Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

Abstract

Background: The prevalence of childhood obesity is increasing rapidly in low-and middle-income countries, and informed policies to tackle the problem must be defined. Objective: We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low-and middle-income countries. Design: We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool. Results: From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from 20.48 to 1.61). BMI decreased in 8 studies (effect size ranged from 20.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum. Conclusions: School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low-and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.Am J Clin Nutr 2012;96:415-38.

Role of Developmental Overnutrition in Pediatric Obesity and Type 2 Diabetes

“…By 2010 the eating habits and physical activity levels of students attending APPLE Schools had significantly improved whereas the prevalence of obesity had declined relative to their peers attending other Albertan schools [6]. These findings are consistent with other school-based programs internationally that took a comprehensive approach to promoting healthy eating and active living [5,[7][8][9].…”

Achieving a nutrition revolution for Africa: The road to healthier diets and optimal nutrition

“…Second, the existing evidence is often not adapted to the priorities and conditions of national and subnational contexts (Morris, Cogill, and Uauy 2008;Holdsworth et al 2014;Verstraeten et al 2012) or to low-and middle-income countries (LMICs) (Resnick et al 2015). Furthermore, insufficient effort is invested in championing use of existing nutrition research by policy makers Lachat et al 2014), and evidence that is used is often less robust than decision makers may think.…”

Qualidade da dieta de escolares de 7 a 10 anos do município de São Paulo: associação com o número e os locais de refeições

“…Considerando que tanto em casa como fora do lar os alimentos industrializados, principalmente os processados, são bastante utilizados, algumas ações políticas foram direcionadas para a indústria no intuito de reduzir a gordura, os açú-cares e o sódio presentes nesses alimentos [30][31][32][33][34] . A Organização Mundial de Saúde, baseada em diferentes experiências acerca da redução de sódio, açúcares e gorduras nos alimentos industrializados em países como Chile, Hungria, Tailândia, Reino Unido e Austrália, estabeleceu ações de incentivo à redução desses nutrientes nos alimentos produzidos pelo mundo.…”

“…A Organização Mundial de Saúde, baseada em diferentes experiências acerca da redução de sódio, açúcares e gorduras nos alimentos industrializados em países como Chile, Hungria, Tailândia, Reino Unido e Austrália, estabeleceu ações de incentivo à redução desses nutrientes nos alimentos produzidos pelo mundo. A meta é que, em 2020, tenha-se um teor mínimo desses nutrientes nos alimentos industrializados 30 . É importante ressaltar que, dentre esses alimentos, estão alguns alimentos bastante consumidos pelo público infantil, como os salgadinhos de pacote, doces, bebidas lácteas, sucos prontos, bolos, biscoitos, macarrão instantâneo, embutidos e refeições prontas [30][31] .…”

“…A meta é que, em 2020, tenha-se um teor mínimo desses nutrientes nos alimentos industrializados 30 . É importante ressaltar que, dentre esses alimentos, estão alguns alimentos bastante consumidos pelo público infantil, como os salgadinhos de pacote, doces, bebidas lácteas, sucos prontos, bolos, biscoitos, macarrão instantâneo, embutidos e refeições prontas [30][31] . Nas Américas, a Organização Pan-Americana de Saúde (OPAS) firmou um pacto de redução do percentual de gordura trans nos alimentos processados.…”