Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component

Christina-Paulina Lambrinou, Odysseas Androutsos, Eva Karaglani, Greet Cardon, Nele Huys, Katja Wikström, Jemina Kivelä, Winne Ko, Ernest Karuranga, Kaloyan Tsochev, Violeta Iotova, Roumyana Dimova, Pilar De Miguel-Etayo, Esther M González-Gil, Hajnalka Tamás, Zoltán Jancsó, Stavros Liatis, Konstantinos Makrilakis, Yannis Manios, Feel4Diabetes-study group, Yannis Manios, Greet Cardon, Jaana Lindström, Peter Schwarz, Konstantinos Makrilakis, Lieven Annemans, Ignacio Garamendi, Yannis Manios, Kalliopi Karatzi, Odysseas Androutsos, George Moschonis, Spyridon Kanellakis, Christina Mavrogianni, Konstantina Tsoutsoulopoulou, Christina Katsarou, Eva Karaglani, Irini Qira, Efstathios Skoufas, Konstantina Maragkopoulou, Antigone Tsiafitsa, Irini Sotiropoulou, Michalis Tsolakos, Effie Argyri, Mary Nikolaou, Eleni-Anna Vampouli, Christina Filippou, Kyriaki Apergi, Amalia Filippou, Gatsiou Katerina, Efstratios Dimitriadis, Jaana Lindström, Tiina Laatikainen, Katja Wikström, Petteri Hovi, Jemina Kivelä, Päivi Valve, Esko Levälahti, Eeva Virtanen, Greet Cardon, Vicky Van Stappen, Nele Huys, Lieven Annemans, Ruben Willems, Samyah Shadid, Peter Schwarz, Patrick Timpel, Konstantinos Makrilakis, Stavros Liatis, George Dafoulas, Christina-Paulina Lambrinou, Angeliki Giannopoulou, Lala Rabemananjara, Maria Stella de Sabata, Winne Ko, Ignacio Garamendi, Luis Moreno, Fernando Civeira, Gloria Bueno, Pilar De Miguel-Etayo, Esther Mª Gonzalez-Gil, María L Miguel-Berges, Natalia Giménez-Legarre, Paloma Flores-Barrantes, Aleli M Ayala-Marín, Miguel Seral-Cortés, Lucia Baila-Rueda, Ana Cenarro, Estíbaliz Jarauta, Rocío Mateo-Gallego, Violeta Iotova, Tsvetalina Tankova, Natalia Usheva, Kaloyan Tsochev, Nevena Chakarova, Sonya Galcheva, Rumyana Dimova, Yana Bocheva, Zhaneta Radkova, Vanya Marinova, Yuliya Bazdarska, Tanya Stefanova, Imre Rurik, Timea Ungvari, Zoltán Jancsó, Anna Nánási, László Kolozsvári, Csilla Semánova, Éva Bíró, Emese Antal, Sándorné Radó, Remberto Martinez, Marcos Tong, Christina-Paulina Lambrinou, Odysseas Androutsos, Eva Karaglani, Greet Cardon, Nele Huys, Katja Wikström, Jemina Kivelä, Winne Ko, Ernest Karuranga, Kaloyan Tsochev, Violeta Iotova, Roumyana Dimova, Pilar De Miguel-Etayo, Esther M González-Gil, Hajnalka Tamás, Zoltán Jancsó, Stavros Liatis, Konstantinos Makrilakis, Yannis Manios, Feel4Diabetes-study group, Yannis Manios, Greet Cardon, Jaana Lindström, Peter Schwarz, Konstantinos Makrilakis, Lieven Annemans, Ignacio Garamendi, Yannis Manios, Kalliopi Karatzi, Odysseas Androutsos, George Moschonis, Spyridon Kanellakis, Christina Mavrogianni, Konstantina Tsoutsoulopoulou, Christina Katsarou, Eva Karaglani, Irini Qira, Efstathios Skoufas, Konstantina Maragkopoulou, Antigone Tsiafitsa, Irini Sotiropoulou, Michalis Tsolakos, Effie Argyri, Mary Nikolaou, Eleni-Anna Vampouli, Christina Filippou, Kyriaki Apergi, Amalia Filippou, Gatsiou Katerina, Efstratios Dimitriadis, Jaana Lindström, Tiina Laatikainen, Katja Wikström, Petteri Hovi, Jemina Kivelä, Päivi Valve, Esko Levälahti, Eeva Virtanen, Greet Cardon, Vicky Van Stappen, Nele Huys, Lieven Annemans, Ruben Willems, Samyah Shadid, Peter Schwarz, Patrick Timpel, Konstantinos Makrilakis, Stavros Liatis, George Dafoulas, Christina-Paulina Lambrinou, Angeliki Giannopoulou, Lala Rabemananjara, Maria Stella de Sabata, Winne Ko, Ignacio Garamendi, Luis Moreno, Fernando Civeira, Gloria Bueno, Pilar De Miguel-Etayo, Esther Mª Gonzalez-Gil, María L Miguel-Berges, Natalia Giménez-Legarre, Paloma Flores-Barrantes, Aleli M Ayala-Marín, Miguel Seral-Cortés, Lucia Baila-Rueda, Ana Cenarro, Estíbaliz Jarauta, Rocío Mateo-Gallego, Violeta Iotova, Tsvetalina Tankova, Natalia Usheva, Kaloyan Tsochev, Nevena Chakarova, Sonya Galcheva, Rumyana Dimova, Yana Bocheva, Zhaneta Radkova, Vanya Marinova, Yuliya Bazdarska, Tanya Stefanova, Imre Rurik, Timea Ungvari, Zoltán Jancsó, Anna Nánási, László Kolozsvári, Csilla Semánova, Éva Bíró, Emese Antal, Sándorné Radó, Remberto Martinez, Marcos Tong

Abstract

Background: Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies.

Methods: Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019.

Results: From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention's acceptance in specific or vulnerable population groups.

Conclusions: Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives.

Keywords: Families; Obesity prevention; Primary school children; School based intervention; Type 2 diabetes prevention.

Conflict of interest statement

Two co-authors are members of the editorial board (Associate Editor - Odysseas Androutsos, Section Editor- Stavros Liatis) of this journal. The authors declare that they have no further competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the publication identification process. Effective strategies in childhood obesity prevention interventions at the primary-school setting: A narrative review for the development of the Feel4Diabetes-study intervention

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