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Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster
Zheng Liu1, Pei Gao2, Ai-Yu Gao3
1Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
Insights
A novel multifaceted intervention significantly reduced childhood obesity by decreasing body mass index (BMI) and obesity prevalence in Chinese primary school children. This approach shows promise for wider implementation.
Area of Science:
- Public Health
- Pediatrics
- Nutritional Science
Background:
- Childhood obesity is a growing global concern, driven by rapid nutritional transitions.
- Effective preventive interventions are limited, necessitating novel approaches.
- Primary school-aged children are a key demographic for obesity prevention efforts.
Purpose of the Study:
- To evaluate the effectiveness of a new multifaceted intervention for preventing obesity in primary school children.
- To assess the intervention's impact on body mass index (BMI) and other obesity-related indicators.
Main Methods:
- A cluster randomized clinical trial involving 1392 children aged 8-10 years across 24 schools in China.
- The intervention group received a multifaceted program promoting healthy diet and physical activity, with enhanced family involvement via a smartphone app.
- The control group followed usual school practices. Data were analyzed using generalized linear mixed models.
Main Results:
- The intervention group showed a significant mean decrease in BMI (-0.46 kg/m²) compared to the control group (P < .001).
- Obesity prevalence decreased by 27.0% in the intervention group versus 5.6% in the control group.
- Improvements were noted in dietary behaviors, sedentary time, and obesity-related knowledge, but not in physical activity intensity, fitness, or blood pressure.
Conclusions:
- The multifaceted intervention effectively reduced BMI and obesity prevalence in primary school children.
- The intervention's success across diverse socioeconomic regions suggests potential for national scalability.
- Strengthening family involvement through technology is a key component of this effective obesity prevention strategy.
Importance:
A rapid nutritional transition has caused greater childhood obesity prevalence in many countries, but the repertoire of effective preventive interventions remains limited.
Objective:
To determine the effectiveness of a novel multifaceted intervention for obesity prevention in primary school children.
Design, Setting, And Participants:
A cluster randomized clinical trial was conducted during a single school year (from September 11, 2018, to June 30, 2019) across 3 socioeconomically distinct regions in China according to a prespecified trial protocol. Twenty-four schools were randomly allocated (1:1) to the intervention or the control group, with 1392 eligible children aged 8 to 10 years participating. Data from the intent-to-treat population were analyzed from October 1 to December 31, 2019.
Interventions:
A multifaceted intervention targeted both children (promoting healthy diet and physical activity) and their environment (engaging schools and families to support children's behavioral changes). The intervention was novel in its strengthening of family involvement with the assistance of a smartphone app. The control schools engaged in their usual practices.
Main Outcomes And Measures:
The primary outcome was the change in body mass index (BMI; calculated as weight in kilograms divided by height in square meters) from baseline to the end of the trial. Secondary outcomes included changes in adiposity outcomes (eg, BMI z score, prevalence of obesity), blood pressure, physical activity and dietary behaviors, obesity-related knowledge, and physical fitness. Generalized linear mixed models were used in the analyses.
Results:
Among the 1392 participants (mean [SD] age, 9.6 [0.4] years; 717 boys [51.5%]; mean [SD] BMI, 18.6 [3.7]), 1362 (97.8%) with follow-up data were included in the analyses. From baseline to the end of the trial, the mean BMI decreased in the intervention group, whereas it increased in the control group; the mean between-group difference in BMI change was -0.46 (95% CI, -0.67 to -0.25; P < .001), which showed no evidence of difference across different regions, sexes, maternal education levels, and primary caregivers (parents vs nonparents). The prevalence of obesity decreased by 27.0% of the baseline figure (a relative decrease) in the intervention group, compared with 5.6% in the control group. The intervention also improved other adiposity outcomes, dietary, sedentary, and physical activity behaviors, and obesity-related knowledge, but it did not change moderate- to vigorous-intensity physical activity, physical fitness, or blood pressure. No adverse events were observed during the intervention.
Conclusions And Relevance:
The multifaceted intervention effectively reduced the mean BMI and obesity prevalence in primary school children across socioeconomically distinct regions in China, suggesting its potential for national scaling.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03665857.
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