Health promotion initiatives at school related to overweight, insulin resistance, hypertension and dyslipidemia in adolescents: a cross-sectional study in Recife, Brazil

Abstract

BackgroundThe emergence of diseases such as dyslipidemia, systemic arterial hypertension, insulin resistance and metabolic syndrome in children and adolescents has brought about a change in the epidemiologic profile of the pediatric population. As action to promote health in the school environment is a useful tool for changing the pattern of health/disease in the young population, the present study aimed to identify schools that promote healthy eating and physical activity and to study the relationship between these practices and the prevalence of overweight, hypertension, insulin resistance and hypercholesterolemia in adolescents.MethodsA cross-sectional population-based study was conducted with 2400 adolescents aged from 12 to 17 years old and participating in the “Study of Cardiovascular Risk in Adolescents” (ERICA – Estudo de Riscos Cardiovasculares em Adolescente). The association between dependent (overweight, insulin resistance, hypertension and dyslipidemia) and independent variables (implementation of health promoting initiative in schools) was investigated using the chi-square test and prevalence ratio (PR) with a confidence index (CI) of 95%.ResultsThe unsatisfactory implementation of a “health promoting environment” (PR = 1.02; CI 95%: 1.0; 1.04) and “partnerships with the health sector” (PR = 1.03; CI 95%: 1.01; 1.05) were linked to a high prevalence of overweight in adolescents. Hypercholesterolemia was found to be higher in the schools with unsatisfactory implementation of “healthy eating and health on the scholar curriculum” (PR = 1.71; CI 95%: 1.22; 2.44) and those lacking a “healthy-eating promoting environment” (PR = 1.29; CI 95%: 1.10; 1.54). Schools with unsatisfactory implementation of a “health-eating promoting environment” (PR = 1.36; CI 95%: 1.04; 1.79) and those lacking “partnership with the health sector” (PR = 2.12; CI 95%: 1.38; 3.24) had more adolescents with insulin resistance. There was no association between hypertension and any other component studied.ConclusionSchools which have implemented adequate health promotion in their curriculums showed a lower prevalence of overweight, insulin resistance and hypercholesterolemia in adolescents.

Attitudes and Values of Physical Education Professionals and Undergraduate Students about Their Role in Health Promotion

“…Finally, our data shows that regulations must be more aligned with the PE teacher training, in agreement with recent studies that claim to support schools developing a healthy environment, clear regulations, improvement of physical spaces for physical activity, and understanding the challenges posed to the school PE teachers [10].…”

“…Despite the lack of studies verifying the impact of the school in health promotion in Brazil [10], and the need for data from the non-English speaking world [33], our study shows that despite the efforts and laws regarding the role of the physical educator as a health profession, neither undergraduate students nor professionals' values encompass a paradigm shift towards health promotion. On the other hand, values regarding school PE among men and women were similar, suggesting a common view about the role of school PE.…”

“…The first three positions reveal that both professionals and students attribute responsibility to child obesity to external agents regarding the school. The fourth position is occupied by a justification of the limitations of the reach of PE, followed by structural elements of professional development (5 and 6), then social and structural components of the scholar environment (7 and 8), the government (9), and in notably lower proportion, the PE teacher (10).…”

“…Also, with variations, the bachelor's curriculum is mainly based on biological, exercise, and training contents, and licensure curriculum is based on pedagogy and education backgrounds. Despite the different roles and areas of expertise, both are recognized as health professionals, and are assigned as agents of health promotion [10].…”

“…Several causes contribute to this complex scenario, among them an obesogenic environment that comprises energy imbalance related to food intake and a reduction of time expended with physical activity and sedentarism [10]. The situation is the same in Brazil.…”