The Costs and Cost-Effectiveness of a School-Based Comprehensive Intervention Study on Childhood Obesity in China

Abstract

BackgroundThe dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA) is more cost-effective than the same intensity of single intervention.Methods And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its’ control group were located in other 5 cities. In nutrition education group, ‘nutrition and health classes’ were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m2 (SE 0.09) and 0.01 (SE 0.11) in the combined intervention, respectively, significantly lower than that in its’ control group (0.82±0.09 for BMI, 0.10±0.11 for BAZ). No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its’ control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively.ConclusionsThe school-based integrated obesity intervention program was cost-effectiveness for children in urban China.Trial RegistrationChinese Clinical Trial Registry ChiCTR-PRC-09000402 URL:http://www.chictr.org/cn/

Nutrition Education Practices of Health Teachers from Shanghai K-12 Schools: The Current Status, Barriers and Willingness to Teach

“…If this cannot be done, China needs to train its own teachers (mainly health teachers) with effective programs. Currently, there are some localized TOT programs reported in our study and in the literature [51,52]. However, few of them have been assessed and generalized to country level.…”

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

“…57 A study from China showed, in school programmes for children, that physical activity combined with a nutrition programme is more effective than either intervention alone. 58 Through a systematic review of population-wide interventions in adults and children across multiple countries, Laine and colleagues 32 found the most efficient interventions to increase physical activity were community trails built alongside or over abandoned rail tracks ($0·006 per metabolic equivalent of task hours [MET-h]), pedometers ($0·014 per MET-h), and school health education programmes ($0·056 per MET-h). Nearly all physical activity interventions, especially those related to tracking or motivating physical activity, require more detailed evaluation of effectiveness and cost-effectiveness.…”

Obesity-Related Policy/Environmental Interventions

“…Of the 27 included studies, eight studies 34,[37][38][39]43,51,53,54 focused on the community and built environment; seven studies 30,31,33,36,[48][49][50] assessed on nutrition-related policy/education changes, of which five studies 31,33,36,48,50 analyzed state implementations of the U.S. Expanded Food and Nutrition Education Program (EFNEP); nine studies 32,41,42,[44][45][46]52,55,56 focused on school environments; and three studies 35,40,47 evaluated social marketing and media interventions.…”

“…Most (15 of 27) studies 32,34,35,[37][38][39][41][42][43]46,51,[53][54][55][56] analyzed policy or environmental changes at the local level, six studies 31,33,36,47,48,50 at the state level, and seven studies 30,40,[44][45][46]49,52 at the national level. Note that the number of studies does not sum to 27 as one study analyzed an intervention at more than one level of government.…”