TY - JOUR
T1 - Can the Healthy Primary School of the Future offer perspective in the ongoing obesity epidemic in young children? A Dutch quasi-experimental study
AU - Bartelink, Nina H. M.
AU - van Assema, Patricia
AU - Kremers, Stef P. J.
AU - Savelberg, Hans H. C. M.
AU - Oosterhoff, Marije
AU - Willeboordse, Maartje
AU - van Schayck, Onno C. P.
AU - Winkens, Bjorn
AU - Jansen, Maria W. J.
N1 - Funding Information:
Taking all the results and limitations into account, it can be concluded that HPSF was effective in lowering children’s BMI z-scores after 1 and 2-year follow-up and no specific subgroups of children were found to benefit more from the intervention. Even though longer follow-up periods are needed to draw hard conclusions, both versions of the initiative seem promising in offering perspective in the ongoing obesity epidemic in young children. We are grateful to all of the schools, the children and other collaborating partners participating in the project. We thank the PhD students and research assistants for their help in data collection. Contributors NHMB, PvA, SPJK, HHCMS, MW, OCPvS and MWJJ were part of designing the intervention. NHMB, MO and MW collected the data for the manuscript. NHMB and BW analysed the data. NHMB drafted and revised the manuscript. PvA, SPJK, HHCMS, MO, MW, OCPvS, BW and MWJJ critically reviewed the manuscript during the writing process. All authors have read and approved the final manuscript. Funding This study was funded by the Limburg provincial authorities, project number 200130003, by FrieslandCampina, project number LLMV00, and by Maastricht University. Competing interests None declared. Patient consent for publication Not required. Ethics approval Ethical approval was given by the Medical Ethics Committee Zuyderland located in Heerlen (MEC 14 N-142). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available on reasonable request.
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/10
Y1 - 2019/10
N2 - Objectives Schools play an important role in promoting healthy behaviours in children and can offer perspective in the ongoing obesity epidemic. The `Healthy Primary School of the Future' (HPSF) aims to improve children's health and well-being by enhancing school health promotion. The current study aims to assess the effect of HPSF on children's body mass index (BMI) z-score after 1 and 2 years follow-up and to investigate whether HPSF has different effects within specific subgroups of children.Design A longitudinal quasi-experimental design.Setting Four intervention and four control schools participated; located in a low socioeconomic status region in the Netherlands.Participants 1676 children (aged 4-12 years).Interventions HPSF uses a contextual systems approach and includes health-promoting changes in the school. Central to HPSF is the provision of a daily healthy lunch and structured physical activity sessions each day. Two intervention schools implemented both changes (full HPSF), two intervention schools implemented only the physical activity change (partial HPSF).Main outcome measures BMI z-score, determined by measurements of children's height and weight at baseline, after 1 and 2 years follow-up.Results The intervention effect was significant after 1-year follow-up in the partial HPSF (standardised effect size (ES)=-0.05), not significant in the full HPSF (ES=-0.04). After 2 years follow-up, BMI z-score had significantly decreased in children of both the full HPSF (ES=-0.08) and the partial HPSF (ES=-0.07) compared with children of the control schools, whose mean BMI z-score increased from baseline to 2 years. None of the potential effect modifiers (gender, baseline study year, socioeconomic status and baseline weight status) were significant.Conclusions HPSF was effective after 1 and 2 years follow-up in lowering children's BMI z-scores. No specific subgroups of children could be identified who benefitted more from the intervention.
AB - Objectives Schools play an important role in promoting healthy behaviours in children and can offer perspective in the ongoing obesity epidemic. The `Healthy Primary School of the Future' (HPSF) aims to improve children's health and well-being by enhancing school health promotion. The current study aims to assess the effect of HPSF on children's body mass index (BMI) z-score after 1 and 2 years follow-up and to investigate whether HPSF has different effects within specific subgroups of children.Design A longitudinal quasi-experimental design.Setting Four intervention and four control schools participated; located in a low socioeconomic status region in the Netherlands.Participants 1676 children (aged 4-12 years).Interventions HPSF uses a contextual systems approach and includes health-promoting changes in the school. Central to HPSF is the provision of a daily healthy lunch and structured physical activity sessions each day. Two intervention schools implemented both changes (full HPSF), two intervention schools implemented only the physical activity change (partial HPSF).Main outcome measures BMI z-score, determined by measurements of children's height and weight at baseline, after 1 and 2 years follow-up.Results The intervention effect was significant after 1-year follow-up in the partial HPSF (standardised effect size (ES)=-0.05), not significant in the full HPSF (ES=-0.04). After 2 years follow-up, BMI z-score had significantly decreased in children of both the full HPSF (ES=-0.08) and the partial HPSF (ES=-0.07) compared with children of the control schools, whose mean BMI z-score increased from baseline to 2 years. None of the potential effect modifiers (gender, baseline study year, socioeconomic status and baseline weight status) were significant.Conclusions HPSF was effective after 1 and 2 years follow-up in lowering children's BMI z-scores. No specific subgroups of children could be identified who benefitted more from the intervention.
KW - BEHAVIORS
KW - CHILDHOOD OBESITY
KW - INEQUALITIES
KW - INTERVENTIONS
KW - OVERWEIGHT
KW - PREVENTION
U2 - 10.1136/bmjopen-2019-030676
DO - 10.1136/bmjopen-2019-030676
M3 - Article
C2 - 31676651
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - 030676
ER -