Battling the obesity epidemic with a school-based intervention: Long-term effects of a quasi-experimental study

Abstract

Background School-based health-promoting interventions are increasingly seen as an effective population strategy to improve health and prevent obesity. Evidence on the long-term effectiveness of school-based interventions is scarce. This study investigates the four-year effectiveness of the school-based Healthy Primary School of the Future (HPSF) intervention on children’s body mass index z-score (BMIz), and on the secondary outcomes waist circumference (WC), dietary and physical activity (PA) behaviours. Methods and findings This study has a quasi-experimental design with four intervention schools, i.e., two full HPSFs (focus: diet and PA), two partial HPSFs (focus: PA), and four control schools. Primary school children (aged 4–12 years) attending the eight participating schools were invited to enrol in the study between 2015 and 2019. Annual measurements consisted of children’s anthropometry (weight, height and waist circumference), dietary behaviours (child- and parent-reported questionnaires) and PA levels (accelerometers). Between 2015 and 2019, 2236 children enrolled. The average exposure to the school condition was 2·66 (SD 1·33) years, and 900 participants were exposed for the full four years (40·3%). After four years of intervention, both full (estimated intervention effect (B = -0·17 (95%CI -0·27 to -0·08) p = 0·000) and partial HPSF (B = -0·16 (95%CI-0·25 to -0·06) p = 0·001) resulted in significant changes in children’s BMIz compared to control schools. Likewise, WC changed in favour of both full and partial HPSFs. In full HPSFs, almost all dietary behaviours changed significantly in the short term. In the long term, only consumption of water and dairy remained significant compared to control schools. In both partial and full HPSFs, changes in PA behaviours were mostly absent. Interpretation This school-based health-promoting intervention is effective in bringing unfavourable changes in body composition to a halt in both the short and long term. It provides policy makers with robust evidence to sustainably implement these interventions in school-based routine.

Effects of School-Based Health-Promoting Activities on Children’s Health: A Pragmatic Real-World Study

“…The present study investigated the effectiveness of the scaled-up HPSF initiative in several real-world primary school contexts. Despite HPSF's positive health impact observed in the original efficacy trial [17][18][19], only limited effects of the scaled-up initiative could be detected in the present study. However, this does not diminish HPSF's potential health impact.…”

“…Two partial HPSF schools implemented the PA component only, and four schools continued with their regular curriculum, serving as control schools in an efficacy trial [15,16]. Longitudinal analyses revealed significant positive intervention effects on outcomes, such as the children's body mass index (BMI) z-scores and dietary and PA behaviours [17][18][19]. Following the efficacy trial's positive results, other Dutch primary schools became interested in implementing HPSF-related activities.…”

Challenges in evaluating implementation and effectiveness in real-world settings: evaluation proposal for school-based health-promoting intervention

“…The research that we will discuss as an example throughout this paper comprises the Healthy Primary School of the Future (HPSF), a school-based health-promoting intervention that was evaluated using a quasi-experimental design involving eight Dutch primary schools (four intervention schools and four control schools) (Willeboordse et al, 2016). For 4 years, HPSF's efficacy on various outcomes was investigated, revealing significant positive intervention effects on outcomes such as children's body mass index z-score and dietary and physical activity (PA) behaviours (Bartelink et al, 2019a,b;Willeboordse et al, 2022). Following HPSF's efficacy, the ambition rose to spread its principles to other schools.…”

Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

“…Effect evaluations showed significant positive intervention effects on various health outcomes (e.g. BMI z-score and dietary behaviours) (Bartelink et al ., 2019b, c; Willeboordse et al. , 2022).…”

“…Effect evaluations showed significant positive intervention effects on various health outcomes (e.g. BMI z-score and dietary behaviours) (Bartelink et al, 2019b, c;Willeboordse et al, 2022). Following these positive effects, other Dutch primary schools expressed their interest in implementing HPSFrelated activities, which created the opportunity to "scale-up" HPSF.…”