Effectiveness and acceptability of a novel school-based healthy eating program among primary school children in urban Sri Lanka

Abstract

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.

Web-Based Student Extracurricular Value Monitoring Application

“…The flow of the SDLC waterfall can be shown in the figure below: In using the waterfall SDLC, the process must be sequential from analysis to implementation and must not skip the previous stage. Even every step can't be done at the same time [8].…”

A Systematic Review of School-Based Nutrition Interventions for Promoting Healthy Dietary Practices and Lifestyle Among School Children and Adolescents

“…Among 23 studies [ 8 , 9 , 11 , 13 - 16 , 23 , 28 , 32 , 35 , 36 , 38 , 43 , 51 - 57 , 60 , 61 ], 22 are randomized controlled trials [ 8 , 9 , 11 , 13 - 16 , 23 , 28 , 32 , 35 , 36 , 38 , 43 , 51 - 55 , 57 , 60 , 61 ], and one study [ 56 ] is a pooled analysis from five randomized studies. There were six quasi-experimental trials [ 17 , 20 , 27 , 31 , 34 , 40 ] and 10 experimental or interventional studies [ 10 , 12 , 19 , 21 , 24 - 26 , 42 , 59 , 62 ].…”

“…In terms of sample sizes, they ranged from 51 to 5926 participants [ 8 - 17 , 19 - 21 , 23 - 28 , 31 , 32 , 34 - 36 , 38 , 40 , 42 , 43 , 51 - 55 , 57 , 59 , 60 - 62 ]. Fourteen studies [ 11 , 12 , 17 , 24 , 27 , 31 , 34 , 36 , 38 , 40 , 53 , 57 , 59 , 60 ] had fewer than 500 participants, 12 studies [ 8 , 9 , 13 , 20 , 21 , 23 , 25 , 35 , 42 , 43 , 54 , 62 ] had between 501 and 1000 participants, and another 12 studies [ 10 , 14 - 16 , 19 , 26 , 28 , 32 , 51 , 52 , 55 , 61 ] had more than 1000 participants.…”

Fetal programming of obesity and type 2 diabetes

“…This should be followed by proper guidance for parents regarding appropriate nutrition, physical activity, and screen time in early childhood. Furthermore, school based interventions with family involvement could be effective in improving dietary habits and lifestyle in primary school children[ 111 ]. Whole community interventions addressing both policy and behavior change are needed[ 112 ].…”