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Updated: May 22, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Multilevel analysis of the Be Active Eat Well intervention: environmental and behavioural influences on reductions in
B A Johnson1, P J Kremer, B A Swinburn
1The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia. brittamyjohnson@gmail.com.au
Insights
The Be Active Eat Well intervention modestly reduced child BMI by targeting individual behaviors and household environments. Household factors significantly influenced weight changes, highlighting the need for family-centered obesity prevention strategies.
Area of Science:
- Childhood obesity prevention
- Public health interventions
- Behavioral science
Background:
- The Be Active Eat Well (BAEW) intervention utilized a multi-strategy, multi-setting approach to reduce unhealthy weight gain in primary school children.
- Previous findings indicated modest success in reducing unhealthy weight gain.
Purpose of the Study:
- To analyze the correlation between changes in obesity-related factors (individual, household, school) and standardized child BMI (zBMI).
- To ascertain if the BAEW intervention moderated these relationships.
Main Methods:
- Longitudinal multilevel modeling was employed to examine relationships between changes in variables and zBMI.
- Individual behaviors, household factors, and school environments were assessed at multiple time points.
- The intervention's moderating effect was evaluated, controlling for child age, gender, and maternal education.
Main Results:
- The BAEW intervention significantly lowered child zBMI compared to the control group (-0.085 units).
- Household environments accounted for the largest proportion of unexplained zBMI change (59%).
- Increased screen time, sweet drink consumption, and lack of household TV rules were linked to higher zBMI.
Conclusions:
- Childhood obesity is multifactorial, influenced by individual, household, and school environments.
- Obesity prevention should integrate individual behavior change with household environmental and family practice modifications.
- Modest zBMI reductions can yield significant population-level impacts on childhood obesity.
Background:
The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.
Objective:
To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.
Methods:
The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n = 1812) at level 2 and households (n = 1318) and schools (n = 18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.
Results:
This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (-0.085 units, P = 0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P = 0.03), sweet drink consumption (P = 0.03) and lack of household rules for television (TV) viewing (P = 0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P = 0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P = 0.04).
Conclusions:
The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.
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