Background Obesity rates are rising rapidly in low-middle-income-countries (LMICs). School-based interventions have shown moderate efficacy in improving diet and lifestyle associated with obesity in high-income countries. However, there is little data available on effective interventions suitable for LMICs. We devised a novel program for primary school children including a simple storybook and sticker-based food-diary (FD) and conducted a pilot study to evaluate the acceptability and short-term effectiveness of the program. Methods This pre-post intervention study included grade 1 and 2 students from four public schools in Colombo, Sri Lanka. Weight and height were assessed, and participating children self-monitored their diet using sticker-based FDs for one week at baseline (pre-test). The following week, class teachers discussed the storybook, which incorporated the benefits/disadvantages of a healthy/unhealthy diet and lifestyle in classrooms. At the end of the intervention, participating children were self-monitoring their diet again for a week (post-test). A simple scoring system was used to derive a weekly score based on the healthiness of the meals consumed each week (FD-score). The primary outcome of the study was change in eating habits following the story book discussion (post-test FD score - pre-test FD score). Acceptability and effectiveness were also assessed by anonymized feedback questionnaires for parents and teachers. Results One thousand and forty-two students completed the program. There was an improvement in eating habits of participating children, with FD scores improving by 12% from 51 ± 23 at baseline to 63 ± 24 following the intervention (p < 0.001). Further, when considering BMI category of participants: 69.1% were normal weight (NW), 18.3% underweight (UW), 7.4% overweight (OW) and 5.2% obese (OB). Improvement in eating habits were seen among children of all BMI categories (change in FD-score: UW 13.2%, NW 12.3%, OW 10.4% and OB 12.4% (p < 0.001)). Furthermore,> 90% parents(n = 1028) and > 95% teachers(n = 39) strongly agreed/agreed that the intervention was easy to implement, motivated children and led to an observable improvement in healthy eating. Conclusion This novel program led to an immediate improvement in eating habits and was well accepted by parents and teachers making it a potentially suitable intervention for wider implementation in primary schools in urban Sri Lanka.

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Background: The foundation for lifelong good health is laid in childhood. Schools can play a pivotal role in preventing obesity/type 2 diabetes with effective interventions. Methods: We devised a novel school-based program using a sticker based food diary (FD) and colorful 12-page story book to motivate young school children to adopt a healthier diet/lifestyle. This study to conducted among 1500 grade 1 and 2 students from 4 schools between March 2018- April 2019, to evaluate its effectiveness. During the first week(W1), each child self-monitored his/her food intake daily at home for a week, using the FD, and received a Smiley Face based Score (SFS) based on the healthiness of each meal. In the second week, class teachers read the story book (illustrating the physical and psychosocial effects of obesity and benefits of healthy lifestyle in a child friendly manner). In the third week(W3) children completed the FD again. Effectiveness of the program to improve healthy eating/lifestyle was assessed by comparing mean SFS between W1 and W3, and by anonymized graded-response and open response questionnaires completed by parents and class teachers. Results: Completed FDs were returned by 1029 students. Overall there was an improvement in healthy eating, with mean SFS increasing by 11.7% from W1 to W3 (51.3 ± 22.9 vs. 63.1 ± 24.2, p&lt; 0.001). SFS improved &gt;10% in all BMI categories. SFS improvement was more in boys (13.0 vs. 9.7, p=0.02), and in 2nd graders compared to 1st graders (13.1 vs. 10.3, p=0.045). Majority of responding parents (&gt; 90%) and teachers (95%) strongly agreed/agreed that this program motivated children towards a healthier lifestyle and led to an observable improvement in food habits. Conclusion: This novel program led to a demonstrable improvement in healthy lifestyle among 5-7 year olds and was received favorably by parents and teachers. Based on these results and positive (ongoing) longer-term follow up data, wider implementation involving 750,000 children is planned for mid 2020. Disclosure S.N. Seneviratne: None. S. Sachchithananthan: None. P.S. Angulugaha Gamage: None. S. Ramamoorthy: None. R. Peiris: None. V.P. Wickramasinghe: None. N. Somasundaram: None. Funding World Diabetes Foundation (WDF15-1291)