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A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: a randomized controlled trial

Lucia Tarro2, Elisabet Llauradó2, Rosa Albaladejo2, David Moriña34, Victoria Arija5, Rosa Solà6* and Montse Giralt1*

Author Affiliations

1 Unit of Farmacobiology, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain

2 Health Education and Promotion, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain

3 Technological Center of Nutrition and Health (CTNS) - TECNIO - URV – CEICS Avda Universitat 1, Reus 43204, Spain

4 Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda de Can Domènech, Cerdanyola del Vallès 08193, Barcelona, Spain

5 Unit of Nutritional Epidemiology, IISPV, Institut d’Investigació en Atenció Primària, Jordi Gol i Gorina, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain

6 Unit of Lipids and Arteriosclerosis Research, CIBERDEM, Hospital Universitari Sant Joan, IISPV, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain

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Trials 2014, 15:58  doi:10.1186/1745-6215-15-58

Published: 14 February 2014

Abstract

Background

Obesity is one of the main determinants of avoidable disease burden.

To implement a program by university students acting as “health promoting agents” (HPAs) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle, including dietary and physical activity recommendations over 28 months.

Methods

Two school clusters were randomly assigned to intervention (24 schools, 1,222 pupils) or control (14 schools, 717 pupils); 78% of pupils were Western European. Mean age (±SD) was 8.4 ± 0.6 years (49.9% females) at baseline. Generalized linear mixed models were used to analyze differences in primary outcome between both groups. Data collected included body mass index (BMI) every year. Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study. The interventions focused on eight lifestyle topics covered in 12 activities (1 hour/activity/session) implemented by HPAs over 3 school academic years.

Results

At 28 months, obesity prevalence in boys was decreased −2.36% in the intervention group (from 9.59% to 7.23%) and increased 2.03% (from 7.40% to 9.43%) in the control group; the difference was 4.39% (95% CI 3.48 to 5.30; P = 0.01). The boys in the intervention group had an effective reduction of −0.24 units in the change of BMI z-score (from 0.01 to −0.04), compared to control (from −0.10 to 0.09); 5.1% more intervention pupils undertook physical activity >5 hours/week than control pupils (P = 0.02).

Fish consumption was a protector (odds ratio 0.39; 95% CI 0.23 to 0.67) while “fast-food” consumption was a risk factor for childhood obesity (odds ratio: 2.27; 95% CI 1.08 to 4.77).

Conclusions

Our school-based program, conducted by HPA students, successfully reduced childhood obesity prevalence in boys.

Trial registration

International Standard Randomized Controlled Trial Number: ISRCTN29247645.

Keywords:
Childhood obesity; Healthy lifestyle; Obesity prevention; Intervention program; Health promoting agent