Integrative Review of School-based Childhood Obesity Prevention Programs

Childhood and adolescent overweight and obesity in the United States are rapidly becoming a major pediatric health concern. Schools are a critical part of the social environment that shape children's eating and physical activity patterns. While school-based programs may affect a student's perception of physical activity and the influence of dietary practices on overall health, the current variability in the theoretical underpinnings and methodological approaches used to implement these programs makes them difficult to evaluate for quality and evidence of effectiveness of the outcomes achieved across programs. The purpose of this study is to conduct an integrative research review using Cooper's framework to provide an overview of the degree of variability in the methodological approaches and theoretical frameworks of school-based obesity prevention programs that utilize one or more of the following interventions: dietary, physical activity, healthy lifestyle education, and/or parental involvement. This review will examine the variations in the duration of the interventions; whether the interventions were guided by the use of a theoretical framework; the strength of evidence supporting the studies; and whether the interventions demonstrated a reduction in body mass index or weight loss. A total of 16 articles were found based on the inclusion criteria for this study. Eight of the 16 studies (50%) applied theoretical frameworks. Significant variability was found in the duration of intervention between the studies analyzed. The range of duration was 5 weeks to 8 years, with an average of 16.8 months. Fourteen of 16 studies (88%) implemented dietary habit interventions. Fourteen of 16 studies (88%) implemented physical education programs. All 16 studies applied healthy lifestyle education. Nine of 16 studies integrated family involvement into the obesity intervention. Nine of 16 studies (56%) evaluated the effect of their intervention on body mass index.     

Childhood Obesity

Childhood obesity is an issue of serious medical and social concern. In developing countries including India, it is a phenomenon seen in higher socioeconomic strata due to the adoption of a western lifestyle. Consumption of high calorie food, lack of physical activity and increased screen time are major risk factors for childhood obesity apart from other genetic, prenatal factors and socio-cultural practices. Obese children and adolescents are at increased risk of medical and psychological complications. Insulin resistance is commonly present especially in those with central obesity and manifests as dyslipidemia, type 2 diabetes mellitus, impaired glucose tolerance, hypertension, polycystic ovarian syndrome and metabolic syndrome. Obese children and adolescents often present to general physicians for management. The latter play a key role in prevention and treatment of obesity as it involves lifestyle modification of the entire family. This article aims at discussing the approach to diagnosis and work-up, treatment and preventive strategies for childhood obesity from a general physician’s perspective.     

Health Consequences of Childhood Obesity

Objectives  

To evaluate the cardiovascular and endocrine effects of childhood obesity as well as prevalence of metabolic syndrome associated with it.     

Insulin Secretion in Childhood Obesity

In 132 severely obese children (72 boys and 60 girls) who underwent institutional therapy, oral glucose tolerance tests were carried out on admission, and these children were divided into groups with normal and high insulin levels, in terms of the I values obtained, on the basis of the reference value + 2SD calculated by Maruhama et al [8]. From these children, those who had diabetes mellitus (DM) and those in whom DM was suspected were distinguished according to the diagnostic criteria of USPHS (Drash et al [1]). The insulin levels were normal in 58 children and high in 64. Ten children were found to have DM, and 19 were suspected to have DM. Metabolism of the glucose load occurred at both normal and high insulin levels in some children. There was also a group of children in whom glucose metabolism was incomplete at high insulin levels and a group of children in whom glucose metabolism was not possible even at high insulin levels, showing an obvious DM reaction. These findings suggest that there is a difference in the sensitivity of the insulin receptors in these children. Age, severe obesity and a family history of DM were considered to be risk factors for DM. Although there was a moderate, positive correlation between I and the obesity index and between I and age, it seems that the level of insulin secretion varies considerably in obese children.     

The Clinical Treatment of Childhood Obesity

With the rising prevalence of childhood obesity, pediatricians are increasingly called upon to treat clinically overweight children. The primary treatment options are behavioral lifestyle modification, pharmacotherapy, and surgery. The cornerstone of childhood obesity treatment is lifestyle modification and has been shown to be effective in improving the severity of overweight and obesity. Several guidelines discuss appropriate methods for lifestyle modification in overweight and obese children. This review will summarize three recent guidelines/recommendations (released by the Scottish Intercollegiate Network, the American Academy of Pediatrics, and the United Kingdom National Institute for Health and Clinical Excellence) and describe by way of example, a current child obesity treatment program in the United States (Duke University Medical Center). Finally, evidence for pharmacologic and surgical treatment options will also be discussed, which can be valuable treatment options for select patients.     

儿童肥胖的评价标准及流行现状

肥胖是高血压、糖尿病、冠心病等慢性疾病发生和发展的重要危险因素，儿童和青少年时期的肥胖更对其成长和健康产生持久和远期的影响。要控制未来慢性病发展趋势、减轻疾病负担，就要在儿童期着手预防肥胖及相关慢性病发生的危险因素。本文对儿童期肥胖的评价指标和标准进行概述，并简要介绍儿童肥胖的流行现状、危险因素及健康危害。