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

Abstract

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.

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Abbreviations

BMI:

body mass index

CBI:

community based intervention

EPODE:

Ensemble Prévenons l’Obésité Des Enfants

GEE:

generalized estimating equations

PA:

physical activity

PAQ-C:

physical activity questionnaire for children

TCHP:

Thao child health program

WC:

waist circumference

WHtR:

waist-to-height ratio

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Acknowledgements

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.

Funding

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.

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Authors

Contributions

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.

Corresponding author

Correspondence to Helmut Schröder.

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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.

Additional information

Communicated by Mario Bianchetti

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Gómez, S.F., Casas Esteve, R., Subirana, I. et al. 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. Eur J Pediatr 177, 1531–1539 (2018). https://doi.org/10.1007/s00431-018-3207-x

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Keywords

  • Childhood obesity
  • Community-based intervention
  • Lifestyle