EFFECTIVENESS OF OBESITY INTERVENTION PROGRAMS BASED ON GUIDELINES FOR ADOLESCENT STUDENTS: SYSTEMATIC REVIEW

Wolf, Vaneza Lira Waldow; Samur-San-Martin, Juan Eduardo; Sousa, Suzy Ferreira de; Santos, Hemerson Dinis Oliveira; Folmann, Augusto Gerhart; Ribeiro, Roberto Régis; Guerra-Júnior, Gil

doi:10.1590/1984-0462/;2019;37;1;00015

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 37 (1) • Jan-Mar 2019 • https://doi.org/10.1590/1984-0462/;2019;37;1;00015 copy

EFFECTIVENESS OF OBESITY INTERVENTION PROGRAMS BASED ON GUIDELINES FOR ADOLESCENT STUDENTS: SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To verify the effectiveness of educational interventions based on guidance on physical activity and nutrition in schoolchildren.

Data sources:

A systematic search was carried out in four electronic databases containing articles published between October 2007 and January 2017 and addressing educational interventions with emphasis on both nutritional education and physical activity in schoolchildren and adolescents aged 10 to 19 years.

Data synthesis:

Twelve articles were selected for this review, of which four included only educational interventions; four made and association between educational interventions, inclusion of healthy foods and physical activity; two made a relation between guidelines and physical activity; and finally, two associated guidelines with consumption of healthy foods.

Conclusions:

Interventions based on physical activity and/or nutrition counseling were efficient and showed superior results in studies that associated the practice of physical activity with counseling. However, the need for new studies on educational interventions among schoolchildren and adolescents was made evident.

Keywords:
Child health services; School health; Health behavior; Eating habits; Physical activity.

Study	Sample	Goals	Intervention	Evaluation	Results
Casazza and Ciccazzo, 2007¹⁹19. Casazza K, Ciccazzo M. The method of delivery of nutrition and physical activity information may play a role in eliciting behavior changes in adolescents. Eat Behav. 2007;8:73-82.	3 schools Age range: 13-18 years. CON: n=1,599; CBI: n=2,565; TDI: n=2,573	To compare the results of two methods of service delivery to health education programs in order to determine whether the strategy was effective to adolescents adopting a healthier lifestyle.	11 weeks. CON: recruitment and evaluations. CBI: CD-ROM education, study guide. TDI: lectures, leaflets	Weight; BMI; 24-hour reminder; FFQ; nutritional knowledge questionnaire; PAQ-a; trust on diet and exercise survey; social support survey; questionnaires after the intervention.	BMI: no difference between groups, but TDI group presented pre<post reduction (23.1±0.7 to 22.9±0.7, p<0.001). Knowledge about nutrition: CON = CBI = TDI; CBI< knowledge of nutrition, pre- and post- (40.4+1.25 to 53.2+1.19, p<0.001); TDI> knowledge about pre- and post-nutrition (42.8±1.19 to 50.9±1.12, p=0.003). Physical activity: CON = CBI = TDI. Physical activity pre<post: CBI (17.6±5.92 to 19.6±5.82, p=0.005); Calories intake: pre<post: CBI (p=0.006); TDI (p=0.009). Fat intake: CBI pre<post (p<0.001); CON = TDI. Meals ignored: CBI pre<post (p=0.001). Social support in diet: CBI and TDI pre<post (p<0.001).
Fairclough et al., 2013²²22. Fairclough SJ, Hackett AF, Davies IG, Gobbi R, Mackintosh KA, Warburton GL, et al. Promoting healthy weight in primary school children through physical activity and nutrition education: A pragmatic evaluation of the CHANGE! randomised intervention study. BMC Public Health. 2013;13:626.	12 schools Age range: 10-11 years; CG: n=152; IG=166	To evaluate the effectiveness of the program “Change” in body composition, physical activity practice and food consumption.	20-week intervention and 10-week follow-up. IG: 20 weekly lesson plans, homework, spreadsheets and a CD-ROM. CG: received information during school classes, but not related to the program.	Weight, BMI, waist circumference, accelerometers, 24-hour record, APHV and 20m SRT	waist circumference: IG≠CG pre-post: IG> WC (β=-1.63 (95%CI -2.20--1.07) cm, p<0.001). zBMI and LPA: IG≠CG pre-follow-up: IG>zBMI (β=-0.24 (95%CI -0.48--0.003), p=0.04); LPA (β=25.97 (95%CI 8.04-43.89) min, p=0.01). WC: OW≠NW, OW>WC (β=-2.82 (95%CI -4.06--1.58) cm, p<0.001) NW (β=-1.34 (95%CI -2.00--0.72) cm, p<0.001). Girls >BMI e zBMI: BMI (β=-0.39 (95%CI -0.81-0.03) kg/m², p=0.07) zBMI (β=-0.18 (95%CI -0.42-0.06) cm, p=0.14). Boys <BMI e zBMI: BMI (β=0.47 (95%CI 0.03-0.91)) kg/m², p=0.04) zIMC (β=0.27 (95%CI 0.02-0.52) cm, p=0.04).
Ezendam et al., 2012²⁰20. Ezendam NP, Brug J, Oenema A. Evaluation of the Web-Based computer-tailored FATaintPHAT intervention to promote energybalance among adolescents: results from a school cluster randomized trial. Arch Pediatr Adolesc Med. 2012;166:248-55.	20 schools Age range: 12-13 years; IG: 11 schools (n=485); CG: 9 schools (n=398)	To check the relevance and understanding, as well as news about information provided by FATaintPHAT, and the association between behaviors after four months of follow-up.	10 weeks IG: eight 15-minute lessons via internet. CG: recruitment and assessment	Weight, waist circumference, BMI. Pedometers in five students per class for seven consecutive days, questionnaire after each module, food frequency questionnaire, food frequency questionnaire for snacks, leisure physical activity questionnaire, active transport and screen time, questionnaire for frequency of activities for more than 60 minutes, demographic data questionnaire.	4 months IG≠CG IG> intake of more than 400 mL of sugary beverages. IG> intake of snacks per day (β=0.81 snacks/day). IG< intake of vegetables (β=19.3 g/d). IG< intake of fruit (β=19.3 g/d). IG> steps (β=-10.856 steps/week). No effect on weight, BMI, waist circumference and physical activity. Also no difference in 2-year follow-up.

Study	Sample	Goals	Intervention	Evaluation	Results
Kong et al., 2013²¹21. Kong AS, Sussman AL, Yahne C, Skipper BJ, Burge MR, Davis SM. School-based health center intervention improves body mass index in overweight and obese adolescents. J Obes. 2013;2013:575016.	Two schools Students and parents/caregivers Action: n=28 Mean age: 15±1 year. SCG: n=23 Mean age:14.6±0.7	To evaluate whether the Action program could reduce zBMI in IG when compared to SCG.	During school year. Action: eight motivational meetings, DVD, assessment results, print material, recommendations by the American Academy of Pediatrics + information leaflets for parents. SCG: one visit upon intervention start, brochure on “balance for a healthy life”, assessment results, recommendations by the American Academy of Pediatrics.	Weight, BMI, hematocrit in girls, cholesterol, FitnessGram Pacer, research on changes in living habits, diabetes and liver fat tests in obese or overweight students with family history of diabetes.	zBMI pre-post: Action ≠SCG, Action>zBMI =(=-0.3 (95%CI -0.6-0.3), SCG (=0.2 (95%CI -0.1-0.8) (p=0.04). WC pre-post: Action ≠ SCG, Action >WC =(=-0.0 (95%CI -1.4-1.4), SCG (=1.7 (95%CI 0.4-2.9) (p=0.04). Screen time on week days pre-post: Action ≠SCG: Action>SCG =(=-0.4 (95%CI -1.0-0.2), SCG (= 0.2 (95%CI 0.3-0.6) (p=0.03).
Jago et al., 2011²⁹29. Jago R, Mcmurray RG, Drews KL, Moe EL, Murray T, Pham TH, et al. HEALTHY intervention: Fitness, physical activity, and metabolic syndrome results. Med Sci Sports Exerc. 2011;43:1513-22.	42 schools Mean age: 11.3±0.6 IG: n=3,222; CG: n=3,191.	To investigate whether the intervention program “Healthy” led participants to increase their levels of physical activity, and the prevalence of metabolic diseases, comparing IG with CG.	2,5 years. IG: inclusion of healthy food in diet, Flash, social marketing campaign and more active physical education classes social. CG: recruitment and assessment.	Weight, BMI, waist circumference, 20-m shuttle test (20-MST), SAPAC, MPVA time, lab tests (LDL, HDL cholesterol) and blood pressure.	No statistically significant difference in any test.
Willi et al., 2012³⁰30. Willi SM, Hirst K, Jago R, Buse J, Kaufman F, El Ghormli L, et al. Cardiovascular risk factors in multi-ethnic middle school students: The HEALTHY primary prevention trial. Pediatr Obes. 2012;7:230-9.	42 schools Age range: 11-14 years IG: n=2,185; CG: n=2,178	To examine the effects of the intervention program “Healthy” on cardiovascular risk factors.	2.5 years. IG: changes in eating habits and in physical activity practice, social marketing campaign to reinforce messages and images. CG: recruitment and assessment.	Weight, BMI, lab tests (LDL, HDL cholesterol) and blood pressure.	No statistically significant difference in any test.

Study	Sample	Goals	Intervention	Evaluation	Results
Love-Osborne et al., 2014²⁴24. Love-Osborne K, Fortune R, Sheeder J, Federico S, Haemer MA. School-based health center-based treatment for obese adolescents: feasibility and body mass index effects. Child Obes. 2014;10:424-31.	Two schools CG: n=83 Mean age: 16±1.5 years. IG: n=82 Mean age: 15.7±1.5 years.	To evaluate whether the program “HE” promotes more contact with students and improves lifestyle and results in BMI in overweight adolescents.	IG: healthy eating in school environment or the community, orientation for 1 hour of daily physical activity, self-monitoring by weekly records; IG TM: received electronic messages; IG NMT: did not receive messages. CG: preventive service, assessments	Peso, IMC, hematocrit in girls, cholesterol, FitnessGram Pacer, research on changes in living habits, diabetes and liver fat tests in obese or overweight students with family history of diabetes.	zBMI: 55% of IG and 72% of CG had zIMC reduced or stable (p=0.025); 40% of CG and 18% of IG had zIMC reduced (p=0.02). Participation in sports: 47% of CG and 28% of IG (p=0.02) Sports practice: CG>IG (47% versus 28% in IG; p=0.02) Students aged > 15 years had better results in zIMC reduction (p=0.03).
Johnston et al., 2007²³23. Johnston CA, Tyler C, Fullerton G, Poston WS, Haddock CK, McFarlin B, et al. Results of an intensive school-based weight loss program with overweight Mexican American children. Int J Pediatr Obes. 2007;2:144-52.	71 schoolchildren. Age range: 10-14 years. II: n=46 SH: n=25	To evaluate the effect of a randomized intervention in school environment as to weight loss in overweight schoolchildren.	24 weeks II: 12 weeks of physical activity, nutritional counseling, inclusion of healthy foods, monthly meetings with parents, guidance material and 12 biweekly follow-up sessions. SH: book “Trim Kids” for both students and parents.	Weight, BMI, lab tests (cholesterol, triglycerides, HDL, LDL, glucose), blood pressure and body fat percentage with electric bio-impedance scale.	IMC: II≠SH, II>IMC (p=0.004). II>zBMI at three and six months (p=0.001). Body fat percentage: II≠SH at six months, II> body fat percentage (p=0.001)
Johnston et al., 2010²⁶26. Johnston CA, Tyler C, McFarlin BK, Poston WS, Haddock CK, Reeves RS, et al. Effects of a school-based weight maintenance program for Mexican-American children: results at 2 years. Obesity. 2010;18:542-7.	71 schoolchildren. Age range: 10-14 years. II: n=40 SH: n=20	To verify long-term effectiveness of the intervention program carried out by Johnston et al.²³23. Johnston CA, Tyler C, Fullerton G, Poston WS, Haddock CK, McFarlin B, et al. Results of an intensive school-based weight loss program with overweight Mexican American children. Int J Pediatr Obes. 2007;2:144-52..	1 and 2-year follow-up of the study conducted by Johnston et al.²³23. Johnston CA, Tyler C, Fullerton G, Poston WS, Haddock CK, McFarlin B, et al. Results of an intensive school-based weight loss program with overweight Mexican American children. Int J Pediatr Obes. 2007;2:144-52..	Weight, BMI, lab tests (cholesterol, triglycerides, HDL, LDL, glucose), blood pressure and body fat percentage with electric bio-impedance scale and triceps fold.	1 and 2-year follow-up II≠ SH II >zBMI, SH (p<0.001); II: 1 and 2 years (p<0.001, p<0.05). 1-year follow-up. II>BMI (p<0.001); II>Weight (p<0.001) II>overweight percentage (p<0.001). II>cholesterol (p<0.05), II>triglycerides (p<0.05) II>triceps fold (p<0.01).

Study	Sample	Goals	Intervention	Evaluation	Results
McFarlin et al., 2013²⁸28. McFarlin BK, Johnston CJ, Carpenter KC, Davidson T, Moreno JL, Strohacker K, et al. A one-year school-based diet/exercise intervention improves non-traditional disease biomarkers in Mexican-American children. Matern Child Nutr. 2013;9:524-32.	Age range: 12-14 years IG: n=152; SH: n=69	To validate a school-based intervention along 12 months, using plasma, resistin, adipokine, leptin concentrations and biological results.	IG: physical activity practice, nutritional counseling, SH: instruction manual on weight loss and weight maintenance.	Weight, BMI, blood plasma (resistin, adiponectin and leptin).	Pre-post zBMI: IG ≠SH 6 months, IG>zBMI IG (-0.211±0.005) versus SH (-0.173±0.004) (p<0.05); 12 months IG (-0.105±0.004) versus SH (-0.068±0.006). Pre-post six months resistin = IG≠ SH, IG> resistin in six months (p=0.001). Adipokine= IG ≠SH, six months (p<0.001); 12 months (p<0.001). Pre-post 12 months Leptin: IG≠SH, IG>leptin (p=0.013)
Covell, 2008²⁷27. Covelli MM. Efficacy of a school-based cardiac health promotion intervention program for African-American adolescents. Appl Nurs Res. 2008;21:173-80.	62 schoolchildren Age range: 14-17 years IG: n=37 CG: n=25	To raise the level of knowledge about health, increase daily exercise practice, increase intake of fruits and vegetables, maintain blood pressure levels.	Nine weeks. IG: classes with lectures and discussions, physical exercise, guidelines on diet and exercise and self-reported food consumption and weekly practice of exercises. CG: Life Management Class, theoretical intervention.	Blood pressure, demographic data, physical activity questionnaire, nutrition questionnaire with 2-day recall report and test for knowledge about health.	Pre-post knowledge: IG≠CG, IG<knowledge (p=0.0001). Pre-post fruit and vegetable intake IG≠CG, IG< fruit and vegetable intake (p=0.0001). Pre-post physical activity practice: IG≠CG, IG> physical activity practice (p=0.0001), superior among girls.
Grydeland et al., 2014²⁵25. Grydeland M, Bjelland M, Anderssen SA, Klepp K-I, Bergh IH, Andersen LF, et al. Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: the HEIA study. Br J Sports Med. 2014;48:768-73.	37 schools. Mean age: 11,2 ± 0,3 IG: n=465 CG: n=859	To investigate the effectiveness of a 20-month HEIA intervention program.	IG: classes, posters, inclusion of fruits and vegetables in diet, regular physical activity, campaigns for active transportation, online counseling, school and parents meetings, information leaflets for parents and a machine for cutting and selling fruit and vegetables. CG: recruitment and assessment.	Weight, BMI, height-to-waist ratio, pubertal stage, parents’ educational level, demographic characteristics.	No significant differences in body composition between groups. Parents with low educational level, pre-post: IG >CG: 0.426 (0.422 to 0.430) CG 0.420 (0.417 to 0.423) (p=0.020) Parents with high educational level: IG>CG, pre - = 18.6 (95%CI 18.5-18.8) -; post- =18.4 (95%CI 18.2-18.6) (p=0.027) Girls IG≠CG pre-post IG>BMI, IG - =19.2 (95%CI 19.1-19.3); CG - =19.0 (95%CI 18.8-19.3) (p=0.02); IG>zBMI, IG - =0.03 (95%CI -0.01-0.08); CG - =-0.8 (95%CI -0.14--0.02) (p=0.003).

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[1] *Corresponding author. E-mail: vanezawolf@hotmail.com (V.L.W. Wolf).