24.
    Koplan JP, Liverman CT, Kraak VI (2005) Preventing childhood obesity: health in the balance: executive summary. J Am Diet Assoc 105/1:131–138CrossRefGoogle Scholar
  25. 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. CrossRefGoogle Scholar
  26. 26.
    Li P, Redden DT (2015) Small sample performance of bias-corrected sandwich estimators for cluster-randomized trials with binary outcomes. Stat Med 34:281–296. CrossRefPubMedGoogle Scholar
  27. 27.
    Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn B, James WP, Wang Y, McPherson K (2015) Child and adolescent obesity: part of a bigger picture. Lancet 385:2510–2520. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Moore JB, Hanes JC Jr, Barbeau P, Gutin B, Treviño RP, Yin (2007) Validation of the physical activity questionnaire for older children in children of different races. Pediatr Exerc Sci 19:6–19CrossRefPubMedGoogle Scholar
  29. 29.
    Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD (2009) Interventions for treating obesity in children (review). Cochrane Database Syst Rev 3:1–57. CrossRefGoogle Scholar
  30. 30.
    Pate RR, Trost SG, Mullis R, , Sallis JF, Wechsler H, Brown DR (2000) Community interventions to promote proper nutrition and physical activity among youth. Prev Med 31: S138–S148.CrossRefGoogle Scholar
  31. 31.
    Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A, Avon Longitudinal Study of Parents and Children Study Team (2005) Early life risk factors for obesity in childhood: cohort study. Br Med J (Clinical Research Edition) 330:1357–1359CrossRefGoogle Scholar
  32. 32.
    Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, Lo Conte R, Paton JY, Grant S (2006) Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 18/333/7577:1041CrossRefGoogle Scholar
  33. 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. CrossRefPubMedGoogle Scholar
  34. 34.
    Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, Brown M, Zive MM, Marshall SJ, Alcaraz JE (2003) Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. Am J Prev Med 24(3):209–217CrossRefPubMedGoogle Scholar
  35. 35.
    Sánchez-Cruz JJ, Jiménez-Moleón JJ, Fernández-Quesada F, Sánchez MJ (2012) Prevalencia de obesidad infantil y juvenil en España en 2012. Rev Esp Cardiol 66(5):371–376. CrossRefGoogle Scholar
  36. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean diet quality index in children and adolescents. Public Health Nutr 7:931–935PubMedGoogle Scholar
  38. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL (2011) The global obesity pandemic: global drivers and local environments. Lancet 378:804–814. CrossRefPubMedGoogle Scholar
  40. 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.
  41. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD (2011) Interventions for preventing obesity in children. Cochrane Database Syst Rev 12:CD001871. CrossRefGoogle Scholar
  43. 43.
    World Health Organization (WHO) (2012) Population-based approaches to childhood obesity prevention. WHO, GenevaGoogle Scholar
  44. 44.
    World Health Organization (WHO). Department of Nutrition for Health and Development (2008) Training course on child growth assessment. WHO, GenevaGoogle Scholar
  45. 45.
    World Health Orgzaniation (2012) Population-based approaches to childhood obesity prevention. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Santiago Felipe Gómez
    • 1
    • 2
  • Rafael Casas Esteve
    • 3
  • Isaac Subirana
    • 4
    • 5
  • Lluis Serra-Majem
    • 6
    • 7
    • 8
  • Marta Fletas Torrent
    • 9
  • Clara Homs
    • 1
  • Rowaedh Ahmed Bawaked
    • 10
    • 11
  • Lidia Estrada
    • 12
  • Montserrat Fíto
    • 8
    • 10
  • Helmut Schröder
    • 5
    • 10
    Email author
  1. 1.Gasol FoundationSant Boi de LlobregatSpain
  2. 2.GREpS, Health Education Research Group, Nursing and Physiotherapy DepartmentUniversity of LleidaLleidaSpain
  3. 3.Sharing Healthy & Active LifestyleBarcelonaSpain
  4. 4.Cardiovascular Epidemiology and Genetics Research GroupIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  5. 5.CIBER Epidemiology and Public Health (CIBERESP)Instituto de Salud Carlos IIIMadridSpain
  6. 6.Reseach Institute of Biomedical and Health SciencesUniversity of Las Palmas de Gran CanariaCanary IslandsSpain
  7. 7.Fundación para la Investigación Nutricional (Nutrition Research Foundation)BarcelonaSpain
  8. 8.CIBER Physiopathology of Obesity and Nutrition (CIBEROBN)Instituto de Salud Carlos IIIMadridSpain
  9. 9.North Metropolitan Unit of Research SupportJordi Gol University Institute of Research in Primary Care (IDIAP Jordi Gol)MataróSpain
  10. 10.Cardiovascular Risk and Nutrition Research GroupIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  11. 11.PhD Programme in BiomedicineUniversidad Pompeu FabraBarcelonaSpain
  12. 12.Gasol FoundationLos AngelesUSA

Personalised recommendations