Can the Healthy Primary School of the Future offer perspective in the ongoing obesity epidemic in young children? A Dutch quasi-experimental study

Nina H M Bartelink, Patricia van Assema, Stef P J Kremers, Hans H C M Savelberg, Marije Oosterhoff, Maartje Willeboordse, Onno C P van Schayck, Bjorn Winkens, Maria W J Jansen, Nina H M Bartelink, Patricia van Assema, Stef P J Kremers, Hans H C M Savelberg, Marije Oosterhoff, Maartje Willeboordse, Onno C P van Schayck, Bjorn Winkens, Maria W J Jansen

Abstract

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.

Trial registration number: NCT02800616.

Keywords: community child health; preventive medicine; public health.

Conflict of interest statement

Competing interests: None declared.

© 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.

Figures

Figure 1
Figure 1
Flow chart. *Reasons for drop-out T1: switched to other include school (n=2), other reasons, for example, moved away or actively stopped participation (n=62). **Reasons for drop-out T2: finished school (n=228), switched to other included school (n=17), other reasons, for example, moved away or actively stopped participation (n=45). ***Selection for effect study: at baseline (T0) children from study year one to seven, at T1 children from study year 2–8, and at T2 children from study year 3–8. HPSF, Healthy Primary School of the Future.
Figure 2
Figure 2
Observed change in children’s BMI z-score at 1 and 2-year follow-up compared with baseline. BMI, body mass index; HPSF, Healthy Primary School of the Future.

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