Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren

Caballero, Benjamı́n; Clay, Theresa; Davis, Sally; Ethelbah, Becky; Rock, Bonnie Holy; Lohman, Timothy G.; Norman, James E.; Story, Mary; Stone, Elaine J.; Stephenson, Larry; Stevens, June

doi:10.1093/ajcn/78.5.1030

Cited by 519 publications

(564 citation statements)

References 34 publications

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“…The current review includes Caballero's study on American Indian schoolchildren. 17 Epstein studied children of obese parents and compared two strategies, one that increased fruit and vegetable intake and the other that decreased fat and sugar intake. 18 One of the studies by Alexandrov 7 included, to some extent, a high-risk strategy, since boys with multiple risk factors for cardiovascular disease received more intensive preventive intervention than the others.…”

Section: Discussionmentioning

confidence: 99%

“…None of these studies have reported any harmful effects, which is encouraging for future plans and projects. 17,20 Publication bias One could ask whether publication bias might be responsible for the distribution of positive and neutral studies and the lack of negative findings. However, a large number of studies have been included, many of which did not present positive results, but were published nevertheless.…”

Section: Risks Of Preventive Interventionsmentioning

confidence: 99%

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Interventions to prevent obesity in children and adolescents: a systematic literature review

2006

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Objective: Preventive measures to contain the epidemic of obesity have become a major focus of attention. This report reviews the scientific evidence for medical interventions aimed at preventing obesity during childhood and adolescence. Design: A systematic literature review involving selection of primary research and other systematic reviews. Articles published until 2004 were added to an earlier (2002) review by the Swedish Council on Technology Assessment in Health Care. Methods: Inclusion criteria required controlled studies with follow-up of at least 12 months and results measured as body mass index, skinfold thickness or the percentage of overweight/obesity. Children could be recruited from normal or high-risk populations.Results: Combining the new data with the previous review resulted in an evaluation of 24 studies involving 25 896 children. Of these, eight reported that prevention had a statistically significant positive effect on obesity, 16 reported neutral results and none reported a negative result (sign test; P ¼ 0.0078). Adding the studies included in five other systematic reviews yielded, in total, 15 studies with positive, 24 with neutral and none with negative results. Thus, 41% of the studies, including 40% of the 33 852 children studied, showed a positive effect from prevention. These results are unlikely to be a random chance phenomenon (P ¼ 0.000061). Conclusion: Evidence shows that it is possible to prevent obesity in children and adolescents through limited, school-based programs that combine the promotion of healthy dietary habits and physical activity.

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Section: Discussionmentioning

confidence: 99%

Section: Risks Of Preventive Interventionsmentioning

confidence: 99%

Interventions to prevent obesity in children and adolescents: a systematic literature review

2006

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“…It should include appropriate indicators of body fatness according to age, sex and ethnicity of the group 30,33 .…”

Section: Prevention Of Overweightmentioning

confidence: 99%

Prevention of overweight and obesity: a Spanish approach

Aranceta-Bartrina

Rodrigo

Serra-Majem

et al. 2007

Public Health Nutr.

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Background: Obesity is considered a major public health issue in most developed countries nowadays. This paper provides an overview of current population data available in Spain and the approach to develop preventive strategies in the country. Methods: Review of population data available is based on individually measured weight and height as well as determinants. On this basis, the approach used in the country to develop preventive strategies is discussed. Results: According to the DORICA study, the prevalence of obesity (BMI $ 30 kg m 22 ) is 15.5% in Spanish adults aged 25-60 years (13.2% in men and 17.5% in women). Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Population estimates for the prevalence of obesity in Spanish children and young people based on the enKid study are 13.9% for the whole group. In this study, overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables, high consumption of cakes, buns, softdrinks and butchery products, low physical activity levels and a positive association with time spent watching TV.In 2005, the Spanish Ministry of Health jointly with the Spanish Agency for Food Safety and Nutrition launched the multifaceted NAOS strategy for nutrition, physical activity and the prevention of obesity. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric Care in the prevention of obesity is highlighted in the document. The need for environmental actions is recognised. The PERSEO programme, a multicomponent school-based intervention project is part of the strategy currently in place. Conclusion: Obesity is a public health issue in Spain. A national multifaceted strategy was launched to counteract the problem. Environmental and policy actions are a priority. Young children and their families are among the main target groups.

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“…On the other hand, programmes of low 'certainty of effectiveness' and high 'potential for population impact' (e.g. the Pathways schools intervention programme from the USA that had positive qualitative results on reach, uptake and programme logic Gittelsohn et al 1999) but lack of hard positive outcomes (Caballero et al 2003)) could also be rated as promising.…”

Section: Promising Programmesmentioning

confidence: 99%

Methods of defining best practice for population health approaches with obesity prevention as an example

McNeil

Flynn

2006

Proc. Nutr. Soc.

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Childhood obesity has reached a crisis stage and has become a population health issue. The few traditional systematic reviews that have been done to identify best practice provide little direction for action. The concept of evidence-based practice has been adopted in health care, and in medicine in particular, to determine best practice. Evidence-based medicine has its origins in the scientific method and for many researchers this concept means strict adherence to standards determining internal validity in order to justify a practice as evidence based. Practitioners addressing population health face challenges in identifying criteria for determining evidence, in part because of the nature of population health with its goal of shifting the health of whole populations. As well, the type of evidence provided by more traditional critical appraisal schema is limiting. Expanded approaches in finding and defining evidence have been proposed that use: expert panels; broad and inclusive search and selection strategies; appraisal criteria that incorporate context and generalizability. A recent synthesis of 147 programmes addressing childhood overweight and obesity provides a concrete example of using a broader approach to identify evidence for best practice (Flynn et al. 2006). Incorporating evaluation and population health frameworks as criterion components in addition to traditional methodological rigour criteria, this synthesis has identified programmes that provide contextual information that can be used to populate what Swinburn et al. (2005) have described as the 'promise table'. Using this approach a range in 'certainty of effectiveness' and a range in 'potential for population impact' are integrated to identify promising strategies. The exercise can provide direction for agencies and practitioners in taking action to address obesity.

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Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren

Cited by 519 publications

References 34 publications

Interventions to prevent obesity in children and adolescents: a systematic literature review

Interventions to prevent obesity in children and adolescents: a systematic literature review

Prevention of overweight and obesity: a Spanish approach

Methods of defining best practice for population health approaches with obesity prevention as an example

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