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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

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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.

Author information

Authors and Affiliations

  1. Gasol Foundation, Sant Boi de Llobregat, Spain

    Santiago Felipe Gómez & Clara Homs

  2. GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain

    Santiago Felipe Gómez

  3. Sharing Healthy & Active Lifestyle, Barcelona, Spain

    Rafael Casas Esteve

  4. Cardiovascular Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Isaac Subirana

  5. CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Isaac Subirana & Helmut Schröder

  6. Reseach Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Canary Islands, Spain

    Lluis Serra-Majem

  7. Fundación para la Investigación Nutricional (Nutrition Research Foundation), Barcelona, Spain

    Lluis Serra-Majem

  8. CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Lluis Serra-Majem & Montserrat Fíto

  9. North Metropolitan Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP Jordi Gol), Mataró, Spain

    Marta Fletas Torrent

  10. Cardiovascular Risk and Nutrition Research Group, IMIM (Hospital del Mar Medical Research Institute), c/ Doctor Aiguader 88, 08003, Barcelona, Spain

    Rowaedh Ahmed Bawaked, Montserrat Fíto & Helmut Schröder

  11. PhD Programme in Biomedicine, Universidad Pompeu Fabra, Barcelona, Spain

    Rowaedh Ahmed Bawaked

  12. Gasol Foundation, Los Angeles, CA, USA

    Lidia Estrada

Authors
  1. Santiago Felipe Gómez
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  2. Rafael Casas Esteve
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  3. Isaac Subirana
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  4. Lluis Serra-Majem
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  5. Marta Fletas Torrent
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  6. Clara Homs
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  7. Rowaedh Ahmed Bawaked
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  9. Montserrat Fíto
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  10. Helmut Schröder
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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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