061 国外以学校为基础的肥胖和身体活动干预项目回顾

儿童青少年期是预防和控制肥胖发生发展的关键时期，学校是一个很好的干预单位，本文综述了国外的一些以学校为基础的肥胖和身体活动干预项目，为我国的肥胖和身体活动干预项目提供借鉴和参考。     

国外以学校为基础的肥胖和身体活动干预项目回顾

儿童青少年期是预防和控制肥胖发生发展的关键时期,学校是一个很好的干预单位,本文综述了国外的一些以学校为基础的肥胖和身体活动干预项目,为我国的肥胖和身体活动干预项目提供借鉴和参考。     

061国外以学校为基础的肥胖和身体活动干预项目回顾

儿童青少年期是预防和控制肥胖发生发展的关键时期,学校是一个很好的干预单位,本文综述了国外的一些以学校为基础的肥胖和身体活动干预项目,为我国的肥胖和身体活动干预项目提供借鉴和参考.     

儿童青少年单纯性肥胖的运动干预

市根据世界卫生组织(WHO)的有关报道,肥胖可简单地定义为过多体脂堆积达到可危害健康的程度的一种疾病[1],其中无明显内分泌代谢病病因可寻者称为单纯性肥胖(simple obesity),占肥胖症总数的95%以上.     

徐州市儿童肥胖干预研究

[目的]了解儿童肥胖现状,探讨控制儿童肥胖的有效措施. [方法]采用多级整群分层抽样,对8～13岁15119名学生进行问卷调查、体格检查等,并从中抽取单纯性超重与肥胖学生208名进行干预研究,采用健康教育+有氧运动+合理营养综合干预措施为主要内容,对减肥前、后的行为、形态指标进行干预研究. [结果]干预后的超重与肥胖儿童行为、形态变化较干预前与对照组相比差异有统计学意义(P<0.05).[结论]综合干预措施对防治儿童超重与肥胖是安全有效的.     

以学校为基础的儿童青少年心理健康促进干预研究进展

随着中国经济的快速发展,儿童青少年的心理健康问题受到社会的广泛关注。早期存在的心理健康问题会增加成年后精神疾病发生风险,给家庭和社会带来沉重的负担。研究对国外以学校为基础的儿童青少年心理健康促进干预研究进展进行综述,旨在为中国出台相关政策早期防控和干预儿童青少年心理健康问题提供借鉴。     

利用学校环境对肥胖儿童进行集体干预效果分析

【目的】探讨利用学校环境对儿童青少年单纯性肥胖症的防治方法。【方法】采用“12周连续膳食与运动干预法”，根据在校小学生的特点，通过实施有利于控制肥胖的学校健康促进策略，于2001年10～12月对肥胖儿童开展集体干预活动。同时，对肥胖儿童饮食和运动行为给予个体指导。【结果】参与干预活动的90名肥胖儿童中有86．67％的体重得到了有效控制，与此同时，肥胖儿童身高、臀围、腹围、肺活量、总胆固醇等生理、生化指标也发生了明显改善。【结论】利用学校环境采用连续的饮食运动的集体干预和个体指导相结合的方法是控制儿童肥胖症的有效途径。     

儿童肥胖干预场所研究进展

儿童肥胖已成为发达国家和发展中国家常见的公共卫生问题,适宜的干预措施和适宜的干预场所对于实施有效干预至关重要。本文从儿童肥胖干预场所的角度出发,综述儿童肥胖干预场所(学校、家庭、社区和多个场所联合)的干预研究进展,探讨各种场所进行干预的作用与局限性,发现更为有效且实施性强的干预方式。     

儿童肥胖综合干预效果研究进展

近年来,中国儿童肥胖流行趋势日益严重。2005年全国学生体质与健康调研结果显示,我国学龄儿童中超重与肥胖检出率继续增加⁽¹⁾。超重肥胖已成为影响我国儿童身心健康的重要问题。目前关于儿童肥胖的干预研究很多,多采用包括饮食、运动和行为的综合干预模式。干预措施多种多样,干预效果也不一致。对不同儿童肥胖综合干预效果进行评价和分析,可为制定科学合理的干预策略提供理论依据。     

儿童肥胖健康干预研究

目的为建立有效可行的肥胖健康教育及健康促进模式提供科学依据;为家长、教育系统实施肥胖干预提供借鉴.方法随机整群抽取贵阳地区7所学校部分肥胖学生进行危险因素问卷调查.就其中一所学校106名肥胖儿童与相应对照人群进行生理、心理指标检测,并对抽取的肥胖儿童进行为期一年的干预研究.结果通过饮食结构调整、生活方式改善、指导体能训练、及时心理指导等手段进行健康干预.干预后,生理指标改善明显,肥胖度、收缩压、甘油三脂、血尿酸等多项指标降低,饮食行为中总热能及脂肪摄入减少,且运动形式转变、运动量增加.心理指标中除人格测定中E分提高外,其余变化不明显.结论本次干预对肥胖儿童生理指标改善明显,但对心理健康改善不显著.心理影响一旦形成便不易纠正,这更说明预防肥胖及对超重和轻、中度肥胖患者进行健康干预的重要性.     

Economic analysis of a school-based obesity prevention program

OBJECTIVE: To assess the cost-effectiveness and cost-benefit of Planet Health, a school-based intervention designed to reduce obesity in youth of middle-school age children. RESEARCH METHODS AND PROCEDURES: Standard cost-effectiveness analysis methods and a societal perspective were used in this study. Three categories of costs were measured: intervention costs, medical care costs associated with adulthood overweight, and costs of productivity loss associated with adulthood overweight. Health outcome was measured as cases of adulthood overweight prevented and quality-adjusted life years (QALYs) saved. Cost-effectiveness ratio was measured as the ratio of net intervention costs to the total number of QALYs saved, and net-benefit was measured as costs averted by the intervention minus program costs. RESULTS: Under base-case assumptions, at an intervention cost of $33,677 or $14 US dollars per student per year, the program would prevent an estimated 1.9% of the female students (5.8 of 310) from becoming overweight adults. As a result, an estimated 4.1 QALYs would be saved by the program, and society could expect to save an estimated $15,887 USD in medical care costs and $25,104 USD in loss of productivity costs. These findings translated to a cost of $4305 USD per QALY saved and a net saving of $7313 USD to society. Results remained cost-effective under all scenarios considered and remained cost-saving under most scenarios. DISCUSSION: The Planet Health program is cost-effective and cost-saving as implemented. School-based prevention programs of this type are likely to be cost-effective uses of public funds and warrant careful consideration by policy makers and program planners.     

A school-based program of physical activity may prevent obesity

An organized intervention program in pre-pubertal children based on increased physical education and activity together with nutritional advice to the children and their families may prevent obesity. Children aged 9 to 11 received double hours of weekly physical education lessons and additional nutritional advice for 2 years. They were compared with a similar group who received standard physical education lessons only. A total of 82 study and 26 control children completed the 2 years of the project. Boys in the control group gained significantly more weight than the corresponding study group (8.4 kg vs 3.2 kg, respectively (P<0.016)), control delta body mass index (BMI) 1.02 vs study 0.44 (P<0.012). There was no significant change in the weight or BMI in the girls. We conclude that the prevention of obesity may be attained by similar programs. Hormonal effects and compliance at this age may be responsible for the sex differences in this study.     

基于学校儿童肥胖综合干预的效果评价

了解采用结合移动健康技术辅助饮食及身体活动的综合干预对学校儿童人群进行干预的效果,为有效开展儿童超重肥胖干预提供依据.方法 选取北京市城区和郊区各1 所学校共58 名四年级学生进行3 个月的综合性肥胖干预,干预期间采用微信服务号的形式加强家长互动.在干预前后分别进行身高、体重、腰围、臀围、血压及体成分等身体测量,并调查肥胖相关的饮食及身体活动行为的达标情况.结果 干预前后儿童的体质量指数Z 评分、腰臀比及舒张压差值分别为-0.13,-0.02 和-2.47 mmHg,均有统计学意义(t 值分别为-4.24,-2.07,2.15,P 值均<0.05).超重肥胖率和中心肥胖率均下降(39.60%和34.48%, 36.21%和32.76%),但差异均无统计学意义(P 值均>0.05).干预前后肥胖相关的行为达标率除过量饮食外均得到提高,且差异均有统计学意义(χ2 值分别为3.85,4.00,8.26,7.54,9.85,P 值均<0.05).结论 采取移动健康技术辅助的饮食和身体活动的综合性干预措施对儿童肥胖相关指标的改善有较好效果.     

Evaluation of a school-based teen obesity prevention minimal intervention

ObjectiveA school-based nutrition education minimal intervention (MI) was evaluated.DesignThe design was experimental, with random assignment at the school level.SettingSeven schools were randomly assigned as experimental, and 7 as delayed-treatment.ParticipantsThe experimental group included 551 teens, and the delayed treatment group included 329 teens.InterventionThe minimal intervention was Present and Prevent, a commercially available PowerPoint program presented in two 30-minute time slots over 1 week.Main Outcome MeasuresThe dependent variables were nutrition knowledge, attitudes, peer and family influences, behavioral intentions, and program satisfaction. The independent variable was group assignment.AnalysesA matched-pairs and 2-sample t test were used respectively to assess within-group and between-group changes.ResultsSignificant experimental posttest improvements occurred in the following: knowledge (P < .001); intention to maintain a healthy body weight because of importance to friends (P < .001); and intention to eat fewer fried foods, eat fewer sweets, look more at food labels, and limit TV watching (all P < .001). Program satisfaction measures were significantly associated with each of the healthy weight maintenance behavioral intentions.Conclusions and ImplicationsThe MI teen obesity prevention program made an impact on nutrition knowledge and positive behavioral intentions in only 2 classroom sessions and was well received by participants.     

New Moves: a school-based obesity prevention program for adolescent girls

BACKGROUND: This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class. METHODS: Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys. RESULTS: The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant. CONCLUSIONS: New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.     

Adolescent obesity intervention: validation of the SHAPEDOWN program

The effectiveness of the adolescent obesity intervention SHAPEDOWN was evaluated for 15 months through a randomized experimental design study. Test groups (no. = 37) participating in the intervention were compared with a no-treatment control group (no. = 29) at four sites in northern California. The program employs a variety of cognitive, behavioral, and affective techniques adapted to make successive small modifications in diet, exercise, communication, and affect that are sustainable. Very-low-calorie or restrictive diets are avoided in the program. Parents are instructed on strategies for supporting their adolescents' weight-loss efforts. Participation in the group application of the program was associated with significant improvement in relative weight, weight-related behavior, depression, and knowledge of weight management concepts at post-treatment and at 1-year follow-up. Self-esteem increased significantly regardless of condition. Change in relative weight for the test group was -9.9 +/- 14.9% (mean +/- standard deviation) and for the control group was -0.10 +/- 13.2%. At month 15 of the study period, weight change in the test group compared with the controls was -5.15 kg. For all subject variables examined in the test group, mean change in relative weight at 1-year follow-up was negative, suggesting that none of the characteristics examined contraindicate program participation among obese adolescents seeking care. Drop-out rate was 16%. The study suggests that the program produces significant long-term outcomes in obese adolescents and is transferable to a variety of settings.     

A school-based asthma intervention program in the Buffalo, New York, schools

This project investigated the feasibility and effectiveness of a school asthma program in reducing asthma exacerbations among school children. In 1997-1998, two schools were selected for a case control pilot study. The intervention required that students with asthma, who needed medication daily at school, must present a written plan from the health care provider. Students with asthma were identified through parent/guardian or school reports. The pilot program was expanded into five schools in 1998-1999. All schools kept records of rescue treatments for asthma episodes. The pilot intervention resulted in an 80% decrease in rescue treatments from 1996-1997 to 1997-1998. In the additional five schools, an overall decrease of 17% occurred in rescue treatments during 1998-2000. Overall, 65% of physicians provided requested Asthma Care Plans (ACP). In two schools, the number of asthma care plans that required anti-inflammatory medications tripled. Preliminary results indicate this school asthma program proved feasible and effective in reducing the frequency of asthma exacerbations at school.     

Formative research in a school-based obesity prevention program for Native American school children (Pathways)

This paper describes how formative research was developed and implemented to produce obesity prevention interventions among school children in six different Native American nations that are part of the Pathways study. The formative assessment work presented here was unique in several ways: (1) it represents the first time formative research methods have been applied across multiple Native American tribes; (2) it is holistic, including data collection from parents, children, teachers, administrators and community leaders; and (3) it was developed by a multi-disciplinary group, including substantial input from Native American collaborators. The paper describes the process of developing the different units of the protocol, how data collection was implemented and how analyses were structured around the identification of risk behaviors. An emphasis is placed on describing which units of the formative assessment protocol were most effective and which were less effective.     

单纯性超重肥胖儿童综合干预效果评价

了解单纯性超重肥胖儿童的各项体检指标干预前后变化,为探讨合理有效的干预措施提供依据.方法 分层随机整群抽取海淀区216名中小学生为研究对象,对其采用适宜的有氧运动、健康教育、合理营养、医务及家长监督、心理疏导等综合措施进行干预.结果 干预后,儿童超重、肥胖率明显下降,13.4%的超重肥胖儿童恢复正常体重,差异有统计学意义(x2=61.83,P<0.01).儿童形态、生理、生化指标改善明显,血糖、三酰甘油、胆固醇等多项指标降低,差异均有统计学意义(P值均<0.01).结论 健康教育,适宜的运动方式,家长、学校共同参与的综合干预措施是控制儿童肥胖有效、方便、无副作用的方案.     

基于学校环境的重庆市中小学生超重肥胖干预效果评价

目的 探讨基于学校环境的学生超重肥胖综合干预效果,为预防和控制中小学生超重肥胖提供依据。方法 采用多阶段分层整群抽样方法抽取重庆市主城区12所中小学9 933名学生,随机分为6所干预校和6所对照校,对干预校采取学校环境政策干预、健康教育、体育活动指导结合的综合干预,干预前后进行体格检查和问卷调查。结果 干预后干预校超重率在原有基础上(12.9%)上升了0.2%,肥胖率(7.4%)未变化;对照校超重率、肥胖率分别在原有基础上(11.5%、7.7%)上升了0.5%、0.1%。干预前两组学校正常体重的学生在干预后BMI、腰围、臀围均升高(P<0.05),干预校超重肥胖的学生在干预后BMI、腰围均下降(P<0.05),对照校超重肥胖的学生在干预后臀围升高、腰围降低(P<0.05);干预校学生在干预后肥胖相关饮食问题正确率上升,不健康饮食行为报告率下降(P<0.05)。结论 基于学校环境的学生超重肥胖综合干预能控制肥胖相关指标的增长速度,改善中小学生的饮食行为。